Workers Comp Kit Blog

Can Medication Side Effects Be a Disability Under ADA

Rebecca Shafer, J.D. — Thu, 29 Jul 2010 21:30:57 +0000

A federal appeals court recently dealt with the following question: “Can the side effects of prescription medications qualify as disabilities all by themselves?” According to the case of Sulima v. Tobbyhanna Army Depot et al, the answer is “yes.”

A civilian employee at the Tobyhanna Army Depot in Pennsylvania was deemed to have sleep apnea. According to his doctors, it was likely caused by his obesity. In order to assist him in losing weight, and decrease the symptoms of the sleep disorder, the man was prescribed a medication “bind” a portion of the fat in his diet. Unfortunately, a side effect of the medication caused the individual to frequently go to the rest room.

According to court papers, the man spent two hours one day in the bathroom. Over time, the man was laid off. He then sued, claiming he’d been terminated due to his disability — the side effects of the prescribed weight-loss meds. The court was then charged with deciding if the man’s bathroom difficulties due to his weight loss medicine was covered under the Americans with Disabilities Act (ADA).

The judge ruled no — but only due to the fact the employee had the choice to ask his doctor to change his meds. Otherwise, the judge also ruled side effects from medication and medical treatments could qualify as disabilities. (workersxzcompxzkit)

Due to the fact the man had other options for treatment, his prescription didn’t fall under the umbrella of “required in the prudent judgment of the medical profession,” according to the court.

Author Rebecca Shafer, Consultant/Attorney, President, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, healthcare, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604.

WC Calculator: http://www.reduceyourworkerscomp.com/calculator.php
TD Calculator: http://www.reduceyourworkerscomp.com/transitional-duty-cost-calculator.php

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.

EEOC Publishes Notice for Series of Changes to Discrimination Complaint Regulations

Director — Thu, 29 Jul 2010 21:24:42 +0000

Advancing its efforts to improve the federal complaints process, the U.S. Equal Employment Opportunity Commission (EEOC) has published in The Federal Register a Notice of Proposed Rulemaking on a series of discrete changes to discrimination complaint regulations. The agency is soliciting comments from the public and other interested parties by February 19, 2010.

The proposed changes represent consensus measures identified in the report of an internal federal sector work group run by Acting Chairman Stuart Ishimaru when he was EEOC Commissioner. The changes include allowing agencies to conduct pilot projects for complaints processing, conforming the standard for bringing complaints of retaliation in the federal sector to private sector standards, and requiring agencies to notify complainants of their right to request a hearing when an agency investigation has gone on for more than 180 days.

"The federal EEOC process is vital for government workers, who have fewer available remedies than private-sector workers," Ishimaru said, "and I'm pleased that we're moving forward on implementing some key improvements recommended by our workgroup."

Acting EEOC Vice Chair Christine Griffin added, "This is an important step in the Commission's ongoing efforts to make the complaints process more fair and equitable for federal employees."

The proposed regulations also authorize administrative judges to make final decisions on class complaints and provide for expedited processing of appeals from class certification decisions. Other changes include mandating agencies comply with management directives and bulletins issued by the EEOC, and requiring agencies and encouraging complainants to submit filings electronically, to expedite the process and move from paper-intensive files.

The EEOC will consider the public comments received and may make changes in the proposed rule based on those comments. The proposed final rule will then be coordinated with other federal agencies and reviewed by the Office of Management and Budget, before becoming effective. (workersxzcompxzkit)

During fiscal 2008, the latest year for which data are available, federal agencies completed some 39,000 counseling sessions regarding employment discrimination, and handled nearly 17,000 complaints.

\Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, healthcare, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact: Robert_Elliott@ReduceYourWorkersComp.com or 860-553-6604.

FREE WC IQ Test: http://www.workerscompkit.com/intro/

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.

