Top 8 Considerations When Selecting Your Workers’ Comp Claims Adjuster

Top 8 Considerations When Selecting Your Workers' Comp Claims Adjuster

If you are the risk manager or workers’ compensation claims coordinator for a large company where you report new work comp claims on a regular basis, you need to select your adjuster. Whether your workers’ compensation claims are handled by the insurance company or a third-party administrator (TPA), your claims handling agreement should specify that your company has the right to select, from their staff, the adjuster(s), who will handle your claims. If the insurance company or TPA balks at your company having input into who handles your claims, it is time to get another insurance company or another TPA.

 

Someone in your company must have an in-depth knowledge of the adjuster handling your claims – NOT just the adjuster’s name and phone number. If you want to maximize the effectiveness of your adjuster, you need to know the adjuster’s claim handling style. You also need to know when to step in if the adjuster is not achieving your expected results.

 

 

#1- Dedicated or Designated 

 

If you have multiple workers’ comp adjusters in the same claims office handling your claims – ASK — “How many of our claims are you handling?”

 

The problem with having multiple adjusters in the same office each handling only a few claims for your company is:

  1. They do not know what your preferences are.
  2. They do not know your return-to-work program.
  3. And, they do not know the claim handling philosophy of your company.

Depending upon the jurisdiction and the statutes involved, the experienced workers’ comp adjuster can handle from 125 to 150 claims at a time. If you have less than 125 claims in the claims office, it would be in your company’s best interest to have only one adjuster, a designated or dedicated adjuster, working on your claims.

 

A “designated” adjuster handles all your claims plus claims for other employers. On the other hand, a “dedicated” adjuster handles only claims for your company. If, for example, you have 280 open workers’ comp claims in the same claims office, you want two dedicated adjusters who working exclusively on your claims.

 

If your insurance company or TPA is using multiple adjusters on your claims, you need to have a serious chat with them about having a designated adjuster or dedicated adjuster(s) for your program.

 

 

#2- Adjuster Experience – Why It Is Important 

 

The level of experience and training the adjuster(s) bring to your program makes a major difference in the outcome of your workers’ compensation claims. While every adjuster has to go through the training stage, do you want the adjuster-trainee making mistakes on your claim files? Let the adjuster trainee learn how to handle claims on the workers’ comp files of the employers who not attuned to their workers’ comp program.

 

Request an experienced adjuster who knows:

 

  1. the statutes and case law within the jurisdiction,
  2. the plaintiff attorneys who settle fast and cheap
  3. the attorneys who drag the employees’ claims out trying to maximize them,
  4. the medical providers and their treatment style
  5. the medical providers who are liberal with their permanency ratings and the medical providers who are conservative
  6. the best defense attorneys, and
  7. the tendencies of the industrial commission/workers’ comp board/court

 

 

#3- Investigator or Record Taker 

 

You do not want the experienced dedicated adjuster who is a record taker. A “record taker” copies what is on the Employer’s First Report of Work Injury form to obtain the description of the accident that injured the employee.

 

An “investigator” reads the Employer’s First Report then contacts the employer’s workers’ comp coordinator, the employee’s supervisor, the employee, and any witnesses to the accident. The investigator obtains detailed information from each party about how the accident occurred before accepting compensability.

 

The investigator does not stop being quizzical when compensability is accepted. The investigator reads every medical report thoroughly to have a complete understanding of the medical status and medical issues. The investigator then uses that knowledge to move the claim toward resolution. The record taker just makes a note of what the medical report stated.

 

 

#4- Combatant or Complacent 

 

When the employee’s attorney makes an unreasonable demand, you want an adjuster who will stand up and say NO. Your company does not need an adjuster who takes the easy way out and accepts whatever the employee or the employee’s attorney wants. Your adjuster should not always be in a combatant mode but should know when to take a stand on statutes, principles, or common sense. The complacent adjuster who does not stand up for the employer’s rights will cost your company a lot of money. When selecting your adjuster ask questions about how aggressive the adjuster will be in defending your workers’ comp claim.

 

 

#5- Up to Date or Behind the Times 

 

The workers’ comp statutes and the case law in every jurisdiction are constantly being challenged and changing. The adjuster (and the adjuster’s company) you select for your workers’ comp program should be staying current on all legislative changes and recent case law. When selecting your adjuster, ask what sources the adjuster uses to know about changes in the workers’ comp statutes. The best adjusters have several sources of new information including defense firm newsletters, workers’ comp websites (like this one), and workers’ comp groups on LinkedIn and other social networks.

 

The adjusters for your company’s workers’ comp claims should be current in their state required continuing education courses. It is also a good sign if the adjuster has obtained their AIC, ARM, AIM or CPCU designation, as it shows the adjuster has continued to learn and improve his/her skill set.

 

 

#6- Supervised or Unsupervised 

 

As a part of your claims handling agreement with your insurance company or TPA, you need access to their on-line claim file notes. While you expect to see your adjuster notes frequently,  how often do you see the supervisor’s file notes? Does the adjuster’s supervisor offer suggestions or recommendations on your claims, or, do you never see a file note by the supervisor? Even if you have the claims office’s best adjuster, every adjuster can benefit from a second set of eyes on the file. The supervisor should be reviewing the file and making comments on the progress of the file every 60 to 90 days. If not, you need to get the supervisor involved.

