6 Strategies to Determine Workers’ Comp Causation

6 Strategies to Determine Workers’ Comp CausationCausation is one of the most challenging concepts in the claims community. Causes of low back pain, carpal tunnel syndrome, and other soft tissue pain are often a matter of conjecture on the part of treating physicians, leaving claims managers scratching their heads.

 

But that doesn’t mean you have to blindly accept the doctor’s diagnosis on a claim with obvious red flags. Partnering with the right experts can better ensure payers don’t end up footing the bill for a non-work related injury.

 

 

The Problem

 

The back is the most common body part facing the claims community, and causality is the challenge. That statement during a recent webinar speaks to an all too familiar problem in the workers’ compensation system: determining the cause of an injury where there is often no clear-cut answer.

 

Unfortunately, many treating physicians are not focused on causation and instead seek only to help their patients. They take the word of the patient that the pain is work-related.

 

Many payers are apt to simply accept the treating physician’s determination, figuring da challenge of the doctor’s opinion will likely end up costing more money in the end. However, the problem is often not limited to one or two such cases. “Contagious syndrome,” a term coined by attorney Stuart Colburn, refers to the phenomenon where other workers see a colleague receiving benefits for soft tissue injuries and claim their own.

 

 

Scenarios

 

A 35-year old worker files a claim for a lumbar strain he says he sustained at work. Additional facts are; he is overweight, has a new baby at home, and has expressed an interest in becoming a dispatcher on light duty.

 

In another example, an older woman claims carpal tunnel syndrome in her right wrist, has surgery and returns to work. Six months later, she says her wrist never fully healed and files a claim for CTS on her left wrist. She says both were caused by her repetitive motions at work. Her supervisor has alluded to potential psychosocial factors.

 

In both cases, comorbid factors are clearly evident. In addition to being overweight, the male with low back pain is likely losing sleep due to the new baby (an evidence-based factor for low back pain) and has indicated he would like to be transferred to a less-intensive job on light duty. The other worker has at least two comorbid factors that are indicative of CTS: being female and older.

 

 

Solutions

 

  1. Know the risk factors. Evidence-based medicine identifies clear risk factors for developing soft tissue injuries, both work-related and non-occupational. For example, CTS may be work-related if there is a combination of force and either repetitive motions or awkward posturing. But repetitive motion on its own is not an evidence-based cause of CTS. There are few work-related causes of low back pain. Job dissatisfaction is perhaps the biggest.

 

  1. ID appropriate physicians. Where possible, you want to work with physicians who understand the issues surrounding occupational injuries, such as the importance of determining causation and return-to-work. In rural areas where there are few or no occupational physicians available, payers need to educate physicians on workers’ compensation-related issues

 

  1. Provide job insights. Physicians faced with a patient in pain want to help the person and tend to believe what they are told. The worker who says he injured his back because he is routinely lifting heavy objects and/or is in awkward positions may be misrepresenting his actual job duties. Payers can clarify job duties in several ways:

 

 

  • Invite the physician to the worksite to see what the job entails.
  • Videotape someone doing the job so the physician can see the actual tasks involved.
  • Provide a thorough, detailed job description so the doctor understands what the worker does on a day-to-day basis.

 

  1. Review the history. The claims adjuster should look at the worker’s

 

  • Previous work history; i.e., what he did before working at your company. This may reveal activities consistent with his current complaint.
  • Check medical records. There could be prior injuries in the same or nearby body locations, indicating the injury is not new. This may also show comorbid conditions that could be factors.
  • Determine employment start date. See if the worker is a long-time employee or a new hire, which may be a red flag for a preexisting condition.

 

  1. Approach the physician. If your reviews uncover several red flags, your claims adjuster may be able to convince the physician to take a closer look.

 

  1. Use peer review. The insurance carrier or third party administrator who is managing the claim can request a peer review. An independent medical reviewer can look at the records, test results, etc., and may have a different opinion from the treating doctor. The peer reviewer probably stands a better chance of persuading the treating physician to consider revising his initial determination, since it is a physician to physician discussion.

 

Ideally, you should have established relationships with peer review physicians. If not, the insurance carrier or third-party administrator may have some available.

 

 

Conclusion

 

Identifying causation for a soft tissue injury is often as much of an art as a science. But following evidence-based medicine and working closely with treating physicians can get you that much closer to the true cause.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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 & lead trainer of Amaxx Workers’ Comp Training Center .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©2018 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.

Medcor Announces the Acquisition of TalisPoint

Chicago-based Medcor, Inc., the leading health navigation firm, has acquired San Francisco-based Talisman Systems Group, Inc., the leading provider of network management services for workers’ compensation and other industries. Talisman will operate as an independent subsidiary of Medcor, retaining its leadership and TalisPoint brand and will remain based in San Francisco.

