Reduce Your Workers Compensation Insurance Coverage Costs with Timely Information for Employers | Work Comp Roundup

Gould & Lamb’s National Institute for Medicare & Medicaid Education & Other Workers Comp News

Michael B. Stack — Fri, 24 May 2013 16:23:49 +0000

Making ends meet on healthcare

One of the key long-term concerns of many accident survivors involves finding acceptable and affordable health insurance. Two news stories this week show how daunting this task is and point out the vital need for accident victims to ensure regular (and significant) funding to cover their healthcare needs.

Start with indications that many employees are having their weekly hours cut so they fall below the coming federal standard to qualify for employer-sponsored health coverage, according to this new survey from the International Foundation of Employee Benefit Plans.

Railworker Unjustly Fired For Acting In Self-Defense Against Abusive Customer

Michael B. Stack — Fri, 24 May 2013 12:30:39 +0000

British Rail Union RMT recently confirmed that a ballot was entered into service on London Midland over the victimization of a Revenue Protection Officer fired by the company for resisting a physical and verbal assault by a known troublemaker.

Employee Verbally & Physically Assaulted Acted In Self-Defense

According to RMT information, James Crabtree is a London Midland Revenue Protection Inspector and on the day the incident happened he was serving on the gateline at Watford Junction.

The report notes that he was reportedly verbally abused and physically pushed by a well-known troublemaker when he requested to see a valid travel ticket. The situation rapidly intensified when the lout stood in front of Crabtree and continued the verbal abuse, in the process reportedly spitting chewed up food all over his uniform coat. In fear of being physically assaulted and to protect his own well-being, Crabtree reportedly pushed the aggressive and threatening individual out of the way in a clear act of self-defense.

Company Fired Worker Rather Than Defend

As the story goes, instead of protecting a member of staff dealing with a violent situation in a vulnerable position London Midland opted to level a series of alleged trumped-up and nonsensical charges against Crabtree and, refusing to listen to reason from the union, fired him while the perpetrator got away with it.

RMT has a stated policy of fighting abuse and assaults on rail staff, a commitment clearly shared by London Midland in words only, and as a result of this latest reported travesty of justice involving a revenue protection inspector the union decide to begin balloting RPI members in the southern arm of London Midland. The balloting involved both strike action and action short of strike in pursuit of the campaign for justice for Crabtree and his immediate reinstatement.

Company Has Failed Miserably in Protecting Staff

According to RMT General Secretary Bob Crow, “London Midland display posters at their stations stipulating ‘we always prosecute those who intimidate and abuse or assault our staff.’ Yet the company has failed miserably in their duty of care and support towards James Crabtree. Instead of protecting him, the company has dismissed him in the most blatant travesty of workplace justice – siding instead with a known troublemaker who is the kind of menace who should be barred from our railways

“RMT is clear that the trumped-up allegations leveled against James are unfounded and that the harsh decision taken by London Midland is not only intimidating but highly offensive towards a hardworking, loyal member of staff. RMT has therefore informed the company that a dispute situation now exists between our two organizations and that RMT demand the immediate reinstatement of James Crabtree.

“RMT remains available for talks aimed at righting this appalling miscarriage of workplace justice which sends out a signal to thugs that rail staff are fair game for abuse and intimidation.”

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Techniques to Control Run-Away Cost of Narcotics in Workers Comp

Rebecca Shafer, J.D. — Thu, 23 May 2013 13:30:57 +0000

All insurers and self-insured employers deal with the long-term medical treatment claims where the injured employees become addicted to one or more narcotics. Narcotics, which are opium based and are excellent for treating pain in the short run, have two problems. First, the human body adjusts to the medication, and in order to continue to obtain the same level of pain relief, the amount of the medication must be increased. Second, narcotics are highly addictive, and the injured employee can go through both physical and psychological withdrawal symptoms when the narcotics are taken away.

Employee Focus Can Shift From Recovery to Obtaining Narcotics

Unfortunately, often the injured employee’s focus shifts from recovering from their injury to obtaining their favorite narcotic(s). The injury, while real, becomes the excuse for obtaining the narcotic. Unless the employee has a very high ethical standard, the level of pain associated with an injury becomes overstated. As pain cannot be measured, the treating physician is relying on the honesty of the employee to determine the need for narcotics to manage the pain.

Also, for the employee with low ethical standards, narcotics become a source of income. Many narcotics prescribed for workers’ compensation injuries are resold by the injured employee. The illicit trade in prescription drugs is a huge problem for law enforcement throughout the country.