 

 

#7- Historian or All in Adjuster’s Head 

 

A good adjuster is a historian, meaning everything the adjuster has done on the claim file is documented completely in the file notes. If your adjuster is on vacation or off work sick, you should be able to read the files notes on any of your workers’ comp claims and know exactly where the claims stand. If the adjuster does not keep good files notes, but has it “all in his head,” what happens if the adjuster quits, transfers, gets promoted, or dies? The next adjuster will spend considerable time not working on your claims, but recreating what should already be noted in the file. When you are selecting your adjuster, be sure to state your expectation that activities on the file are to be documented in the file notes.

 

 

#8- Results 

 

Once you have experienced dedicated adjuster(s) working on your workers’ comp claims, don’t stop there. You must benchmark your results each year to verify that the adjuster(s) working on your claims are exceeding the benchmarks for your industry. If your adjuster’s results are not adequate, do not hesitate about asking your insurance company or TPA for the selection of another adjuster(s) for your workers’ comp program.

 

 

 

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.

 

 

Important Safety Improvements to Avoid Severe Injury or Death in Logging

Logging remains one of the most dangerous industries in the United States.  Every year approximately 800 American workers die as the result of workplace accidents.  The logging industry accounts for about 24% of these claims.  Most of these deaths are the result of employees working as fellers, limbers, buckers, choker setters, truck drivers, laborers and material machine operators.  Now is the time for all parties in the logging industry and their workers’ compensation insurers to take note and continually strive for safer work conditions.

 

 

The Dynamics of a Logging Work Injury

 

Work injuries in the logging industry fall into several general categories.  These include injuries resulting from falling objects, falls from heights and crane accidents.  Common injuries involve trauma to a person’s back/neck, fractured bones, TBIs/other brain injuries, paralysis, amputations, disfigurements and permanent scarring.  Beyond the physical component, the average workers’ compensation claim involving someone within the logging industry includes an underlying mental competent that includes psychological or psychiatric trauma.

 

The bottom line is clear – workers’ compensation injuries sustained by a logger are generally more severe and costly to a program.  Any steps that can prevent injuries or reduce costs following an injury have a significant impact on the sustainability of an employer’s bottom line.  Now is the time to take proactive action.

 

 

Moving Beyond the General OSHA Requirements

 

OSHA safety standards have a positive impact on making an inherently workplace safe.  Specific rules have been implemented under 29 C.F.R. §1910.266.  These regulations apply to all types of workplaces regardless of the end use of the forest products such as sawlogs, veneer bolts, pulpwood and chips.  Covered under these regulations include the following safety requirements:

 

  • Extensive first-aid training for all employees;

 

  • Requirements for the use of personal protective equipment;

 

  • Requirements that include the use of rollover and falling-object protective structures; and

 

  • Improved techniques for manual felling procedures. This includes instruction on how to properly undercut and back cut to prevent premature twisting and falling of trees.

 

In addition to following these safety requirements, employers and other interested stakeholders can take additional steps to improve workplace/site safety and prevent injuries.

 

  • Compulsory adherence to safety standards. This includes consistent enforcement of safety policies and termination of employment for repeat offenders.  Safety must also apply equally to all employees;

 

  • Continual evaluation of workplace performance when engaging in work duties. This includes an evaluation of felling techniques by loggers to ensure training is being used on work sites;

 

  • Proper maintenance of all tools and equipment. This includes a commitment to storing equipment in a location that prevents excessive wear and tear.  It also means fixing equipment when problems arise and not continuing to use it if safety is a concern; and

 

  • Commitment to safety with the implementation of a safety committee.

 

 

Avoiding Other Common Safety Hazards

 

Loggers are exposed to countless dangers on a daily basis.  Paying attention to one’s surroundings is only the beginning when it comes to injury avoidance.

 

  • Work boot safety: Loggers must wear steel-toed work boots.  Problems arise when boots are not labeled correctly to avoid potential electrical hazards or are subject to product recall;

 

  • Review of Safety Reports: Interested stakeholders can learn a lot about the anatomy of common and avoidable injuries by reading OSHA injury reports.  Learning how to avoid these issues is key; and

 

  • Education, education, education: Logging remains a dangerous occupation notwithstanding the inclusion of safety standards, regulations, and  Interested stakeholders need to make education a priority.

 

 

Conclusions

 

The nature of the logging industry makes it a hazardous workplace activity.  The result of an injury in this occupation is life-changing.  Interested stakeholders need to be proactive when it comes to workplace safety and strive to reduce the prevalence of injury and death through ongoing efforts.

 

 

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.

Operation Safety: A Case Study in Preventable Workplace Falls

Operation Safety: A Case Study in Preventable Workplace FallsFalls from heights and elevated surfaces continue to be a driver in workers’ compensation costs across the United States.  Now is the time for employers and other interested stakeholders to take a stand against falls.  It will not only reduce workers’ compensation program costs but increase morale within the workplace.

 

 

A Case Study in Preventable Workplace Falls

 

Falls within the workplace continue to be the leading cause of workplace deaths despite improvements and availability of cost-effective safety equipment.  This is mainly prevalent in the construction industry where workers engage in daily activities in a variety of settings and conditions.  This includes smaller residential construction projects, which account for a disproportionally high number of catastrophic workers’ compensation claims.  Preventing these incidents all starts with a proactive contractor dedicated to improving the safety on their job site.

