Surveillance Cameras Can Make Difference In Work Comp Claims

I always laugh when I hear my friend talk about the fact that “Big brother is watching us.”  Really, what does that mean?  I’m sure the government has bigger things to do than watch my pal’s daily activities.  This guy is the last of the great types of people out there. For example, he has never paid a bill online.  He doesn’t own a cell phone. He refuses to join those clubs at the supermarket so you can get the discount card because “They will track what I buy, and I don’t want them to know my weekly grocery list.”

 

I’m serious, this is a real guy.  He is a great friend, and a great insurance professional, but I really think he needs some professional help. These days everything is intertwined. Social Networking, internal company networking, outside work groups and seminars, etc.  Everyone learns a lot of everyone else because they see each other at the same seminars, they mingle at the same vendor day outings, and they talk about current events over lunch, etc.

 

The point of this is that we are all aware that someone is indeed watching our activities to some degree.  It may not be satellites from outer space that are focused on following us around, but a lot of businesses have surveillance cameras and they use them all day, every day.  The reason for the cameras will vary from employer to employer, but it is safe to say that the main reason is for security, and the second reason is for being able to obtain evidence should something happen to an employee or customer. What are the benefits of having cameras around your workplace?

 

1.   Obtaining video evidence

 

Having some video footage of an injury or crime is fairly concrete.  The tapes will not lie.  If you can identify the subject on the videotape, it is damning evidence against them should they try to say that they are not guilty of whatever wrong that was committed.  Now that most videos are digital, these files can be emailed and downloaded to your insurance company no matter where they are located. An adjuster has a picture in their mind of how the injury or act was committed, but being able to see actually what happened can really nail the defense of a claim.

 

 2.   Increased safety

 

If an employee knows that the cameras are rolling they are less likely to take a safety risk while working.  Workers will cut corners now and then in any capacity. Sometimes these corners will lead to an injury.  Most jurisdictions have a defense against injury caused by a direct violation of safety protocol.  If you take the video evidence away, you lose some of the structure to your defense of a claim.

 

 3.   Employees know you they are being watched

 

Employees behavior will change if they know they are being watched, especially when it comes to horseplay around the workplace.  A degree of horseplay is to be expected at work, whether it is harmless or not.  In fact, most jurisdictions allow work comp coverage of a horseplay injury to some extent.  Of course, not all employees will be aware of this fact.  Just the presence of cameras will lessen horseplay overall, which will save an injury at some point.  I have seen countless claims as a result of horseplay, some minor in nature and some that result in surgical intervention.  Any way that you can decrease these claims should be seen as a positive.

 

 4.   Psychological impact

 

Going back to my paranoid pal, you can see the psychological impact that cameras can have.  Workers will be on their best behavior if it is known that there are cameras around and that these videos are constantly being reviewed.  Several studies have been done that show the positive impact of cameras in the workplace, so why should you not implement them at your work?

 

 5.   Camera review opens a light duty job possibility

 

I have worked with a lot of employers that use videotape review as a light duty job with employees that have medical restrictions from a comp claim.  They will monitor the closed circuit TVs, watch for spills, report theft or suspicious behavior, and also be in charge of tracking and labeling the video files for storage.   This is not the most glamorous job in the world, but it is one that needs to be done.  It is also job that benefits the employer, especially if it helps to deter theft.

 

 

Summary

 

The use of surveillance cameras in the workplace is nothing new.  Employers that use them have less injury, especially from questionable incidents around the job floor.  My advice is to look at your options and get some consultations on how this can benefit your workplace.  The cost of the equipment is little in comparison to the cost of a severe injury happening at your workplace.

 

 

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

WORKERS COMP MANAGEMENT MANUAL: www.WCManual.com

VIEW SAMPLES PAGES

MODIFIED DUTY CALCULATOR: www.LowerWC.com/transitional-duty-cost-calculator.php

 

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

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

 

Is Your Adjuster Playing Favorites With Your Claims

Adjuster Will See Thousands of Claims

 

Throughout the course of an adjuster’s career they will handle hundreds if not thousands of claims.  Most of these claims will be audited for company and state compliance, and plans of action will be discussed on all of them.  Whether to deny or accept claims can be based on a multitude of factors using the comp statues and company policies as guidelines.

 

There are no two claims that are exactly alike, the same way that there are no two adjusters that are identical.  There is room for interpretation in this field of workers compensation.  Adjusters will review the details of a claim and make a decision on the compensability based on their investigation.  But not all of these factors are based purely on law alone.  There are plenty of personality factors that are taken into account, especially when dealing with subjective claims where the claim is questionable.  But why would one person’s claim be accepted, when another person with similar circumstances could be denied?