There are several techniques insurers and self-insured employers can used to attempt to control, if not stop, the run-away cost of narcotics.

Techniques to Control Run-Away Cost of Narcotics:

Require the physician treating the employee to complete a urine toxicology drug screen at each office visit

If the prescribed medication(s) is not in the injured employee’s system, the further replacement of the medication should be stopped

If the prescribed medication(s) is in the injured employee’s system, but at a lower level then it should be, the dosage and/or frequency of the prescribed medication should be reduced accordingly

If the drug screen included cannabis or other illicit drugs, all narcotics should be stopped, if state law permits

Often there is a less expensive narcotic that provides the same level of pain relief to which the injured employee can be switched, for example from oxycodone to tramadol

Generic versions are available for many name brand narcotics

A request should be made to the nurse case manager to discuss with the medical provider the switching of the claimant from his/her favorite narcotic(s) to an opiate agonist. An opiate agonist is a drug that causes the receptors in the brain to feel the effects of a narcotic, even though the effect isn’t actually occurring.

If the medical provider has also been dispensing the drugs to the injured employee, a letter should be sent to the employee, employee’s attorney and the doctor advising all medications will be provided by the pharmacy benefit managing company through the pharmacy benefit card provided to the employee. This accomplishes two things, it removes the incentive for the doctor to over prescribe, and it prevents the employee from self choosing the pharmacies to obtain duplicate prescription refills.

A list of medications prescribed along with the dosage amount of each medication prescribed for the injury should be obtained from the medical provider. This list of medications should be provided to the pharmacy benefit management company with instructions to not provide any other medications or higher amounts than the prescribed dosages.

If the medical provider is indifferent to controlling the employee’s narcotics addiction, a drug utilization review to verify the adequacy and accuracy of the medications being prescribed should be completed.

A senior nurse reviewer can be utilized to constantly oversee and manage the drugs prescribed to an injured employee.

For more information on fighting narcotics addiction, or to obtain a referral to a drug utilization review company or to a nurse case manager, please contact us.

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact:RShafer@ReduceYourWorkersComp.com.

Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.

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Ontario Unveils Final Report on Vulnerable Workers and Precarious Work

Michael B. Stack — Thu, 23 May 2013 12:30:54 +0000

Many workers oftentimes get placed in positions that can be both hazardous and counter-productive to their health. With that in mind, what can be done to change things?

The Law Commission of Ontario (LCO) recently unveiled its Final Report on Vulnerable Workers and Precarious Work. The Report includes 47 recommendations designed to respond to the challenges faced by vulnerable workers to reduce their vulnerability to or the impacts of precarious work which extend to their health, family relationships and other areas of life beyond the workplace.

In particular, the Project looks to improvements to the statutory and policy framework of the Employment Standards Act and the Occupational Health and Safety Act in protecting these workers.

However, it also reviews and provides recommendations regarding present community and government supports and programs for workers, employers and for training and education, along with the role of labor organizations.

Report Notes How Much Work is ‘Precarious’ in Nature

“It is important for Ontarians to recognize that the nature of employment has changed. Much work can be characterized as ‘precarious’ – that is work with low wages, less job security, few benefits, and only minimal control over working conditions. The workers who work at these jobs are vulnerable. Precarious work and vulnerable workers present a challenge for us as a society. This Report attempts to provide recommendations on how we might meet that challenge,” commented Bruce Elman, chair of the Board of Governors of the LCO.

The LCO formed an Advisory Group made up of academics, advocates and representatives of government, workers, employers and community organizations.

In early 2011, the LCO released Background and Consultation Papers for this project, and over the course of the Project the LCO has undertaken extensive research, including commissioning two research papers by noted academics and experts, and has conducted approximately 50 consultations with individuals and organizations. The LCO’s Interim Report was released for public feedback in August 2012. The Board of Governors approved the Final Report in December 2012.

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5 Additional Tips To Improve Your Workplace Safety

Michael B. Stack — Wed, 22 May 2013 13:30:27 +0000

Workplace safety is one of those topics where it is hard to overemphasis its importance. There can be such a thing as “too much safety”, but that level is the small majority of companies. It is my experience that most companies have something in place for workplace safety. If you are a company operating a workplace safety program, here are 5 additional tips to help you improve. If you are not currently operating a workplace safety program, get started today.

Hazard awareness through company communication

Once you identify your hazards, you need to communicate to the work staff what hazards are out there, so they are aware of the risks associated with doing their jobs day in and day out. All the safety prevention in the world is not going to be effective unless your employees first know about the hazard, and do something about it. Use of email communication may not reach all of the employees, so hang posters around areas where a hazard is common. Workers will get the hint if they are constantly reminded of the risks associated with working in particular areas.

