A Commonwealth of Pennsylvania employee was arrested recently by agents from the Attorney General's Public Corruption Unit and charged with soliciting and receiving bribes in exchange for favorable treatment of businesses insured through the State Workmans Insurance Fund (SWIF).
Attorney General Linda Kelly identified the defendant as James McDonnell, 53, of Scranton, Lackawanna County. McDonnell is an auditing supervisor with SWIF, which is a division of the Department of Labor and Industry. Kelly noted that McDonnell's wife, Michelle McDonnell, 44, of the same address, was also arrested and charged with criminal conspiracy. [WCx]
According to the criminal complaint, between 1999 and 2011 James McDonnell and his wife received more than $80,000 through a scheme where he solicited and promised Pennsylvania business owners, who were insured through the SWIF program, that he could reduce their insurance premiums in exchange for kickback payments.
Kelly said that all businesses in Pennsylvania are required to carry workers comp insurance, which can be purchased through any private insurance company or can be obtained through the SWIF program.
The charges state that there were at least 15 instances where James McDonnell released refunds to businesses without documentation to support the transactions.
Kelly said that the bribes James McDonnell allegedly solicited were either paid directly to him in cash or by the solicited businesses putting his wife, Michelle McDonnell, on the company payroll as a ghost employee.
James McDonnell is charged with five counts of bribery in official and political matters, three counts of conflict of interest - restricted activities, three counts of conflict of interest - statement of financial interest required to be filed, two counts of dealing in proceeds of unlawful activity, and two counts of criminal conspiracy. [WCx]
Michelle McDonnell is charged with two counts of criminal conspiracy.
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He is an editor and contributor to Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: Info@ReduceYourWorkersComp.com.
WORKERS COMP MANAGEMENT MANUAL: www.WCManual.com
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.
Fifty-eight percent of Alberta (Canada) employers will see no change or a reduction on their 2012 WCB premiums, according to a report from Alberta’s WCB.
Good performance means that top employers and their workers have developed suitable strategies to help those injured on the job recover at work, in a more positive environment than alone at home.
On the flip side, WCB-Alberta’s poor performance program aims to galvanize 1,600 poor performing employers to take immediate action to improve return-to-work planning and injury prevention practices. The strategy is working.
In 2012, 592 employers joined the PPS program, while 710 employers have improved their performance significantly enough to leave the program behind.
“We all share responsibility for getting better at managing workplace injuries,” said Guy Kerr, president and CEO of WCB-Alberta. “Modified work, investments in safety and prevention, safety associations, occupational injury clinics, and many more of our joint initiatives are making a difference.”
Key 2011/2012 Trends
The number of workers with lost-time claims is expected to increase to approximately 27,400 (7.5 per cent) for this year and 3.7 per cent next year.
Average claim duration is expected to increase somewhat to 37.2 days in 2011 and 38 days in 2012.
Fully-funded claim costs are also on the rise as WCB forecasts year-end costs of $748.1 million, with another increase of 6.5 per cent expected for 2012.
Worker wage protection will also increase in 2012. WCB has raised the maximum insurable income (MIE) level to $86,700.
Alberta employers mitigated these inflationary trends through long-term investments in safety and return-to-work programs so that overall injury trends remained stable, leading to positive expectations for 2012. (WCxKit)
The lost-time claim rate should remain stable at 1.5 lost-time claims per 100 covered workers for the third year in a row.
The disabling injury rate is expected to remain steady at 2.8 per 100 covered workers.
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He is an editor and contributor to Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: Info@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.
WorkSafeBC recently announced that the average base premium rate for registered employers in British Columbia remains unchanged from 2011.
According to a report from the WBC, the 2012 average published base rate will be $1.54 per $100 of employers assessable payroll. WorkSafeBCs average published base rate for 2008 through 2010 was $1.56. The rates continue to be among the lowest in Canada and the lowest rates in B.C. for the last 30 years. (WCxKit)
The average published base rate is a composite of rates in 67 individual rate groups, or insurance pools, which are compilations of various classification units. Insurance premium rates for B.C.’s 206,000 employers are based on the claims cost (or safety) history of their industry and of similar employers, and are further adjusted based on individual performance.
For 2012, 53 percent of employers will experience a base rate decrease and eight percent of employers will have their base rate remain unchanged, while 39 percent of employers will experience a base rate increase.
WorkSafeBC projects a deficit at the end of 2011 and modest increases to the average base rate starting in 2013.