 

 

Reputation of the injured worker

 

One of the questions a claims adjuster will ask the employer is if this claimant is a credible worker.  Since the employer deals with this worker day in and day out, they get to know whether this worker is a “troublemaker” or “dramatic” over the course of time. Some workers are known for being drama kings and queens, where they can complain about every little thing.  Other workers are workhorses, complaining little if at all about the work and just putting their nose to the grindstone and getting the job done day after day.  When it comes to subjective injury, especially one that is not witnessed, the claims adjuster will hold a lot of weight on the worker’s credibility. Sometimes this fact alone can determine whether or not a claim is accepted or denied, where the adjuster will lean towards denial of the claim based on credibility of the worker alone.  This is by no means applicable to all cases, but it can come up in the minor ones.  This fact can be very true if the worker has a history of reporting injuries about every little nick or strain.

 

On the other hand, if a “good” worker has a subjective injury, and little to no injury history, then you can bet that the employer will pass that on to the adjuster. Chances are that this claim would be accepted just based on the fact that this particular worker is never hurt, a good worker, and because they reported an injury means that they are probably in need of some medical assistance to recover.  Whether this is considered ethical or not is in the eyes of the beholder, but it is a reality.

 

It can be viewed as negative in the eyes of an adjuster if the worker was recently moved, assigned a different job, suffered a wage decrease, or was recently disciplined.  It can be seen as “getting back” at the employer if one of these events happens and all of the sudden a worker claims an unwitnessed subjective strain injury.  Whether it was warranted or not, employees can harbor some resentment towards their employer for whatever “wrong” was committed.  A lot of workers see filing an injury as a way to get back at their employer.  But just because they file an injury doesn’t mean that it will be accepted. This will come down to the investigation of the adjuster on the aspects of the claim.  Sure an injury was reported, but if it was not witnessed and the doctor cannot find anything wrong with them, did an injury actually occur?

 

 

 

90% of Claims Are Accepted

 

Keep in mind that for the most part, approximately 90% of claims are accepted.  The adjuster sees payment of a few medical bills as less costly than if they deny the claim and the worker files a lawsuit for comp benefits.  If this were to happen, the adjuster is now faced with legal fees which would probably be triple what the claim would cost if they had just accepted it, so they may accept it based on that fact alone. It will depend on the facts of the case, the reputation of the employee, and the medical details.  If nothing seems to add up, then you can bet the claim will be denied or disputed. The burden of proof is always on the injured worker.

 

 

Rapport Between Adjuster and Injured Worker

 

Maybe the most important factor in claims such as these will be the rapport between the adjuster and the injured worker.  Sometimes the relationship is like oil and water.  If this is the case, the adjuster may default to questioning everything, and making the claimant do everything by the book exactly.  If the relationship is rocky the adjuster leans toward an overall denial versus acceptance.  Especially true will be those claimants that call the adjuster over and over and over again, but not in a positive way. Saying that the “squeaky wheel gets the grease” is not always true. Sure it is common for someone to have questions about their claim, but when it turns negative in nature, adjusters are taught to notice that something may be up. That will make them take another look at the claim to make sure everything adds up.

 

On the other side of the coin, let’s say the adjuster and the injured worker click for whatever reason.  The employer sees the worker as a “good guy” and the investigation doesn’t turn up anything to go crazy about.  In this scenario, adjusters are likely to give an injured worker the benefit of the doubt.  This adjuster can let a few things slide and can push the claim towards compensability versus a denial, based on their relationship alone.

 

 

Is This Ethical?  Not Really.

 

So is this ethical?  Just because two people do not seem to see eye to eye, does that mean that their claim should be denied due to a personality conflict?  The answer depends. Ethical adjusters can look past any personality flaws and focus purely on the facts of the case, and they can make their decision on compensability based on that alone.  For all intents and purposes that is the proper way that adjusters should conduct themselves.  However, this is not reality.

 

This is where managers and audits should come in to play.  Even if everyone on Earth did not like said claimant, that should not mean that this worker cannot get their fair shake when they file for a work injury. This point should be taught to newer adjusters, and the veteran adjusters should be reminded of this from time to time.  This is the proper and professional way to conduct the determination of claims, day in and day out, no matter how little or how often you have to argue with a claimant.  Personal feelings and attitudes need to be left in your car in the parking lot when you come in to work. They should not influence if a claim is accepted or denied.

 

 

Summary

 

Adjusters will get along with some people, and they will have conflict with some people.  That is the nature of the business.  But professional adjusters can leave their personal opinions outside of the workplace, and handle claims based on the merits of their investigation.  If the employer does not see this happening, then something needs to be said to the adjuster.  Everyone deserves the right for a fair, non-biased claim investigation and determination.

 

 

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

 

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

WORKERS COMP MANAGEMENT MANUAL: www.WCManual.com

VIEW SAMPLES PAGES

MODIFIED DUTY CALCULATOR: www.LowerWC.com/transitional-duty-cost-calculator.php

 

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

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

 

Identify Real Cost Drivers in Post Loss Workers Compensation

Best Practices Approach to Post-Loss Costs Containment.