 

Medcor navigates patients to optimal care through onsite clinics and virtual health services, using evidence-based medicine, proprietary clinical systems and patented processes. Medcor clients include employers from a wide range of industries and insurance carriers. The TalisPoint system validates, updates and manages network data and produces referral documents for insurance carriers, claims administrators, provider networks and employers.

 

Through this acquisition, Medcor expands its innovative health navigation services. These begin with rapid, convenient access to health assessment at the onset of symptoms or injury, followed by guidance to appropriate care. Often, Medcor can provide the care directly or guide patients in self-care. When referrals into the healthcare system are necessary, Medcor’s systems help ensure patients receive the care they need and avoid overtreatment and unnecessary costs. Sophisticated algorithms help Medcor identify serious cases quickly. TalisPoint data helps connect patients with the right provider in the proper network to improve clinical and financial outcomes.

 

Medcor President and CEO Philip Seeger explained, “We are combining two best-in-class businesses whose services are very complementary to one another. This is a powerful way to bring more value to our clients; the fact that we already have mutual clients shows that our customers have independently come to the same conclusion. The high-quality network information that TalisPoint provides will help us more efficiently navigate patients to the right place, at the right time, to receive the right level of care.”

 

Talisman President and CEO Monique Barkett said, “TalisPoint allows for fast, accurate and up-to-date access of vendors and medical networks. This facilitates Medcor’s service delivery by providing person-specific information and pinpointing the exact facility and provider called for by Medcor’s care protocols. To stay at the forefront of our industry, we prioritize innovation to ensure our systems will continue to be best-in-class in the years to come. With Medcor, Talisman now has a proven information technology partner to help us develop the next generation of TalisPoint.”

 

The two companies share reputations for transparency, high customer service, and operating without conflicts of interest. For more information, watch the short video at this link https://youtu.be/AvAFzJJqjSI, contact media@medcor.com or call 815-759-5442.

 

 


 

Medcor operates 240 clinics at or near client worksites and provides virtual health services to over 309,000 worksites throughout the United States and Canada. Medcor serves clients across a wide range of industries, including private firms and government agencies. Medcor helps employers and patients navigate the complexities of healthcare to achieve better clinical and financial outcomes. Learn more at medcor.com.

 

Talisman’s core product, TalisPoint, offers web-based customized network management tools to assist users in selecting medical providers and other vendor types. Access to verified provider data is a key to effective communication between patients, providers and employers. Learn more at talispoint.com.

 

 

 

The Intersection of Medicine and Disability: A Doctor’s View & Other Top WC Tidbits

The Intersection of Medicine and Disability: A Doctor’s View

Whether we are a health care practitioner, an employer or a claims professional, disability is something we deal with on a daily basis. What are the nuances of a disability claim and how can the roles and responsibilities within these claims be better understood?

Dr. Iglesias breaks down what goes into a disability determination and how employers, claims administrators, and physicians can make better and more timely disability determinations that will benefit all the stakeholders in a disability claim.

 

 

Facetime With Phil — Introduction To Analgesics

What are the different drugs available and how does a prescriber make a choice? Join myMatrixx Chief Clinical Officer Phil Walls as he begins a discussion on Analgesics. In this vlog, Phil covers the basics on this topic and begins a deeper dive into the treatment of pain management.

 

 

 

Dan Anders: Building a Better Relationship with your MSA Vendor

Let’s face it. When you realize that settlement of a workers’ compensation claim will require a Medicare Set-Aside (MSA) you may let out an audible groan or even a choice profanity. An MSA will no doubt add cost and time to settlement of a claim. This is why it is so important to partner with a Medicare Secondary Payer (MSP) compliance vendor that can effectively work with you to limit those costs and reduce the time involved with the MSA to the greatest extent possible while still ensuring you are compliant with Medicare requirements.

 

 

 

Opioid Litigation Update

Two-thirds of the deaths from drug overdoses in the U.S. involve opioids. This has been declared a crisis in America. On this Ringler Radio podcast, host Larry Cohen and co-host, Heather Anderson discuss how the Beasley Allen law firm’s attorney Rhon Jones is joining forces with the Attorney General of Alabama in litigation to put a halt to this devastating crisis that touches so many lives today.

 

 

 

Workers’ Compensation Cost Reduction Starts with Better Medical Care

Seek the best possible care for employees with workers’ compensation injuries, because better care will result in fewer treatments and ultimately lower costs. So said Margaret Spence, president and CEO of C. Douglas & Associates in West Palm Beach, Fla., during a June 20 concurrent session at the SHRM 2017 Annual Conference & Exposition in New Orleans. Spence recalled one employer in the panhandle of Oklahoma whose workers were told they had to use doctors in the rural area. When Spence got involved with the handling of the firms’ workers’ compensation claims, the company concluded that the doctors in that area were less qualified and every employee was sent to Oklahoma City for treatment.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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 & lead trainer of Amaxx Workers’ Comp Training Center .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©2018 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.