Premium rates charged to employers must be sufficient to cover the current and future needs of B.C.’s injured workers, some of whom will require financial and medical aid for the rest of their lives. To support financial requirements and maintain low and stable rates, WorkSafeBC invests a portion of the funds collected from employers.
Rate decreases are projected for the following industries: municipalities, public schools, fishing, ranching, log hauling, real estate, steep- and low-slope roofing, retail art galleries, movie theatres, bingo halls, telephone and cable services, ferry services, heavy equipment manufacturing, general retail, private schools, greenhouses, wineries, couriers, auto servicing, dentists, optometrists, most health care services, orchards and berry farming, coffee shops, wood mills, libraries, garbage removal services, recycling depots, public art galleries, and construction management consulting.
Most accommodation services, finishing carpentry, supermarkets, butcher shops, colleges, law and notary public offices, travel agencies, insurance, accounting, business and computer consulting services, restaurants, taxis, and general trucking will see their rates remain virtually unchanged or will incur modest rate changes. (WCxKit)
Industries whose rates are projected to increase include: movie and television production and post-production; television or radio broadcasting; ski hills; retail bakeries; animal boarding; airports; flooring stores; farm labour supply services; dump truck operations; campgrounds; liquor stores; residential framing; most waterfront operations; sawmills; construction labour supply; log-home construction; helicopter services; log towing; house construction; unions; residential tree services; casinos; manual tree falling; and grain, hay, white-mushroom, and vegetable farming.
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@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
Every employer buying workers compensation coverage knows it is an insurance policy for the costs associated with injured employees, but few employers ever read the actual policy. The primary reason most people do not read the insurance policy is because it is written in “insurance speak” or legalese. The following in an effort to translate a generic workers compensation insurance policy into everyday English so more people can understand it.
A workers compensation insurance policy is actually divided into two parts. The first half covers what most employers think of in workers compensation. The second part is the “Employers Liability Insurance.” Part two is designed to cover instances where workers compensation insurance does not apply and an employee brings a lawsuit against the employer. Part one’s coverage and workers compensation statutes are so broad that it is rare for an employee to be able to bring a claim under Part two. For the purposes of this article, we will only be addressing what is typically found in Part one of the policy coverage.(WCxKit)
Section A – What the Insurance Covers
Workers compensation insurance will pay for injuries caused by accidents, or for illness/disease caused by being exposed to an unfavorable environment. Accidents and illnesses also include death. This section limits the coverage to the policy period. The injuries or illness has to be caused by conditions associated with the employee's employment. If the work comp claim brought by the employee is for work-related illness, the employee's last day of exposure to the conditions causing the illness must occur within the policy period.
Section B – What the Insurance Company Pays
The insurance company agrees to pay for all benefits as defined by the workers compensation statutes of the state where the employer does business. The insurance company agrees to make timely payment of these benefits.
Section C – The Right to Defend Claims
The insurance company reserves the right to determine which claims it will pay willingly and which claims it will contest. In exchange for the insurance company making this decision, the insurance company agrees to pay the cost of defending the employer from any claim brought against the employer. This allows the insurer to investigate and settle claims as it deems appropriate. It also includes the insurer's right to not to defend a claim if it is not covered by the policy.
Section D – Additional Things Paid By Insurance
The insurance company agrees to pay the cost associated with the claim in addition to benefits provided by the work comp laws. This includes such things as:
- Attorney fees and expenses.
- Surveillance and extraordinary investigative expenses.
- Medical management expenses (triage, nurse case managers, etc).
- Court cost.
- Employer's expenses incurred at the request of the insurer, excluding loss of earnings.
- Appeal bonds.
- Any other expenses incurred by the insurer.
Section E – When There Exists Other Insurance
If the employer has a self-insurance retention or large deductible, the insurer will not pay until the employer has met its financial responsibility under the policy. Also, (this rarely happens), if the employer has other workers compensation insurance that will pay for the employee's injuries, the insurance company will not pay more than its share of the benefits.
Section F – What the Employer Must Pay
The insurance policy makes the employer responsible for payments when the employer:
- Intentionally fails to comply with a safety law or regulation.
- When the employer has serious and/or willful misconduct.
- When the employer knowingly employs someone in violation of the law.
- When the employee brings a claim against the employer for discharging, coercing or discriminating against the employee for bringing a work comp claim.
Also, if the insurance company is compelled to make a payment in one of these situations, the employer agrees to reimburse the insurance company for all cost associated with the situation.