Claims Resolution and Settlements: Knowing When and How to Settle a Workers Compensation Claim

Rebecca Shafer, J.D. — Thu, 29 Jul 2010 21:20:57 +0000

Negotiations
The effective adjuster has developed the talent, through practice and experience, to negotiate the claim by emphasizing the strengths of his/her case. Prior to starting the settlement negotiations, the adjuster outlines in the Action Plan the strengths and weaknesses of the claim, obtains settlement authority, and develops a strategy to stress the reasons the claim should be settled for the amount the adjuster recommends.

As part of any negotiation, the adjuster should establish a settlement range for the claim based upon the strengths and weaknesses. The initial offer starts at the bottom of the settlement range and is not increased until the employee or the employee's attorney has made a counter offer.

The adjuster negotiates in increments with counter offers until an agreement is reached within the settlement range.   The adjuster never increases the offer upward more than the employee's counter offer has decreased.   If the adjuster sees the claim is not going to settle within the settlement range established, the adjuster should cease negotiating; advising the employee or the attorney their demand is outside the justifiable settlement range and no further offers will be made until a more reasonable settlement demand is made.

Waivers and Releases

Each state has its own forms or documents to be executed when the claim is concluded. The adjuster should settle all aspects of the claim — current indemnity benefits, future indemnity benefits, current medical benefits, and future medical — to prevent future financial exposure to your company. This requirement should be specifically stated in your account handling instructions.

The method to close out future benefits is different in each state. For example, in California the employee must execute a Compromise and Release (C&R) to receive a lump sum for the payment of future medical expense and close out the exposure for the future medical care. The C&R must be approved by a workers' compensation judge.

If the employee will not be returning to work, the settlement release in addition to the standard language of "to be a complete, entire and final release and waiver of any and all rights to any and all past, present and future benefits" should also include language stating the separation from employment is voluntary.

Also, all other civil actions outside the realm of workers' compensation the employee might consider should be included. If the above California C&R was for an employee who filed a psych injury claim for sexual harassment, and the Release is not modified to include the civil matter of sexual harassment, the employee would be free to bring a sexual harassment lawsuit against your company even though you have paid and settled the work comp claim with the C&R.

Due to the complexity of making sure all financial exposures to your company are resolved at the time of settlement, it is recommended you have your in-house counsel prepare the Waivers and/or Releases in any complex or high value claim.

In those states mandating a particular release agreement form, be sure the adjuster utilizes the state mandated form. In the states not mandating a particular release format, a Workers' Compensation Release should be obtained.

If there is any possibility of the employee attempting to circumvent the workers' compensation settlement with an age discrimination claim, sex discrimination claim, Americans with Disabilities Act claim or other type of claim against the employer, a General Release should also be obtained from the employee in conjunction with the Workers' Compensation Release.

All settlement releases should contain language stating Medicare's interest was protected to the best of the parties' ability and Medicare's interest was considered at the time of the settlement (see section below on Medicare Set Asides). (workersxzcompxzkit)

In the states permitting subrogation, the release should also convey all rights of subrogation from the employee to the employer.

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Author Rebecca Shafer, President, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, healthcare, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604.

FREE WC IQ Test: http://www.workerscompkit.com/intro/
WC Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
WC Calculator: http://www.reduceyourworkerscomp.com/calculator.php
TD Calculator: http://www.reduceyourworkerscomp.com/transitional-duty-cost-calculator.php

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.

What Should a Small Business Do If They Have Not Complied with Workers Compensation Laws

Rebecca Shafer, J.D. — Thu, 29 Jul 2010 01:41:54 +0000

If you are a large employer it is impossible (and also illegal) to fail to carry workers compensation insurance. Most states maintain a database of employers in their state. The states compare the information reported to them by insurers and approved self-insurers on who is insured against:

1. information reported to them by the department of labor (list of employers paying unemployment insurance)

2. information reported to them by the department of state (list of corporations and partnerships). (WCxKit)

3. information reported to them by the department of commerce (businesses collecting sales tax)

If you are a large employer, you will quickly get a notice from the department of insurance if for any reason your workers comp coverage expired and you did not replaced it.

[The State of New York's database contains 800,000+ employers in New York compiled from these and other sources].