Emergency action plans

What should a worker do if they are injured? Who is in charge of calling an ambulance should you need one? Which hospital or clinic should they go to? What paperwork do they need to get treatment? What is the contact information for the work comp carrier? All of these things should be addressed, and every employee should be educated on what to do and who to report to should an injury occur. These are usually addressed in an orientation program for new employees, but sadly they are also the first thing forgotten once work begins. Constant reminders are extremely helpful. Hang posters of contact information and the steps to report injuries in common areas where workers congregate. It may seem like a minor step, but it is the most effective.

Use of inspection checklists, maintenance programs, job site inspections, etc.

Regular and routine maintenance of machinery can prevent a lot of injuries. Every machine should have a pre-operation checklist before work begins to see if some upkeep needs to be performed before starting work. An example could be replacing blades or grinding discs, changing belts, machine lubrication, and so on. It is not rocket science, but regular and routine inspection could have long term payoff in injury prevention. This will also identify anyone that may have modified the machine prior to your use, potentially saving an injury from happening in the first place.

Contactor/Vendor screening

Should you open your doors to outside vendors or contractors, make sure they are qualified and insured themselves, especially if they are the ones working on your machines. Failure to do so may result in loss exposure under your coverage, even though this worker does not directly work for you. Now is a great time to dust off that paperwork, and touch base with all of your contractors/vendors that do business under your roof. Pre-screening them and making sure all of their paperwork and insurance information is current could save you a huge headache down the road.

Contractor/Vendor communication on your injury requirements

Once you do the task of making sure your vendors/contractors have all of their information up to date, and their insurance information is on file, you should not just leave it at that. Make sure that they know what your protocol is should an injury occur, either to them or to one of your employees. Going back to effective communication, you should walk them through your safety program, and who they should report to should an incident occur. That way everyone that comes into your building, be it a direct employee or an outside employee of a vendor/contractor, knows what to do should an injury occur on your premises. The key is communication. If everyone knows what they should do when an injury happens, the process will run its course, and everyone will be on the same page.

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Insurance Agent Picks Wrong Lead Generation Method, Ends Up In Jail

Michael B. Stack — Wed, 22 May 2013 12:30:55 +0000

An Oklahoma insurance agent has found himself on the wrong side of the law, allegedly miscoding workers compensation policy applications.

As Oklahoma Attorney General Scott Pruitt’s office breaks it down, the defendant was leveled with eight felony charges earlier this month for reportedly making false or misleading statements in insurance applications and receiving funds via false pretenses.

Fernando Espinoza, 27, of Norman, is alleged by authorities to have miscoded workers’ comp insurance policy applications in order for roofing employers to look like “paint and paper hanging” businesses so they could acquire workers’ comp coverage. As the law states, the insurer does not issue workers comp policies to roofing companies and therefore, considers such policies to be invalid.

Investigation Showed There Were No Actual Policies

As the investigation unfolded, it was determined that the roofing companies informed Espinoza they were working primarily as just that, roofing companies.

The charges noted that there were a number of cases where the defendant reportedly issued certificates of insurance that did not have the backing of actual policies and would use a quote number as opposed to a policy number. Even though the items looked real, there were in fact no actual policies.

In the end, Espinoza could get up to seven years behind bars and/or a fine of up to $10,000 if found guilty.

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5 Tips to Improve Your Workplace Safety

Michael B. Stack — Tue, 21 May 2013 13:30:38 +0000

I am not 100% sure why I am intrigued by workplace safety. Throughout the course of my day I am always looking for safety violations, especially when I am running errands. My day can take me in and out of businesses of all types, and rarely will a time go by when I do not see some sort of safety violation happening. These may be insignificant in nature, but everyone can always be more proactive when it comes to workplace safety.

Here are 5 ideas to get you thinking about workplace safety, and tips on how to be more proactive with regard to cutting down your workplace injury exposure. I am sure you may have heard of some of these before, but some may be new. Remember it is never too late to start a safety initiative:

Identify your hazards by reviewing loss run data

The first step in figuring out how to be safer is to figure out where your hazards are. By reviewing your work comp claims history, you can identify certain areas or trends in injury occurrence. But don’t limit yourself to the last 6 months or the last year; go back 2-3 years or further if you can. I would be willing to bet a lot of the machinery and a lot of the work processes that you have in place have been the same for a number of years. So go back 3-5 years, and try to sort the data to see what trends stick out more than others. It could be machinery injuries, types of injuries such as lifting or slip/falls, or maybe it is a certain department that has more injuries than the other departments. Whatever the case may be, you need to begin with sorting the data.