Seven Sections of Documentation For A Properly Organized Workers’ Comp Claim File

Seven Sections of Documentation For A Properly Organized Workers' Comp Claim FileThe workers’ compensation claim file should have Seven Sections of documentation that relates to the claim in a properly organized manner.

 

 

1- Claim Investigation:

 

The claim investigation section of the file should contain the adjusters claim file notes on everything that has occurred during the entire course of the claim. This includes a summary of each telephone call and a summary of all medical reports, state forms, letters, attorney reports, etc.

 

The claim investigation section should also contain either the transcript of the employees recorded statement or the claim file notes should contain a detailed review of the employees recorded statement. If a recorded statement was not obtained, the details of the employee’s initial interview should be summarized in the claim file notes. The claim investigation section should also include the employer’s supervisors recorded statement or a detailed review of the supervisor’s version of the accident.

 

A copy of the Employers First Report of Injury should be included in the claim investigation section for a comparison of the claimants version of the accident with the insured’s version of the accident.

 

When there is the potential for subrogation, for example – injuries involving an automobile accident or injuries involving a machine malfunction, documentation to support the subrogation should be included in the file investigation. This can include anything from a police report to a mechanical engineers evaluation of the machine that malfunctioned.

 

If there is a question of compensability or subrogation, the claim investigation section of the claim file should also include the recorded statement of witnesses or others who have detailed knowledge of the accident or occurrence.

 

If the claim lingers and there is a question of malingering by the employee, the claim investigation section will also contain the surveillance reports on the employee.

 

 

2- Medical Documentation:

 

The medical documentation section of the claim file should be divided into two categories, medical bills, and medical reports. Each of these two areas should be further divided into medical providers, with all medical bills by each medical provider grouped by date of service, and all medical reports by each medical provider grouped by the date of service.

 

Miscellaneous medical documentation – ambulance bills, prescriptions, durable medical equipment, etc., should be grouped by the category and organized chronologically.

 

 

3- Indemnity Documentation:

 

The employer’s wage statement reflecting the total compensation (over the state determined pre-injury period for benefits calculations) should be clearly identified in the claim file. Attached to the wage statement should be the calculations used to determine the temporary total disability benefit. If the disability benefit rate for permanent partial disability or permanent total disability is different from the disability rate for temporary total disability, the calculations used to determine the permanent partial disability or the permanent total disability rate should be shown.

 

Any documentation submitted by the employee to claim a higher rate of indemnity benefits should also be included in this section. This could include W-2 forms, copies of previous bonus checks or commission checks, etc.

 

 

4- State Forms:

 

A copy of every form submitted to the state by the employer, the employee or the insurance company should be included in this section of the claim file. State forms can be organized either numerically by the state form number, alphabetically by the state form name or chronologically by the date the state form was submitted to the workers’ compensation commission/bureau/agency/department, etc.

 

 

5- Hearings & Legal:

 

If any party requests a hearing, trial or other legal determination of benefits, this section would contain the documentation of the legal proceeding. This can include petitions for benefits, request for hearings, discovery documents and transcripts of depositions or transcripts of hearings.

 

This section of the claim file should also contain all correspondence between the work comp adjuster and the employee’s attorney, all correspondence between the work comp adjuster and the defense attorney, and all correspondence between the employee’s attorney and the defense attorney. If outside experts have been brought into the claim, the correspondence between the outside experts and any other party would be included in this section of the claim file.

 

 

6- Medical Management:

 

The medical management section of the claim file should include all correspondence and communications between the triage nurse and any other party. It should all obtain all reports, correspondence and communications between a nurse case manager assigned to assist the employee and any other party.

 

 

7- Vocational Rehabilitation:

 

The vocational rehabilitation section of the claim file will contain all the reports and activities of the vocational counselor assigned to the employee. This can include a broad range of information from vocational testing results, to available jobs in the community, to vocational retraining of the employee.

 

 

Summary:

 

The properly organized workers’ compensation claim file will prevent mistakes in the claim handling. It will also reduce the amount of time the adjuster works on the claim file by eliminating time spent searching for specific information. When the claim file is complete and well organized, everyone – employee, employer and insurer – benefit by having all aspects of the claim handled and concluded timely and properly.

 

 

 

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 co-author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact:.

Contact: RShafer@ReduceYourWorkersComp.com.

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

 

©2018 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.

