10 Common Questions Claimants Have When Filing a Worker Comp Claim

Being in the insurance or risk management field we often forget that the workers that get injured do not know nearly as much as we know about claims.  At times, adjusters forget to take the time needed to properly explain what rights injured workers have when these claims occur, and that can lead to a disconnect between the adjuster and the injured worker.  This disconnect can make the claim travel down a bumpy road rather than a nice, smooth, streamlined one.

 

Here are some common questions claimants have when filing a work comp claim.  Please note the answers to these questions can vary by jurisdiction, be sure to consult your adjuster or local legal counsel if you have questions.

 

 

  1. How do I get paid?

 

If your case is deemed compensable, you will receive a workers compensation check, probably in the mail or direct deposit, every week or two after the waiting period has subsided.  This check is meant to replace your lost wages from work.  It will not be 100% of the pay you are accustomed to receiving but rather a percentage of your gross wages based on whatever formula the state of jurisdiction uses.

 

 

  1. When will I get paid?

 

Generally wages are paid after your case has been deemed compensable by the adjuster handling the file.  Usually this can range from a period of a week or two to maybe a month or so.  Other factors can delay payment, including the investigation of the claim and the gathering of the pertinent medical records.

 

 

  1. How much will my work comp check be?

 

This will depend on your jurisdiction.  Typically you will receive anywhere from 66% of your net pay to up to 80%, maybe even more. Fringe benefits that you receive from your employer can also affect the amount of your work comp check.  Anything that you are responsible for regarding your personal medical insurance or 401k may still have to be paid by you, the injured worker.  Work comp pay is not taxable income, and you will not receive a W2 for work comp wages paid out for whatever year you received benefits.

 

 

  1. Can I go to my primary care physician?

 

This will vary by the jurisdiction, but generally the answer is yes. After a certain period of time, you can go to an appointment with your primary care doc, and usually the first one will be paid for by the insurance carrier that is handling the work comp claim.  Whether or not you can continue to treat with your personal doctor is up to your adjuster, and if your personal doctor accepts work comp patients and does proper work comp billing.

 

 

  1. Do I have to go to “your” doctor all the time?

 

Maybe, depending on the jurisdiction and if your adjuster authorizes you to treat with your physician instead of the occupational medicine doctor.

 

 

  1. Why is the work comp doctor’s opinion more important or more crediblethan my doctor?

 

This will depend on what each doctor is saying in their medical reports. Sometimes personal physicians will say one thing with you in the exam room, and meanwhile when they dictate their notes they may mention diagnoses and findings not essentially shared with you personally.  The same is true for the occupational doctor.  The best way to stay the most informed is to request a copy of your medical records from both doctors, this way you can see all of the information that the adjuster is seeing, in regards to the medical chart.

 

 

  1. What if I have two jobs? Do I receive lost wages for both jobs?

 

Usually yes, but again this will depend on the jurisdiction. You will have to provide your adjuster with a copy of your personnel file and wage records from your second employer, and be sure to tell this other employer than you sustained a work comp injury at your other job and that you may not be able to work your job during your healing period until you are fully released from medical care with no more restrictions.

 

 

  1. The light duty job assigned to me pays less than my normal job. Is this legal?

 

Yes it is legal, but the insurance carrier will be obligated to pay you a “partial” wage.  This means that they take the reduced wages you will earn and issue you a supplemental check for the difference.  The amount of this check will depend on the jurisdiction the claim is in.  If you have questions about how this supplemental check is determined, contact your adjuster and have them walk you through the process.

 

 

  1. Why isn’t my adjuster returning my calls?

 

Adjusters can handle and be responsible for hundreds of files, of which you are one of.  These files are all in different stages, and are of varying complexity.

 

Give your adjuster a day or so to have a chance to return your call.  One thing an adjuster hates is someone that calls them every hour. Sadly, the squeaky wheel rarely gets the grease.  Be patient, and allow your adjuster the professional courtesy to get to your claim.  But, you also have to be persistent.  If you have left a few messages and 3-4 days go by without a callback, you can call and ask for their supervisor.  Every adjuster has an obligation to return calls to their claimants, no matter how insignificant the question may be.  Failure to return calls can be considered “bad faith” on the part of the adjuster, and they or their company can incur penalties or fines if they do indeed fail to return your call within a reasonable timeframe.

