The situation worsens when an injured worker faces situations such as elimination of their job, permanent physical restrictions, or a long recovery after a major surgery. These factors mean pending workers compensation claims are being held open much longer, inflating claims counts for adjusters across the board.(WCxKit)

 

 

Below, are five situations that contribute to delays in closing workers compensation files:

 

In the minds of most injured workers, having some money coming in is better than having no money coming in. The injured worker may not have a job to return to or may fear termination because of an on-the-job injury, so they maximize the symptoms of their injury; this is called malingering.

 

 

Whatever the reason, a current trend involves injured workers stretching claims out as long as possible. Some purposefully take longer to recover by doctor hopping, trying non-conventional forms of treatment, and exaggerating pain complaints. The length of time out of work must be proportionate to the degree of disability.

 

 

Most physicians will catch this and mention something in medical records, which should alert the adjuster to set an independent medical evaluation (IME) or to do some surveillance on the file. Using the MDGuidelines is also helpful; since that offers a range of times a worker should be approaching maximum medical improvement (MMI). If the worker is not back to work within the guidelines, it is time for an IME. Be proactive on the claim or the months will continue to go by and the claimant will achieve their goal.

 

  

2.      Injured workers have no job to return to for light duty, let alone full duty:
 As mentioned above, a common scenario for an extended compensation claim is when the position the worker was in is eliminated, or when the employer does not have a transitional duty program. Since the job market is tight, some injured workers let their accepted workers compensation claim go on as long as possible.

 

 

Employers should alert adjusters before job cutbacks so they can discuss strategy on who will be affected. The adjuster can form an action plan to get the claimant back to full duty without letting him or her slip through the cracks.

 

 

When claims are denied, workers may think they have nothing to lose by filing for a hearing or seeking counsel. This causes the claim to be open for several months or years while the litigation ensues and parties work toward an eventual settlement. The wheels of the legal system often move slowly, and this contributes to the number of open claims out there. If you take a slow-moving legal system and overload it with everyone filing for a WC claim hearing, you get a backlog of claims and the system barely moves. Stay in touch with counsel to make sure he or she is trying to settle the claim and move negotiations forward. The very best way to avoid litigation is to communicate with the employees. Have an employee brochure, a written transitional duty policy, have employee's acknowledge receipt of the policy, have a brochure for your network physicians, and most importantly have an Injury Treatment Medical Information Form, a/k/a Work Ability Form. THIS gathers information from the injured employee's doctor at the first medical visit. Employees contact attorneys because they can't get information from their employers about their claims or their medical bills are not paid.

 

 

Due to company cutbacks as mentioned above, one worker may be doing the work of three. This leads to employers trying to do more with less. Injuries are bound to happen, especially in more heavy-duty, manual-labor positions. Employees working longer hours and doing more strenuous activity are leading toward a musculoskeletal injury and a probable surgery, if not worse.

 

 

These workers may be reluctant to report an injury for fear of losing their job. So they try to work thorough the pain, until the injury gets so bad it needs immediate attention. Workers need to know to promptly report injuries no matter what the circumstance, so they can be treated before it gets worse. Workers with wrist pain wait until they have full-blown carpal tunnel before reporting the pain; whereas if it had been reported sooner, full recovery would have been more rapid and less traumatic; waiting is prevalent when pay is conditioned on production-based pay.

 

 

The dreaded MSA. If an injured worker is eligible for Medicare and the case is in litigation or parties want to settle, in order to settle the claim, an MSA is necessary. This will pay the employee what Medicare would have paid for the continued treatment of the injury. The employee then pays for future treatment from this account. He or she then files paperwork with CMS that tracks the claimant’s continued medical treatment long after the workers compensation carrier settles.