But what if you are a very small employer, not incorporated or a partnership, and you do not collect sales taxes? Each state sets its own requirements for when an employer is “big enough” to be required to purchase workers comp coverage. In most states, excluding limited exceptions noted in various state statutes, an employer must carry coverage once their small business meets the state specific requirements for number of employees. The number of employees needed to require a business to carry workers comp insurance varies by state from one to five employees, with three employees being the most common threshold for requiring workers compensation insurance.

Let's consider the small business in a state where three employees is the threshold for requiring workers comp coverage. The owner of the business started out with just himself doing everything related to his business. As time went on, he became more established and hired an assistant. Soon the business reached the point where he had to hire a part-time secretary. He never thought about having workers compensation insurance for his assistant and his part-time secretary. Then the big break comes. In order to handle the new business he hires two additional employees to work with him and his assistant. With the pressure to handle the new business plus training the two new employees, workers compensation insurance never crosses his mind.

A few months later, one of the new employees suffers a workplace injury, tripping, falling and breaking an arm. Now the owner of this small business realizes he needs workers comp insurance. As the business owner cannot buy workers comp insurance retroactively, he has unknowingly joined the ranks of the self-insured. His small business will need to pay all the medical bills his employee incurs as a result of this accident, plus the business will need to pay at least two-thirds (higher in a few states) of the employee's wages while the employee is off work. [The owner of this small business might be better off to pay the employee's wage the entire time he is off work and arrange for the employee to return to work on modified duty as soon as possible].

The business owner after paying for the employee's medical bills and wages realizes he should have had workers compensation insurance, and wonders what can he do to get legitimate? First, he should contact his business insurance agent and report he needs workers comp coverage as he has hired two additional employees. The insurance agent will be glad to write the coverage for the business, but can only write with an inception date in the future (hopefully the next day).

Depending on the state where this hypothetical business is located, the business owner may have problems besides paying the workers comp claim of his employee, such as:

1. Criminal prosecution for non-compliance with the law.

2. A civil fine or penalty imposed on the business by the state (some states have hefty fines in the thousands of dollars).

3. The employee obtaining an attorney when he realizes the business owner has no workers comp insurance, and the attorney exercising the option to pursue a tort claim and suing the business owner.

Let's assume the insurance agent for the business elects not to ask too many questions and is able to place the small business with a workers comp insurance carrier. Other than the expenses of paying the workers comp claim, and buying workers compensation insurance coverage for the future, the business owner gets out of this problem with no further cost. But, he still will probably lay awake at night wondering if the state will find out and prosecute him and/or fine his business. (WCxKit)

Another example of a small business getting into trouble by not knowing the workers comp laws could be a Canadian business expanding into the United States. At first they check the laws of the first state they expand into and learn you must have two employees to be required to buy workers comp coverage. Since they only have one salesman in the state, they elect to not buy workers comp insurance.

Then the Canadian company has a change in the risk management department. The new risk manager sees they do not have workers comp coverage for their United States salesman, so he concludes it is not required. The Canadian company is successful and they add additional salesman to the same state. Within 5 years they have six salesmen working from their homes. Then someone in the Canadian company asks about workers comp coverage for the six salesmen.

They wish to be legitimate, but what can they do? They cannot buy workers comp coverage in arrears — no carrier will sell them a policy covering a time frame in the past. They can buy workers comp coverage going forward. Depending on the workers comp statutes of the state they are in, they may be fined for their failure to have the coverage. Their best bet is to talk with a knowledgeable insurance broker who can guide them in obtaining coverage and address with the state any penalty they may have to pay. (WCxKit)

If you need assistance in obtaining workers comp coverage for your small business for the first time, please contact us and we will be glad to provide you with assistance and guidance in the selection of your workers comp insurance broker.

Disclaimer: This article is not intended to be legal advice. If you have questions of a legal nature about failing to comply with the workers comp statutes of your state, please consult with your attorney or legal adviser.