A solid workers’ compensation cost control program requires an employer to first identify the key cost drivers; i.e., those company-specific factors causing workers to stay out of work too long.

Many companies that take a hit or misidentify the causes of their workers’ compensation costs. They start by looking at what their vendors are doing, rather than at their own internal company practices. Employers need to follow a systematic method to diagnose the key real-cost drivers within their company, based on a best practices approach to post-loss (not pre-loss) cost containment. Employers would be wise to write an assessment of their own internal company practices to address post-lost costs containment.

 

Items to Consider Before Writing Your Assessment:

  • What can managers learn from an assessment?
  • What methods could assess a company’s workers’ comp process?
  • What are the benefits of each?
  • What areas should be reviewed?
  • Who should do the assessment and what are the benefits of each?
  • What should a company do AFTER the assessment?

After an assessment, employers need to decide the next steps in reducing workers’ compensation costs.

 

 

Do Not Wait to Take Action

 

Some companies wait until they are in serious trouble before taking action. They think of workers’ compensation as a cost of doing business and do not realize there are things they can do to control costs. Do not to have a perfect system in place before beginning. Often the process of doing the assessment is the start of the process of change.

 

 

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

 

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

WORKERS COMP MANAGEMENT MANUAL: www.WCManual.com

VIEW SAMPLES PAGES

MODIFIED DUTY CALCULATOR: www.LowerWC.com/transitional-duty-cost-calculator.php

 

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

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

 

It is Deer Hunting Season, Be Aware of a Spike in Work Comp Claims

Deer Season Can Equal Spike in Work Comp Claims

 
Fall has arrived.  Time is say goodbye to days at the beach and trade in your golf clubs for shotguns or bows and arrows.  In the early Fall, whitetail deer season is a tradition among many families.  These hunters dress up in their camouflage fatigues and paint their faces in order to try and bag their trophy buck.   It is a time to become one with nature and to spend time with family and friends at the deer cabin or the family cottage.
 
What does this mean for employers?  The answer is simple: a spike in work comp claims.  Although I have not seen many formal statistical studies, I know from years of experience that this time of year creates spikes in lost work production time due to worker absences. I know of many people, hurt or not, that would drag themselves out to their deer blinds no matter what type of pain they are experiencing.  Many people hold deer season in very high regard due to the tradition of families spending time together away from home roughing it in rural areas around the country.  So what can you do to protect yourself from questionable comp claims around this time of year?
 
 
 
Do a Thorough Investigation
 
Be it this time of year or not, the best defense you can have in any comp claim is a thorough investigation.  Some workers may plot to have a “work injury” around this time of year so they can get the allotted time off to go hunting.  It may start off simply enough in the form of casual conversation around the water cooler talking about an injury that may or may not have occurred. Bill may say to you “Boy my back sure is sore today, I think I may have overdid it the other day unloading inventory off the truck.”  You ask them if they are ok and if they need treatment.  Oftentimes they will say they do not, and they do not want to file a claim or anything, since this “injury” should get better on its own. But they will let you know if they need treatment or need to file an actual comp claim for the “injury.”   
 
Then a month later when deer season comes around, Bill heads up to your office and says he has been receiving treatment and his doctor says he needs to take some time off of work. In addition, he should file a comp claim so his bills can be paid.  Be this a work injury or not, you still need to complete your investigation by sitting Bill down and asking him the normal questions about the injury, getting his medical information from his doctor, and asking about witnesses and other pertinent information.  Be sure to follow up and be as thorough as possible.  Just because Bill said he was injured at work a month ago doesn’t make that entirely true.
 
 
 
Gather the Facts
 
Be honest when Bill comes to your office asking you if you remember him mentioning an injury to you a month ago.  Sometimes employers are afraid to say no, fearing that they could get in trouble for not documenting something.  Chances are you may not remember, and that is OK.  But if you want to be more proactive, when an employee comes to you and mentions an injury, no matter how insignificant it may be or however casual the conversation, you should always jot a note down and put it in his personnel file for future reference.  You do not have to do a full blown investigation at that time, but it is a good idea to get some general details and get some potential witness names, then go talk to those witnesses and see if Bill’s story checks out.  If you have that feeling that something isn’t right, file the claim and send him to your occupational clinic and have the doctor do an evaluation.  Chances are if this injury isn’t entirely legit, the doctor will release Bill from care without any work restrictions.  When this happens, it automatically derails Bill’s idea that he can bring this injury back up at a future date. 
 