Section G – The Right of Recovery
In exchange for the insurer paying the work comp claim, the employer and the employee agree the insurer will have the right to recover the cost of the claim from a third party who is at fault for the injury (think auto accident or equipment malfunction).(WCxKit)
Section H – Legal Stuff
This section includes several miscellaneous conditions including:
- Most states consider notice to the employer of a work comp claim to be notice to the insurer.
- An employer’s bankruptcy does not relieve the insurance company from paying the work comp claims.
- The insurance company agrees it is primarily responsible for any benefits owed under the policy.
- The legal jurisdiction is the state where the employer is located.
- The insurance company agrees the policy conforms to the applicable law.
- The insurance company agrees to pay any special taxes or assessments that arise due to the issuance of the insurance policy.
- Anything in the policy that conflicts with the state law is modified to comply with the state law.
Not every workers compensation policy will follow this generic outline, but the above outline should assist you in understanding your workers' compensation insurance policy.
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.
In Tennessee, every employer who has five or more full or part time employees, is required to carry workers compensation insurance. Employers in the construction or coal mining industry must provide workers compensation coverage if they have any employees. Corporate officers may decline workers compensation insurance. But they are included in the count of employees. Family members working in the business are also included in the count of employees. State and local governments are exempt from the workers compensation law, as are employers of farm laborers and domestic help. But all can elect to purchase workers comp coverage.
Obtaining Coverage
To obtain workers compensation coverage in Tennessee, the employer has 4 options
1. purchasing a workers compensation insurance policy from an insurance company licensed to do business in Tennessee
2. self-insurance for the employer who has sufficient assets to self insure
3. purchasing insurance from the state owned Tennessee Workers Compensation Insurance Plan
4. setting up a self-insurance trust (WCxKit)
Claim Reporting
The employee must report the injury to the employer within 30 days in writing. when the employee receives medical care outside of the employer's premise. If the employer does not have actual notice, the employer must report the injury to the Tennessee Department of Labor within 14 days
Medical Benefits
The employer must provide the employee a panel of three physicians. From this panel, the employee will choose a medical provider. If it is a back injury, the panel must include a chiropractor. However, chiropractic visits are limited to a maximum of 12 visits under the workers comp law. If specialized treatment is needed, the selected medical provider will make a referral. At this time, the insurer or employer is required to form another panel of three physicians that offer the specialized medical care needed.
There are neither time nor monetary limitations on medical care. The medical care will continue as long as the authorized panel physician deems it necessary. Mileage to and from medical treatment facilities is reimbursed only if exceeding 15 miles. The mileage rate is set by the state.
Temporary Total Disability Benefits
The temporary total disability (TTD) benefits are calculated as two-thirds of the employee's average weekly wage earned over the 52 weeks prior to the injury. The TTD weekly maximum and minimum is adjusted each year on July 1st. The weekly maximum is capped at $867.90 for injuries occurring from July 1, 2011 to June 30, 2012. The weekly minimum TTD amount is $118.35. TTD benefits are paid every two weeks and can be for a maximum of 400 weeks.
The first 7 days of disability (the waiting period) is not paid to the injured employee unless the employee is disabled for more than 14 days.
Temporary Partial Disability Benefits
In Tennessee, temporary disability (TPD) benefits are paid if an employee is able to return to any type of work but is earning less than prior to the injury or working fewer hours per week. The TPD benefits are paid at two-thirds of the difference between the pre-injury wage and the post-injury wage.
Permanent Partial Disability Benefits
Tennessee employees who incur a permanent partial disability (PPD) are entitled to two-thirds of their average weekly wage, not to exceed a maximum of $789 per week. The minimum for PPD is equal to the minimum TTD benefit. For non-scheduled injuries, the maximum period of payments is 400 weeks. For scheduled injuries, the loss of a body part has a maximum of 200 weeks of benefits for a limb. The number of weeks declines based on the body part to only ten weeks of benefits for a toe other than the great toe.
Permanent Total Disability Benefits
Permanent total disability (PTD) benefits are set identically to PPD benefits. The exception is that if the worker is 100% disabled, the PTD benefits are payable to age 65 and may be offset by social security benefits. (WCxKit)
Death Benefits
Burial expenses in Tennessee are covered for a work-related death up to $7,500. The death benefits for a surviving spouse and dependents follow the same guidelines as TTD benefits. They are two-thirds of the average weekly wage up to a maximum of 400 weeks. If the spouse remarries, the spouse loses the benefit. But the children continue to receive the death benefit. until they are 18 years old, or 22 years old if enrolled in an accredited educational institution. When the deceased employee does not have any dependents, $20,000 is paid to his or her estate.