 

 

 

Avoid High Cost of Denied Claims With Solid Investigation Strategy

Avoid High Cost of Denied Claims With Solid Investigation Strategy

There are many reasons for members of the workers’ compensation claim management team to deny a claim.  This includes denials of primary liability based on a lack of medical support, evidence of a pre-existing condition, idiopathic claims, intoxication defenses and statutory reasons such as notice and statute of limitations.  While the facts of the case may look good at the time of the denial, studies indicate that these denied claims can become costly in the long run.  To better manage claims in a cost-effective manner, it is essential even the most seasoned claim handler think twice before issuing a denial.

 

 

Program Efficiency and Denied Claims

 

Various studies indicate that from 2013 to 2017, claims denial rates have increased from 5.8% to 6.9%.  Reasons for a workers’ compensation claim to be denied include lack of medical evidence, information indicating the injury is not related to one’s work activities, and documentation supporting the contention the person injured was not an employee.  While there has been an increase in workers’ compensation claims denied, this has not translated into program savings.  Instead, these same studies indicate that approximately 67% of all initially denied claims will convert to admitted claims within 12 months.  The result is over a 50% increase in money eventually paid out to fully resolve the matter.  This adds $15,000 to each claim.  Multiple this by many claims and workers’ compensation programs end up paying out a lot of money.

 

 

Barriers to an Effective Claim Investigation

 

Members of the claims management team face many challenges when reviewing a claim and making a determination as to primary liability – and other issues of compensability.  One of the driving factors is the rigid framework many jurisdictions place on insurance carriers.  These barriers are numerous and include the following:

 

  • Inability to issue a retroactive denial of primary liability: In some jurisdictions, members of the claim management team are not able to deny a claim once payment of medical or indemnity benefits has been made. Paying anything on a claim may also diminish the chances of obtaining a $0 Medicare Set-aside allocation under the voluntary review/approval by CMS; and

 

  • Administrative penalties for the late issuance of a denial: Paying administrative penalties does not promote program efficiency.  It also does not make a workers’ compensation insurer look attractive to prospective clients as most states publish statistics on penalties issued by a state industrial commission.  Penalties can also be cumulative, which result in a system of graduated costs for throughout the year.

 

The result of these barriers should also have an increased urgency to deny a claim if it does not pass the proverbial “smell test.” While this may seem like a good strategy, the result can lead to decreased program efficiency.  Now is the time to implement change and take a more reasoned approach to denying a workers’ compensation claim.

 

 

Improving the Claims Process — Making Better Decisions

 

Studies indicate that claims converted from denied to paid are particularly high in California, Florida, and Texas.  Claim management teams who handle claims in these jurisdictions should take note.  Additional education and coordination with other interested stakeholders such as employers and defense counsel can mitigate the payment of unnecessary benefits and reduce the percentage of converted claims.  Other strategies can include:

 

  • Better communication with insureds regarding accident reporting and injury investigation;

 

  • Education and training on workplace safety and injury prevention; and

 

  • Improvements in the claims handling process via the utilization of analytics and technology. This includes making the claims process more accessible to employers and other stakeholders through web and app-based reporting features.

 

 

Conclusion

 

The only good file is a closed file – but this does not mean files should be closed by simply denying primary liability.  Claims management teams seeking to reduce workers’ compensation program costs must make better decisions when denying workers’ compensation claims.  This needs to include better communication and involving all interested stakeholders.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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 & lead trainer of Amaxx Workers’ Comp Training Center .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©2018 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.

School System Summer Break – 4 Proactive Work Comp Tips

School System Summer Break - 4 Proactive Work Comp Tips

Interested stakeholders in the workers’ compensation process are constantly seeking ways to reduce program costs.

 

One area includes the discontinuance of workers’ compensation benefits for school employees and teachers suffering from the effects of a work injury during the summer break period.  While statues and case law interpretations vary in each jurisdiction, employers and insurers are generally limited in their ability to discontinue or suspend various workers’ compensation benefits for school employees during this time of year – even if they have no plans of looking for work while under restrictions on their activity.

 

 

Schools Out – Time to Discontinue Work Comp Benefits?

 

While the school year typically runs from late August through late May, employees of school districts around the country sustain work-related injuries every day.  The ongoing effects of those work injuries do not magically disappear for summer break.  Sadly, those hot summer days a teacher, paraprofessional or administrative staff employee would like to spend at a beach, can be spent at home convalescing.  Proactive members of the claims management team might view this as an opportunity to discontinue ongoing wage loss and vocational rehabilitation benefits.  Unfortunately, this is often not consistent with many state workers’ compensation laws via case law interpretation.

 

One case on point comes from Minnesota, where a school district sought to discontinue ongoing wage loss benefits at the conclusion of a school year.[1]  The rationale for the discontinuance was based on the premise the employee did not intend to work during the summer months, and the result was no loss in wages.  A compensation judge rejected this argument and affirmed by the Minnesota Workers’ Compensation Court of Appeals.