 

 

  1. Should I consult an attorney?

 

There is no right or wrong answer to this question.  The only person that can answer this question is you.  If you will feel more at ease by talking to a legal professional, then by all means do so.  Having a phone consultation with an attorney doesn’t mean that you are filing a lawsuit against your employer. If it makes you sleep better at night knowing you talked to an attorney, then by all means do so. Better yet, talk to a few attorneys if you have to.

 

 

Summary

 

These questions are normal questions every claimant will have with their work comp claim.  Some people know more about the work comp system than others, but don’t take your fellow coworkers advice about what to do with your claim.  Many coworkers that have a vast experience in dealing with work comp situations will not always give you credible or correct advice.  Your adjuster is the one handling your claim, and they will be there to walk you through the process.

 

If you feel that the adjuster did not answer your question good enough, feel free to consult an attorney.  You want to make sure you are very involved in how your claim is handled.  After all, being injured doesn’t mean that you do not need to know anything about how the process works and what rights you have as an injured worker.

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

Author Michael Stack, Principal, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices.

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Live Stream WC Training: http://workerscompclub.com/livestreamtraining

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

Most Common Workers’ Compensation Errors

Companies with exorbitant workers’ compensation costs are doing several things wrong, however, the most common error is not properly managing their programs. Too many companies sit back, assume nothing more can be done and wait for the legislature to introduce problem-solving laws. There certainly are some laws that could be changed, but most companies don’t take advantage of the options already available to them.

 

 

Common Workers Compensation Errors

 

Employer Directed Care

 

For instance, some states allow the employer to select the doctor who will treat employees injured on the job. These are “employer directed” states. In these states employers enjoy a special opportunity to use physicians experienced in industrial/occupational medicine and also familiar with the employer’s workers’ compensation program. Despite the opportunity, only about 20 percent of employers in these states are using this tool.

 

 

Failure To Follow Up With Injured Work

 

Another common error is failure of companies to follow up on injured workers after they become disabled. The employer assumes the worker’s doctor will give the word when the employee is ready to come back to work. These employers neglect to consider the doctor probably doesn’t know about the employer’s modified duty program or an employee’s job might be changed to accommodate the applicable medical restrictions.

 

These employers typically neglect to contact the employee, a grave mistake. Without contact, the employee may lose the incentive to return to work and become “psychologically disemployed.” (As typically happens to all of us after a few weeks on vacation). The proper focus, to return the employee to work, is lost.

 

 

Lack of Workers’ Comp Understanding

 

Employers that make the most common errors often don’t know enough about the workers’ compensation system and the options that are available to control their programs.  The lack of understanding makes it relatively easy for employees so inclined to abuse the system.

 

Example: A company has operations in 15 states with “fee schedules” (a special lower rate physicians must charge for treating employees injured on the job.) for industrial accidents. No one was assigned to make sure medical bills were audited for compliance with the fee schedules in the various states. Result: The company paid out hundreds of thousands of dollars in excess medical fees.

 

 

The First Step

 

Companies need to establish an orderly process beginning in the first moments after an injury. The process must ask and answer such questions as where the employee received treatment, how the employee gets to the doctor, who contacts the employee to make sure medical care is appropriate, when the employee is expected to return to work, and so forth.

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

5 More Things The New Workers Comp Manager Needs to Know

Being new to workers’ compensation can often seem like you are trying to navigate a foreign land. It helps to know what to expect getting started.  Here are five additional items it helps to know about the job.

 

  1. Sometimes it is time to babysit.

Injuries do happen. The employee needs to know the company still cares after the worker is no longer able to work. If there is a workers compensation coordinator, you can delegate to her the job of keeping in touch with all the injured workers until they are back to work doing transitional duty. The best policy is to contact the injured employee after each medical appointment to learn of any issues with their medical treatment, their return to work status and any concerns they have about their job or their work comp claim. By showing the injured employees the employer cares, it will have an overall effect of lowering cost of workers compensation.

