Hiring Unqualified People Is Big Worker’s Comp Mistake

Hiring Unqualified People Is Big Worker’s Comp MistakeHiring unqualified people to fill positions within the workforce is by far one of the biggest mistakes made in maintaining low workers’ comp costs.

 

The trucking industry and bus drivers for school buses, over the road or municipal buses is a perfect example of how applying ability standards as conditions of employment help maintain work comp costs, while maintaining productivity and high safety standards.

 

The Department of Transportation (DOT) requires medical exams to ensure a driver is physically capable and qualified to operate a big rig truck. Using a variation of these standards in hiring can help companies protect their workers’ comp budgets by making sure they hire an employee who can do the job!

 

 

Adapt DOT Approach to Meet Your Company Needs

 

DOT’s approach can easily be adapted to meet the needs of all companies. Place the emphasis not only in performing background checks and drug screening, but also make sure potential employees are qualified to perform the job they are hired for. If the position calls for someone with above average hand-eye coordination, would it be wise to hire the next candidate who walked through the door without qualifying him/her for the job?

 

When a company suffers from too many employee accidents, the nature of the accident needs to be examined. Policies need to be put into place to prevent reoccurrences. Accidents do happen and with proactive policies dictating how these events are handled, management personnel has tools to help them fine tune employee training and accident avoidance policies.

 

Many companies have strict procedures requiring the immediate reporting of all accidents, whether there was injury or not, followed up by detailed documentation of the event. Where there is an injury, these policies ensure the injured employee receives prompt medical treatment, timely filing of required workers’ comp paperwork and claims forms, and the employee’s recovery is monitored to ensure a prompt return to work, even if into modified duty.

 

Additionally being on top of all work related accidents and injures affords greater control of these situations and provide the means to monitor and evaluate employee qualifications and adherence to workflow procedures.

 

 

Cost Savings Are Easy to Calculate

 

Cost Savings is easy to calculate. Enter the total incurred losses and your profit margin, and when you calculate, it will show the sales to pay for accidents. For example, it will take 11 Million dollars to replace $500,000 in incurred losses if your companies profit margin is 4.5%. So, it’s cost effective to put a program in place to screen new hires and make sure they are physically and psychologically suited to the job.

 

The focus of administration is on fostering safety within the workflow and encouraging employees to follow procedures and help newer employees do the same. By making employee safety as important as meeting production quotas and timelines, you, the employer, show your employees you care about them. The employer’s sincere concern is then perceived by the employees as their company caring about their welfare.

 

By establishing qualification testing and standards in the workforce, a company can ensure safety and work procedures are not compromised, keep the workforce safe while maintaining workers’ comp costs and workforce productivity. There are numerous companies that help set up employment screening programs. Interview several, and ask them to come to your facility to meet them and let them see the jobs your company performs.

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

Dr. Jacob Lazarovic Joins Amaxx As Medical Advisor

Kennebunkport, Maine. September 13, 2017 – Amaxx, the nation’s leading resource for workers’ compensation cost containment best practices is proud to announce the addition of Jacob Lazarovic, MD as Medical Advisor.  Dr. Lazarovic will work directly with Amaxx Virtual Consulting professional services clients on the evaluation and implementation of workers’ compensation medical cost containment best practices.

 

Jacob Lazarovic, MD brings to Amaxx 30 years of experience in medical management and managed care. He has been published extensively in industry journals and has held several senior medical management positions at companies including HealthAmerica, Blue Cross/Blue Shield of Florida and Vivra Specialty Partners.

 

Dr. Lazarovic comes to Amaxx from Broadspire, where he spent 18 years as Chief Medical Officer. In this role, his department produced clinical guidelines and criteria to support sound medical claim and case management practices; participated in analysis, reporting and benchmarking of outcomes and quality improvement initiatives; developed educational and training programs that updated the clinical knowledge and skills of claim professionals and nurses; provided expertise to enhance the medical bill review process; and operated a comprehensive and unique in-house physician review (peer review) service.

 

“I am thrilled to be working with Dr. Lazarovic,” said Michael Stack, CEO of Amaxx, adding, “I’ve worked with Dr. Jake for many years in his role as Chief Medical Officer at Broadspire prior to his retirement, and have tremendous respect for what he accomplished for that organization.  I value the opportunity to work with him more closely, as well as share his knowledge and expertise with my client base.”

 

Dr. Lazarovic, who is based in Boca Raton, FL stated “it is a pleasure to be working with Michael and Amaxx.  I look forward to focusing on the clinical aspects of its consulting activities, enabling clients to better ensure that the medical services they manage are of optimal quality, availability, and cost-effectiveness.”