 

Preventing falls from heights and elevated surfaces can be prevented by simple strategies:

 

  • Advance planning that includes understanding the job site and unique conditions employees might face when performing their work activities;

 

  • Making sure all employees and others on a construction site have the necessary safety equipment. This includes making sure the equipment is properly working and free from defect; and

 

  • Providing the necessary training on how to correctly use the safety equipment used in the workplace. A surprising number of work injuries and deaths occur when this equipment is not correctly used by employees.

 

 

Communication is Key!

 

The first step in preventing falls in the workplace is communication.  When it comes to workplace safety and a known safety risk, interested stakeholders can never communicate to its workforce enough.  This communication must also be effective.  Steps contractors can take should include:

 

  • The need for buy-in on safety and the expectations of all stakeholders from the beginning. This includes a commitment to working with employees and independent contractors before a project starts;

 

  • All employees need to have the right equipment when work is performed at elevated surfaces and heights. Expectations also need to be set for independent contractors who will work on a project; and

 

  • Proper training that is constant and effective. This must include teaching new employees and veterans the importance of workplace safety and how to use the equipment.  Consistent enforcement and immediate discipline for those who choose not to follow safety procedures is

 

The involvement of labor unions is also important.  Contractors and unions should have a common goal of promoting safety and avoiding falls from heights.  One step both sides can take is to promote the sharing of ideas and creating an atmosphere to create a safe working environment.  Reasonable accommodations should be made when implementing protocols and using equipment to prevent injury and death.

 

 

Operation Stand-down: Taking the Next Step in Workplace Safety

 

Interested stakeholders can also participate in the “National Safety Stand-down to Prevent Falls in Construction” project, which takes place May 7 – 11, 2018.  This is a time designed to bring awareness to the inherent dangers of working at heights, evaluating safety concerns on current job sites and implementing effective strategies in the future.

 

Useful resources are available for employees and employers at the following website: https://www.osha.gov/StopFallsStandDown/resources.html.  This free resource contains easy to use information such as posters, hard hat stickers and other resources to educate all interested stakeholders on easy to implement strategies.  It also has useful information to improve training programs when using ladders and scaffolding.  It also includes information on how to properly use personal fall arrest systems (PFAS).  This information is also available in other languages for employees who do not use English as their primary language.

 

 

Conclusions

 

Falls within the workplace continues to be a significant driver in workers’ compensation costs.  Notwithstanding free resources available to interested stakeholders, injury and death from falls continue to drive program costs.  Now is the time to be proactive on this issue.  Effective and constant training can reduce costs, but also improve workplace morale.

 

 

 

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.

U.S. Workers’ Compensation Prescription Drug Spending Decreased 3.3 Percent in 2017

ST. LOUIS /PRNewswire/ — Workers’ compensation pharmacy spending decreased 3.3 percent in 2017, according to new data released by myMatrixx, an Express Scripts (NASDAQ: ESRX) company.

“By merging the core capabilities of Express Scripts and myMatrixx to deliver superior clinical expertise, market-leading client experiences and innovative technology-based solutions, myMatrixx is now uniquely positioned to serve workers’ compensation clients and injured workers,” said Phil Walls, RPh, Chief Clinical Officer for myMatrixx. “We’re doing more to help clients balance appropriate care for injured workers while keeping costs down.”

 

More than half of myMatrixx Workers’ Compensation plans reduced drug spending last year.

 

 

Curtailing the Opioid Epidemic

 

Spending on opioids declined 11.9 percent for workers’ compensation payers in 2017.

 

For decades, myMatrixx has championed safe and appropriate use of opioids through solutions that leverage data, educate those at risk for adverse events and ensure connectivity across the care continuum. In addition, many states have taken action to address the opioid crisis through a multifaceted approach involving state-specific formularies, opioid guidelines and limits on initial opioid dispensing days’ supply and/or morphine equivalent dose.

 

These factors resulted in 74.2 percent of workers’ compensation payers spending less on opioids in 2017 than in 2016.

 

“While a decrease in the utilization of opioids is a positive sign for the workers’ compensation industry, there is still work to be done,” said Brigette Nelson, senior vice president of workers’ compensation clinical management at myMatrixx.

 

myMatrixx research found dangerous drug combinations and long-term use of opioids still pose care and cost concerns. Nearly 40 percent of injured workers took an opioid along with a muscle relaxant, while nine percent took an opioid and benzodiazepine. Taking these medications together can increase the risk of side effects and death from respiratory depression.

 

By deploying a holistic approach to manage opioid use, myMatrixx works with physicians, pharmacists and injured workers to mitigate the concerns of drug interactions or overuse.

 

Additionally, myMatrixx noted by the eleventh year of injury, the cost per injured worker reached $3,402.07, with $1,862.36 spent on opioid medications. Among those with age of injury of 10 years or more, more than half filled an opioid medication in 2017.

 

 

Compounded Medications Decline Further

 

For the third year in a row, spending on compounded medications decreased – a decline of 37.9 percent in 2017, falling out of the top 10 therapy classes.

 

While compounded medications continue to be a focus because of their high cost, it is clear that effective management strategies can reduce unnecessary costs and waste associated with clinically unproven ingredients.

 

 

Specialty Medication Utilization Remains Low, but Growing

 

Spending on specialty medications to treat conditions such as HIV and osteoarthritis increased 3.8 percent in 2017. While these drugs represent less than 1 percent of all medications used by injured workers, the extreme high cost per prescription requires payers to stay vigilant.