 
 
Be a Proactive Listener
 
No matter what time of year, you should always be a good listener.  You spend a lot of time with your workers day after day, year after year.  You may already know the people that are avid in outdoor activities such as hunting, fishing, snowmobiling, etc.  You may know that Chuck has a cottage up north where his family goes a few times a year to hunt or vacation.  In addition, other workers may unintentionally spill the beans on their coworkers.  If you are in the lunchroom and hear a conversation between some coworkers about another worker “planning some extra time off around the holidays by saying they got hurt at work” then it is probably a good idea to make a note of that. 
 
Now this is not to say that you can deny a claim based on some hearsay you obtained one day a few months ago.  But, it may remind you that someone knew this was coming, and it certainly won’t help them try and pull the wool over the eyes of their adjuster that is handling the claim.  Little tidbits of info like that are priceless to an adjuster.  That information alone can be what it takes to get the adjuster to take an extra close look at the claim, and sometimes that is what you need in good overall aggressive claims handling.  Perhaps Bill really did get hurt, and if that is the case and all of his details check out, then fine.  But if not, and the claim is questionable, then you may have prevented financial leakage by paying for a work injury claim that was never work related to begin with.
 
 
 
Accommodate Work Restrictions
 
Nothing is better at stopping a mini-vacation from work like not being able to be off in the first place.  Your workers are not dumb.  They know by being around the work floor that anytime someone gets hurt, they are never back to work until they are fully released from their doctor.  This is ammo they can use against you down the road when it is their time to claim a work “injury.”  By being flexible and accommodating medical restrictions whenever possible, workers know that just because they may get injured it doesn’t mean that they will be off of work until the doctor releases them from care. 
 
One of the best deterrents against questionable soft tissue work injury claims is providing light duty work while they rehab from said “injury.”  Workers know that they cannot cash in easy time off of work just by claiming they are hurt, and the more examples they see of this the better.
 
 
 
Summary
 
The arrival of deer season will possibly create a spike in work comp claims around your workplace.  But by taking notes, gathering facts, being a good listener, and accommodating medical restrictions you can take a leg up on your potential workers planning an extended vacation to go bag their trophy buck.  In the end, these claims cost you money in the form of dollars spent and possible increased insurance premiums.  By following the guidelines above, you can keep these workers in check and focus on more important issues. 
 
 

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

 

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

 


WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com

VIEW SAMPLES PAGES

MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php

 

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

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

Many Injured on Job in New Hampshire Did Not Receive Workers Comp Coverage

 

According to a new report from New Hampshire’s Department of Health and Human Services, merely half of the people who were injured while working in New Hampshire in 2008 had their medical costs covered by workers compensation. The survey was released by the NewHampshireDepartmentofHealthandHumanServices, titled “Work Related Injuries 2011.”
 
“Our study estimated that only about half of those employed for wages and injured seriously enough to require medical treatment had some or all of their treatment paid for by workers’ compensation,” according to the report. “This represents a substantial financial burden falling on private and public insurers as well as on individual families.”
 
The report cautioned, however, that the data, collected from telephone surveys in 2008, is imprecise “due to the small number of respondents reporting on payment for treatment.”
The total report was based on phone surveys of 6,892 adults. It indicated that close to 5 percent of workers had been injured at work seriously enough to need treatment in the prior year, which it stated was consistent with the levels discovered in other states.
 
The surveys have been conducted for many years, but 2008 was the first year that questions were included about compensation, partly out of concern that lack of payment options leads to underreporting of injuries on the job. If there’s no chance of getting medical costs covered, there’s little incentive for workers to report injuries.
 
The data in the report indicate several trends, including:
 
.      Manufacturing industries are on the decrease in New Hampshire
 
.      From 2000–2008 there were 127 work-related fatalities in New Hampshire
 
.      In NH, between 2002 and 2007, 6% of all Emergency Department discharges of patients age 16 and older, were paid for by workers compensation, compared to the U.S. as a whole, where only 2% of ED discharges of patients age 16 and older were paid for by workers comp.
 
.      Between 2002 and 2007, 28% of all NH ED visits with the expected payer of workers comp involved traumatic amputations. Of these work-related amputations, 85% involved amputation of finger(s) and 15.4% involved amputation of the thumb, compared to the U.S. where 21% of all visits involved traumatic work-related amputations, 98% of which involved amputation of the finger(s) and 15% involved amputation of the thumb.
 
.      In 2008, workers comp awards to injured workers totaled $239,290, with the average workers comp award per covered New Hampshire worker totaling $354.
 
.      More than 47,000 New Hampshire workers are employed in high mortality risk. occupations.
 
.      More than 78,000 New Hampshire workers are employed in high mortality risk industries.
 
The survey also discovered that, in general, workers with more education had fewer injuries, presumably because they were less likely to work in physical jobs. While 4.9 percent of all New Hampshire workers came forward with an injury, the rate was 14 percent among those who did not have a high school degree, just 2.3 percent among those holding bachelor’s or higher degrees.
 