 

 

  1. Know the adjuster(s).

The adjuster is now a new best friend. A competent adjuster who does the job well will make the WC manager’s job easier. The better the working relationship with the adjuster, the fewer snags encountered on workers compensation claims. (The fewer adjusters to work with, the easier it is to learn their strong points and weak points. If the claims are not already consolidated with the minimum number of adjusters possible to cover the claims, work toward consolidating claims with the best adjusters available.

 

 

  1. Know your insurance broker.

The broker is now a second new best friend. A mistake a lot of new workers comp managers make is thinking the broker works for or is an employee of the insurance company. The broker is a knowledgeable business person who works for the employer as an advisor. The broker’s main job is to keep the employer (insured) happy.  Discuss with the broker what benefits are provided. Hold the broker to this, and the new job will get easier. Expect more than simply an annual stewardship report. Ask the broker to be proactive and make suggestions about your workers compensation program. 

 

  1. Know the return to work program.

The better the company’s transitional duty program, also known as modified duty or light duty, the quicker and faster the workers compensation claims will come to an end. The company is going to be paying the cost of the indemnity benefits through higher workers comp premiums. To reduce the cost of those benefits, return the employee to modified duty. While the injured employee may not be as productive as an uninjured employee, all the productivity of the injured employee on light duty is benefiting the company to some extent while reducing the cost of the claim.

 

  1. Review the claim files.

If asked, most third party administrators or insurance companies will arrange online access to the claim file notes where the adjuster records the activities and events of the claim. While the file notes are helpful, they do not tell the whole story. Go to the claims office and read everything in the claim files. The claims office will probably try to talk you into doing an on-line review, but an in-person review with the adjuster(s) about the claims will provide the most information. There are also claim consultants who do claim file audits, if that is preferable.

 

Good luck in the new role as the work comp manager. Use the ideas and consult our website often for advice on workers compensation.  For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

5 Things the New Workers Comp Manager Needs to Know

While more colleges are now offering majors in risk management and insurance than there were available just ten or twenty years ago, many of the people who come in to the field of risk management and the even more specialized field of Workers Compensation Manager, do not have previous experience or backgrounds in workers compensation. It is nothing unusual in this day of tight hiring practices and double duty jobs for the new workers comp manager to also be working in another department such as finance or human resources. It becomes a learn-as-you-go-experience.

 

 

The new workers comp manager, even the one who has been a workers comp adjuster, often needs a guide on what to anticipate in the new role. Therefore, we have put together a list of 5 things it helps to know about the job. Here is our list of five things the new workers compensation manager knows, but no one will tell.

 

 

  1. The Safety Manager is your new best friend. 

The better the safety manager does the job, the easier the new WC manager’s job will be, as fewer accidents means fewer workers compensation claims to be made.  Ask the safety manager what can be done to eliminate accidents and injuries.

 

 

  1. Learn how to read the loss run. 

The loss run provides tons of useful information on the nature and the extent of the injuries. Learn about the types of injuries that occur most often and discuss with the Safety Manager what can be done to eliminate the frequent reoccurrences. Review the loss run to see how much money is being spent on medical and how much money is paid out in indemnity benefits. Look for areas where costs can be reduced. Customize the loss run; ask friends about the most helpful stats they have on their loss run, and include those on yours.

 

 

 

  1. Know your insurer.

The insurance company that writes the workers compensation insurance is the insurer. The term “insurance carrier” will also be used. This does not mean they carry premiums to the bank. It is an old fashion term for carrying the burden of insurance loss. (Not to be confused with “insured” which is the employer). Learn about the insurer. Are they a mammoth insurance company who writes workers compensation as one of many types of insurance, or are they a smaller regional or local company that specializes in workers compensation. What services do they offer as part of you program or at low cost. Ask them to explain ALL of their services, not just those they pre-select.