 

 

Workers’ Comp Mastery Training

 

Join Michael Stack & Dr. Lazarovic in their Workers’ Comp Mastery training session “How to Leverage Evidence Based Medicine to Create Better Workers’ Comp Claim Outcomes” on Tuesday, September 19, 2017 at 2:00 pm EST.  Learn how to leverage evidence based medicine tools, review case examples, as well as best practices on integrating evidence based medicine into your program.

 

 

About Amaxx

 

Amaxx helps employers in all industries reduce workers’ compensation costs through education, publishing and consulting. The injury management system taught is a best-in-class process based on 25 years experience lowering employer’s workers’ compensation costs while improving overall program efficiency.  Contact Michael Stack, mstack@reduceyourworkerscomp.com.

 

 

 

Five Things to Include in Your Workers’ Comp Communication Policy

workers' comp communicationPart of managing your workers’ comp budget is reducing indemnity payments to your injured workers. There are a variety of reasons why some workers may not return to work as soon as they can, such as disagreements with the doctor’s recommendation, complications with treatment, and in some rare cases, employees simply trying to stay out of work.

 

 

Proactive Communication Improves Outcome & Limits Costs

 

Whatever the case, company administration must use proactive communication and monitoring of injured employees to ensure treatment is progressing well and the treating doctor has projected a return-to-work date. In cases of disagreements with either State workers’ comp claims or the doctor’s prognosis, help your employees to resolve these issues as quickly as possible. A quick resolution equals a quick return to work and limits your costs. Think: modified duty.

 

Some people may think — Why do I need to bother with such a plan, when the insurance company is paying off the claim?

 

The insurance company is paying the claim, but you still cover your deductible (or premium in guarantee cost). And, depending upon per incident costs, an employee suffering a moderate injury could cost as much as $35,000.00.

 

Take the approach of a well-informed and concerned employer concerned with both safety in the workplace, but also with the injured worker’s recovery and return to work after an injury. Weekly or monthly safety and work practices meetings help reinforce company policy and procedure for safe work related conduct and maintaining a safe work environment.

 

 

Five Things to Include in Your Workers’ Comp Communication Policy

 

Your communication policy as a part of your injury reporting and claims process must include:

 

  1. A first day phone call or visit to the injured employee.
  2. Communication with the doctor on prognosis, a reasonable treatment plan, and estimated date for a return to work.
  3. Documentation of every accident/injury.
  4. Investigate any claims raising “red flags” for potential fraud.
  5. Close communication with your insurance claims adjuster to make sure all claims are reviewed before processing.

 

By getting your employees back to work before the mandatory waiting period for indemnity payments, you reduce your claims costs and protect your profit margin. Suspicious claims should be thoroughly investigated and brought to the attention of your claims adjuster.

 

Injuries occurring without witnesses or off company property while the employee was on duty may be hard to investigate. However, failure to do so could easily cost the company a substantial amount of money. That is not to say all accident claims falling into these categories are false or attempts at fraud, but in the event they are, investigating helps you to protect the company by detecting them before they affect 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 work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

Navigating the Perils of Work Comp, ADA, & FMLA Laws

The workers’ compensation landscape is filled with pitfalls that can trap the uninformed.  In addition to the many procedure hurdles presented under a workers’ compensation act, other challenges including complaints or penalties under FMLA, ADA and other discrimination claims.  Proactive members of the claims team need to be informed on these issues to run an efficient operation and prevent troubles for the people they seek to serve.

 

 

Common Pitfalls Associated with Work Comp

 

There are many legal issues surrounding a workers’ compensation claim.  Some of the most common include:

 

 

Family Medical Leave Act (FMLA)

 

FMLA is a federal law that applies to qualified employees and employers.  Employers covered under this law generally must have over 50 employees, or are a public agency or a school.  In order to qualify, an employee must work for the employer for one year, work 1,250 hours during a 12-month period and have a “serious health condition” personally or with a family member.  This can include most work-related injuries.  Problems arise in the context of a workers’ compensation claim when:

 

  • The employee qualifies for leave in disputed workers’ compensation claims and proper communication on their rights is not provided by the employer;

 

  • The employee is off work due to disability and never receives official notice of hours remaining in their leave “bank.”