 

 

Getting CMS to approve an MSA can take from eight months to two years as there are numerous payment issues to be ironed out. Carriers and CMS employees are adjusting to this new system and, so far, it has not been a smooth transition, according to Gould and Lamb, experts in MSA issues. An adjuster or counsel can further explain how this works in individual jurisdictions.(WCxKit)

In summary, workers compensation claim closure rates have slowed nationwide with multiple forces to blame. But, with a good action plan, some persistence, and a bit of patience, these issues can be resolved and the file can eventually be closed for good.
 

 

Our WORK COMP Book: www.WCMANUAL.COM
 

Posted in Claim Management, Communication with Employees, Coordinating Medical Care, Fraud and Abuse, Implementation and Rolling Out Your Program |

There are times while engaged in a workers compensation file that you are better off just settling the file out, redeeming all costs for medical, wages, and future medical exposure. Some files will not necessarily call for a full settlement, maybe it is better to settle either wages or medical, or both, but it has to be done when the scenario calls for it. Some examples are below.

Note: These are general examples, and all actual claim situtations should be reviewed by your legal counsel.

 

The cause of a good percentage of litigated files comes when the employer terminates employment with the claimant during the course of their injury and subsequent rehabilitation. The claimant feels they were terminated unfairly due to their injury, and this will send them directly to a plaintiff attorney. This will open up significant exposure for ongoing wage loss, and it will extend the life of a claim. (WCxKit)

 

 

On most occasions you are better off waiting to drop the axe on termination until the claimant has either reached their end of healing, or the end of the case. This way, if you want to settle the file, you can include the voluntary resignation of the claimant from the employment. 

Note: consult with legal counsel before settlement, having them review voluntary resignation to make sure it meets requirements of state law as "voluntary" and that it complies with all other requirements.

 

 

This scenario happens a lot when a major surgery or amputation is involved. The job the worker once did can no longer be done by that worker. You have the option of moving the employee to another department or position, but often with smaller companies the option is just not there.

 

 

This is a good time to settle the wage portion of a claim. If you know for sure the worker can no longer do the job they once did, and you do not want to spend the cost of vocational retraining or vocational job placement, then you should settle out the wage portion of their claim. Again it is best to wait until their medical situation stabilizes before you approach this topic. You do not want to pursue this too early, as the claimant may try to stretch out their medical recovery, further securing their wage loss benefits and adding to the cost of the claim’s wage loss.

 

 

Depending on the job, some claimants will know they have little to no hope of returning back to work at their old position. But not every injured worker is easy to deal with. Changing jobs or losing your job is a major roadblock in a claim, and it can be costly to settle out the wage portion of these claims. But in the long run, it is worth it. Vocational training and placement is not a guarantee, and you do not want to incur those costs and then also have to settle the wage portions out when you cannot find the injured worker a job.

 

 

In this case you do not have to settle the wages and medical to include a voluntary resignation, unless you want to add it in. If the adjuster denied the case as being compensable, but the worker filed their claim under their disability coverage, and then filed for hearing after returning to work once released from medical care, this is a case to settle after all the exposure for wage loss and medical bills are gathered.

 

 

This case gives you the total exposure, since the lost wages are known, and the medical cost to full duty is known. This is known as a “closed period” settlement.

 

 

Typically the adjuster will have to negotiate a lien with the medical carrier, and a compromise will be made on the wage loss the worker incurred. Unless you have a fantastic denial and can take your defense all the way to trial, it is best to make the compromise and settle for a portion of the exposure. This is probably the most common litigation example in the world of workers compensation.

 

 

Here we have an example of taking a wage loss offset, and negotiating a medical lien. This is a fairly simple case to settle. Most states will allow a claimant to get unemployment pay when they are laid off. Even when they are off on a medical leave. This is a "collateral source benefit" because the employee may be making more when not working than when working.

 

 

However, if this person files for litigation, the insurance company can offset what the full-wage loss would have been, so, in essence, they get a credit for the wage loss, and only have to deal with the medical lien from the carrier. These medical carriers are usually easy to negotiate with, and most liens can be settled for easily up to 50 percent of their cost.