 

 

 

  1. Know the cost of workers compensation.

Learn what is paid for workers compensation insurance each year, and if the premium is paid monthly, quarterly, or annually. Learn policy dates and which way the premium has been trending in recent years. (Declining premiums are a good sign the safety manager is doing his job well, while increasing premiums indicates a need to team with the Safety Manager to reduce the number of claims and the severity of the claims that do occur. Know how to translate this into total dollars spent on workers compensation.

 

 

  1. Timing is everything.

The most successful workers compensation managers are the ones that learn time is of the essence in almost everything done as a work comp manager. New injury? Report it immediately to the claims office and immediately advise the medical provider’s office of the transitional duty program. New disability slip? Coordinate with the injured employee’s supervisor on how to accommodate the light duty work slip. New information on an older claim? Call the adjuster and share it with her so she can act on the information while it is still beneficial.

 

Good luck in the new role as the work comp manager. Use the ideas and consult our website often for advice on workers compensation.  For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Who’s In Control Of Your Workers Compensation Program?

 

We all like to be in control, right? Or at least feel like we’re in control anyway, but we know that there are times, and there are situations when the chickens are actually ruling the roost.

 

 

The Chickens Are Ruling The Roost

 

I’m going to show you a little clip. This is a YouTube clip from the show Super Nanny to really show and explain my point a little bit further. Let’s take a look at this together.

 

Donuts! Donut, donut. Please mommy! Please mommy! I’ll be extra good if you give me a donut!

 

Now anyone who has children probably knows that scene maybe all too well. My wife and I have four kids ourselves, so it’s something that we’re working on regularly.

 

If that parent gives in to the child and gives her the donut, who’s in control of that situation? If you get a note like this from Joe Martin, that says no work until seen by this office again, and you accept that note, who’s in control of that situation?

 

It’s going to create a worse outcome for that child long term if you give her that short term fix instead of working on the attitude and the behavioral challenges to create a better human being in the long term. The same is true for your work comp management program. If you accept a note like this from Joe without getting the needed information and plug him into your system, you’re creating long-term challenges and you’re creating a very expensive work comp system for your organization.

 

 

Information Needed At Time Of Injury To Take Control

 

Here’s the information that you need in order to take control of an injury at the start of that claim. You need to know the information about the injury itself, the diagnosis, the prognosis, the treatment plan. You also need to know some important information with regards to return to work. You need to know the estimated return to work date, as well as the medical restrictions from that treating physician for what that individual can and cannot do.

 

Finally you need to know some pertinent scheduling type information. Things like the next appointment date as well as that doctor’s contact phone number. If you get that information that puts you in control. If you deny that child the donut at that time, you start to get in control of that situation, creating a better long term outcome in both scenarios.

 

I’m Michael Stack with AMAXX, and remember your success in worker’s compensation is defined by your integrity, so be great.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Make Your Work Comp Message Stick Like Gorilla Glue

This Is Part 2 in a 3 Part Mini Series.

 

The Tipping Point in Workers Compensation

  1. Paul Revere, Workers Compensation, and the Tipping Point
  2. Make Your Work Comp Message Stick Like Gorilla Glue
  3. How Work Comp Can Be Just Like Prison

 

I’m Michael Stack with Amaxx and welcome back to The Tipping Point mini series where we’re reviewing the elements discussed by Malcolm Gladwell in the book The Tipping Point: How Little Things Can Make a Big Difference. When you’re trying to implement change, when you’re starting to try to implement an epidemic of proper work comp management to reduce your work comp costs and really create a better outcome for your injured workers.

 

In the first series, I talked about the law of the few and really that’s very relevant when you’re trying to get buy in to your program. The CEO and senior management are onboard, but don’t forget about those employees that have an influence over others. They have those innate skills that connectors, the mavens, and the sales people.