 

 

Americans With Disabilities Act (ADA)

 

The ADA has been in existence since the 1990s and impacts employers with more than 15 employees.  The law prohibits an employer from discriminating against a prospective or actual employee based on their disability.  Common areas where claims arise under this law are in the context of workers’ compensation claims that include:

 

  • Return to work or written job offers that do not take into consideration the employees work restrictions or limitations; and

 

  • Employment practices where questions are asked on an application or during an interview regarding an employee’s physical limitations or restrictions. Injured workers seeking post-injury employment fear this situation as they are walking a fine line between being honest and not being excluded from an applicant pool.

 

Employers seeking to comply this law must make “reasonable accommodations” to all persons, regardless of their ability.  Questions remain as to the extent these accommodations are appropriate or place an “undue hardship” in the process.

 

 

Implementing Proactive Compliance to Avoid Problems

 

The workers’ compensation claim management team can be a resource for the employers they work with on these complex issues.  Legal advice from an attorney practicing in these areas should be sought when doubt or questions arise.

 

Best practices for FMLA compliance:

 

  • Create a FMLA checklist that outlines the various timelines and employee eligibility requirements;

 

  • Designate one person in the human resources department who understands and is familiar with this law. This person should be a point of reference for all supervisors and managers who have employees potentially subject to this law; and

 

  • Conspicuously display U.S. Department of Labor approved notices in office common spaces regarding an employee’s rights and responsibilities.

 

Guidance regarding ADA issues can be more difficult.  Proactive stakeholders should consider the following:

 

  • Understand that the ADA may allow an employee to take additional leave time, beyond FMLA;

 

  • Have a designated HR representative engage employees on suggestions for workplace modifications. Remember that this is only one step in making “reasonable” accommodations; and

 

  • Foster a culture that views all employees regardless of ability as a human being. Being courteous and respectful to all is something everyone deserves.

 

 

Conclusions

 

The workers’ compensation system impacts a number of federal laws that demands attention from all interested stakeholders.  Claims management teams can be proactive on this issue by partnering with their employer-clients to foster a workplace that complies with these rigorous laws.  It can also drive changes for the better in company culture that promote goodwill among the workforce, including those suffering from a work injury.

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

September 11th Remembered – Tribute To Marsh And AON

Article republished from a previous post.

 

Everyone remembers where they were the when they learned the World Trade Center crumbled to the ground. I was scooping ice cream at the Mansfield Center General Store. Having recently retired from the risk management and insurance industry, I had moved back to the area, built a house in Mansfield Center and worked from my home office. I was helping my family restore and run the General Store.

 

I had an exciting career in risk management and insurance working for two of the best insurance brokers in the industry. BOTH companies had sizeable offices located in the World Trade Center. So, when Bill called and asked me if I was watching TV, did I know a plane flew into the World Trade Center, I was alarmed. Initially I thought he meant it was a small plane, but when I turned on the TV, I could see it was a huge plane and the building was on fire. And then another plane had flown into the other tower.

 

 

We Never Knew How 9/11 Could Affect An Entire Industry

 

Everyone in the risk management field “plans”… we plan for every eventuality, thinking things through. That’s what we do. We help our clients, which are large companies such as The New York Times, Universal Orlando, and USAir, etc. plan how to provide safer workplaces, safer products and safer environments. But we never planned for Sept 11. We never knew how it could affect an entire industry.

 

AON and Marsh are the two largest insurance brokers in the world and I – with a loyal team of consultants – was responsible for development of the workers’ compensation practices at those companies. Workers’ comp insurance is the largest line of insurance coverage – a huge cost to most employers – and I had found the solution to reduce those costs significantly. Helping a wide-variety of types of organizations was gratifying, and there was a new challenge every day. I had written, published, traveled, and worked hard for 25 years, so I looked forward to scaling back.

 

When a retirement opportunity presented itself, I left the workforce to enjoy being a mom. My daughter was 17 and Glastonbury High School had not gone well. Against her will, we had moved her to a private school, and she and I were getting reacquainted during the long drive to and from school in Farmington, CT. Life was good.

 

 

Many Former Employees Went Back To Work

 

It wasn’t part of the plan to go back to work, but two weeks after Sept 11, I went back to AON, filling in for Lisa Ehrlich. Lisa was an outsourced risk manager who worked on-site at a company in Stamford, CT. On 9/11, she had gone into the NY office for a meeting and was killed that day. I was honored to be able to help in some small way. Many former employees went back to work in the intervening years to help the brokers rebuilt their practices. Here is a remembrance of my colleagues.