Analyze the risk by job classification

So now that you have sorted your data, you need to implement ways to become a safer place to work. Some tasks on the work floor may yield more risk than others. For example, a welder may have more risk associated with their job than an accountant or Human Resources person. This is taking your data analyzing a step further by classifying it by the actual job or job tasks. This will help you come up with ways to try reduce your workplace safety risks.

Implement hand/finger safety requirements

For whatever reason, a lot of employers modify machinery once they purchase it. This may be to customize the machine for whatever task they have to complete during the job. Guards are removed, auto-shutoff buttons are covered, belts and engines may be exposed, etc. The hand is one of the leading body parts that are injured. This comes from reaching into machines or from handling materials without the proper gloves. Remember that safety guards are there for a reason. The last thing you should do is tamper with a machine. Countless people lose fingers or hands due to severe lacerations, amputations, or limbs becoming caught in the moving parts of machinery. Even more surprising is that oftentimes management is not aware that the machines are modified to begin with. Workers that use the machines may modify safety components for whatever reason, and it is only after an injury that supervisors notice that the machine was modified.

Eye injury safety programs

The eye is another body part that gets injured quite often. This is usually from flying debris. These injuries are the easiest to prevent, since safety glasses are no longer the bulky, heavy pieces of eyewear that they used to be. Companies need to identify heat, chemicals, dust/airborne particles, radiation, welding flash, etc. and implement areas where eye protection is mandatory. Provide your workers with dependable, easy to wear safety glasses and make sure they use them.

Slips, trips, and falls

These injuries are more difficult to identify, but if you are proactive in inspecting areas such as flooring, steps, railings, ladders, and stools, then you should see a decrease in injury occurrence. Also important is the use of non-slip footwear and work boots to cut down on slip exposure. Another thing to remember is to inspect entryways, hallways, and steps that are not covered in non-slip flooring. These areas become hazards when it is rainy or snowing outside. You should keep floor cleaning equipment around to clean up liquid spills, condensation, and materials spills to prevent others from slipping and falling in someone else’s mess.

The best workers compensation claim is the one that never happens. Safety should be an integral part of any workers compensation management program.

For assistance in helping you get started with safety, contact us today.

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OSHA Ratchets Up Safety Info for Emergency Responders

Michael B. Stack — Tue, 21 May 2013 12:30:09 +0000

Emergency responders are oftentimes put to the test, given conditions that most people would prefer avoiding.

With that in mind, the Occupational Safety and Health Administration (OSHA) recently published Firefighting Precautions at Facilities with Combustible Dust*, a new, informative booklet that outlines safe procedures for emergency responders who are at risk for coming in contact with fires and explosions caused by combustible dust.

"This booklet will keep both emergency response and facility workers safe by giving them a framework to prepare for potential emergencies involving combustible dust," Assistant Secretary of Labor for Occupational Safety and Health Dr. David Michaels stated. "Stakeholders that have reviewed the booklet, including fire chiefs and union health and safety representatives, describe it as 'an excellent resource for explaining the hazards associated with combustible dust and outlining the best practices for pre-incident operational preparation by emergency responders.’”

Worker Death Toll at More Than 130 Since 1980

Since 1980, more than 130 workers have been killed and more than 780 injured in combustible dust explosions.

By reading the publication, both employers and workers can learn how combustible dust explosions occur and review previous incidents to illustrate how firefighting operations can prevent combustible dust explosions. The booklet explains the preparations emergency responders can make before a response and how these preparations will affect the operational plan during a response.

Combustible dusts include fine particles, fibers, chips, chunks or flakes that, under certain conditions, can cause a fire or explosion when suspended in air. Types of dusts include metal (for example, aluminum and magnesium), wood, plastic, rubber, coal, flour, sugar and paper, among others.

Meantime, OSHA's Combustible Dust Web page provides employers and workers with additional information and resources for preventing and minimizing the effects of combustible dust fires and explosions.

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Common Workers Compensation Assumptions And Facts

Rebecca Shafer, J.D. — Mon, 20 May 2013 15:10:58 +0000

There are many assumptions surrounding workers compensation. Here are a few common assumptions and associated correct facts.

Assumption: There is nothing you can do to control workers’ compensation costs.

Fact: There are tried and true methods to reduce costs.