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.
Oklahoma Insurance Commissioner John Doak, recently reported the company, which manages the nation’s largest database of workers compensation insurance information, has filed a request with the Oklahoma Insurance Department to decrease the cost of workers comp insurance in Oklahoma.
According to Doak, the National Council on Compensation Insurance Inc. (NCCI) filed to reduce workers compensation insurance rates in Oklahoma by 1.7 percent starting Jan. 1, 2012. The Commissioner said NCCI attributed the rate drop to this year’s passage of Oklahoma Senate Bill 878. Before the passage of SB 878, rates were expected to increase again. (WCxKit)
Reforming Oklahoma workers comp law was high on Governor Mary Fallin’s agenda, and SB 878 received overwhelming support from both parties in the Legislature.
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@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.
The Ohio Bureau of Workers Compensation has proposed an economic development initiative that could discount a new Ohio employer’s premium by as much as 51 percent. If approved by the BWC Board of Directors, Grow Ohio would offer eligible employers a 25 percent discount on their workers compensation premiums for two years. Or they give them immediate access to participation in the Group Experience Rating Program.
“Employers have many factors to consider when choosing a location, and the costs of conducting business, including workers compensation, are high on that list,” said BWC Administrator/CEO Stephen Buehrer. “By lowering the initial premium of new businesses, Grow Ohio is freeing up more money for those companies to invest in job growth and help restore prosperity to Ohio.” (WCxKit)
Under Grow Ohio, new employers will receive the 25 percent discount on their workers comp premiums, unless they elect to participate in another program incompatible with the Grow Ohio discount. The discount will be applied for the effective new employer’s coverage date and the four subsequent six-month payroll periods.
If new employers prefer, they may instead elect to immediately participate in the Group Experience Rating Program. This program normally is inaccessible to new employers until they have had workers comp coverage for a full year. Employers have 30 days to pursue the Group Rating option, or the 25 percent Grow Ohio discount will be automatically applied.
Participation in group rating could reduce their premiums up to the maximum allowable amount, Currently that amount is 51 percent for the July 1, 2011 policy year. (WCxKit)
If approved by the board on Sept. 29, the incentives will apply to new Ohio business entities or out-of-state businesses and report payroll in Ohio on or after July 1, 2011. Those incentives will be reflected on bills employers pay beginning in February 2012.
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@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.
The Alaska Workers Compensation Board assessed a $1.5 million civil penalty to Ultimate Tours, LLC, and Godwin Glacier Tours, LLC, for its reported failure to carry workers compensation insurance, misclassifying employees as independent contractors and violating stop-work orders.
"Ultimate Tours/Godwin Glacier Tours operates seasonally in the Seward area," said Mike Monagle, director of the workers compensation division.(WCxKit)
"Division of Workers Compensation staff repeatedly attempted to resolve the situation and bring the employer into compliance with state law, but for six seasons failed to reach an agreement with this employer," Monagle added.
The tour company, which operates glacier dog sled tours, glacier hikes, and helicopter flight seeing on the Kenai Peninsula, was in violation of stop-work orders for failure to insure its employees for 341 days, from Nov. 7, 2005 to Aug. 30, 2010. Five injuries have been reported to the division of workers compensation.
The tour company was assessed the penalty on 1,215 uninsured employee work days and additional penalties for knowingly misclassifying employees to evade workers compensation premiums.
Alaska law requires all employers to carry workers compensation insurance.
Employers who fail to comply with the law may be liable for civil penalties up to $1,000 per uninsured employee per workday.
Employers, who violate a stop work order issued by the Alaska Workers Compensation Board or the division of workers compensation, may be liable for an additional civil penalty of $1,000 for each day the employer is in violation of the stop work order.(WCxKit)
Officials also point out that employers who knowingly misclassify employees for the purpose of evading payment of workers comp premiums are not only subject to civil penalties for failure to insure, but may also be subject to criminal penalties for fraud.
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, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@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.
WorkCover NSW of Australia is leaving workers compensation industry classification rates unchanged for 2011-12, according to information from the Work Cover Authority of NSW.