 

In the 15 years since Sept 11, a new generation has taken over. Some hardly know our industry lost so many that day, key leaders and pioneers in the field of workers’ compensation cost containment. In the intervening years, my niece and nephew, Kori and Michael Stack, have taken over a leadership role in my company and become industry leaders in their own right. I am very proud of them for carrying on the legacy and memory of our beloved colleagues lost on that fateful day.

 

 

 

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:RShafer@ReduceYourWorkersComp.com.

 

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

 

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

 

 

 

Effective Medical Cost Management in Workers’ Comp Programs

effective workers comp medical cost managementWorkers’ compensation is a complex system with varying laws in each jurisdiction and a changing American workforce. While there are many things that change, the fundamentals of a best in class workers’ compensation management program generally stay the same.  One of those elements is the need for effective Medical Cost Management.

 

 

What is Medical Cost Management?

 

“Medical Cost Management” is a term that describes various operations carried out by a workers’ compensation third-party administrator or insurance carrier to reduce the cost of medical claims.  It includes a number of different features that meets the needs of the employer that considers the nature of their industry, the workforce population it employs, injuries common to the work the employees perform and trends in health care that reduces the number of visits to health care professionals.  It also must provide the medical care and treatment injured parties are entitled to as the result of a workplace injury.

 

Common features of a medical cost management program include, but are not limited to:

 

  • Preferred Provider Organizations (PPOs);
  • Nurse case management, including web-based and telephonic hotlines and access;
  • Injury case management, including medical and vocational experts;
  • Utilization review of medical care and treatment. Given the dangers and overuse of prescription drugs, a complete review of prescription drug usage is essential;
  • Independent Medical Exams (IME) & Peer Review;
  • Pharmacy / Opioid Management
  • In-Home healthcare services; and
  • Medical billing review.

 

 

Implementing Medical Cost Management in Your Program

 

The implementation of an effective medical cost management program requires buy-in from a number of interested stakeholders.  This includes an employer concerned about providing quality care and benefit delivery to injured workers.  It also requires a third-party administrator or workers’ compensation insurer that cares about the service it provides to the employer/client and the workers served under the program.  It also includes the effective implementation of the following program components.

 

  • Prompt Reporting of Work Injuries: Any cost-effective program must include a number of different methods for employees to report a work injury.  Advances in technology have moved the industry beyond paper forms that confuse even a trained claims professional.  The use of web-based portals or smartphone apps can assist employees and their supervisors in prompt reporting of all workplace injuries.  It can also include features that allow impacted parties and potential witnesses to preserve evidence related to the injury.  One of the most important features of any injury reporting system needs to include access to immediate and appropriate medical care and treatment.

 

  • Expedited Medical Care and Treatment: Beyond the issue of compensability, all workers are entitled to immediate and effective medical care and treatment following any work related injury.  It should also include steps to monitor and manage the care so that drivers in healthcare (including fraud, waste and abuse) can be eliminated without sacrificing quality.

 

  • Return-to-Work. Return-to-work is an often overlooked component of medical cost containment.  Sadly, interested stakeholders who do not include effective return to work in their cost containment programs are doing a complete disservice to all interested parties involved in a claim.  Implementation of a return to work program should be something that is re-evaluated frequently to meet the needs of each individual client and employee.  It should also include an industry specific review of all processes and options.

 

 

Conclusions

 

Medical cost management in workers’ compensation is an important part of running an effective program focused on compliance with the law and supporting the needs of all interested stakeholders.  A multi-pronged approach requires buy-in from the employer and execution by the third party administrator or insurance carrier.  When done correctly, it will reduce costs and promote program efficiency.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

 

6 Steps to Mitigate PTSD Workers’ Comp Claims after Trauma

Escape, hide, fight back. Those are the suggested reactions — in order — to an active shooter situation provided to employees of one of the nation’s largest supermarket chains. In a dramatic, realistic-looking video, a man with a gun walks into a grocery store and begins shooting.

 

The fact that the video is part of required training for all company employees underscores the very real threat of violence in many workplaces. While employers can and should take any and all precautions to prevent violent incidents from occurring, there are still situations that arise all too often.

 

One thing companies can do is prevent such a situation from escalating into long term claims involving post traumatic stress disorder. Identifying and intervening early after a workplace trauma will help ensure employees recover and get back to work as quickly as possible.

 

 

Who Gets PTSD

 

Just about everyone will have stressful reactions to a traumatic event, such as workplace  violence. But the vast majority will recover and have no symptoms within several months.

 

A segment of the population — around 7 to12 percent will have a more difficult time recovering. They may improve, only to see their symptoms recur with a new stressor. Some may develop a lifelong illness that affects every aspect of their lives.