 

“Payers who have injured workers with occupational exposure to needle-sticks often include HIV medications on their formulary to ensure quick access to work-related HIV prophylaxis therapy,” Nelson said. “This therapy class saw the highest spending among specialty medications.”

 

 

Other Key Findings of the Workers’ Compensation Drug Trend Report include:

 

  • Generic fill rate increased to 85.6 percent across our workers’ compensation payers in 2017. Yet, payers could have saved $80.8 million through an optimal mix of clinically appropriate generic options.

 

  • The average cost of a physician-dispensed medication was $270.70, compared to $108.49 for a pharmacy-dispensed medication. This means plans paid a $162 premium for physician-dispensed medications which bypass pharmacist review at the point of sale. Of the medications dispensed by physicians, nearly half are used to treat pain.

 

  • On average, payers spent $1421.36 per injured worker for prescription medications in 2017.

 

 

About the 2017 myMatrixx Drug Trend Report

 

The 2017 myMatrixx Workers’ Compensation Drug Trend Report is among the industry’s most comprehensive analyses of workers’ compensation drug spending in the U.S. In its 12th edition, the research examines de-identified prescription drug use data of injured workers with a pharmacy benefit plan administered by myMatrixx. The report also includes analysis of state and federal government regulations and their impact on pharmacy-related challenges in workers’ compensation.

 

In calculating trend, prescription drug use was considered for legacy Express Scripts clients with a stable injured-worker base, defined as having a change in user volume of less than 50 percent from 2016 to 2017.

 

The comprehensive review of trends in prescription drug spending for workers’ compensation plans is available at myMatrixx.com

 

 

About myMatrixx, an Express Scripts company

 

myMatrixx® is a full-service workers compensation pharmacy benefit management company focused on patient advocacy. By combining agile technology, clinical expertise and advanced business analytics, myMatrixx simplifies workers’ compensation claims management. Located in Tampa, Florida, myMatrixx has positioned itself as a thought leader in the workers’ compensation industry.

 

For more information, visit myMatrixx.com

 

Media Contacts:
Phil Blando
202-258-4978
PJBlando@express-scripts.com

 

Ellen Drazen
314-684-5355
EVDrazen@express-scripts.com

 

 

SOURCE myMatrixx

Related Links

http://www.mymatrixx.com

Make OSHA a Partner for Workplace Safety Instead of a Pain

Make OSHA a Partner for Workplace Safety Instead of a Pain

The Occupational Safety and Health Administration (OSHA) was created at the federal level on December 29, 1970, with the goal of assuring “safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education, and assistance.”  Since its creation, the agency has evolved and become commonplace in the workers’ compensation scene as a means of investigating work injuries and providing information to interested stakeholders.  Parties seeking to reduce workers’ compensation program costs should understand OSHA and view the agency as a partner in making workplaces safe for employees.

 

 

Understanding OSHA Basics

 

There are many misconceptions about OSHA.  It is important to those seeking to provide a safe workplace to understand better the requirements and how the agency is responsible for enforcing safety standards.

 

OSHA standards and agency overview covers most private sector employers.  While it does not include many state and local government agencies, employees of these entities are subject to protections by the federal act and applicable state programs.

 

The federal act also allows states to create their own OSHA programs.  In these jurisdictions, the state agency receives funding from the federal government to run its program.  This allows states to develop their own standards, provided they meet the federal minimums required under the Act.  There are currently 22 OSHA approved programs that include: Alaska, Arizona, California, Hawaii, Indiana, Iowa, Kentucky, Maryland, Michigan, Minnesota, Nevada, New Mexico, North Carolina, Oregon, Puerto Rico, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, and Wyoming.

 

 

OSHA Rights and Responsibilities

 

OSHA mandates the creation of a series of rights and responsibilities that impact covered employers and their employees.  These issues are governed by the basic premise of OSHA – employees have a right to a safe workplace.  It is the responsibility of the employer to provide this environment.  Basic guidelines include the following:

 

  • Employers – Requirements to inform employees of workplace hazards and provide training on how to avoid injury. This provides information people are able to understand, which can include written information in multiple languages.  Accident information needs to be posted in common workspaces.  Prompt response to employee complaints and OSHA corrective action are required.

 

  • Employees – The ability to voice concerns without fear of retaliation. They also should have access to critical safety information.  This includes information concerning chemicals and other harmful materials in the workplace.  All employees need to understand how and when to report workplace incidents.

 

 

Using Workplace Safety Committees to Drive a Culture of Safety

 

There are no federal requirements for employers to have an established and functioning safety committee.  However, many state-based OSHA programs require these committees based on the size of the employer.  Even if one is not required by a state program, employers have found them to be useful in identifying issues, mitigating the danger and implementing cost-effective changes that promote worker safety and injury reduction.  Important steps for a committee to take include:

 

  • Prepare a plan for a safe workplace and best practices;

 

  • Create a safety program and written forms;

 

  • Prepare and present annual training on safety-related issues;

 

  • Initiate a workplace “self-inspection” program to review all safety practices and identify corrective action; and

 

  • Generally promote a safe workplace through legal, compliance and human resources departments. Be creative.  Consider hosting events such as a companywide “safety week” to make all employees aware of safety issues and foster a workplace environment dedicated to safety.

 

Additional information and guidance can be found in federal regulations, which are located at 29 C.F.R. §1960.36 et seq.