Each year the NSW government approves rates the WorkCover Scheme will charge employers for workers compensation cover. The government recently approved rates for the 2011-12 policy year and has published them in the Insurance Premiums Order 2011-12.(WCxKit)
The Insurance Premiums Order includes important information on the WorkCover Industry Classification System, premium rates, dust diseases rates and the manner in which an employer’s workers compensation premium should be calculated by scheme agents for the relevant policy period.
According to WorkCover NSW CEO Lisa Hunt, 87 percent of NSW employers covered by the scheme would see no change in their premium in 2011-12 unless their wages increase or decrease – or they move industry classification.
“For the 13 percent of employers whose premium takes into account their own claims experience, their premium may be affected by their wages and claim costs relative to other employers in the same industry classification,” Hunt said. “Those with a good claims record relative to their industry will benefit from a reduction in their basic tariff premium. Those with a relatively poor claims record would pay more than their basic tariff premium.”
Hunt added the NSW WorkCover Scheme target premium collection rate for 2011-12 will be 1.68 percent of wages covered by the scheme. “The decision to leave workers compensation industry classification rates unchanged is a good result for NSW employers, particularly small business,” she said.(WCxKit)
About 85,000 claims are made each year and premiums need to cover ongoing costs and claims payments, possibly over decades.
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, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@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.
When you review your broker's or insurer's website, there is one subject in workers compensation that most brokers and insurers never mention – leakage.
Leakage in an insurance claim is any payment that is more than the payment should be. Leakage is defined as the difference between what the claims office spent and what they should have spent. Leakage is also been defined as lost opportunities to save money.
As workers compensation premiums are directly tied to the frequency and severity of employers' claims, you will never hear the workers comp insurer say, “We did a poor job controlling the cost of your claims.” Their leakage becomes the employer's expense through higher insurance premiums. (WcxKit)
5 main causes of workers compensation claims office leakage:
1. Inadequate claims handling.
2. Judgmental mistakes.
3. Poor claim processes.
4. Over payments.
5. Bad customer service.
While leakage can be caused from any one of these areas, it is often a combination of them that results in leakage.
There are about as many forms of leakage in workers compensation as there are workers comp subjects to be discussed.
10 examples of leakage in workers compensation:
1. Payment of medical bills without adjustment to the fee schedule.
2. The failure to properly investigate compensability and payment of claims that are not covered.
3. The failure to pursue subrogation.
4. The failure to utilize the early return-to-work program of the employer.
5. The failure to properly manage utilization review opportunities.
6. The failure to control the selection of the medical provider in those states where the employer controls the medical provider selection.
7. The selection of inadequate defense counsel.
8. The failure to pay medical benefits or indemnity benefits timely resulting in fines and/or penalties.
9. The lack of automation and/or technology in the process where it could be utilized.
10. The additional management and administration time due to any mistake in the claims handling.
The list could go on and on. Any failure to control the insurance claim can result in leakage.
Some consultants and
insurance brokers who attempt to identify leakage by the use of computer outcome modeling or algorithms. These provide a detailed report reflecting payment areas in which the employer's claim cost exceed the average for their industry or the employer's prior lost history. When the employer has thousands of claims, automated methods can identify some possible areas where there is leakage, but will miss many others. When the employer does not have thousands of claims, the cost averages can be influenced by a few outlier claims making the identification of leakage by computer averages less reliable.
An example of how computers and algorithms fail to identify leakage: A computer average for indemnity paid will not show the failure to contest small claims that should been investigated and denied. Because it is easier for the adjusters to pay numerous small claims rather than contesting them, the behavior looks like superior performance on a computer average, though, in fact, every small claim that was paid but should not have been, is leakage.
A better way to control leakage is the utilization of these 6 time-proven methods:
1. Having an established set of best practices for workers compensation claims.
2. Proper education and training of the workers comp adjuster including state statutes, customer service, and claims-handling practices.
3. Excellent education and training of all support staff.
4. Linking salaries and pay raises to compliance with best practices.
5. Having an established work-flow process. WcxKit
6. Incorporating automation and technology into the claims process.
An integrated approach incorporating all of the methods will eliminate most leakage. WcxKit
If you feel like there is leakage in handling your workers compensation claims, there probably is. Identification of various forms of leakage on your claims can be done through a claims audit. An experienced quality assurance auditor will be able to point out where leakage has already occurred
and identify situations where mistakes have already been made, but can be corrected before additional money is paid. If you would like to discuss a leakage audit of your insurance claims, please contact us.
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. 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
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