 

Diagnosing PTSD is not an exact science, as its symptoms often mirror other conditions. Generally, experts say having the following for more than one month are clues:

 

  • Reliving the event. Internal or external cues that resemble any aspect of the incident may cause images, perceptions, dreams, or dissociative flashback episodes.
  • Avoiding certain stimuli. The employee may refuse to discuss the incident, or avoid places or people associated with it, including coworkers.
  • No interest in participating in group activities.
  • Feeling detached from others.
  • Emotional overload. The worker may be irritable or have outbursts of anger, or trouble concentrating, and may be easily startled.
  • Physical symptoms. Headaches, high blood pressure or gastrointestinal issues may be present as well.

 

The risk of developing PTSD depends on many factors, including the presence of psychosocial issues. Even many of those who recover slowly and are at increased risk can be helped and recover, often within 8 to 12 weeks. The key is to get them into appropriate treatment as soon as possible.

 

 

Crisis Intervention

 

Traumatic incidents can happen in any industry, but are especially prevalent in certain ones. Employers in fields such as healthcare and retail are wise to consider implementing a post trauma crisis intervention protocol to help employees immediately after a traumatic event.

 

The plan should include the following elements:

 

  1. Early contact. Within 24 hours of a workplace trauma, employees should be contacted by a trained trauma specialist. That contact should continue until there is a face-to-face meeting for acute psychological intervention. Responding early shows the employer cares about the employees, which can help prevent delayed recovery and require less use of medical and mental health services.
  2. Face-to-face assessment. A psychologist should perform an assessment and begin trauma recovery of care. In most cases, no more than three visits will be needed before the employee can return to work.
  3. PTSD determination. If symptoms persist for more than one month, the psychologist should conduct a criterion-based PTSD diagnostic assessment to help determine whether the workplace trauma was the actual cause of the employee’s symptoms.
  4. Trauma interventions. An employee diagnosed with PTSD may find his work and daily living is disrupted. Increased absenteeism and decreased productivity may be among the results. Once a PTSD determination is made, the worker should be referred for specific treatment.
  5. Long, drawn-out therapies are not necessarily needed to help injured workers with PTSD. Cognitive behavioral therapy, for example, has been shown to help. It includes principles of learning and conditioning to help injured workers change their negative beliefs about themselves while gradually exposing them to the thoughts and situations they fear. Exposure/desensitization therapy is also effective in treating PTSD. This may involve imaginal exposure, where the worker is exposed to the traumatic event through mental imagery; or in vivo therapy, in which the worker confronts the actual scene or similar events associated with the trauma.
  6. Short term use of certain medications may be helpful, depending on the severity of the symptoms and the worker’s preference. Some antidepressants have been approved by the Food and Drug Administration to treat PTSD. However, benzodiazepines such as Valium and Klonopin should be avoided, as there is no evidence they are beneficial and can even increase the likelihood of developing PTSD when they are prescribed in the acute aftermath of trauma exposure.

 

Conclusion

 

Workplace trauma can take a devastating toll on all affected employees and an organization as a whole. But it does not need to result in long term disabilities.

 

The vast majority of people who are exposed to traumatic events recover with limited help. Of those who need further follow up, many will be able to return to work and function. Employers who are proactive about identifying and intervening can better protect their workers and their bottom lines.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

The Single Biggest Mistake With BIG DATA in Workers’ Comp

 

Hey, there, Michael Stack here, CEO of Amaxx and founder of Amaxx Workers’ Comp Training Center.

 

Today is an exciting day in the Stack household. It’s back to school day. We have four children, a daughter going into second grade, a son going into first, another daughter in pre-K and a youngest son in first year of preschool. Everyone is excited, we did the first day of school pictures and the whole nine yards and they got on the bus just this morning.

 

 

Proper Sequence Is Critically Important

 

What if I told you that our seven-year-old daughter, instead of putting her into second grade, we actually enrolled her in Kennebunk High School? The odds of her being successful in that environment are basically very slim, if not, impossible. It’s not that the information taught at the high school level isn’t critical to her educational journey which hopefully then leads on to a successful life and career. It just that it’s taught out of sequence and she needs that foundational knowledge taught at the elementary level to be able to properly use and utilize that information.