Another cautionary piece of information from the authors was that the survey did not cover illness, only injury, so that chronic ailments caused by workplace conditions are not included.
 
The survey was released by the NewHampshireDepartmentofHealthandHumanServices, titled “Work Related Injuries 2011.”
 
“This comprehensive report looks at the core occupational health indicators of work-related injuries and illnesses,” said Dr. José Montero, director of Public Health at the New Hampshire Department of Health and Human Services. “The report contains some important data and we hope it will be useful to our partners and the people of New Hampshire in preventing such injuries in the future.”
 

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

 

 


WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com

VIEW SAMPLES PAGES

MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php

 

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

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

Three Areas Where Best Practices for the Employer Can Make a Difference

 
We often hear about “best practices” for workers compensation claims-handling by the adjuster. Best practices are guidelines used throughout the insurance industry to provide full benefits to the employees while protecting the insurer and the employer from too much being paid on the claim.
 
 
Best practices for the employers work in a similar manner. The following guidelines are designed to assist the employer in controlling the workers comp claims cost while providing the injured employees with all the benefits to which they are entitled.(WCxKit)
 
 
There are three areas where best practices for the employer can make a significant difference. The areas are:
 
1.     The pre-injury best practices.
2.     The injury best practices.
3.     The claim handling best practices.
 
 
1.  Best Practices Pre-injury
Prior to the time an employee reports an injury, there are many things the employer can do to prevent the claim from ever happening. Among these best practices would be:
 
1.     Have a strong safety program.
2.     Have an awards program that provides recognition and prices to the department that has the best safety record.
3.     Tie management bonuses, raises, and promotions to the safety record.
4.     Train all supervisors/managers on proper procedures for reporting an injury claim.
5.     Include an employee accident brochure outlining what the employee needs to do in the case of an injury in the new hire package.
6.     Post the injury procedure where all employees will see it.
7.     Post state-required posters on workers comp next to the poster reminding all employees that workers comp fraud is a crime and will be prosecuted.
8.     Have a medical provider network in place.
9.     Post the required medical providers (in the states where the employer selects the medical provider) or the recommended medical providers (in the states where the employee can select the doctor) where all employees will know who to treat with in the case of an injury.
10.  Have a written transitional/modified duty program ready for employees who can return to work with restrictions.
 
2.  Best Practices for the Injury Occurrence
For the employer to control cost and to assist the employee, the following best practices are recommended when an injury does occur:
 

1.     Obtain immediate medical assistance for the employee – guide the employee to the appropriate medical facility.

2.     Call the medical facility and advise an accident just occurred, the nature of the accident and the type of injury to allow the facility to be ready immediately upon the arrival of the injured employee.

3.     Advise the medical facility of the light duty jobs you can offer the employee.

4.     Do not allow the macho man to delay treatment of minor injuries – the employee will end up seeking medical care from their family doctor or hospital emergency room, the cost will be higher and the control over when the employee can return to work will be diminished.

5.     Have a goal of returning all injured employees to work within 3 days unless the employee is unable to perform any role for the employer.

6.     Report the claim immediately to the claims office with full details.

7.     Provide all necessary state forms to the claims office or the appropriate department within the state government.

8.     Place on your calendar a weekly reminder to contact the employee until the employee is ready to return to work.

3.  Best Practices Post Injury
The employer needs to continue to manage the work comp process. The best practices for the employer after the injury include:
 

1.       Contact the claims office to confirm receipt of the first report of injury, wage documentation, and any other information that should have been provided to them with the claims report.
2.     Advise the claims adjuster of the employee's prior workers comp claim history, as the approach the adjuster will take on the claim will vary significantly between the employee who has never had an injury and the employee who files his annual summer/hunting season/winter holidays work comp claim.
3.     Make the internal arrangements for the injured employee to return to work on modified duty.
4.     Arrange for the injured employee's supervisor and co-workers to discuss the claim with the adjuster.
5.     Be empathetic with the employee and let the employee know the company cares about the employee.
6.     Maintain regular contact with the employee, either weekly or after each medical visit until the employee is released to return to work.
7.     Coordinate with the employee, the medical provider and the adjuster the employee's return to work.
8.     Monitor the state filings by the adjuster and all claims related paperwork.(WCxKit)  


In summary, the above recommended best practices are not meant to be an all inclusive list of the things the employer can do to control  workers compensation claims. These suggestions and guidelines should be supplemented by other processes the employer has established to handle their workers' compensation claims.