 

 

Stickiness Is Message Into Memory

 

In this session, I want to talk about the stickiness factor and how memorable your message is. Maybe you’ve created a brochure, maybe you’ve done some training, maybe you’ve had safety meetings in regards to your work comp management, but you’re not getting your claims reported timely, which is really where this is very, very important in how memorable your message is, particularly at the time of injury to get that claim reported immediately. You have a very low cooperation or a very low implementation rate in getting those claims reported. Here’s the study, Yale University 1960s, what they were trying to do is get the students to get their tetanus shot.

 

It was a free tetanus shot at the health clinic. They did two different types of brochures, a high fear and a low fear, and they wanted to see if it made a difference and really gory photos of what happens if you get tetanus and why you should get the shot. Then, a very less intrusive or less fearful brochure. Here’s what was interesting that a month later, only 3% of students ended up getting the shot, very, very low cooperation with what they were trying to do and it didn’t matter whether they were in the high fear or the low fear group to get those outcomes.

 

 

Not The Message, But The Package

 

Often times, it’s not the quality of the message and you’re beating your head against the wall with why aren’t my employees reporting their claims when I’ve told them 100 times maybe it’s the way that you’re telling them that’s going to make a difference. In this study, all they did is they put a map of the campus of where the health center is as well as the times that it was open and they saw those rates increase to 28% of their students cooperating and going to get the shot. It didn’t matter what the message was from these groups. It was both relatively equal. When you’re trying to get by them, when you’re trying to get cooperation, particularly with your claims reporting for your program, don’t forget or discount the stickiness factor of how you’re packaging the message.

 

Maybe you have an injury triage hotline and you need to give them a wallet card, you need to put it on your lanyard, you need to create a new sign. You need to make some changes and do some testing in how you’re displaying or packaging that message. Remember the stickiness factor in getting your claims reported.

 

I’m Michael Stack with Amaxx. This is the Tipping Point In Worker’s Compensation mini series. Remember, your success in worker’s compensation is defined by your integrity, so be great!

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Excess Workers’ Compensation Insurance 101

Excess Workers Compensation Insurance 101

Self-insured employers purchase excess insurance coverage to limit the risk of exposure to catastrophic injuries. This is often accomplished by having a workers compensation policy with a high deductible. Common deductibles for excess insurance are $250,000, $500,000 and $1,000,000.  The self-insured employer needs to carefully analyze the amount of risk that is financially feasible before deciding on the deductible for the excess insurance.

 

 

The excess insurer has a strong interest in knowing about the workers compensation claims that have the potential to exceed the self-insured employer’s deductible. The insurance contract will normally state the self-insured employer must report to the excess insurer any time the reserve amount on a self-insured employer’s workers comp claim equals half of the deductible amount.

 

 

Any Injury With Potential To Exceed Deductible Should Be Reported

 

The excess insurance contract will call for the self-insured employer to report all “catastrophic” claims, regardless of the dollar amount of the claim.  This could include

 

  • Fatalities
  • Amputation of a major extremity
  • Spinal cord – quadriplegic, hemiplegic and paraplegic injuries
  • Brain and brain stem injuries
  • Comas
  • Burns over more than 25% of the body
  • Severe disfigurement and scarring, where applicable
  • Loss of eyesight
  • Loss of hearing
  • Heart attacks
  • Strokes
  • Multiple surgical interventions
  • Rape and sexual assault
  • Post-Traumatic Stress Disorder
  • Occupational disease claims
  • Non-union of bone fractures
  • Damage to organs – lungs, liver, heart, stomach, etc.

 

 

This list is not all inclusive.  Any injury that has the potential to exceed the self-insured employer’s deductible should be reported to the excess insurer. The report to the excess insurer should be completed by the third party claims administrator adjuster or the self-insured employer’s internal claims adjuster as soon as the information becomes available that there is the potential for the claim to exceed the self-insured employer’s deductible.  The failure to report the claim timely (within the requirements of the excess insurance policy) could create a situation where the excess insurer denies coverage, or accepts the claim under a reservation of rights which allows them to deny coverage after thoroughly investigating the matter.