 

 

Biggest Mistake Companies Make with BIG DATA

 

Now, I want to talk to you about a topic in worker’s compensation which is very popular: big data and analytics. I see a lot of companies making that same mistake. It’s not that the information or the tool of leveraging big data and analytics isn’t critical to your journey to a best in class work comp management program. It’s just that it’s typically implemented out of sequence and most companies don’t have those foundational, fundamental, necessary elements in order to be able to properly use and utilize the information both inputted into that big data tool and extracted from that tool. If you don’t know how you are measuring success, if you have no clear goals in your organization and a way to understand if you’re being successful or not and you’re spending all your time and resources researching and implementing this tool, then you’re out of sequence and I encourage you to go back and look at some of those fundamental elements in order to be able to properly use and utilize that extremely valuable tool.

 

Again, I’m Michael Stack with Amaxx and your work in workers’ compensation cannot only dramatically reduce your workers’ compensation cost but it will dramatically impact someone’s life. Be great.

 

To Learn more, check out The Step by Step Process to Master Workers’ Comp in 90 Days

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

The Deep Cut That Got Deeper Due to Poor Injury Response Procedure

The best time to develop defense strategies is before a claim is even filed. Employers that implement proactive tactics toward injury response management will see reduced attorney involvement and lower overall claim costs.

 

Instead of leaving things to chance, employers need to take control of all facets of a post-injury situation. Employers who do so also exude competence, which helps set expectations for the injured worker and can reduce much of the animosity typically present in the workers’ compensation system.

 

 

The Problem

 

The less control an employer exerts following a workplace injury, the longer the time off work — leading to higher costs.

 

Consider the following example;

 

A worker gets a fairly deep cut in her arm rounding a corner at work as she’s carrying a heavy load of paper. Neither she nor her supervisor know what to do, so the supervisor calls someone in HR who asks if the injury is ‘life threatening.’ Since it is not, the HR person spends 20 minutes asking a series of questions before sending the employee to a physician’s office.

 

In the meantime, the injured worker and a coworker have covered her wound with paper towels from the restroom. The cut is deep and she loses enough blood to make her feel dizzy.  

 

Appalled at the presence of unsanitary paper towels on the employee’s cut, the physician prescribes antibiotics as well as stitches and suggests she take a few days off work because of her dizziness and to see if there is an infection.

 

She is not contacted for several days and becomes increasingly disgruntled. Ultimately, she files a workers’ compensation claim.

 

This scenario shows the disorganization and wasted time, energy and expense that occurs all too often following the injury. Having a formal, post-injury procedure in place can avoid much of that.

 

 

The Strategies

A post injury response plan that is fully communicated to managers, supervisors and employees is a must to avoid the scenario described above. It should incorporate a series of action steps to be taken after any workplace injury.

 

  1. Supervisor’s responsibilities. Immediately after the injury the employee should contact her supervisor, as she did in the case above. However, the supervisor should understand and follow a specific protocol. She should know that the employee’s injury is the most immediate need. If the company employs a triage nurse, he should be contacted immediately to determine the severity of the injury and next steps. If the case is an emergency, the employee should be taken to the closest emergency room. In the absence of a triage nurse, the employee should be given the names and locations of the company’s workers’ compensation physicians. The supervisor should escort the worker to the physician’s office; if not possible, she should designate someone to drive her there.

 

  1. Information. A packet should be readily available for the supervisor to give to the injured worker. It should include instructions and phone numbers on whom to call, how to file a claim and what to expect in the days ahead. It should also contain a ‘work ability form,’ for the physician to fill out.

 

  1. Investigation. The supervisor should immediately begin an incident investigation, that includes statements from any witnesses to the incident. If immediate medical attention is unnecessary, the supervisor should speak with the injured worker about the incident.

 

  1. WC designee. A workers’ compensation coordinator should be available to meet with or speak with the employee upon her return to the office. The coordinator should review the physician’s notes and restrictions — if any — and determine if transitional or modified duty is required.

 

  1. Communication. If the employee cannot return to work immediately, she should be contacted by her supervisor, a manger or the workers’ compensation coordinator on day 1. The communication should continue on a regular basis.

 

  1. Documentation. The designated workers’ compensation coordinator should fill out and send to the insurer or third-party administrator a first report of injury that includes statements from the worker and any witnesses, as well as photos of the incident site. A detailed job analysis should also be provided to the carrier/TPA.

 

  1. Monitoring progress. The workers’ compensation coordinator should meet with and/or contact the employee at least weekly to discuss the employee’s progress, and when she might return to work in some capacity.

 

Establishing such a procedure requires up-front leg work to be effective. A workers’ compensation coordinator must be designated and properly trained in workers’ compensation issues, including alternative leave plans; the injury response plan should be formally written up and presented to all employees; treating physicians should be identified and working with the company to understand its culture and the focus on returning the employee to work as soon as possible; and transitional work assignments should be outlined.