 

In affirming the reinstatement of wage loss benefits, the court noted that “A teacher who has no summer school duties is presumably free to pursue other part-time or short-term employment.  Therefore, a teacher with a work injury might be entitled to continuing wage loss benefits through the summer if the teacher is totally unable to work for medical reasons attributable to the injury or has injury-related restrictions that affect is his or her ability to secure other employment.”

 

In sum, wage loss benefits are typically payable as long as the employee has a disability related to the work injury. The basis for this decision is also applicable to other forms of workers’ compensation benefits, including vocational rehabilitation.

 

 

Staying Proactive to Avoid the Summertime Claims Blues

 

Being away from work can cause the summertime blues in anyone – especially people who work in an educational environment.  Now is the time for claims professionals handling claims related to school employees to be proactive on these matters to reduce their exposure and ensure improper discontinuance of benefits is not made.

 

  • Investigate whether the school employee is engaged in seasonal employment. People who work in a school environment may be likely to work seasonal jobs during the summer months.  This can include individuals suffering from work-related  Efforts to investigate these matters may also include the use of surveillance if there is credible information the employee is working and not reporting their work activities.

 

  • Make efforts to return the injured school employee to work. Proactive return to work efforts should be made on every claim.  This is especially the case for school employees where wage loss benefits could be paid for an extended period of time.  Suggestions include developing a “Work on Loan” relationship a local non-profit, volunteer agency, or other light duty work inside school district buildings and facilities.

 

  • Monitor the status of claims involving school employees and stay in contact. Lack of communication between the employer/insurer and employee leads to conflict, fear and  Staying in contact with the injured worker provides for effective communication and minimizes problems.

 

  • Determine if the school employee is cooperating in vocational rehabilitation efforts. Summer break and time off from school does not give an injured school employee a vacation from their recovery and achieving their vocational rehabilitation goals.  Various workers’ compensation benefits can still be discontinued or suspended for failure to cooperate with a rehabilitation plan.

 

 

Conclusions

 

School employment and summer breaks create an opportunity for interested stakeholders to stay engaged with employees and reduce workers’ compensation program costs.  While most benefits typically remain payable during summer breaks, there are opportunities for motivated members of the claims management team to engage injured employees and minimize their exposure.  This includes claim monitoring, engagement and ongoing efforts to return an employee back to work.

 

[1] Qualy v. Special School District No. 1, 1994 WL 421773 (MN WCCA).

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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 & lead trainer of Amaxx Workers’ Comp Training Center .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©2018 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 Impact of Fatigue and 10 Ways to Mitigate the Risks

If one of your employees is sleeping on the job, he may actually be doing you a favor. Lack of adequate sleep is a major risk factor for injuries, errors, and chronic diseases. In fact, ‘shiftwork sleep disorder’ has been deemed a carcinogen because of the increased risk of breast cancer.

 

Those most at risk are workers with frequent overnight shifts, rotating shifts, or early morning start times. While you may not be able to change the need for workers on shifts other than daytimes, there are strategies you can take that can help employees be less fatigued and save you significant amounts of money.

 

 

The Sobering Stats

 

Employers and payers are likely unaware of the stunning costs associated with workplace fatigue. Here are the numbers for a hypothetical Florida construction company with 800 workers:

 

  • Decreased productivity: $590,463
  • Absenteeism: $249,962
  • Healthcare: $458,075

 

The National Safety Council’s Fatigue Cost Calculator also estimates the number of employees likely suffering from specific sleep risks at this sample company:

 

  • Obstructive sleep apnea: 101
  • Insomnia: 69
  • Restless Legs Syndrome: 40
  • Shift work disorder: 1

 

‘Shiftwork sleep disorder’ occurs when a person’s internal clock becomes misaligned with his sleep/wake schedule due to shift work. Those affected may experience excessive sleepiness during night work and/or insomnia during daytime sleep.

 

The good news is the potential savings from taking simple actions to mitigate all these conditions are $625,250.

 

The safety risks associated with fatigued workers is higher among night-shift workers and increases with each succeeding night

 

Overall statistics show:

 

  • The risk of injury or accident on the night shift is 30 percent higher than on the day shift
  • The risks are 36 percent higher on the fourth consecutive night shift compared to the first
  • 13 percent of workplace injuries are due to fatigue problems.
  • The National Transportation Safety Board says fatigue is a contributing factor in 20 percent of its investigations
  • Employer costs for one worker with an untreated sleep disorder are $3,500.
  • Up to 90 percent of sleep disorders go untreated.