 

 

 

Review Specific Reporting Requirements of Excess Insurer

 

The report to the excess insurer should include the basic information about the workers compensation claim. This includes:

 

  • The facts surrounding the injury
  • Compensability
  • The nature and extent of the injury
  • The medical management of the claim
  • The amount already spent on the claim
  • The reserves for the future cost of the claim
  • Subrogation potential
  • Any other offsets of cost
  • Any Medicare or Medicaid issues
  • The action plan to bring the claim to a conclusion
  • The litigation management plan, if applicable

 

 

The self-insured employer at the start of the excess insurance policy should review with the excess insurer the specific reporting requirements of the excess insurer. A diligent effort by the self-insured employer to comply with the requirements of the excess insurer must be made.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

Ingress/Egress: Issues of Compensability Outside The Normal Workday

Questions concerning compensability under any workers’ compensation act starts with a simple question.  Did the personal injury arise out of and occur in the course and scope of employment?

 

While it may seem very basic, the reality is there are many gray areas that lurk beneath the surface.  One such issue involves the “ingress and egress” of employees as they enter and leave the workplace.  This is a challenge the claims management team must master in order to be effective.

 

 

The Origins of Ingress/Egress Compensability

 

When dealing with these questions of whether a personal injury is “work-related” courts early on recognized that employees need to first enter the workplace on time in order to perform the necessary functions of their work duties.  The result of this was an acknowledgement that employer’s obligations under a workers’ compensation act sometimes start even before the workday begins.

 

It is important to remember that claims involving these matters are fact specific.  The result is members of the claims team need to investigate these issues on their own merits and sometimes consult with an attorney before they accept or deny primary liability.

 

 

Understanding Unique Scenarios

 

There are an infinite number of possibilities when it comes to the ingress and egress of an employee.  Here are some of the common situations that take place:

 

  • Beginning/Completion of a Work-Shift: Generally, employees are covered under a workers’ compensation act from the time they arrive on company property until the time they leave.  Injuries that occur during these times are generally compensable when they take place within a reasonable time before or after work in entryways/cloakrooms, bathrooms, parking lots and sidewalks on or near the company premises.

 

  • Unpaid Work/Rest Breaks: Just because an employee is not being paid, does not mean they are not covered under a workers’ compensation act.  Examples of compensable injuries include taking breaks on company premise and even when the employee is walking to a nearby restaurant or convenience store.  Most jurisdictions also recognize injuries that take place when employees are smoking cigarettes.

 

  • Traveling Employees: This type of employee should send fear down any claim handlers spine.  They typically receive “portal-to-portal” coverage, which means they are covered from the minute they leave until they return.  The possibilities for mischief are endless as they go out to eat, engage in the entertainment of clients and countless other activities not directly related to their work.

 

When determining issues of compensability for these types of injuries, courts will look at a number of factors.  The circumstances that generally lead to an injury being compensable are as follows:

 

  • If the injury occurs at a location that could be constructed as the employer’s workplace, or an area under their control; or

 

  • When the employee is furthering the interests of the employer or engaging in activities necessary for the human condition. Common examples are eating food, drinking a non-alcoholic refreshment or situations involving necessary bodily functions.

 

 

Other Factors to Consider

 

The doctrine of “special hazards” can sometimes serve as the lynchpin for whether a claim is compensable.  Examples of these hazards people encounter inside and outside the workplace are numerous.  A review of case law has noted many examples where people are struck by a batted baseball, stray bullets or assisting in the rescue of unknown third parties become compensable injuries.  In these instances, the courts will generally use a balancing test to determine compensability.  Issues examined under this test will often include whether the hazard is unique to the workplace itself or if its origins rest in risk the employee would encounter in everyday life.

 

 

 

Conclusions

 

All work-related injuries require members of the claims management team to conduct a diligent investigation.  In circumstances involving ingress/egress or other hazards they must redouble their efforts.  This includes knowing the law and in other cases, coordinating their efforts with appropriate legal counsel.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

How The Heck Did You End Up In Workers Comp?

So, how the heck did you land in workers’ comp? I’m just going to guess and say it probably isn’t something you dreamed about as a kid.