 

 

Medical carriers will also get a better fee reduction than workers compensation insurance carriers, so not only does the workers compensation carrier get a credit for the unemployment pay the worker received, they also get cheaper medical cost for all the medical expenses the injured worker incurred during their treatment and recovery. These are also usually closed-period settlements, and can be redeemed for a relatively low legal cost.

 

Occupational injury claims are usually filed by seasoned workers who have spent their lives working for several employers.  When their shoulder or back finally gives out and they need surgical repair, if they seek out an opinion at a plaintiff attorney’s office. The counsel will usually file a hearing for an occupational injury claim, and they will list all of the claimant’s past employers, since they will assert that each period of employment lead to the accelerated degeneration of the worker’s body, which lead to the ultimate injury they incurred.

 

 

In this case, each employer will contribute an amount towards a global settlement. The exposure of each employer will depend on the duration of employment, types of jobs the claimant performed, and the associated risk involved in relation to the injury. The hardest part about these claims is figuring out how much each adjuster should have to contribute. Once the adjuster takes all the past employers and the exposure into consideration, they will nominate a general amount for the represented employer’s exposure, and once all parties agree on all the amounts the case can be settled. It can take some time for all carriers and adjusters to agree, but they eventually get there and the case can be resolved.(WCxKit)

 

Workers compensation claims are settled all the time, usually for one of the reasons outlined above. As you can see, you have a number of opportunities where a settlement is the best option, and you should discuss with your adjuster if this is the road you should explore, instead of incurring other costs to bring an injured worker back to work at your place of employment. This differs from my normal opinion of bringing every able employee back to work.
 

 

Our WC Book: http://corner.advisen.com/partners_wctoolkit_book.html

Posted in Medical Issues, Settling WC Claims |

This week at the Workers Compensation Roundtable discussion group on Linkedin there are several new discussions, including this one from Deborah Pfeifle: What is the average life span of a WC claim from first report of injury through closure, nationally? What is the #1 issue that precludes claim closure?

 

Charlie Larson of South Dakota responds with, “We are allowed to file written discovery and conduct depositions. After the petition is filed, we have 30 days to answer, each side has 30 days to answer discovery, and after obtaining a medical authorization, it takes forever to get medical records. After that is done, the depositions begin. I've had some cases drag out for years, but that typically is the result of a claimant attorney not moving the case forward.”

 

He encourages participants from other states to write their comments.

 

Mike Benishek writes that, while he knows of no national figures for claim closure, his “med-onlys usually close out in 60 days. Lost time varies by claim.” He adds, “As for what precludes claim closure, #1 is Attorneys (both claimant & defense attorneys) and the ever popular Medicare Set Aside (MSA) requirements.”

 

And Karen Rutledge writes, “I am not certain about national standards, but in TX if we could obtain claim closure on an indemnity case within 105 weeks it was a success as there is lifetime medical treatment option. In OK and CO, an indemnity case with litigation could be up to 2 years. I agree with Mike medical only was usually 60 days as you had to wait for medical providers to submit all the bills.”

 

Though an older discussion, the topic asking which state has the worst WC laws is still drawing comments. This week David Sheck, a WC and PEO broker for 20 years, writes, “I would say it is a tie between Ca and NY. Generally states in the Northeast are close runner ups.” And participant Mark Walls directs readers to a document showing the Oregon WC premium ranking summary.(WCxKit)

 

John Winkler says, “NC should be in the running as well — No cap on TT and the requirement to return injured workers to ‘suitable employment’ can be a bear with an Avg. cost per claim 34% higher than the median of 46 other states and medical costs increasing in cost per visit.”