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 website 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. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
 
 

 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

Titanic Carried “The Average” Number of Lifeboats

Some thoughts on whether being "average" is good enough…
What does it cost to buy a bad car? For example, one that will break down 25% more than others. One that will be in more accidents. The “cost” is not the purchase price but the incidental costs of not having a good car.
A good plan for dealing with workers comp is measured by what you don’t see or hear. An accident that didn’t occur leaves little evidence of its non-existence. A person who never left work saves enormous replacement costs, but how do you enter that on the books? (WCxKit)
Measuring work comp, therefore, is almost always done by measuring actual damage. A “good” result is having average amounts of damage. Few operations will commit substantial effort to improving much beyond “average” results even though a small additional effort might put a company in the top 5% of employers.
If a company insists on measuring with a yardstick of negative results, it is worth noting that comp costs worse than average are the best indicator that a business is heading toward catastrophic failure.
Comp costs measure more than accidents. They measure morale, leadership, hiring practices, attention to detail, ability to cope with stress and ability to learn from mistakes.
A proactive, imaginative workers comp program undertaken while comp costs seem to be “average” produce unexpected, positive results throughout a company.
Two areas where improvement can be achieved at little cost are:
1.      Better reporting and early sharing of accident information. (WCxKit)
2.      Better coordination of comp claims with group medical and STD benefits.
 
Any executive team that thinks “average” is a good goal should be aware: The Titanic carried more lifeboats than were legally required. It was above “average.”
 
When purchasing insurance-related products, such as claims handling, keep this in mind.
 
Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, New York. He is a frequent writer and speaker and has represented employers in the areas of workers compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Contact Attorney Ronca at 631-722-2100.
 
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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.


©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Info@ReduceYourWorkersComp.com.

Eight Focus Areas for Best Practice Cost Containment of Workers Compensation

To maximize your company’s potential for workers’ comp cost containment we recommend focusing on these eight areas.
 
But, you say, this is just another checklist. Yes, it is. However, checklists are very useful tools to help those involved in the complex process of managing workers’ compensation claims, implementing best practices, and controlling costs, to very quickly triage those areas where they need to improve. Workers’ Comp Kit Blog, in over 1,300 blogs, provides suggestions and answers on how to implement all of the areas listed here, as faithful readers know.
 
1.     Management Commitment and Resources
  • Is there a lack of awareness of resources such as books, conferences?
  • Do you need additional personnel e.g., workers’ comp coordinator(s) for large multi-division company?
  • Is your cost allocation immediate and cost sensitive?
2.     Work Closely with Third-Party Administrator(s)
  • Proactively use account instructions.
  • Examine the TPA's internal quality control; ask – do they give “grades” and bonuses to adjusters for superior performance.
 3.     Intake Procedures are Key
  • Be sure you have tight post injury response procedures.
  • Be involved – don’t leave this to your insurance company or TPA.
  • Immediate reporting is very important.
4.     Nurse Triage
  • Start management at tiime of injury. Have the triage nurse identify type of treatment that is needed.
  • Coordinate medical care early.
 5.     High Standards for Medical Provider Quality
  • Rank your medical providers.
  • Lower duration means better outcomes, less litigation, and lower medical costs! Ask for specialized networks with better outcomes.
 6.     Peer-to-Peer Physicians
  • Get your medical doctors to discuss each claim with the treating doctor.
  • Get pharmacy benefits management proactively when MDs at TPA review the claim while it is just beginning.
7.     Return-to-Work Policies: Clear and Organized
  • Start transitional duty immediately after the incident; inform the injured employee of your return-to-work policies.
  • Let injured employee know you expect a return to work as soon as the worker is medically able. (workersxzcompxzkit)
  • Consider off-site RTW programs such as charitable, home-based, cross-divisional, and alternate employers.
 8.     Improved Communication is a Simple Way to Improve WC Programs
  • Target communication to your employees.
  • Target additional communication specific to supervisors, management, TPAs, and medical providers.
  • Communicate, communicate, communite
  • First day phone calls, weekly meetings (that's er …. every week)…
Author Rebecca Shafer, Consultant, President, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, healthcare, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact her:  RShafer@ReduceYourWorkersComp.com   or 860-553-6604.

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

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

©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com 

Assessment is Your Number One Tool for Cost Control

Small changes in your workers’ compensation program lead up to large cost savings. Your company’s central job is to find where to make those little changes. Find problems while you can still fix them.

 

 Assess your current state:

 

  1. Claims are reactive so management needs to stop waiting for things to happen.
  2. Assess your corporate best practices.
  3. Assess consistency across all locations or business units.

 

So how do we find these TONS of little things we can do better?

 

A retroactive review of claims is a good place to find trends, but it’s more waiting! Consider doing an Early Satisfaction (or Dissatisfaction) Survey by calling employees 10-14 days after the injury to get feedback on their experience. You will use carefully scripted questions, and have professional interviewers. By doing an EARLY ASSESSMENT you find out problems while you can still correct the situation.

 

Meaning, you will be waiting until a problem costs you money in order to find it in a loss run.