 

One of the challenges we are facing as an industry is how to attract the millennial generation. If none of us dreamed of being here, how did we all end up here? If we can understand where we’ve been it may help us understand where we are going.

 

Answer this short survey to share your experience https://www.surveymonkey.com/r/5WLRGKG. I’ll publish the results next week.

 

For me, I studied accounting and computer information systems at Indiana University. I’m not sure I even knew that workers’ compensation existed. When I first got started working with Becki Shafer (she is my wife’s Aunt – http://tinyurl.com/hfjxtle) doing research and small projects, my thought was “sure, I’ll help you out with some projects to make a couple extra bucks, but I’ve already got things figured out with my career path”.

 

 

We Never Know What Journey Our Career Will Take

 

Of course, we never know what journey our careers are going to take. The more I worked with Becki the more I liked it and found it made a lot of sense to me. Working with Becki, the projects and responsibility of working with employers on cost containment best practices continued to grow and it wasn’t too long until I decided that workers’ compensation was the perfect career for me.

 

 

To the outside world it’s an industry that seems completely foreign with a different language and an interesting dynamic of stakeholders. Once you start working in this industry it takes a while to figure things out. Becki was, and continues to be, a tremendous mentor for me. Without her help, teaching, and guidance, my career and interest in workers’ compensation would have started and stopped quickly.

 

 

What we do in this industry is incredibly important. We make an impact on the lives of individuals at a time when they are feeling the most vulnerable. And the reason it was so easy for me to decide that workers’ compensation was the right career is I learned that doing the RIGHT THING actually costs the employer the LEAST amount of money. Act with HIGH INTEGRITY, and you will get the BEST RESULTS. It’s just too good of a concept to pass up.

 

 

However, after being in this industry for many years now, what I’ve realized is that not everyone has the luxury of having someone like Becki as a mentor. So many get thrown into it and are expected to produce results with little to no training and guidance.

 

 

Workers’ Comp Newcomers

 

Because of this fact I am inspired to share the lessons I learned working with Becki, so I have spent the last 10 months in the creation of the Workers’ Comp Newcomers Course. I’ve designed it as a comprehensive introduction to workers’ comp cost reduction and injury management systems for employers. It is designed specifically for employers and insurance brokers working with clients that have the goal of reducing workers’ compensation costs.

 

 

I took everything that I needed to learn entering this industry and broke it down into bite-sized lessons that average about 10 minutes each. In our fast paced, demanding world, flexibility and accountability are critical components to learning. The course is mobile-enabled and spread out over 8 weeks, with 2 weeks to complete each of the 4 modules. Each lesson has a short quiz to self-test comprehension and a final exam that requires 75% to achieve the certificate of completion.

 

 

I hate to even count up how many hours are invested in the creation of this course, so I’m very excited to finally release it. The first class starts Monday, August 22nd. Find out more here: https://workerscompclub.com/wcnew/

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

The Secret To Success In Workers’ Compensation

Hello Michael Stack here. Principle of Amaxx, founder of Comp Club and co-author of Your Ultimate Guide to Mastering Worker’s Comp Costs.

 

This past weekend was the start of the 2016 Rio Olympic Games. It is an impressive display by the world’s most elite athletes. It is something that I always look forward to and really enjoy watching. One of the elements in addition to the events that I really like to see is those personal stories, the back stories about the Olympians. Katie Ledecky is one of the US’s most decorated female swimmers. Just yesterday, she set the world record by almost two seconds in the 400 meter freestyle. It was an incredible event.

 

Before that event aired, before that race aired, they showed an interview between her and Matt Lauer from the Today Show. Matt asked Katie, he said, “What’s the secret to your success?” I thought the answer was just fantastic. She said, “The secret to my success is that there is no secret.” The secret to my success is that there is no secret. That’s years and years of practice, dedication and preparation in order to be able to dive into that pool at the sound of the gun and deliver an extraordinary outcome.