 

And Greg Krohm adds, “I am really surprised by the near consensus on CA, IL and NY. The next interesting question is: What specific system features are the most disliked by employers (payers)? I suspect the reasons would be diverse and different in each of the above states, e.g., IL fee schedule is being racked over but the CA fee schedule is not bad relatively speaking. Hearing delays may be a big problem in one state but not in another. IL has no treatment guidelines and NY and CA guidelines have been the focus of a lot of discussion. Another interesting question: would organized labor pick a different list of states?”

 

And lastly, a new discussion was brought up by Thomas, who asks, “Does anyone have experience with the use of EBT cards for scheduled indemnity benefit transfers? Vendor recommendations?”

 

Join us at Linkedin's Workers Compensation Roundtable right now and right here! Better yet, invite your friends so they too can become informed on hot topics in the Workers Compensation industry.(WCxKit)

 

Workers Compensation Roundtable is jointly managed by people dedicated to the concept that workers compensation is a manageable line on your expense ledger, and that informed professionals are empowered achievers. Workers' compensation is not simply a cost of doing business, it is a cost that can be controlled. Beginning with an assessment of cost drivers, benchmarking data, and integrating the solutions, employers can reduce workers' comp costs 20 to 50 percent. With proper information, professionals managing compensation claims can reduce costs and improve outcomes for all stakeholders in the process. This group is for employers, business owners, risk managers, HR managers, insurance executives, and brokers to discuss the obstacles and strategies to overcome them.

Posted in Professional Development Issues |

Wal-Mart has agreed to pay $440,000 to a group of Hispanic employees in Fresno who say they were subjected to ethnic slurs and derogatory remarks by a co-worker.

 

 

The settlement was announced recently by the Equal Employment Opportunity Commission.

 

 

The EEOC sued Wal-Mart and its affiliate Sam's Club in 2009, alleging the workers were being harassed and that Wal-Mart failed to halt the mistreatment in a timely manner a charge Walmart has denied. (WCxKit)

 

 

At least nine employees of Mexican descent and one, who is married to a Mexican, claim they endured ethnic slurs on a daily basis by a co-worker, who was also Hispanic. The workers, who provided food samples to customers, complained in April 2006, but no immediate action was taken, EEOC officials report.

 

 

Instead, the harassment intensified, according to Christine Park-Gonzalez, an EEOC program analyst in Los Angeles.

 

 

It was not  until the workers filed a complaint with EEOC in October that Sam's Club fired the harasser in December 2006.

 

 

According to Wal-Mart spokesman Greg Rossiter, the company fired the worker once the full extent of the allegations was brought to the company's attention.

 

 

As part of the settlement, Wal-Mart also agreed to make changes in how it deals with these issues at its Fresno and Bakersfield Sam's Club stores. (WCxKit)

 

 

The company committed to a three-year agreement to provide training to employees regarding anti-discrimination laws; teach managers how to investigate and report harassment complaints; and create a tracking system for complaints.

 

 

 

 

 

Posted in California Workers Comp, EEOC Discrimination Laws |

 

Just like anything else with work, you must be prepared. Create a negotiation plan, listing your strengths and weaknesses, along with rebuttals to weak areas of your defense. Make sure the plan is up-to-date with current demands and defenses. If you get to a settlement meeting or mediation unprepared to settle the claim, you have wasted time. The point of mediation is to bring the parties together to resolve the claim  — sooner rather than later. List potential obstacles and weak points of your case and think through IN ADVANCE how to overcome those obstacles.

 

 

This is a common mistake in claims. Rarely do you get a file you can fight all the way to the finish. You can have great defenses and a good aggressive stance, but you may have to give up a little in some area to actually settle the claim. Remember the goal is to hedge the risk. If the goal is to settle to avoid future costs, you will have to pay something, whether it is wage loss or medical bills. Do not slam the door shut by refusing to negotiate. You may end up looking bad in the eyes of  the mediator and opposing counsel. You can expect to run into these people again, so keep a good reputation and do not ignore the natural give-and-take of claim negotiation.

