Medical and Risk Trends for 2013

 

Each new year brings talk and speculation about what will be the “next big thing” during that year — a new medical procedure; a new change in laws; or increases in disability and reserving. Some common themes popping up on blogs and in discussion threads are about medical procedures and distracted driving hazard effecting risk management.
 
1.   Aggressive Total/Partial Joint Replacement Surgeries
 
Hip and knee joint replacements are among the most commonly performed surgical procedures in the United States, according the Center for Disease Control and Prevention. Between 1996 and 2006, total hip replacements increased by one third and total knee replacements by 70%.
 
Part of this new trend means doctors are finally realizing that months and months of physical therapy and other treatments are not resulting in outcomes patients’ desire. Injured people want to regain as nearly as possible most of their mobility and activity levels they enjoyed prior to an injury. This is particularly true of injuries taking years to develop before the joint finally gives out.
 
In addition, technology has changed, implants are better, more functional, and last longer and, depending on the comorbidities of the patient, recovery times have lessened. Therefore, physicians are going directly to joint replacement surgery, rather than waste a year on therapy.
 
Employers need to be aware of the actual causal relationship of joint failure to the issue of a workers compensation injury, keeping in mind most joint replacements are due to degenerative changes, not necessarily an occupational injury. The decision of whether or not an employer is liable for a workers comp claim can vary by state statute, meaning be very aware of all state statutes in every state where your company operates.
 
Rarely will a carrier opt to pick up a case with a joint replacement recommendation, since the costs are high, and the outcomes for total success can be limited. Be prepared to argue any case where a physician leans toward joint replacement following a workplace injury. Look for possible pre-existing conditions and be sure to have an independent medical examination (IME) done by a qualified and reputable physician.
 
 
2.   Increasingly Sophisticated Bionic Implants/Prosthetics
 
Great outcomes are rare for severe occupational injuries that include the loss of a limb since these cases are catastrophic in nature and carry a massive dollar reserve. The days of peg legs and hooks for hands are gone. Current prosthetics are capable of grasping objects with a mind/body connection doing the work, rather than plain mechanics.
 
Prosthetic limb advancements have grown exponentially over the years, but are very expensive. Prosthetic hands and arms are now like mini computers, with sophisticated wiring and performance. This leads to increased hazards and damage, wear and tear, and replacement/maintenance costs.
 
Some state statues only require replacement of a lost limb with a “suitable” prosthetic. But suitable to whom? Is it suitable to the claims adjuster, or suitable to the person affected by this life-changing injury? Unfortunately in many insurance claims, the best is not always something the carrier is prepared to pay for. The carrier’s opinion is to replace with a suitable device, a Ford Focus, not a Cadillac Escalade or Ferrari. So a lost limb can be replaced by the Ford Focus of limbs, not the Cadillac of prosthetic devices, or the latest/greatest thing out there.
 
Prosthetic eyes have also come a long way from the days when eye implants were riddled with infection potential and replacement eyes had little reality to what a natural eye looked like. Today’s eye prosthetics are incredibly life-like, although they do not replace vision. However, a good-looking prosthetic eye is a confidence builder and beneficial to a good appearance.
 
Be prepared to litigate over the issue of “type of replacement” and do not be surprised when it arrives after coverage for the Cadillac version of a prosthetic is disputed. Avoid legal problems by doing due diligence and get multiple opinions and recommendations for treatment as well as estimates on maintenance costs/repairs.
 
 
  1. Changing Demographics of the Workforce
 
Today businesses are doing more with less, leading to employees who are prone to more severe injuries with longer recovery times. Both the increase in obesity and aging adds to this statistic. It is not uncommon for workers compensation claims to increase when layoffs are rumored or forthcoming. Fear of losing a job may cause an employee to file a workers compensation claim over a minor injury and this spells disaster for the employer.
 