 

 

Conclusion

 

Workers who are injured on the job do not typically start out being angry toward their employers. But the failure to have a formal, structured, well-understood post-injury response plan can lead to confusion and anxiety and, ultimately, an expensive claim.

 

Employers can cut disability durations, hostility and costs with a well thought-out plan that addresses the employee’s needs as well as the company’s.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

Practical Implications of the Revised CMS WCMSA Reference Guide

Earlier this month the Centers for Medicare and Medicaid Services (CMS) released a revised Workers’ Compensation MSA Reference Guide (WCMSA) (find Version 2.6 here) with several notable changes and additions impacting its review of MSAs in workers’ compensation cases. The Tower MSA compliance team has taken some time to review and consider not only the substantive impact these changes have on our processes, but the implications for our clients. Please find below a summary of the notable changes to the Reference Guide along with practical implications.

 

 

Recognition of a Hearing on the Merits of the Case (Section 4.1.4)

 

The relevant change to this section is as follows:

 

Because the CMS prices based upon what is claimed, released, or released in effect, the CMS must have documentation as to why disputed cases settle future medical costs for less than the recommended pricing. As a result, when a state WC judge or other binding party approves a WC settlement after a hearing on the merits, Medicare generally will accept the terms of the settlement, unless the settlement does not adequately address Medicare’s interests. This shall include all denied liability cases, whether in part or in full . . .

 

 

Practical Implications:  Over the years CMS has had several definitions of under what circumstances it will recognize a hearing on the merits, but the takeaway has consistently been that CMS gives itself complete discretion as to whether or not it will recognize a particular judicial decision, order or finding as limiting the MSA. Some commentary in response to the Reference Guide revisions has indicated the changes found in this section will result in Zero MSAs based upon a complete claim denial no longer being approved without a hearing on the merits confirming the basis for the denial. We are not certain this is the correct inference to draw from this change. This section addresses the effect of a hearing on the merits of a case to the projection of future medical care. If there is no hearing on the merits of the case, which is the situation in most MSA submission, Zero MSA or otherwise, then this section should have no applicability to CMS’s review of a Zero MSA.

 

Tower MSA’s plan is to stay the course on the long-used criteria for a Zero MSA based upon a claim denial unless and until we identify any changes through the MSA submission process which requires modification to these criteria.

 

 

Recognition of State-Specific Statutes (Section 9.4.5)

 

The relevant change to this section as follows:

 

Submitters requesting alteration to pricing based upon state-legislated time limits must be able to show by finding from a court of competent jurisdiction, or appropriate state entity as assigned by law, that the specific WCMSA proposal does not meet the state’s list of exemptions to the legislative mandate. For those states where treatment is varied by some type of state-authorized utilization review board, the submitter shall include the alternative treatment plan showing what treatment has replaced the treatment in question from the beneficiary’s treating physician for those items deemed unnecessary by the utilization review board. Failure to include these items initially will result in pricing at the full life expectancy of the beneficiary or the original value of treatment without regard to the state utilization review board recommendation.

 

 

Practical Implications – State-Legislated Time Limits: Similar towards its policy on recognizing decisions stemming from hearings on the merits, CMS has consistently given itself complete discretion as to when it will recognize any state statute as providing a limitation on the medical care allocated in the MSA. Experience has shown CMS to be unwilling, under most circumstances, to recognize a state statute as having the affect of limiting medical care in the MSA. A notable example is the Georgia statutory provision limiting an employer’s responsibility for medical care to 400 weeks post the date of injury in non-catastrophic claims (applicable to cases with DOIs of 7/1/2013 and later). We have yet to see an instance where CMS has agreed to limit the MSA amount based upon this statute.

 

The changes to this section of the Reference Guide provide hope that CMS may be more open to recognizing state statutes, like Georgia’s, as a basis for limiting medical treatment and medications in the MSA. Unfortunately, the requirement “to show by a finding from a court of competent jurisdiction . . . that the specific WCMSA proposal does not meet the state’s list of exemptions to the legislative mandate” presents a challenge in attempting to use a statutory provision to limit the MSA. For example, in Georgia a workers’ compensation case is by default considered non-catastrophic unless accepted by the employer or carrier as catastrophic or the claimant’s attorney submits to the Georgia Workers’ Compensation Board a request for the claimant to be designated as catastrophic. It is unclear at this point whether confirming the non-catastrophic nature of the claim in board approved settlement documents or a separate finding by the board that the claim is non-catastrophic will be sufficient for CMS to recognize the limitation. Based upon our experience with similar types of issues, we expect CMS to require a specific finding separate and apart from the settlement documents. Accordingly, this will require settling parties, whether in Georgia or in other states, to work with their WC board, commission or other judicial authority to provide the necessary finding confirming the claim does not meet any of the exemptions to the statute.