 

So, assess practices as an organization across the whole organization. Then dig down into business units or specific workers’ comp. coordinators to find out if you are consistently following best practices.

 

Follow these steps:

  1. Audit.
  2. Assess.
  3. Educate.

 

Look at the following analytics:

  1. Data Benchmarks (can be retroactive which means more waiting).
  2. TPA practices.
  3. Operational best practices.

 

TPA practices are critical and they tend to lead to the topic of your role as the employer in the process. One way to find out the impact your TPA has on the overall process is to ask the employees.  (workersxzcompxzkit)

 

To effectively assess your operation’s internal practices related to injured workers, focus support efforts in the right places:

  1. Give incentive for honesty.
  2. Get your arms around the truth.
  3. Get the most bang out of your efforts.

 

Claim/policy budget allocations and bonus structures are for incentive and punitive process. Your best practice survey must not be perceived as either.  In order to get to the root of your challenges, it will be important to make this process neutral. The objective is to give your staff in the field the opportunity to identify where they need help.

 

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

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

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


©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com

 

15 BEST PRACTICES Picture Perfect Handling of a Workers Comp Claim

From time to time an external claims auditor comes across a workers' compensation claim approaching perfection in the way it was handled. The following is a synopsis of such a claim profiling the use of Best Practices. 

Note: Best Practices in Italics

1-Timely Reporting of the Claim   
The claim was reported by the employer's location to the TPA's local claim office by telephone at 8:00 a.m. when the claims office opened. The accident occurred a couple hours earlier during the “graveyard” shift at a local fertilizer manufacturer. The maintenance employee was working on a leaking coupling in a phosphate slurry line. The employee turned the coupling in the wrong direction allowing the phosphate slurry to spray onto the employee's legs, causing first, second and third degree chemical burns to both legs. EMS took the employee to the hospital due to the severity of the burns.
The employer immediately reported by telephone the details of the serious accident to the claims office.
 
Note: Another option would have been for the insured employer to use Nurse Triage with 24/7 coverage.

2-Claim File Creation & Assignment   
The claims office in-take person recognizing the severity of the accident had the designated work comp adjuster for the insured join the telephone report of the claim. The telephone report became  a conference call between the insured's claim coordinator, the employee's supervisor, the claims office intake person and the claims adjuster. 

The adjuster discussed
with the employee's supervisor how the injury occurred. The supervisor confirmed to the adjuster the employee violated established safety procedures. The proper procedure to work on the slurry line was to shut the line down and drain the slurry pipe before working on it. The supervisor advised no one saw the accident, but coworkers heard the employee's screams and went to his aid. The adjuster obtained the supervisor's contact information and advised the employer of the Nurse Case Manager being assigned to the claim. 

The employer's claims coordinator
provided all the information on the employee, information about the EMS company, the hospital's name and address, and family contact information for the employee. The claim in-take person requested the employee's wage statement for calculation of indemnity benefits and the completion of the E1 (Employer's First Report submitted to the Industrial Commission). 

After the telephone
report of the claim by the employer, the claims office finished setting up the new claim and entered all the appropriate data into the computer system. 
The claim file was created immediately by the TPA, the adjuster completed part of the 3 point contact (employer), the adjuster completed part of the accident investigation, the wage statement was requested and the state required form was requested.

3-Coverage & First Contacts   
Even though the work comp adjuster handled several claims for the employer's location previously, the adjuster looked up the coverage information on the employer to confirm the workers’ comp coverage was still in force. 
Coverage confirmation

The adjuster
contacted the hospital and confirmed the employee was transferred from the emergency room of the hospital to the severe burn unit. 
Medical provider contact started.

The adjuster contacted
the employee's residence, spoke to a neighbor baby-sitting the children, obtained the wife's cell phone number and left contact information with the baby-sitter in case the adjuster was unable to reach the employee's wife. The adjuster contacted the wife who indicated she only had a minute to talk as she was waiting on the burn unit the doctor to talk to her. The adjuster requested the employee's wife to call back as soon as she could.
Employee contact via spouse.

4-Nurse Case Management & Medical Intervention
The adjuster then contacted the Nurse Case Manager (NCM) and provided the details of the injury, the claimant's location, the contact information for the spouse and information on the medical management program for the employer.

When the employee's
spouse called the adjuster back, the adjuster obtained the information on the employee's medical condition, the names of the treating physician and inquired about visiting the employee. The spouse said the employee was sedated.   The adjuster advised the employee's spouse that a NCM was employed to assist her in the coordination of the employee's medical care and to facilitate the employee's recovery.

The adjuster
 then called the NCM with the information learned from the employee's spouse and had the NCM contact the spouse. After the NCM spoke to the spouse, the NCM made an appointment with the burn unit physician for the NCM and adjuster to meet with the physician, employee and the spouse the following day. 