 

 

Partnering with OSHA for Workplace Safety

 

All OSHA agencies have resources available to employers concerned about safety.  While the nature of these services varies, it does offer stakeholders seeking to create a culture of compliance to work with OSHA on preventing workplace injuries.  Resources commonly found include the following:

 

  • Seminars and education sessions: These workshops are typically offered to employers free or at a nominal cost to educate parties on common workplace safety hazards.  They also offer tips on cost-effective improvements.

 

  • Safety Partnerships: This is an opportunity for employers to have an OSHA safety inspector visit their worksite or location to identify risks without being subject to fines.  The employer is then given a reasonable amount of time to correct any identified safety issues.

 

 

Conclusions

 

The goal of OSHA is to promote a safe workplace.  By understanding how the agency operates, interested stakeholders can foster an environment of compliance and provide safety to its employees.  In turn, this can reduce workers’ compensation program costs.

 

 

 

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.

If You Have a Workplace Policy Against Drunk Driving, Then Pay Attention…

Cell Phones Cause Death, Huge Costs, and Work-Related InjuriesIf you knew a certain behavior put your employees at a four-times greater risk of injury would you encourage it? Probably not. Yet many employers allow and even encourage workers to use cell phones while driving, despite the evidence showing the danger.

 

In addition to putting workers at risk, employers have been held liable for up to $25 million for employee crashes — even when they were using hands-free devices. Companies can protect their workers, greatly reduce their workers’ compensation costs, and steer clear of liability by implementing and enforcing distracted driving policies.

 

 

The Problem

 

Motor vehicle crashes are the #1 cause of work-related deaths each year, and distractions are one of the main reasons for accidents. Cell phone use while driving results in 1.6 million auto accidents annually.

 

Studies show people who drive while talking on the phone are 4 times more likely to have a crash, and those who text are 8 times more likely. Distracted driving also presents risks for workers in the area. In fact, distraction is the top cause of accidents in work zones.

 

The problem is our brains are not equipped to fully concentrate on both driving and cell phone use simultaneously. Driving and communicating via cell phone both require significant brain power. But the brain cannot focus it’s complete attention on more than one task, so it must choose where to focus attention, or split attention between two or more mental activities.

 

The effect is the area of our brain that processes moving images decreases by one-third when we are talking on the phone — whether it is a hand-held or hands-free device, since both are more cognitively demanding than having a conversation with someone in the car.

 

Drivers who use cell phones can miss seeing up to 50 percent of their driving environment. Several studies have shown talking on a cell phone (hands-free or not) while driving is comparable to driving while drunk.

 

One 2006 study showed “when drivers were conversing on either a handheld or hands-free cell phone, their braking reactions were delayed and they were involved in more traffic accidents than when they were not conversing on a cell phone. By contrast, when drivers were intoxicated from ethanol they exhibited a more aggressive driving style, following closer to the vehicle immediately in front of them and applying more force while braking.” This resulted in the conclusion “when driving conditions and time on task were controlled for, the impairments associated with using a cell phone while driving can be as profound as those associated with driving while drunk.”

 

 

The Liability

 

There are numerous cases showing the extent of employers’ liability for accidents caused by cell phone usage. Examples are:

 

  • A jury found that a driver and the company that owned the vehicle were liable for $21.6 million because testimony revealed that the driver may have been talking with her husband on a cell phone at the time of the fatal crash.
  • An off-duty police officer was texting moments before a fatal crash and because he was driving a police cruiser, his employer was held liable for $4 million.
  • An employee was involved in a fatal crash while making ‘cold calls’ as he drove to a non-business related event on a Saturday night. The firm did not own the phone or the vehicle, but the plaintiff claimed that the company was liable because it encouraged employees to use their car phones and lacked a policy governing safe cell phone use. His firm settled the lawsuit for $500,000.

 

Employers can be found legally responsible for negligent employee actions if the employee was acting within the scope of his employment when he crashed. Juries are increasingly finding against employers that fail to prevent distracted driving among their employees. Experts say the way to avoid that liability is by showing there is a policy against distracted driving and that it is enforced.

 

 

Distracted Driving Policy

 

A total ban on cell phone use is the best way to prevent distracted driving crashes. The ban should cover

 

  • All employees
  • All company vehicles
  • All company cell phone devices
  • All work-related communications
  • Both handheld and hands-free devices

 

Employers may also want to include personally-owned phones that are reimbursed by the company. And they need not worry about decreased productivity. In fact, there is research showing that not only is productivity generally not reduced, but in some cases it improves.

 

The policy should make the car a distraction-free zone, and include the following:

 

  1. Prohibit all non-emergency use of hand held or hands-free phones and mobile electronic data devices while driving or operating equipment.
  2. Require cell phones in cars to be put on silent and located in a purse, briefcase or the console.
  3. Allow cell phone use in cars only when the driver has parked in a safe location. That should be an area that is away from the road, such as a parking lot.
  4. Enforce the ban. For example, some companies give warnings to employees the first two times they are caught driving while using a cell phone, while a third violation is grounds for immediate dismissal.

 

Managers can help promote a culture of distraction-free driving by doing the following:

 

  1. Advise employees to carefully plan their trips, to see when and where they can park to make phone calls.
  2. Avoid scheduling conference calls during travel times for staff.
  3. Encourage employees to have a voicemail greeting that informs callers they are driving and cannot answer the phone

 

 

Conclusion

 

Where cell phones are seen as a great benefit to the workplace, they can be just the opposite when employees who use them while driving. Employers can reduce or eliminate the risk by implementing cell phone policies for driving, educating employees, monitoring compliance and enforcing the policy.