Author Rebecca Shafer, J.D./ Consultant, President, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604.

WC Calculator: http://www.LowerWC.com/calculator.php
TD Calculator: http://www.LowerWC.com/transitional-duty-cost-calculator.php

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.

Alleged Horseplay Unsafe Work Practices Lead to Investigation

Director — Thu, 29 Jul 2010 01:36:13 +0000

A video of what appears to be horseplay and unsafe work practices on a Calgary construction site has prompted an investigation by Alberta Employment and Immigration (AEI) and action from the city's building officials.

Canadian OH&S News reports the video was filmed at a condominium development site in Calgary, according to AEI spokesman Barrie Harrison. The vides, apparently shot by a worker, captures one co-worker tossing a clamp to another co-worker across elevated scaffolding.

"I was extremely disappointed to see workers, professionals, acting in such a manner, and obviously, extremely shocked for the disregard for the safety of the public [and] the safety of the workers below," Kevin Griffiths, Calgary's chief building official, said.

If the horseplay as seen in the video is proven to have occurred, it would be a violation of Section 189 of Alberta's Occupational Health and Safety Code, stipulating "if a worker may be injured if equipment or material is dislodged, moved, spilled or damaged, both the employer and the worker must take all reasonable steps to ensure the equipment or material is contained, restrained or protected to eliminate the potential danger." (WCxKit)

"When there's activity like this going on, (in) any sort of scaffolding construction, there should be some sort of safety netting beneath," Harrison said. "In some cases, you may want the sidewalk or street below to be cordoned off, but from the looks of the video, it doesn't look like any of that is in place." However, he adds, he does not want to assume anything until AEI's investigation is complete.

The workers were employed by Edmonton-based construction firm Skyway Canada, according to company president and chief operating officer Gary Carew. He added a pair of the workers in the video were suspended without pay, pending the results of investigations by both Skyway and AEI. The third involved worker recently left the company.

"Skyway Canada Ltd is deeply disturbed by the images in the video which we learned of last week," Carew says. "We do not condone the high-risk behavior of the workers in this video. We have commenced a comprehensive investigation into this incident and will share the results when completed."

Gary Wagar, executive director of the Alberta Construction Safety Association (ASCA) in Edmonton, notes that companies are obligated to manage horseplay through their safety management systems. "I think that there's a culture in general in young people, not just in the construction industry, when it comes to horseplay," he contends.

Wagar suggests that if AEI inspectors were authorized to issue OH&S fines on-site, workers and employers might have more incentive to comply with safety regulations. (WCxKit)

Griffiths, meanwhile, would like to see municipal fine amounts raised for sites that endanger public and worker safety. "We want to send a strong message that everyone needs to do everything possible not to inflict any possible endangerment to the public, and in extension, to workers obviously, on-site," he says.

Contact: Info@ReduceYourWorkersComp.com or 860-553-6604.

WC Round Table LinkedIn: http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

TD Calculator: http://www.LowerWC.com/transitional-duty-cost-calculator.php

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.

Work Comp Scheme Sends Woman to Prison

Robert Elliott, J.D. — Thu, 29 Jul 2010 01:32:33 +0000

Open Mouth – Insert Foot

A Colorado woman who collected more than $25,000 in a workers compensation claim faces two years in prison.

Although originally charged with felony theft and forgery, reported by the Sentinel newspaper, the woman pled guilty to one count of making a false statement to achieve a benefit.

The 42-year-old woman claimed she injured her ankle while employed as a housekeeper at a Grand Junction hotel, but failed to report the injury for a month.

A doctor diagnosed her injury as a minor sprain. A month later, however, additional tests indicated more damage to her ankle and she began receiving partial disability and wage benefits from Pinnacol Assurance.

According to the arrest affidavit, the woman bragged about her ability to fool the system and informed some friends the injury wasn't even work related. A co-worker told investigators the woman said she injured her ankle away from work when she got drunk and fell on a street curb. (WCxKit)

The judge ordered the woman to repay $25,500 in restitution, along with serving the prison sentence.

Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact: Info@ReduceYourWorkersComp.com or 860-553-6604.

Join WC Roundtable LinkedIn: http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

4 Ways the New Health Care Regulations May Cause More WC Claims in New York

Attorney Theodore Ronca — Tue, 27 Jul 2010 22:08:04 +0000

Consider this: A Big Potential Loophole for Small Self-insured Employers

1. With new federal regulation of group medical plans there will be a flood of comp claims adding pre-existing chronic conditions as having been "accelerated or exacerbated" by a comp injury. People age 50+ have a way of getting around restrictions. Medicare won't care if these conditions are transferred to a workers comp claim. New York State Insurance Fund (NYSIF), of course, would fight, but not a self-insured employer.

2. Small self-insured employers will have an remarkable loophole. They can unilaterally make payments of medical for themselves, make it compensable, and take the tax deduction. The Board will not be notified if it is a no lost time claim and no one requests a hearing. You don't need the Board's permission to make things compensable. In fact, you have to fight to exclude them.

A self-insured employer can make payments at any time without Board approval, and carry the payments as comp, which is fully deductible for tax purposes, and is not taxable to the employee. The advantages are obvious and have been built into the law since it was enacted in 1914. The only way it can be challenged is if the self-insured employer wants to fight it and notifies the Board. Sometimes these payments are referred to as “advance” payments, but that’s a misnomer for the term. (WCxKit)

3. Self-insured employers can get the treatment anywhere they want, even offshore. Many of the best New York City doctors are opening clinics in the Bahama. If the employer, or a relative covered as an employee, uses the comp law to get treatment, they can always fly to an offshore medical facility, a fully tax deductible comp expense for the business, even if it's only for a routine comp exam.

4. A smaller self-insured employer could use this to cover every member of their family and transfer treatment of chronic conditions to workers comp. As long as the claims are for medical treatment only, and not wage loss, there will be no reason for hearings, which in New York are traditionally for wage loss only. Medical issues are by arbitration AT THE REQUEST OF THE EMPLOYER, for self-insureds.

All this can be done by using the liberal comp presumptions at the New York board. There is great potential for smaller employer self-insurance as a way around federal restrictions on treatment and selection of providers. The 1914 workers comp law assumed medical treatment would be provided by the employer without Board oversight. The law favored a presumption that medical care should be part of a claim, not be excluded.

Note: Some strategies work very well for self-insureds and not at all when you have a carrier. This is one of them. This is how self-insureds could misuse the system, a possible negative implication of of the new health care initiative.

The comp law, actually, didn't provide for automatic hearings when it was started. So, a self-insured is not automatically subject to much scrutiny on claims for a covered EMPLOYER filing his/her own claim. If it's medical only, there is no reason for having any hearings on non-disputed medical.

That is what makes this work. There is no requirement that the Board has to issue a decision. If a self-insured pays their own claims, they can deduct the payments from the corporate tax return. DON'T PAY THEM THROUGH A TPA!!! It's not required! (And there is no Board form for reporting medical, only wage loss.) (WCxKit)

If you have a carrier (aka insurance company) – forget all of this. The payments would only go into your X-mod. If the carrier ever paid a single cent.

Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers' compensation, Social Security disability, employee disability plans, and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100.

European Employers Have Important Role to Play in Healthy Worker Lifestyles

Robert Elliott, J.D. — Tue, 27 Jul 2010 22:03:08 +0000

Workplace Health Promotion (WHP) leads to better health, reduced absenteeism, enhanced motivation, and improved productivity: that is the message behind the Workplace Health Promotion project of the European Agency for Safety and Health at Work (EU-OSHA). Employers have an important role to play in encouraging workers to adopt healthy lifestyles.

In addition to the health benefits for workers, every Euro invested in WHP leads to a Return on Investment (ROI) of between 2.5 – 4.8 Euros due to reduced absenteeism costs.