 

 

The use of certain words has a great impact on negotiations. For example, if you are arguing over wage loss, it is better to say: “If I give you $30,000 — that is $5,000 more than our current offer.” rather than saying, “I know you want $50,000 but $30,000 is the best I can offer at this time.” Giving certain offers a negative slant affects negotiations down the road and may lead plaintiff counsel to be less open to negotiate other aspects of the claim. Use the strengths of your case and the rationale behind your numbers in negotiation.

 

 

Do not let your confidence level on the claim cloud your judgment. Sometimes it is best to get another opinion on your file about the exposure level. Adjusters have files for a long time, and over the course of time, they have an idea of what a claim is worth. Every now and then, there may be a tendency to become a tad too aggressive on a file. In mediation, overly aggressive methods can blow up in one’s face. Get another opinion of what the claim is worth to make sure you are not missing anything and going into negotiations with a skewed idea.

 

 

Inexperienced adjusters may lack the ability to think quickly. Negotiating “live” in front of others often is a daunting experience. You must know the file in and out because claimant's counsel looks for any signs of weakness and seeks to exploit them. Avoid weaknesses by being prepared and able to talk your way through the offer. If you are caught in a weak point, you must be able to think fast and make sense. The good news is thinking on your feet comes with experience.

A skilled plaintiff attorney may call your bluff by ignoring it. If you say, “All I am offering is $20,000.” and on the  day of mediation they call you for a last-chance effort to settle, and you suddenly offer $30,000, you lose credibility with that particular attorney. Plaintiff firms around the insurance world keep notes on both insurance companies and their adjusters. An adjuster with a reputation of taking a hard stance early on and then caving in as a litigation date draws near, has lost the case. Be honest, make your offer, be consistent, try not to bounce the numbers around, and stand your ground. In this way, you keep a good reputation for yourself and your employer.

When plaintiff counsel accepts a negotiated settlement, some adjusters feel they paid too much for the claim. This happens when the plaintiff takes the offer early in the negotiating process, as opposed to later after a few months of going back and forth. Litigation and negotiation is often hard work, but not always. The acceptance of an offer does not mean the other side was willing to take much less. Inexperienced negotiators often feel this way since they view mediations as a battlefield. However, just because the other side gives in earlier than expected does not mean the claim was overpaid. (WCxKit)

 

 

In conclusion, learning how to negotiate a file during litigation is a complicated job and one that comes with experience. Get other opinions from senior adjusters at your company and know the content of your file inside and out. The more prepared you are, the better you will present, and the better the outcome.
 

 

Posted in Litigation Management, Risk Management, Settling WC Claims |

California workplace safety officials have fined Larry Flynts Hustler Video and another porn producer for not using condoms on set to protect sex performers from exposure to disease.

 

 

Associated Press reports that Hustler is looking at $14,175 in fines for three violations, including failure to provide condoms or other protective equipment, according to a Division of Occupational Safety and Health citation. (WCxKit)

 

 

Hustler "failed to ensure the use of appropriate personal protective equipment, such as condoms" to protect its employees from semen, vaginal excretions and blood in the course of producing adult videos, according to the citation.

 

 

The present penalties are based on the same section of state law that also requires hospitals to provide nurses with protective gear to spare them exposure to blood-borne and fluid-borne illnesses.

 

 

Flynt has commented previously that audiences dont want to watch porn in which actors use condoms.

 

 

Hustler was also fined for failing to maintain a written injury and illness policies and for failing to provide workers with vaccines for hepatitis C.

 

 

Hustlers citation stems from a Sept. 14 inspection of a job site in response to a complaint from the AIDS Healthcare Foundation, a Los Angeles-based nonprofit that advocates for safe sex in pornography.

 

 

Forsaken Pictures faces $12,150 in fines for similar violations. The fines were issued March 9.