 

 

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.

RIMS Conference 2018 Preview: Go Big

RIMS Conference 2018: Go Big

RIMS 2018 Annual Conference & Exhibition is the premier event for the risk management community. If you have risk management responsibilities, GO BIG and join us in San Antonio this April. In the spirit of going BIG, we’re offering four new diversity and inclusion opportunities to ensure that everyone feels included and understood at RIMS 2018.  Learn more & register.

 

 

Alex Sheen to Deliver RIMS 2018 Opening Keynote

Alex Sheen is the founder of because I said I would, a social movement and nonprofit dedicated to bettering humanity through promises made and kept. Sparked by the loss of his father, Alex and his organization send “promise cards” to anyone anywhere in the world at no cost. Alex is someone who truly honors commitment. He once walked over 240 miles across the entire state of Ohio in 10 days to fulfill a promise. Since his father’s passing on September 4, 2012, because I said I would has sent over 4.47 million promise cards to over 150 countries. His charitable projects and awareness campaigns have been featured on ABC World News, CBS Nightly News, Fox News, The Today Show, Good Morning America and many other programs.

 

 

Booth 1426: Medcor Trailblazing Healthcare: Meet Champion Saddle Bronc Rider Jacobs Crawly

Medcor embodies the same entrepreneurial spirit held by the pioneers of the west. Visit Medcor and find out how we can chart a new path to better health outcomes for your workforce. Visit us at booth #1426 at RIMS 2018, April 16th through the 18th and meet champion saddle bronc rider Jacobs Crawley.

 

 

Booth 1417: Crawford / Broadspire / WeGoLook: Wanted – Open Claims with No End in Site

Learn about software, analytics, and strategic plans of action to quickly identify identify and neutralize issues that delay claim closure.

 

 

RIMS Community Service – Soldier Angels

Soldiers’ Angels provides aid and comfort to the men and women of the United States Army, Marines, Navy, Air Force, Coast Guard, their families and a growing veteran population. Founded in 2003 by the mother of two American soldiers, Soldiers’ Angels has grown from a grassroots effort to a national 501(c)(3) nonprofit organization. One of the largest nonprofits dedicated to supporting our military, Soldiers’ Angels has provided over $100 million in aid to service members and their families through care packages, food assistance and support items to patients in VA hospitals. The nonprofit coordinates over 150,000 volunteer hours each year.

 

 

RIMS Thought Leader Theater

The RIMS Thought Leader Theater (TLT) offers attendees additional education through a series of succinct, interactive discussions on a variety of topics. Visit RIMS HQ in the Marketplace to hear these high-speed 20-minute presentations not offered at any other time during the conference.

 

 

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.

What To Expect From A Structured Settlement Consultant 

Injured workers who settle their claims are increasingly looking to settlement experts to help smooth the process. One of the key players in the equation is the structured settlement broker; the person who helps bring the case to resolution.

 

But there are many companies and individuals under the umbrella of ‘structured settlement broker,’ and they do not all function alike. It’s important to understand what they do — and what they can do — to ensure the settlement is truly a win-win for all parties, especially the injured worker.

 

 

Broker vs. Consultant

 

Planning a settlement is much more involved and complex than many may think. It requires more than just getting the money to the injured worker. There are many administrative and governmental issues that may need attention. Also, the injured worker may have needs beyond those of the immediate future must be taken into account. This takes a well-thought-out strategy.

 

The role of a structured settlement broker is evolving. The idea of setting up a transaction, signing the paperwork and then ending the relationship is over. The best companies to handle claims settlements are those that act as consultants to injured workers, understanding their needs and bringing in the best people to handle them.

 

Each settlement must be customized to fit a specific injured worker. Among the issues that may require involvement by experts are:

 

  1. Lien resolution.
  2. Financial planning.
  3. Tax consequences.
  4. Government benefit programs.
  5. Legal issues.
  6. Retirement planning.
  7. Insurance concerns.
  8. Future college education for children or grandchildren.

 

The consultant should know various settlement tools that can address these issues. For example, a consultant that works with insurance planners can provide comparative information on insurance products, such as disability or long-term care insurance. Having the benefit of an expert in Medicare Set-Asides available can ensure compliance and reporting issues are addressed, so future benefits are not put at risk.

 

These experts can be brought into the process early on, so the settlement is set up appropriately. Rather than just running quotes, the structured settlement consultant should act as the general contractor in identifying, bringing and managing the best experts to the table.

 

The consultant’s services should also be completely fee transparent, and come at no cost to the injured worker.

 

 

Examples of Issues and Players

 

Many circumstances may be overlooked in the settlement process. Working with an experienced structured settlement consultant can reveal and address those, such as:

 

  • Attorney Fee Deferrals. There are many ways to structure attorneys’ fees to allow money to be used in the future. Money deferred can be used for supplemental retirement funds, protection against inflation with cost of living adjustments, and potential avoidance of the Alternative Minimum Tax, for example.

 

  • Calculating realistic future medical costs. A top-notch structured settlement consultant should be able to show comparisons of the current costs of medications and procedures relevant to the injured worker with discounted costs offered through the consultants’ networks.

 

  • Trust funds. Trusts can be a great benefit to manage and protect assets, regardless of the person’s wealth level. Proper planning requires establishing a trustee, identifying beneficiaries, and determining how the assets should be held, invested and distributed. A qualified structured settlement consultant should be able to provide unbundled, transparent and competitive administrative and investment advisory pricing that will ultimately save money for the injured worker.