At the meeting
the next day with the physician, employee and the spouse, the NCM explained how she coordinate the medical care for the employee. The adjuster was able to speak directly with the employee and confirm the accident details. The NCM explained how she would arrange the transition from hospital burn unit care to home care and for the follow up care with the dermatologist, neurologist and other specialists.
Employee contact completed, medical provider contact completed and the accident investigation completed.

5-Reserves   
After the meeting with the burn unit physician and the employee, the adjuster discussed future medical care with the NCM. Based on the known medical information and the wage statement from the employer, the adjuster placed a $100,000 medical reserve, a $40,000 indemnity reserve and a $5,000 expense reserve on the claim file. The adjuster reviewed the recommended reserve with the claims supervisor and advised the reserves could be subject further adjustment based on the outcome of the surgical care the employee would need. 
Timely reserving

6-On-Going Contacts   
The adjuster called the employer and brought the employer's claims coordinator up to date on what was accomplished on the claim so far. The adjuster recommended to the claims coordinator that she also keep in touch with the employee on a regular basis until the employee was able to return to work. The adjuster then made a diary note of the file for future contacts with the employee, with the NCM and with the insured. 
On-Going Contacts started and planned for the future.

Throughout the
course of the claim file, the adjuster was in regular contact with the employee, the NCM and the insured.  
On-Going contacts continued.

7-Compensability, Average Weekly Wage Confirmation, Benefits   
Based upon the adjuster's investigation with the insured and with the employee, the adjuster accepted compensability, and filed the appropriate form with the Industrial Commission accepting compensability.   Using the wage statement provided by the employer, the adjuster calculated the average weekly wage of the employee and documented that information in the claim file. The adjuster then contacted the employee's spouse and advised the amount of the temporary total disability weekly check and gave the date the first check would be issued. 
Compensability verified, average weekly wage verified, benefits calculated, state form completed and employee contact continued.

8-ISO Indexing
Even though there was no question about the validity of the claim, the adjuster reported the claim to the central index bureau. A prior workers’ comp claim for an arm injury eight years earlier was found, but no other claims were identified. 
Index completed.

9-First Report   
As the claim handling instructions for the employer required a written report on all severe claims, the adjuster completed a caption report covering all the criteria listed in the client's Best Practices.   A copy of the First Report was also sent to the excess insurer due to the nature of the employee's injuries — third degree burns. 
First Report completed.

10-Status Reports
As the claim progressed, the adjuster kept the employer and the excess carrier informed of the progression of the claim and the employee's medical progress.   A status report was completed each month during the first four months and then on a bi-monthly basis after that until the claim was concluded. 
Status Reports completed on a regular basis.

11-Return-to- Work Program
After nearly four months the treating physician agreed with the NCM for the employee was ready to attempt a return to work on modified duty. The adjuster arranged a month prior to the expected return for the employer to have a light duty job available for the employee. Although the employer was reluctant to provide light duty, the adjuster explained TTD benefits continued until the employer allowed the employee to come back to work, and the sooner the employee was allowed to return to work, the better the chances of a reasonable settlement of the permanent partial disability claim. 
Return to Work program aggressively pursued by both the adjuster and the NCM.

12-Subrogation and Second Injury Fund
During the initial investigation of the claim, the employer, at the adjuster’s request,  shut down the fertilizer slurry line and removed and replaced the coupling. An engineering expert examined the coupling involved in the injury, but concluded it was not defective, just worn out through normal use. Subrogation was not feasible. 
As the prior injury identified by the Index report on the employee was not an injury having overlap with the current injury, a second injury fund claim could not be filed.
Recovery of claim cost through both subrogation and the second injury fund was considered.

13-Litigation Management
Due to the frequent contact from the adjuster, the NCM and the employer, the employee always felt his interest were being protected by the people he was dealing with. The employee never thought he had any need for an attorney to represent him. 
High quality claim handling usually eliminates the need for litigation management.

14-Diary
The adjuster kept the file on a short-term diary throughout the claim and completed all activities listed in the action plan on the schedule the adjuster had set personally.
Diary Maintained

15-File Notes
Every activity undertaken by the adjuster was explained in the file notes. The file notes were concise and complete. Anyone reviewing the claim file would know what the adjuster had completed, what the adjuster had planned and what the obstacles for completion of the claim were. (workersxzcompxzkit)
Proper file notes.

Summary
Full and complete claim handling by the adjuster is necessary for the best results on a claim. When the adjuster closely follows the Best Practices established by your workers’ compensation program, the outcome of the workers’ comp claims are better for both the employer and the employee. 

Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers' Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-553-6604.


Podcast/Webcast: Claim Handling Strategies
Click Here:

http://www.workerscompkit.com/gallagher/podcast/  Claim_Handling_Strategies/index.php 
 

 


Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.
 
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ ReduceYourWorkersComp.com.

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