 

 

In 2010, a porn actor tested positive for HIV at a California clinic, causing panic among actors. Some San Fernando Valley pornographers in the multibillion-dollar adult entertainment industry shuttered productions as a precaution

 

 

 

 

 

Posted in Medical Issues, Safety and Loss Control |

A Texas appeals court has ruled that a landscape manager was within the “course and scope of his employment” when he passed away en route to pick up a co-worker to attend a leadership conference

 

 

The recent ruling by the 3rd District Court of Appeals in Texas in Zurich American Insurance Co. vs. Chantal McVey upholds a lower courts decision denying Zurich's argument that Troy McVey's beneficiary was not entitled to workers compensation benefits due to the fact he was not acting in the course and scope of his job when he died in an auto accident.(WCxKit)

 

 

According to Business Insurance, on the day of the accident, McVey was behind the wheel of a company-owned truck he regularly used to perform his employment. He was scheduled to attend his employer's leadership conference and was slated to pick up the co-worker, who also was required to attend the event and lived in proximity to McVey's route to the company gathering, according to court records.

 

 

Court records also report that the employer “emphasized policies that its employees should be efficient when making company-funded travel and made employees subject to dismissal for repeated perceived abuses.”

 

 

Zurich's arguments were directed toward the belief that McVey essentially was engaged in “an everyday trip to work,” according to court records.

 

 

But the appeals court found that a “coming-and-going” rule that prohibits benefits for accidents while traveling to work does not apply in this case.(WCxKit)

 

 

It said McVey was taking part in travel that furthered his employers business. As a result, his death is compensable, the court concluded, according to BusinessInsurance.com

 

Note: The facts of each "coming and going" case are slightly different even though many may appear to be the same. Make sure to ask your local defense counsel and the insurance company if your employees were "coming or going" to work.

 

 

 

 

 

Posted in Legal Doctrines |

 

 

AIG will also pay $46.5 million in taxes and assessments, and could pay added fines, up to $150 million, if it does not adhere to a compliance plan, according to the ODCBS. (WCxKit)

 

 

 

 

 

 

 

 

 

 

 

 

Posted in Settling WC Claims, WC 101 |

You have finally gotten the state-of-the-art claims management system. Now, that you have the ability to self measure your performance, are you doing so? The following benchmarks suggestions are some of the ways you can compare where you are now with where you were in the past. These benchmarks will also provide you with the information you need to objectively set goals for the New Year.

 

 

Many risk managers and claim managers want to measure their performance by the amount of dollars spent on claims. Financial results can be excellent benchmarks. We will discuss financial benchmarks, but also will look at ways to benchmark the quality of the claim handling process. Here are some benchmarks suggestions. (WCxKit)

 

 

 

1.     Changes in average claim cost – This is the most common benchmark – a comparison of the average cost of medical benefits, indemnity benefits and claim expenses. The data is easily obtainable and allows you to compare your claim cost with last month, last quarter, last year and any other time frame you chose.

2.     Average claim cost compared to your industry – It is often not enough to know that your claim cost has declined since last year. You will also want to know if your claim cost is higher, lower or about the same as your business competitors. (A great way to gain a competitive edge in your industry is to do a better job of managing your workers' compensation program). Information on your industry can often be difficult to obtain. Some of the large TPAs and large workers' compensation insurers have partial data with which comparisons can be made. The National Council on Compensation Insurance (NCCI) collects payment data in the 35+/- states in which they operate, but they charge some hefty fees for their data on your industry.  WorkersCompKit has a good benchmarking system to quickly calculate these numbers.

3.     Initial reserve to ultimate value ratio – This is a ratio of the aggregate payments in a coverage line (for example: medical benefits) to the initial reserve value. This will give you an idea as to the knowledge and accuracy of the adjuster is estimating claim value.

4.     Ratio of reserves + payments (90 days prior to closing) to final claim cost – By comparing what the adjuster has in reserves plus claim payments made 90 days prior to the claim closing date, with the final amount paid on the claim, you can gauge the accuracy of your large claim reserving. [Exclude the claims closed in less than 6 months].   The ratio of reserves plus dollars previously paid on the claim, to the final claim cost should be approximately 1.0. If the ratio is under 1.0, the overall claims are under reserved. If the ratio is over 1.0, there is on average extra money setting in reserves.