 

In Worker’s Compensation, often times we expect that extraordinary outcome that the claim is handled really well, that the employee gets back to work really quickly, and that costs are extremely low. We expect that extraordinary outcome without putting in the preparation, dedication and practice for what is going to happen at the time of the injury. If you watch the gymnasts in particular, you can really see this on display. Before their event, particularly, if one the gymnast is getting ready for a vault, you can see them really going through those movements.

 

 

Consistent Post Injury Response Procedure  

 

What are the movements in your Injury Management Program after an injury occurs? This is what we call the Post Injury Response Procedure. I’m going to go through some five summary steps of what that should look like, so hen that injury occurs at your organization, you know exactly what is going to happen, you know the steps that are going to occur.

 

 

Step 1: Report the Claim

The first step in this then, is to report the claim. The first step is to report the claim. Your lag-time summary, how quickly you’re reporting claims is a leading indicator to your program’s success. If you’re not getting claims reported timely, you’re not going to have positive outcomes, it’s just as simple as that. My recommendation is working with a 24-hour injury triage provider in order to help improve the outcomes of this claims reporting. Getting the proper level of medical treatment, advice to that employee, demonstrating that care right away and getting on top of that claim right away.

 

 

Step 2: Get Medical Care

Number two, get medical care. If you’re working with that triage provider, they’re going to be directed to the right level of care, often times reporting that individual to home treatment. You should also have relationship set up with medical providers, pre-existing relationships with these medical providers, so they know the protocol of your organization, they know the job descriptions at our organization, they know the type of work your employees are doing. When they’re treating that individual, they are a highly respected doctor that can also give you the medical restrictions for that individual employee. Can they lift 5 lbs., 10 lbs, 50 lbs., they can’t stand for a certain period of time. Get that medical care as part of your Injury Response Procedure.

 

 

Step 3: Return to Work

Step number 3, then, if you’ve gotten those work restrictions, is to return that individual to work. You should be shooting for 90% of your employees back to work or staying at work within zero to four days. 90% of employees back to work or staying at work zero to four days is your goal. Once you’ve gotten those medical restrictions, you plug them into your Return to Work Transitional Duty Job Bank descriptions that you’ve advised for how to now accommodate these restrictions that you’ve received from the doctors.

 

 

Step 4: Communication

Step number 4, communicate. This should be done from the direct supervisor: a first-day phone call, a visit to the hospital, a get well card. You’re demonstrating that care immediately. You’re also having weekly meetings with that injured employee. How’s the transactional duty job going? How’s your medical care going? You’re demonstrating care and you’re getting extremely valuable claims management information.

 

Step 5: Identify Fraud

The more you communicate with this individual, the more you’re going to be to identify fraud and malingering. You’re going to be able to sense if they’re not progressing in their return to work or transitional duty job program. Maybe that’s because the medical treatment is not going right, and you need to bring in some additional medical resources. Maybe there is some malingering going on, and you need to bring in some surveillance or additional resources to help that claim on track.

 

 

Know Exactly What Is Going to Occur After Injury

 

This is a very short summary version of what a Post Injury Response Procedure is, but the point is you need to know exactly what’s going to happen at the time of an injury in order to deliver that extraordinary outcome, just like the Olympians in the 2016 Rio Games. You won’t be awarded a gold medal, but what you will be awarded with is a great experience for the injured worker getting them back to work timely, and also extremely low Worker’s Compensation Claims cost. Remember your success in Worker’s Compensation is defined by your integrity, be great!

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Professional Development Resource

Learn How to Reduce Workers Comp Costs 20% to 50%"Workers Compensation Management Program: Reduce Costs 20% to 50%"
Lower your workers compensation expense by using the
guidebook from Advisen and the Workers Comp Resource Center.
Perfect for promotional distribution by brokers and agents!
Learn More

Please don't print this Website

Unnecessary printing not only means unnecessary cost of paper and inks, but also avoidable environmental impact on producing and shipping these supplies. Reducing printing can make a small but a significant impact.

Instead use the PDF download option, provided on the page you tried to print.

Powered by "Unprintable Blog" for Wordpress - www.greencp.de