· Management must have a positive attitude, developing creative ideas to bring employees back to work more rapidly. Returning employees to work as soon as they are medically able to perform any type of transitional duty job is a key to overall cost reduction.

· Include your broker, insurance account executive, the third-party administrators (TPA) claims manager and a medical advisor in brainstorming meetings. Show how much it costs to pay for one workers compensation claim and the annual cost of workers compensation at each company.

· Use the Sales To Pay For Accidents calculator at http://reduceyourworkerscomp.com/sales-to-pay-for-accidents-calculator/ as a tool for team members to gather information. It’s a real eye-opener.

Assumption: The best way to reduce workers’ compensation costs is to change insurance companies or TPAs.

Fact: The best way to reduce costs is to build a better relationship with your current claims administrator.

· A lack of communication is a major cause of discontent between carriers and insureds. This causes a perception that something is being done improperly. For example, in one case a company believed that nurse case management was too expensive. However, an audit by a medical advisor showed that nurse case management services should be used more and be brought in earlier. It wasn’t effective when it was used, thus appearing expensive and wasteful, because it was used too late in the process.

· Become more informed about your claims administrator’s services. Invite your TPA in with all of their services to a Vendor Day. Ask for samples of reports and deliverables to better understand their products and know when to request services. Have them give out brochures before Vendor Day so that you can ask knowledgeable questions about their services.

· Visit a claims office to observe their processes. Find out if adjusters have backup and clerical support to get medical files. Observe the intake desk and the lost time and medical adjusters. Ask to see what happens to medical bills when they enter the system until the time they are paid and filed. This will give you a better understanding of how you can interact more effectively, what information adjusters need from you and what information you can provide about your workplace and employees.

· Invite your adjusters to visit your workplace, so that they know what your company does and the types of jobs and skills required of employees. They cannot accurately visualize exactly how an injury occurred if they never visited your workplace.

Assumption: If you have unions, you’ll never lower your workers comp costs.

Fact: Negotiating with a union can be successful.

· Begin with a positive and cooperative attitude.

· The need for a transitional duty program is usually facilitated by unions. Sometimes unions have creative ideas about how a new transitional duty program can work and they will inform you of collateral source benefits. In one case, the union was angry with management because management hadn’t tried to do more to stop several fraudulent claims.

· Inform the union that staying out of work for long periods normally doesn’t help an injured employee heal. In fact, an employee may become depressed once the employee loses a daily routine and social network.

· Focus on the membership’s economic consequences and interests. For example, if the majority of members are young, emphasize how the extra money helps them pay their children’s college tuition. If members are older, emphasize how the savings helps their retirement accounts.

Assumption: The best thing to do to move a slow claim is request an Independent Medical Evaluation (IME).

Fact: Requesting an IME can be a double-edged sword.

· If a claim is “stalled,” it’s common for adjusters to recommend getting an IME to get the employee’s status. Before a claim is sent for an IME, have a medical advisor review the claim.

· In some cases, an IME may be warranted. However, sometimes a request makes it worse, such as when the timing isn’t right, when inadequate medical records are included with an IME packet or when inadequate medical questions are asked of the doctor performing the IME.

· Consider a Functional Capacity Evaluation (FCE) instead or get a brief surveillance to see the employee’s actual capabilities.

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Arms Trapped In Food Processing Machine Brutal Reminder For Workplace Safety

Michael B. Stack — Mon, 20 May 2013 14:39:36 +0000

Workplace safety can never be stressed too often, hence another recent injury to a worker in Australia.

According to a report from WorkSafe Victoria, the employee suffered serious injuries to her arms after they became trapped in a food processing machine at a manufacturing plant in Shepparton in early April.

The woman, who was thought to be approximately 30 years of age, was working around 1.30 a.m. when the incident took place. The victim was airlifted to hospital in Melbourne with serious crush injuries to both arms.

Dangerous Machines Injured 11,000 Workers Last Five Years

According to WorkSafe Regional Director Shane Gillard the incident was a horrible reminder of the terrible damage that could be inflicted by dangerous machines.

“Our thoughts go out to this young woman and her family, friends and workmates,” Gillard remarked.

He said dangerous machines had injured almost 11,000 workers in Victoria in the past five years.

“We know machines are essential to many businesses, but they can be dangerous and must be controlled,” Gillard went on to say. “Too many workers are still being injured by common types of machines.”

According to Gillard, “Workers should also speak up if they were concerned about safety. If we’re going to keep Victoria the safest place to work, employers and employees have to play their part.”

To find out more about how to make machines safe, check out: www.worksafe.vic.gov.au/plant

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