According to EU-OSHA Director Jukka Takala, “Supporting a healthy lifestyle pays off for everyone. It benefits employees themselves and their employers, but it also helps the wider society, by reducing the burden on healthcare systems. And with an ageing working population, the importance of Workplace Health Promotion schemes is only going to increase – we need to help people stay healthier for longer, and to achieve this we need employers and employees to work together, to create a healthy working culture.”

Health promotion measures support workplace risk prevention, but do not replace proper safety and health management. According to officials, there is no point in implementing a WHP program without also offering a safe and healthy working environment.

WHP is based on a healthy culture by first ensuring all legal requirements are respected. Carrying out WHP activities both organizational and individual level factors should be taken into account. Many European companies have WHP programs in place, ranging from encouraging workers to improve their diet (by including low-fat options in work canteens, for example), to providing training for managers to recognize stress symptoms in their employees and take appropriate action.

Dundee City Council in the UK, for example, has been working to improve the psychological and physical health of staff in its Social Work Department. Initiatives include organizational level actions, such as family-friendly policies, as well as individual level measures such as the provision of a confidential employee counseling service and subsidized reducing club membership.

The scheme has already led to an improvement in the health of employees, with an estimated 165,000 Euros being saved in sickness absence every year through a reduction in stress, anxiety and musculoskeletal problems.

EU-OSHA has just launched a new web portal on WHP, including two new factsheets providing overview and advice to employers and workers, ranging from ways to create a supportive working environment to providing information, ideas and encouragement on health matters, such as giving up smoking. The portal also includes good practice resources such as useful links and case studies.

For more information on WHP, see http://osha.europa.eu/en/topics/whp

Author Rebecca Shafer, President, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact: Info@ReduceYourWorkersComp.com or 860-553-6604.

FREE IQ Test: http://www.workerscompkit.com/intro/
TD Calculator: http://www.LowerWC.com/transitional-duty-cost-calculator.php

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.

Retaliatory Discharge Borrowed Employees Are Protected As Well

WCK Director — Tue, 27 Jul 2010 21:56:39 +0000

A borrowed employee filed a retaliatory discharge action against the borrowing employer, contending that one day after she testified, under threat of subpoena, in a workers' compensation proceeding filed by one of defendant's employees, the borrowing employer told her that her services were no longer needed.

Defendant contended that plaintiff could not maintain a retaliatory discharge cause of action since she was not defendant's employee, that plaintiff had never been on defendant's payroll, that she had not been fired by defendant and was free to work for her employer at any time and at any work. (WCxKit)

The appellate court observed that all rights and remedies of the Workers Compensation Act applied to borrowed employees, that a borrowing employer is primarily liable for the payment of a borrowed employee's workers' compensation claim, and that the public policy considerations which led to recognition of an action for retaliatory discharge equally applied to a claim by a borrowed employee against a borrowing employer. (WCxKit)

Moreover, defendant's argument ignored the nature of a borrowed-employee relationship. In the context of that relationship, the most severe sanction a borrowing employer could impose was to refuse all further work. In that context, the sanction was tantamount to a discharge [Hester v. Gilster-Mary Lee Corporation, 386 Ill. App. 3d 1104, 899 N.E.2d 589 (2008)]. See Larson’s Workers Compensation Law: Ch. 104, § 104.07[1] n.19.1. To read more at Workers Compensation Law Community .

Work Comp Calculator: http://www.LowerWC.com/calculator.php
RTW Calculator: http://www.LowerWC.com/transitional-duty-cost-calculator.php

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.

A Day in the Life of a Busy Workers Compensation Insurance Adjuster

Rebecca Shafer, J.D. — Mon, 26 Jul 2010 20:00:51 +0000

If you have ever wondered what your workers comp adjuster does in a day, please read this fictional, but true-to-life account of an adjuster's typical day. Let's take a look at what a typical adjuster does during the day and reflect on how we can help him/her help us better manager our programs. Although this blog refers to workers compensation adjusters, the work day of others is probably about the same. One noted exception is a "field adjuster" who may work on the road, for example, in auto claims.