 

 

Collaborative Process

 

A successful structured settlement begins with a positive relationship between the injured worker and the consultant. A typical injured worker who is thinking of settling his claim is likely unaware of many issues he will face in the years ahead for which he is not prepared. By working closely and getting to know the injured worker the consultant can proactively identify concerns that may arise over the person’s lifetime.

 

The consultant and injured worker should work together as a team to find the optimal solutions. Bringing in the consultant as early as possible in the process allows him to become better acquainted with the injured worker and uncover his short- and long-term needs.

 

Once the settlement is reached, the consultant should ensure there will be someone to continue acting as a support and guide. They should have relationships with professional administrators who work with the injured worker throughout his life, guiding him through the many regulatory and medical mazes he will face.

 

 

Summary

 

The expectation for a structured settlement broker is a company that brings value beyond just the transaction itself. It should be a consultant that oversees the entire process, with the injured worker and his needs at its core.

 

 

 

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.

Make Your Workplace Safety Committee Successful to Reduce Work Comp Costs

Workplace Safety Committees Reduce Work Comp Costs Employer safety committees play an important role in promoting a safe work environment.  Their function is not limited to reducing workplace injuries.  They can also assist in injury response and educate others within the workplace.  If a committee is well run, they can also promote the reduction of workers’ compensation program costs.

 

 

What is a “Safety Committee?”

 

A safety committee is comprised of members from an employer that assist leadership in promoting workplace safety.  Depending on labor rules, these committees can be required in some instances.  Regardless of the regulatory requirements, they serve an important role in a number of functions:

 

  • Health and Safety Planning: All employers need procedures for a safe workplace. This includes the handling of chemicals or harmful materials, the use and operation of equipment and how one responds to workplace injuries;

 

  • Enterprise accountability: Committees can help other interested stakeholders such as human resources, legal and compliance evaluate the safety within the workplace.  Involving additional people can add credibility to a safety program and promote acceptance of best practices companywide; and

 

  • Accident Investigation: It is essential to go beyond the minimum steps when responding to an injury. An active committee can refine processes and make recommendations to improve conditions.  Avoiding accidents in the best way and most cost-effective approach to preventing workplace injuries.

 

 

The functions of a safety committee are without limit.  Be creative.

 

 

Defining the Roles of the Safety Committee

 

All safety committees should meet on a regular basis and follow an agenda.  It is essential leadership within a company respects the wisdom of the committee and is willing to promote change.  This starts with having a defined chain of command within the committee structure.  Common committee structures include:

 

  • Chairperson: This should be a recognized leader within an organization who has direct access to upper management.  This person establishes meeting agenda and conducts orderly meetings;

 

  • Vice-chairperson: This person should also have influence within an organization.  The position serves as a back-up to the chairperson and also serves on a subcommittee, or is active in committee activities;

 

  • Secretary: Minutes should be taken of all committee meetings that accurately reflect what was discussed and action that will be taken.  These minutes should be compiled in a log that is accessible to all company employees and is distributed promptly to committee members following meetings; and

 

  • General Members: There is no “right” size for a committee.  Membership on the committee should represent different areas within the organization such as administration, operations, and personnel.  Membership on a committee should rotate to obtain input from employees with varying experience and knowledge of an organization.

 

Labor union leaders or representatives should also be included, if applicable, as they would be aware of specific workplace rules.

 

 

Making Your Safety Committee Successful

 

There is no specific recipe for a successful safety committee.  Common traits of committees that make the most impact within an organization include the following:

 

  • Consistent scheduling of committee meetings: Special meetings can be held to address important concerns as they arise on an ad hoc basis;

 

  • Consistent advertising and announcements: It is important to all employees to know what is going on with a safety committee and whom to contact about concerns.  By publishing agendas and meeting minutes that are accessible to all people, employees feel empowered to make a positive change within their organizations;

 

  • Consistent attendance of committee members: Committees can only function and operate when its members attend meetings.  By accepting a position on a safety committee, people need to make it a priority.  The names of members in attendance should always be accurately listed on meeting minutes; and

 

  • Consistent flow of information on committee accomplishments: It is important to let co-workers know what is going on at committee meetings and projects it is working on during the course of business.  Effective committees have bulletin boards or Intranet pages dedicated to committee projects and operations.

 

 

Conclusions

 

Interested stakeholders in workers’ compensation programs can implement a safety committee to improve the workplace environment and reduce costs.  The key to an effective safety committee is creativity and consistency.  It also requires engagement by all employees within the workplace to reinforce the message of best practices and not cutting corners when it comes to avoiding and improving response to work injuries.

 

 

 

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.

20 Workers’ Comp Claims Handling Best Practices

20 Workers' Comp Claims Handling Best Practices

Often you see references to “Best Practices” in the handling of workers’ compensation claims without an explanation as to what they are or what the insurance industry standards are for handling work comp claims. While “Best Practices” vary slightly from insurance company to insurance company, here is a synopsis of the basic standards of how the insurance adjuster handles work comp claims.

 

  1. Coverage:

 

The very first thing a work comp adjuster does is verify the coverage by checking the policy number, policy dates, and insured name.

 

 

  1. 3 Point Contacts:

 

The adjuster makes voice contact (in person contact on severe claims) with the employer, the employee and the treating physician within 24 hours of the claim being reported to the claims office.