Employers must be aware of the risk. Every employer wants to run an efficient business, but employees can be over loaded by being asked to do more with less. What is the general consensus on the work floor? Are workers hearing about pending layoffs and not telling their managers about a potential injury for fear of repercussion or termination? Are workers asked to do more than one job when coworkers are laid off and not replaced? Failure to address these important questions can be dangerous and costly in the end and counter-productive to efficient management.
 
 
  1. Better Recovery that Limits Risk of Permanent Partial Impairment
 
Injuries reported and treated before they morph into major injuries result in reduced recovery time. Reduced recovery time lessens the risk of a permanent injury. In states where an impairment rating is used to pay the claimant additional monies, just opening the lines of communication can save a business/carrier a large sum of money over time.
 
Let us look at carpal tunnel as an example of early treatment as opposed to late treatment.
When a worker is treated at the onset of symptoms, treatment consists of splinting and medication. The problem can resolve on its own with little loss of work time and minimal medical cost. On the other hand, the longer a worker waits to get treatment, the worse the nerves become damaged, sometimes to the point where surgery will be of little benefit to resolve pain and restore function.
 
Some states have an almost automatic impairment rating once surgery is performed and costs can be very large not only in additional wage loss, but also in increased medical coverage. Some states cover reasonable, related, and necessary medical costs over a 10-year period, meaning it is hard to wipe an existing claim of this nature off the financial books. Promote early involvement/medical intervention when an injury happens in the workplace.
 
 
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
 
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
 
©2013 Amaxx Risk Solutions, Inc. 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 about workers comp issues.

The Best Tidbits of News From the Workers Comp Community

 

News From Lexis Nexis:
 
 
 
“The LexisNexis Workers' Compensation Law Community has selected its 2012 honorees. These top blogsites contain some of the best writing out there on workers' compensation and workplace issues. They contain a wealth of information for the workers' compensation community with timely news items, practical information, expert analysis, practice tips, frequent postings, and helpful links to other sites. These blogsites also show us how workplace issues interact with politics and culture. Moreover, they demonstrate how bloggers can impact the world of workers' compensation and workplace issues. View the list of honorees.”
 
 
Deciphering Section 28(b) After Andrepont, by Paul B. Howell, Esq.
“In 1822, a sweaty scientist in a dimly-lit room looked at a rock from Egypt and discovered the key to decoding Egyptian hieroglyphics. 175 years later, a Fifth Circuit Court of Appeals judge with a cup of coffee inSee FMC Corp. v. Perez, 128 F.3d 908, 31 BRBS 162(CRT) (5th Cir. 1997). Read more.”
 
 
 
 
Thousands of federal government employees suffer work-related injuries each year, most of whom recover and return to their pre-injury jobs. There are however, a small percentage of employees who are unable to return to return to their pre-injury jobs due to long-term physical restrictions. Although placement with a federal agency is optimal, it is not always possible, especially at a time when government jobs are being eliminated. This leaves a significant number of individuals with transferable skills, unemployed and heading down a path towards a life of unnecessary long-term disability.  Read more…
 
 
 
 
With more visibility and vulnerability in today’s business landscape due to social media, online commerce and doing business through mobile devices, it only makes sense that there would be more potential risks to a company’s reputation and brand. In fact, now more than ever, executives are attempting to protect their brands from these security threats by being more proactive and looking for blind spots in their risk management program.  Read more…
 
 
 
Austin, TX – Texas recorded a six percent decrease in work-related fatalities in 2011, the second consecutive year of decrease and the lowest level in a decade.  There were 433 fatalities in 2011 compared to the 2010 total of 461 fatalities.  Nationally, there were a preliminary total of 4,609 fatal work injuries in 2011.  Read more…
 

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.comContact 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.