 

 

While there are many ways to gauge your claim handling, these are some suggestions for measuring claim-handling performance:

 

 

1.     Average bill process time – This is simply a comparison of days between the date the medical bill, legal services bill or other expense was received in the claims office, and the date the payment was processed. This allows you to measure the timeliness of your bill payment process and gauge the progress of your staff.

2.     Closing ratios – This is the ratio of files open during the month, quarter or year compared to the files closed during the same time frame.   Ideally 1.0 or better.

3.     Percentage of closed files with payments over $1,000 – This indicator will keep the claim office honest on the closing ratios. It is too easy to manipulate closing ratios, so this will tell you the claim office close files prematurely when the number of closed claims with payments increase.

4.     Average time to input initial reserve – While different claim offices have different standards as to how soon (48 hours, 7 days, 15 days, 30 days) the initial reserve should be in the computer system, by comparing the current average length to time to a prior month, quarter or year, you can gauge how quickly the adjusters are inputting initial reserves.

5.     Average days between reserve changes – By having your computer compute the average number of days between reserve changes, you can quickly determine if the reserving is adequate. If you see on average a reserve change every 6 months, the claim office reserving procedure is probably okay. If you see the average days between reserve changes is 30 days, the claim office definitely has a problem with stair-stepping the reserves.

6.     Files on diary – This is a measurement of the files that are being actively worked on the diary. The claim office should have every file on diary to prevent the files from stagnating.

7.     Files with missed diary – This benchmark can be either a list of the files where the diary has not been updated the diary due date has passed, or it can be a percentage of the files with a claim handling due date that has passed. Either way, it provides you with insight into how current the claims office is in the handling of the claims.

8.     Claim file notes usage – As most computer systems automatically input a note when a check is paid, diary is due, etc., a benchmark measuring non-computer generated file notes will tell you how often on average each file is being actively reviewed/worked on by the adjuster.

9.     Initial index filings – If you require all your workers' compensation indemnity claims to be indexed, this ratio will tell you whether your goal is being met. Your computer system should also be able to tell you the file numbers of the claims that have not been indexed so they can be corrected. (WCxKit)

10.Subsequent index filings – Many work comp insurers require long term claims to be re-indexed every 6 months or every year. This benchmark would compare the number of long term claims with the number of subsequent index filings.

Now while we can make these recommendation for benchmarks, don't ask us to program your computer system. That's a job for your IT department. However, by using these benchmarks, you can measure both the fluctuation in your claim financial and the success of your workers' compensation claims handling program.

 

Grading you adjusters is another aspect of measuring adjuster performance. Ask the carrier or TPA whether they SCORE their adjusters – as in giving them a numeric grade. Broadspire scores and ranks their adjusters in a unique and extremely interesting scoring sytem which is backed up with additional training if needed. Adjusters with superior scores receive monetary incentives each month. This is the only such system I know about although there may be others.

 

Posted in Benchmarking & FTE & Operational Comparison, Settling WC Claims, TPA and Claims Administration |

The supreme court reversed.  According to the court, whether a worker was contractually required to live on the employers premises was not necessarily as important as whether the practical circumstances required that he or she live there. Examining decisions from several other jurisdictions, the South Carolina high court determined that the worker in the instant case was essentially required to live on the employers premises by the nature of his employment and was making a reasonable use of the employer-provided premises at the time of his accident.  The court also indicated that the workers injury was causally related to his employment in that it was due to the conditions under which he lived, i.e., a wet sidewalk outside his building. See Larson's Workers Compensation Law  Ch. 24,[1] n9.1]

Posted in Legal Doctrines, Medical Issues, Safety and Loss Control, Settling WC Claims |