 

Proper contact involves an exchange of information with the employee, the employer and the doctor’s office, not just leaving a voice mail or sending a form letter. On claims of questionable compensability or with subrogation potential, a recorded statement from the employee needs to be obtained.

 

 

  1. Investigation:

 

The adjuster addresses all issues affecting coverage, compensability, subrogation, extent of injuries and benefits within 14 days of the receipt of the claim.

 

 

  1. On-going Contacts:

 

Consistent and on-going contact with the employee (or attorney), the employer and the medical providers are essential to getting the employee back to work as quickly as possible.

 

 

  1. Data records:

 

All data input is completed within 72 hours of receipt of the claim. These sample data items must be correct on every claim: loss location codes, body part codes, and description of injury codes.

 

 

  1. Reserves:

 

The initial file reserves are usually set at the completion of the 3-point contacts and within 72 hours of the claim being reported. Once the adjuster obtains the initial medical records, the reserves are reviewed for accuracy. Any subsequent medical records or other information impacting the value of the claim usually results in a reevaluation and changes in the file reserves.

 

On severe claims where the file remains open for an extended period of time, the reserves must be checked for accuracy ever 6 months.

 

 

  1. Average Weekly Wages:

 

The adjuster obtains information documenting the employee’s wages within 14 days of receipt of the claim.

 

 

  1. Compensability:

 

The basis for the acceptance or the denial of a claim is documented in the file within 14 days of receipt of the claim.

 

 

  1. Payment of Benefits:

 

The file clearly outlines how the indemnity benefits were calculated and confirm the benefits were paid on time (varies per jurisdiction).

 

 

  1. ISO Filing:

 

The index filing is completed within 14 days of receipt of the claim. (Most companies have gone to index filings on only the lost time claims). If the index filing reflects a prior claim, the work comp adjuster follows-up with the prior insurer for information on the prior claim.

 

 

  1. First Reports (Claims Handled by TPAs):

 

When claims are handled by a third-party administrator (TPA) rather than the insurer, it is standard for the TPA to provide a report to the insurer within 14 days outlining the coverage, jurisdiction, compensability, medical management, benefits, subrogation (if applicable), subsequent injury fund (if applicable), reserves, payments and action plan.

 

 

  1. Status Reports (Claims Handled by TPAs):

 

Regularly scheduled status reports updating the insurer on file developments are completed by the TPA’s work comp adjuster. Depending on the status of the claim, the status reports may be every 30 days, 60 days or 90 days, however important developments on the claim is immediately reported to the insurer.

 

 

  1. Action Plans:

 

The file contains an outline of the steps the adjuster plans to take to bring the file to a conclusion. The outline contains a date for each issue, problem or concern to be resolved.

 

 

  1. Medical Management:

 

The work comp adjuster knows the nature of the injury, the cause of the injury, the treating physician’s diagnosis, the prognosis, the treatment plan and the return-to-work status. On severe claims, the adjuster coordinates/supervises the nurse case manager’s involvement in the claim.

Where applicable, the adjuster (or the nurse case manager) provides the treating physician with the necessary information for utilization review and pre-certification.

 

If the adjuster’s office utilizes a medical bill review company to verify proper billing, the adjuster must be sure the medical bills are provided to the vendor for processing.

 

 

  1. Return to Work:

 

The adjuster coordinates with the employer and the medical provider the employee’s to return to work as soon as possible on modified duty or full duty, as appropriate.

 

 

  1. Subrogation:

 

As part of the investigation, the adjuster determines if any third party can be held responsible for the employee’s injury. If so, the adjuster places the third party and their insurer on notice of the intent to subrogate. Once the claim is concluded, the adjuster or the designated subrogation adjuster pursues recovery of the amount paid on the claims.

 

Subsequent Injury Fund/Other Offsets:

 

  • In the jurisdictions with a subsequent injury fund, the fund is placed on notice of the claim as soon as medical information reflects the potential for recovery from the fund.
  • The file reflects how social security disability benefits, short-term or long-term disability benefits, unemployment benefits or any other benefits the employee is receiving will impact the amount paid on the claim.

 

 

  1. State Filing:

 

Properly completes and files on time, all state required forms.

 

 

  1. Litigation Management:

 

All files requiring defense counsel are assigned to counsel on time. The initial assignment of the file to defense counsel provides instructions to counsel on how the adjuster wants to proceed with the claim. Any issues or disputes are brought to defense counsel attention with a request for counsel’s recommendations.

 

A litigation budget is submitted by the defense attorney outlining the projected cost of defending the work comp claim.

 

The adjuster provides defense counsel with on-going instructions on how the adjuster wants to proceed with the claim. All reports from the defense counsel are reviewed and answered as appropriate.  All billing from defense counsel are reviewed and approved, if appropriate or questioned, if needed.

 

 

  1. Diary:

 

When the adjuster completes the initial 3-point contact, all further activity on the file is planned and placed on the adjuster’s calendar for completion. All issues noted in the Action Plans are given a diary date for completion. The diary is kept current until the file is completed.

 

 

  1. Progress Notes:

 

Every activity completed by the adjuster is noted in the file notes. The file notes are clear, comprehensive, concise and understandable.

If the adjuster completes each of these “Best Practices,” the quality of the work comp claim file reaches a high standard, and claim resolution is appropriate.

 

 

 

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.

 

Professional Development Resource

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