Reduce Your Medical Costs With Durable Medical Equipment

Durable Medical Equipment Often Overlooked for Cost Containment

 

Self-insured employers who are trying to control the cost of medical care within their workers’ compensation program will often use medical triage, nurse case managers and pharmacy benefit managers, but overlook durable medical equipment (DME).  Durable medical equipment is reusable medical gear or reusable medical products necessary for the injured employee to function at home or away from a medical facility.  Durable medical equipment must be prescribed by a doctor and most DME will have no benefit to a person who does not have an injury or occupational illness.  The need for durable medical equipment is closely related to the severity level of an injury — the higher the level of severity of an injury, the greater the probability that an injured employee will need DME.

 

 

Can Be Expensive, However Cheaper Than Hospital

 

Depending on the nature of the DME, it can be very expensive adding considerable medical cost to the workers’ compensation claim.  Examples of DME that can add substantially to the claim cost include:

 

  • Oxygen tents

 

  • Hospital beds

 

  • Motorized wheelchairs

 

  • Power operated vehicles

 

  • Lift chairs

 

  • Continuous positive airway pressure (CPAP) machine

 

  • Iron lungs

 

  • Traction equipment

 

  • Prosthetic limbs

 

  • Transcutaneous electronic nerve stimulators (TENS units)

 

  • Air beds or fluid beds

 

 

While some DME can be expensive, it is always much cheaper for the injured employee to be at home using DME than it is for the injured employee to be in a hospital room, nursing home or other type of  convalescent facility.  The cost of medical care supplied away from the home can range from 100% to 1000% higher than the cost of medical care at the injured employee’s home with DME.

 

In some liberal jurisdictions the range of DME has been expanded to include such items as:

 

  • In-home spas

 

  • Whirlpools

 

  • Hot tubs

 

  • Orthopedic/specialty mattresses

 

  • Air conditioners

 

  • Dehumidifiers

 

  • Hearing aids

 

 

Prescription Written by Doctors Should be Verified

 

Prescriptions for these types of items are normally only written by doctors chosen by the employee’s attorney.  If the employer is confronted with a prescription for specialized DME of this type, an independent medical examination of the injured employee can be completed to verify the need for the specialized DME.  An alternative is to have a utilization review or a peer review of the prescription to verify the medical necessity. A different approach is to have the request for specialized DME reviewed by the workers’ compensation board or industrial commission for their concurrence or denial.

 

 

Claims Adjuster Should Arrange for Purchases

 

If it is determined the specialized DME is necessary, the claims adjuster or the nurse case manager should arrange the purchase of the specialize DME.  This will allow the adjuster or nurse case manager to obtain the necessary equipment, but restrict the purchase to what meets the doctor’s prescription, but does not exceed it.  For example – the doctor writes a prescription for a Tempurpedic mattress and the industrial commission rules it must be provided.  If the claimant is left to select and order the mattress, the claimant will select the $6,000 version, while if the adjuster is responsible for obtaining the mattress, the adjuster will select the $3,000 version that meets the requirements of the doctor’s prescription.

 

Some DME is not expensive and is commonly provided to injured employees.  Examples of less expensive DME includes:

 

  • Commode chairs

 

  • Walkers

 

  • Canes

 

  • Crutches

 

  • Nebulizers

 

  • Non-motorized wheel chairs

 

 

Hold Durable Medical Equipment Costs Accountable

 

If the state medical fee schedule includes DME (some state fee schedules do include DME while others do not), and if there is no question in regards to the medical necessity of the DME, it should be submitted to the medical fee bill review service for control of the cost of the DME.

 

In the states where the state fee schedule does not address DME, the self-insured employer should make arrangements with a company that specializes in DME to provide all necessary DME.  A pre-arranged pricing agreement for the DME items listed above will reduce the cost of DME.

 

 

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.

 

How On-Site Medical Clinics Curb Fast-Rising Costs of Medical Care in Workers Comp

 

On-Site Clinics Decrease Costs

 

Many medium and large employers in their never-ending battle to reduce cost and to provide benefits to their employees are opting for on-site medical clinics.  On-site medical clinics can decrease the cost of general health benefits programs and decrease the cost of medical care associated with workers’ compensation claims.  On-site medical clinics have proven they can curb the fast-rising cost of medical care for both personal and work-related injuries and illnesses.