 

In addition to safety risks, fatigue affects cognitive functions and reduces a person’s attention, vigilance and memory. Fatigued workers are slower, less productive and more likely to make errors. And fatigue is also a high-risk factor for developing chronic diseases, including diabetes, cardiovascular disease, obesity, and depression. One study showed that two consecutive nights with less than six hours of sleep are associated with lower performance levels for six days.

 

 

10 Ways to Mitigate the Risks of Workplace Fatigue

 

Employers should become educated and inform their employees about the problems and costs associated with fatigue. They can also look within their organizations to find the causes of fatigue.

 

Additionally, employers can consider some or all of the following strategies:

 

  1. Forward-rotate shifts, such as day to afternoon to night.
  2. Increase rest time between shifts.
  3. Limit the number of consecutive night shifts
  4. Slowly rotate shifts to reduce the impact on sleep schedules, the Panama shift schedule is a good example
  5. Promote an appropriate culture. If workers are rewarded for work they do after hours or by working longer than is typical, employees will get the message that they need to work excessively to get ahead. Instead, reward employees or teams that meet or exceed their goals within normal work hours.
  6. Discourage after-hours work. Rather than sending emails and expecting responses during off-hours, set boundaries for work to be done within certain hours, where possible.
  7. Encourage PTO usage. Workers who feel they should forego paid vacations or work when they are sick are getting the wrong message – and burning themselves out. They not only are risking their own safety and wellbeing, but could be infecting other employees.
  8. Support flextime. A one-hour start-time difference may make a big difference to some employees. Where possible, allow workers to set the hours that best accommodate their sleep needs.
  9. Provide rest areas. A short, 20-minute power nap can make a tremendous difference to at-risk workers for fatigue. Provide a location where employees can rest if the worksite allows for this benefit. Several Fortune 500 companies now provide ‘nap rooms’ for employees.
  10. Avoid screen time. Using a phone or tablet just before bed can activate areas of the brain that make it more difficult to fall asleep. Encourage workers to turn off their electronic devices when going to bed.

 

 

Conclusion

 

Lack of sleep may be costing your company hundreds of thousands of dollars, depending on the number of employees and their work schedules. Being aware of the costs associated with fatigued workers and taking action to ensure workers get enough rest can significantly help your bottom line.

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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 & lead trainer of Amaxx Workers’ Comp Training Center .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©2018 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.

Advocacy and Engagement: 4 Reasons Why and 7 Ways to Do It

Advocacy and Engagement: 4 Reasons Why and 7 Ways to Do It‘Advocacy and engagement’ is much more than a buzz term in the workers’ compensation system. It’s a concept that can easily cut 5 – 10 percent of your workers’ compensation costs. Not only that, but companies that embrace the idea are more profitable than those that don’t – 16 percent more, according to some estimates.

 

With approximately 70 percent of workers feeling disengaged from their companies, the task of persuading injured workers to take a vested interest in the post-injury process may seem daunting. But there are simple things organizations can do to engage their workers and reap the benefits.

 

 

What it Is

 

Advocating for injured workers and getting them engaged in the claims process means focusing on them as human beings, rather than viewing them as ‘claimants’ and being interested only in the dollars and cents part of it.

 

Engaged injured workers are a vital part of the process, starting at the beginning of the claim. Rather than having conversations about the injured worker, claim discussions need to include the injured worker. The ‘us vs. them’ approach needs to be eliminated. The goal is to get them healed and back to function. The vast majority of injured workers share that objective.

 

 

Benefits

 

Selling the idea of advocacy and engagement to the C-Suite should not be hard, once the benefits are explained. In addition to overall happier employees, studies bear out many positive outcomes among injured workers in companies that have an advocacy-based model.

 

  • Faster return-to-work rates. Injured workers heal faster when they are truly engaged in their recoveries. Rather than being passive and having things done to them, they are actively involved in their own treatments, which gets them back to work sooner.

 

  • Less litigation. Part of the engagement process is educating the injured worker on what to expect, along with his rights and responsibilities. Understanding the process and having consistent and constant communication eliminates the majority of reasons an injured worker hires an attorney. Reduced litigation can be a tremendous cost saver, as studies show attorney involvement increases the cost of a claim by an average 4.5 times.

 

  • Better network penetration. Engaged workers are more likely to go to a physician of your choosing, even in states without employer-directed care. There is a level of trust they feel and will listen to your suggestions.

 

  • Improved morale. Injured workers who feel they have been well taken care of during their absence have a positive attitude upon returning to the workplace, which typically spreads to coworkers.

 

 

Tactics

 

The idea of treating injured workers nicely and with respect should be a no-brainer. But the reality is many companies and/or key members of an organization view injured workers negatively, even with disdain.

 

Dealing with the logistics and paperwork is often seen as a deterrent to meeting production deadlines. Many view the injured worker as someone just trying to game the system.