 

 

Practical Implications – Utilization Reviews:  Revisions to this section of the Reference Guide also address the use of URs to limit care in the MSA. According to the requirements delineated by CMS the following must be presented with the MSA submission:

 

UR denial pursuant “some type of state-authorized utilization review board.”
“Alternative treatment plan” from the treating physician showing what treatment has replaced the UR denied treatment or medications.

 

The addition of the language regarding URs raises more questions than it answers. What does CMS define as a UR Board? For example, the California Independent Medical Review (IMR) process, while statutorily created, does not include a UR review board (Although we believe it can be argued that the IMR process is equivalent to such a board). Further, CMS fails to define what would be considered an “alternative treatment plan.” It would seem that an intransigent treating physician could refuse to provide alternative treatment, thus resulting in inclusion of treatment or medications in the MSA denied through the UR process. It is unfortunate CMS added this “alternative treatment plan” requirement as it undermines the very reason a UR process is in place, namely to limit medical care based upon evidence-based treatment guidelines. As Tower MSA submits MSAs to CMS with UR denials we will provide further recommendations as to how CMS is defining a “UR board” and “alternative treatment plan.”

 

 

Addition of “Amended Review” to Re-Review Policy (Section 16.0)

 

As fully explained in the Tower MSA article of 7/12/2017, “Second Chance with MSA Approval!: New CMS Policy Allows for Review of a New MSA Post a Prior Approval,” CMS has introduced what is called an Amended Review process for cases meeting the following criteria:

 

    • CMS has issued a conditional approval/approved amount at least 12 but no more than 48 months prior,

 

    • The case has not yet settled as of the date of the request for re-review, and

 

    Projected care has changed so much that the submitter’s new proposed amount would result in a 10% or $10,000 change (whichever is greater) in CMS’ previously approved amount.

Practical Implications:  The Amended Review criteria presents an opportunity to have a second bite at the CMS MSA review apple when it comes to claims which despite having a previously approved MSA, failed to settle medical. It is important to note that the Amended Review process applies not only to MSA determinations resulting in counter-highers, but any MSA determination, approved as submitted or counter-lower, that meets the above-defined criteria. Please contact Tower MSA to discuss eligible claims.

 

 

Added Section on Required Resubmission (Section 16.1)

 

The addition to this section is as follows:

Where a proposed WCMSA amount has been closed due to inactivity for one year or more from the original date of submission, a full-file resubmission will be required.

 

 

Practical Implications: Previously a case closed for inactivity for one year or more would be reopened if the submitter provided the documentation in response to a Development Letter (The most common reason for case closure). CMS is now indicating solely providing the documentation in response to the Development Letter will be insufficient for them to reopen, instead a completely new MSA proposal and supporting documentation will be required. Tower MSA will advise when a case meets the criteria for filing a resubmission.

 

 

Additional MSA Administration Guidelines (Section 17.1)

 

The addition to this section is as follows:

 

Although beneficiaries may act as their own administrators, it is highly recommended that settlement recipients consider the use of a professional administrator for their funds.

 

 

Practical Implications: While not requiring professional administration, this is an acknowledgement by CMS of the difficulties a claimant may face on their own in administering an MSA. Tower MSA agrees with CMS on the benefits of professional administration and when requested by our client will provide MSA professional administration through our partner, Ametros.

 

Other less notable changes found in the Reference Guide apply to clarifying the order of jurisdictional precedence for MSA pricing, updating requirements for spinal cord stimulator pricing, updating off-label medication requirements, clarifying total settlement calculation guidelines and clarification of change of submitter requirements.

 

 

Final Comments

 

While we are pleased CMS is addressing the concerns expressed by Tower MSA and others in the MSP compliance field concerning a second chance at CMS review of an MSA and recognition of state statutory limitations on injury-related medical care, the real test will be in the coming weeks and months the affect these revisions have on the review of MSAs submitted to CMS for approval. Tower MSA continuously monitors these responses and will provide our clients appropriate guidance on the impact, or lack thereof, of these revisions and additions to the WCMSA Reference Guide.

 

 

 

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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