 

Some employers are hiring clinicians themselves, and others are using contracted providers who also provide software, protocols and other tools to support the clinicians.

 

 

Medical Care Provided at Work Site, Convenient & Effective Treatment

 

With the on-site clinic, the medical care is provided at the work site, which is convenient for employees who otherwise would have to leave work for care.  Injuries and illnesses are evaluated by the clinic staff; many cases can be treated on site.  Employees are referred to off-site medical facilities only if the injury or illness is beyond the scope of the medical professionals in the on-site clinic.

 

On-site clinics often use a variety of staffing models, including RNs, nurse practitioners, and physician assistants – with physician collaboration and direction as needed.  Depending on the employer’s needs, on-site clinics can be staffed with a doctor.  When properly managed, on-site medical practitioners can provide high quality medical care while reducing overall costs.  They can also provide other health services such as wellness, and regulatory exams, etc. On-site clinics can include x-ray machines and pharmacy services, though costs and state regulations affect the feasibility of those services.  Good providers of on-site medical clinics will tailor the services provided to the employer’s needs.

 

 

Benefits to Employees

 

The benefits to the employee injured on the job include:

 

  • Medical services available when the typical doctor’s office is closed – evenings, weekends and holidays

 

  • No appointment is necessary

 

  • Immediate medical care following an injury

 

In addition to the workers’ compensation benefits, the employee also enjoys easy access to medical care, assistance with chronic medical problems and healthy living guidance.

 

 

Benefits to Employers

 

The benefits to the employer of the injured worker include:

 

  • Evaluate and treat employee injuries immediately

 

  • Avoids unnecessary and off-site medical treatment

 

  • Referral to appropriate and screened preferred medical providers when off-site care is needed

 

  • Improved outcomes and faster return to work, increasing productivity

 

  • Assist in keeping all workers healthy and productive

 

  • Reduces absenteeism

 

  • Significantly lower cost for medical services for workers’ compensation claims

 

  • Can provide physicals

 

  • Drug screening

 

  • Improved general health of employees

 

  • Improved employee morale

 

  • Increases employee retention

 

  • Can coordinate pharmacy usage with your Pharmacy Benefits Manager

 

  • Timely reporting of the injury and medical information to relevant parties.

 

  • The First Report of Injury form is completed and filed with both the state and claims office.

 

 

Treat Workers Comp and Health Care

 

On the workers’ compensation side, the on-site clinics can treat lacerations, strains, sprains, other minor orthopedic injuries, abscess drainage, minor skin infections and other routine acute medical conditions.  On the health care side, the on-site clinics can treat the whole gamut of minor medical conditions that causes employees to lose time from work including strep throats, colds, ear and eye infections, skin lesion removal and vaccinations.

 

 

 

Clinics Used For Any Site with 1,000+ Employees

 

On-site clinics are not just for industrial sites like factories, and mines or large office centers.  On-site clinics can be operated for just about any industry where there are 1,000 or more employees in one location.  Mobile and temporary clinics are used  for large construction projects such asskyscrapers, power plants, and highways.  All clinics need to be equipped with the necessary furniture, supplies, equipment, and medications.

 

The cost of drug testing for both employee applicants and existing employees can be significantly reduced by using an on-site clinic.  Drug testing due to reasonable suspicion, random testing and post-accident screening can be completed by the on-site clinic.  In many states the timely completion of a post-accident drug testing can be used to deny workers’ compensation benefits to employees under the influence of a drug at the time of their injury.  A positive drug test result can be sent to a certified lab for further confirmation.

 

 

Be Sure to Select Quality On-Site Medical Provider

 

When an employer is selecting the on-site medical provider, select a medical provider who provides an on-going review of the quality of service they are providing.  The service quality can be evaluated by patient reviews and comments, by clinic audits and by staff performance evaluations.