Most adjusters who have been on the job for a realize their workload will always be greater than they can ever attend to properly. This won't stop most of them from trying to cover everything that needs to be done. It is not unusual for the dedicated adjuster to arrive at the claims office early and be one of the last employees to leave at night.

It is usually the workers comp adjuster who arrives first at the office and makes a pot of coffee for herself (or himself) and her co-workers. After a few sips of coffee, the adjuster turns on her computer and brings up her diary (her computer calendar) of all the claims she needs to work on during this day. However, before she starts to work on any of her claims, she turns to the telephone and retrieves all her voice mails from claimants (employees), employers, medical providers, attorneys, nurse case managers, her supervisor, various vendors and others who have called her about her claims. (WCxKit)

The adjuster than compares her voice mail messages with her diary to see where she can combine the diary and voice mail to save time on the files. After she combines the diary and the voice mails, she prioritizes the claims and creates her work agenda in the order of importance.

During her workday, the workers comp adjuster has frequent and sometimes complex contacts with many parties. For the next couple of hours the adjuster will be on the telephone contacting employers, employees and medical providers to obtain additional information about the progress or status of the claims.

If the adjuster is good at multitasking, she will be entering file notes on each claim as she is talking to each person. If she is not comfortable with multitasking, she will write up her files notes immediately following each phone call and before she starts the next phone call.

By the time the adjuster is done with her phone calls for the morning, the daily mail should have arrived at her desk (or have been scanned into the computer system). The adjuster then turns to reviewing each item of correspondence and entering her file notes on each medical report, attorney's letter, etc.

The adjuster never get through her morning phone calls that she makes and the daily mail without receiving additional phone calls from people. Depending on the claim office philosophy or the adjuster's preference, the adjuster will stop working on the incoming mail and take the phone calls as they arrive, or allow them to start accumulating again in her voice mail.

It is an old claims office adage – “Your interruptions will get interrupted.” The adjuster must decide for herself if she is more proficient by taking each phone call as it arrives, or by grouping them and returning the phone calls once in the morning and once in the afternoon.

Between telephone calls and correspondence, the adjuster's morning is packed with other things to do.

If the supervisor has assigned a new workers comp claim to her, she must put on hold all the items on her agenda and make her three-point contacts with the employer, employee and medical provider. If she has a worker’s comp board hearing, she may have to leave everything and attend the hearing. If she has a settlement conference, she may attend the settlement conference in person, or by telephone. If she has a crisis of some type on any of her files, she will stop work on her daily agenda and deal with the crisis. Our third party-administrators and insurance companies have many adjusters who are the primary contact for many of us in the workers' compensation field.

After a quick lunch, often eaten at her desk in order to save time, the workers comp adjuster starts her afternoon round of phone calls, mail review, outgoing correspondence and file reviews. In the middle of all these activities, the adjuster will often take time out to discuss complicate claim issues with other adjusters or to provide mentoring to inexperienced adjusters. Over the cubicle wall discussions of claims and procedures will occur throughout the afternoon as she assists other adjusters with their claims. (WCxKit)

Every day the adjuster is interpreting and applying the workers comp statutes, the insurance policy coverage and her employer's work policies and procedures. The exercising of judgment and initiatives is a routine part of the adjuster's daily task. The adjuster not only makes many decisions during the day, but also has to communicate effectively those decisions both verbally and in written communications.

In the states with complicated state forms to file on every claim, the adjuster will often set aside a specific time each day to be sure the state mandated forms are completed and filed either electronically or by mail as required within her state.

By the time the adjuster turns out the office lights at night, she will have had an impact on the lives of several claimants as she has assisted them in obtaining the medical and indemnity benefits they are owed. She will have also had an impact on the insurer as she has provided the benefits the employee is entitled to while protecting the assets of the insurer from being overspent. It's not easy being a workers comp adjuster but it is often a satisfying and fulfilling job.

Author Rebecca Shafer, J.D., Consultant, President, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact: Info@ReduceYourWorkersComp.com or 860-553-6604.

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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.