 

Research shows that a small percentage of injured workers fit this description, but nearly all have the same interests as top managers; to recover and get back on the job as quickly as possible.

 

Best practices for engaging injured workers include:

 

  1. Staying in touch with the injured worker starting from day one and then on a consistent basis is vital to show a worker the company truly cares about him. Ideally, the supervisor or manager with whom the worker is close should call the worker. That person and other colleagues should continue the dialogue with phone calls, get well cards, and the like.

 

  1. Along with communicating with the injured worker is active listening. The injured worker may ask questions, express concerns or air complaints. It’s important to hear what the injured worker is saying and reflect that, without engaging in combative dialogue.

 

  1. Education/information. Injured workers don’t know what to expect, are worried about their financial and job security and are in pain. They need to be made aware of the process for them to be engaged. The best way is through an employee brochure that is given to workers upon hiring, and then again if and when they become injured.

 

Here are some additional advocacy strategies organizations use to better engage their injured workers.

 

  1. Onsite care. While a fulltime onsite clinic is ideal, ergonomic evaluations, biomechanics and stretching programs for workers can help them improve their physical stamina and make them feel engaged.

 

  1. Telehealth services. Some companies have a private room with a computer available for workers to speak privately with a healthcare provider. Employees given this option feel their companies truly care about their wellbeing.

 

  1. Nurses and triage. A telephonic triage system for workers who sustain on-the-job injuries is invaluable. A nurse can determine what treatment is appropriate and, at the same time, make the injured worker feel someone is there to help.

 

  1. Partner with other departments. The benefits side of an organization may offer programs that help workers feel more engaged in the company and have a sense that the company cares about them. Examples include:

 

  • Back health, where employees call a number, explain their symptoms and are given specific exercises. This is especially helpful since back injuries are among the most costly in the workers’ compensation system.
  • Second opinions. Some wellness programs include a second opinion to workers free of charge. These can be extended to injured worker as well as those not hurt at work.
  • Family health assistant. Some companies with a whole health model provide a number for workers to call for advice on health-related problems of anyone in the family.
  • Employee assistance programs are available to all workers and can be a tremendous benefit for injured workers who want to talk with someone about financial, familial or other concerns.

 

 

Conclusion

 

The value of engaged employees – especially those who become injured – are clearly borne out in the research. Companies that rethink their attitudes and demonstrate caring and concern for their employees can benefit tremendously.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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 & lead trainer of Amaxx Workers’ Comp Training Center .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©2018 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.

3-Step Strategy to Prevent Workplace Violence

3-Step Strategy to Prevent Workplace ViolenceMore than 2 million workers are victims of workplace violence every year. While healthcare clearly leads the industries reporting workplace violence, many other industries are also at risk. Employers and payers can significantly impact the rate of violent incidents by understanding the risks unique to their industries and worksites and developing strategies to mitigate them.

 

 

The Issue

 

OSHA defines workplace violence as any act or threat of physical violence, harassment, intimidation, or other threatening, disruptive behavior that occurs at the work site. That includes everything from verbal abuse to physical assaults and even homicide.

 

The most recent statistics show that violence in workplaces is increasing, despite lower overall crime among the general population – including homicides. In healthcare, the numbers are 7.8 cases of workplace violence for every 10,000 employees. In the sales industry, half of the work-related deaths are due to homicide. School districts also report higher rates of violence, aside from the much-publicized mass shootings.

 

Despite the high prevalence of workplace violence incidents more than 70 percent of U.S. workplaces do not have a formal program or policy that addresses the issue, according to the Bureau of Labor Statistics.

 

 

Create the Policy

 

There are three steps to creating a violence-free workplace.

 

  1. Assess the risk. First, you need to determine the violence hazards affecting your workforce. They could vary among employees. A healthcare establishment, for example, could have staffers who deal with potentially violent patients in the emergency room, along with nurses in the field. The risks facing each are very different.

 

ER workers should be aware of potential incidents not only from patients themselves but from family members who may become frustrated. A nurse who conducts home health visits may be vulnerable to risks because she or he is alone. The home health worker should know to ask questions, such as whether there are firearms in the home.

 

Some ways to assess the risks facing your organization include

  • Find out from staff members whether, where and when they feel threatened.
  • Review past records. Incident reports can reveal areas where violence has occurred, and they should be a focus of prevention policies.
  • Check the research. Studies provide clues to areas vulnerable to violence. Within healthcare facilities, inpatient and acute psychiatric services, geriatric long-term care settings, and urban ERs have been shown to be at higher risk than some other areas.
  • Walk the grounds. Are there areas where outsiders can easily gain access undetected? Are there nearby parks where unsavory types congregate? Are there particular areas inside that are at high risk? These are locations where your policy can target safety efforts, such as a door in a remote part of the building that can be entered only by someone with a security badge.
  • Gauge staff understanding. It is vitally important that employees know what to do if a situation begins to get out of hand; otherwise, you run the risk of a controllable incident getting out of control. Do workers know whom and/or where to call? Is there a special emergency security code to dial and are they aware of it? Do they know what terminology to use in an emergency?