 

On-site clinics do carry costs and risks as well.  To be successful, the staff needs to be trained for on-site work, and be supported with appropriate software, operating systems, supplies, medical direction, protocols, QA, and other infrastructure.  The medical practice needs to carry malpractice insurance coverings the employer and be compliant with HIPAA, GINA, HITECH and other privacy regulations.  In addition, some on-site providers may introduce conflicts of interest if they are financially tied to the off-site hospitals, clinics and pharmacies that  they refer to.

 

For further information about on-site clinics, please contact us.

 

 

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

 

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

 


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.

 

Ten Medical Cost Containment Strategies To Reduce OVERALL Costs

There are many available techniques to control medical cost in workers compensation.
 
A search of the internet for Medical Cost Containment will provide a tremendous amount of information but each website is focused on the product(s) or service(s) provided by the particular company. There are many and varied means of controlling medical cost in workers compensation which span a broader range of services than almost any single company can provide.
 
 
To be truly effective in controlling the medical cost of workers compensation, employers and insurers should not limit their medical cost containment efforts to only one or a few areas. While state statutes may limit or bar the use of some the methods of controlling cost, the employer or the insurer should utilize as many medical cost containment strategies as possible. All of the following medical cost containment strategies have been shown to save money for the employer or the insurer. (WCxKit)  Spend now to achieve overall lower workers compensation costs. This is how to hold costs down over the long term. This is referred to as the TLC (total loss costs).
 
 
Top 10 Medical Cost Containment Strategies
 
 
1.  A SUPERIOR Medical Provider Network is a group of doctors, hospitals and other medical providers with whom an insurer or a self-insured employer has prearranged for medical treatment for employees injured on the job AND provides better results than other providers – lower litigation rates, better medical outcome, faster return to work. 
 
 
2. Nurse Triage  is used as the very first phone call that is made (after the supervisor). The employee calls an RN who discusses the severity of the injury and the probably type of treatment that will be needed. These aren’t just any nurse, but specially trained ones using medical algorithms and overseen by sophisticated protocol to ensure appropriate referrals are made the the Emergency Dept, clinical treatment or self-care. If every injury is called in to Nurse Triage, the number of lost time claims will be reduced by 40%. The ROI is huge! I’ve toured the Medcor operation and was amazed at the efficiency and the training (I sat in the training room to view the type of training the RNs receive.) I was a guest of Broadspire who uses Medcor for their sophisticated medical protocol partner.  
 
 
3. Medical Management is the practice of having an experienced nurse case manager to coordinate and managed the medical care received by the employee. This includes both the senior nurse reviewer who may be dedicated to an account handling all lost time or serious medical claims for that company. They review all care and treatment for injured employees to insure it is appropriate and timely. If additional tests are needed they will advise the doctors. Their priority is getting the employee back to full recover.
 
 
4. Utilization Review is the independent confirmation of the need for a medical service. Utilization review includes precertification reviews before the medical care is provided, concurrent reviews while the employee is in the hospital or during on-going medical care, and retrospective reviews to verify the needs for the medical services already provided.
 
 
5. Medical Bill Reviews are normally done by companies that specialize in reviewing the medical bill to verify the accuracy of the medical bill diagnostic codes and medical bill charges. The medical bill charges are either compared to the state fee bill schedule or with what are reasonable and customary charges for the medical services provided. Medical bill reviews include both the audits of doctor bill and hospital bill auditing.
 
 
6. Pharmacy Benefit Managers are companies that specialize in managing and controlling the cost of medications prescribed for the employee. This includes both obtaining discounts on medications plus providing drug utilization reviews to prevent the excessive use of narcotics and other medications. Using physicians to actively review claims results in proactive pharmacy benefits management, rather than after the fact review of medications already taken, can stop overuse before it occurs.
 
 
7. Independent Medical Examinations occur when the employee is sent to another medical provider for a second opinion. Independent medical examinations are most often used when the employee’s medical recovery progress is slower than normal.
 
 
8.  Peer Reviews is the practice of sending the medical reports and diagnostic reports to another medical provider for a review of the medical information for the purpose of confirming the appropriateness and quality of the medical care being provided. Using physician review is in my opinion one of the most useful tools an employer can use. They can read he medical reports to find what’s NOT there. They look for other possible causes of injury, appropriateness of care and make sure employees go to the correct specialists.  This service may be called Peer-to-Peer.
 
 
9.  The era of computers has created the ability to use technology to obtain information that would not otherwise be available including:
 
1.      Predictive Modeling is used to identify early on those claims that have a high probability of becoming expensive claims so they can be acted upon quickly.
 
2.      Data Mining is used to identify high cost medical providers; medical providers who are slow to return the employee to work and to identify other claim related information that impacts claim cost.
 
3.      Benchmarking is using the known information about your workers’ compensation claims to compare your cost control results against others employers or insurers. (WCxKit)
 
10. Send me your ideas for YOUR favorite Medical Cost Containment Strategy. Let me know if it’s OK to share your ideas. Please write up to 200 words.

Author Rebecca Shafer, JD, President of Amaxx Risks 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.  Contact:  RShafer@ReduceYourWorkersComp.com.

 
WORK COMP CALCULATOR:   http://www.LowerWC.com/calculator.php
 
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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.

Requesting Maximum Medical Improvement MMI Status From the Adjuster

Requesting Maximum Medical Improvement (MMI) Status from the Adjuster

Follow up
 and documentation are key components to managing workers’ compensation costs.  If time goes by on a specific injury case, it is up to the company to find out if your employee may have healed as much as possible for such an injury. This is called “maximum medical improvement”.  In most cases, it is recommended allowing a period of no more than four moths, or 120 days, to lapse without MMI determination.

Occasionally,
 an injury will indeed be so severe the employee cannot return to former duties. This is unfortunate, but still, it is critical to thoroughly document such a case.

The injury coordinator
 is the person responsible for the communiqué, which may be emailed. A form for your use in documenting the injury can be found at Workers’ Comp Kit  (http://www.workerscompkit.com/), but if you are writing your own, here are some things to include.
1.  Be sure  to include the claim number and name of injured employee.
2.  Carbon  copy the communication to your supervisor.
3.  Give  the employee’s name.
4.  Note  the employee’s injury.
5.  List  the amount of time the employee has been under the care of the treating physician.
6.  Note  what little progress has been made.

Explain to your
 adjuster your company needs to know if transitional duty needs to be extended, or if this employee has perhaps reached MMI and will not be able to resume the original position. If this is the case, let the adjuster know your company will transfer the issue to the human resources department to ensure compliance with legal requirements such as the Americans With Disabilities Act.

Ask your adjuster to contact the doctor to establish:
1.  Is  the employee improving?
2.  When  will the injured worker be able to return to regular duties?
3.  Will  the worker have permanent job restrictions?
4.  Will  the worker ever be able to return to work full-time and full-capacity?
5.  Has  the employee achieved MMI? (workersxzcompxzkit)

Thank your  adjuster for being helpful and request a phone call in response.

Editing Note:  Use gender neutral descriptions.  Say: “Will the employee, injured worker, worker . . .”  instead of:  “Will he/she . . .” or worse, using the plural “they” as in: “He/she . . . and “they”. . . .

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 860-786-8286.

We are accepting short articles* (200-300 words) on WC cost containment. To: Info@ReduceYourWorkersComp.com. *Non-compensable.

WC Best Practices IQ Test: http://www.workerscompkit.com/intro/
WC Calculator: www.reduceyourworkerscomp.com/calculator.php
NEW Article: Return to Work in Unionized Companies
http://reduceyourworkerscomp.com//Return-to-Work-Programs-Unionized-Companies.php

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

©2008 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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