 

  1. Prevention/control. The information gathered during the risk assessment can be used to write the specific policies and procedures to minimize risks. While every workplace is unique, several elements should be considered for inclusion in the policy:

 

  • Strong pre-hire checks. In addition to the usual application and face-to-face interviews, employers should undertake background investigations, criminal history checks, drug testing and reference checks.
  • Roles during crises. Employees should know what to do and where to go if violence erupts.
  • Communication. If an incident occurs, it’s imperative to try to at least contain the situation. You should outline ways to communicate with workers so they can avoid the area in question, call for help, and warn others.
  • Reporting channels. Employees should feel comfortable and know how and where to report any suspicious behavior, as that can prevent a violent situation. The person(s) receiving the report should understand how to respond; such as alerting authorities and/or undertaking investigations.
  • Penalties. The policy should clearly spell out unacceptable behaviors and have associated penalties, such as suspension or termination.

 

  1. Train. A policy only works if all involved are aware of it, understand it, and know what to do in a given situation. Ongoing training should be conducted, at least on an annual basis and with any new hires. The training should include:

 

  • A review of the policy.
  • Role playing various scenarios that could occur. Employees should play the role of both the victim and the perpetrator to get an idea of how both sides work.
  • Personal insights. People who have experienced violent situations in that or similar workplaces should be available to discuss the realities of a violent situation.

 

 

Conclusion

 

Violence can occur in any workplace at any time. By understanding the risks, developing policies to address them, and ensuring all employees have clear expectations, employers can significantly reduce the chances of tragedy in their companies.

 

Proposed PAID Act Intends to ID Medicare Part C, Part D and Medicaid Enrollees for Insurers

Proposed PAID Act Intends to ID Medicare Part C, Part D and Medicaid Enrollees for InsurersOn 5/18/2018, the Provide Accurate Information Directly (PAID) Act was introduced in Congress for the purpose of allowing settling parties an easy method to identify if a claimant is enrolled in a Part C or D plan or Medicaid.  The bill, H.R. 5881, sponsored by U.S. Rep. Gus Bilirakis R-Fla and U.S. Rep. Ron Kind, D-Wisc, requires the Centers for Medicare and Medicaid Services (CMS) to share information on not only whether a claimant is a Medicare beneficiary, but also whether the claimant is enrolled in a Part C Medicare Advantage (MA) Plan, Part D Prescription Drug Plan or Medicaid.  It also requires CMS to provide the identity of the MA or Part D Plan or state Medicaid program in which the claimant is or was enrolled.

 

 

Stepped-Up Efforts to Seek Reimbursement From Settling Parties

 

The catalyst for this legislation comes from stepped up efforts by these various plans and programs, especially by MA Plans, to seek reimbursement from settling parties. MA Plans have largely prevailed against insurance carriers in seeking reimbursement under the Medicare Secondary Payer Act which has led to a heightened awareness of the potential for such claims and the need to identify claimants enrolled in such plans and programs prior to settlement.

 

While liability and no-fault carriers and workers’ compensation plans are now on notice of the potential for such reimbursement claims, there presently exists no universal method to identify a claimant’s enrollment status, short of asking the claimant.  Accordingly, the bill provides a solution by requiring CMS to share such enrollment information.

 

 

Enrollment Information Shared Through Mandatory Insurer Reporting

 

A review of the bill shows the enrollment information would be shared through the Section 111 Mandatory Insurer Reporting query process.  In short, along with identification of whether a claimant is a Medicare beneficiary, the query response would also provide whether the claimant is or has been enrolled in a MA or Part D Plan or a state Medicaid program for the past three years and the name of the plan or program.  The insurance carrier or self-insured entity would then be able to readily contact the Part C or D plan or Medicaid program to resolve any claim for reimbursement.

 

The bill was referred to the Committee on Ways and Means and the Committee on Energy and Commerce for further action.  Tower MSA Partners will provide updates on the legislation when warranted.

 

 

Author Dan Anders, Chief Compliance Officer, Tower MSA Partners. Dan oversees the Medicare Secondary Payer (MSP) compliance program. In this position, he is responsible for ensuring the integrity and quality of the MSA program and other MSP compliance services and products. Based upon his more than a decade of experience in working with employers, insurers, TPAs, attorneys and claimants, Dan provides education and consultation to Tower MSA clients on all aspects of MSP compliance. Contact: (847) 946-2880 or daniel.anders@towermsa.com

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