5 Key Terms That Define Professional Administration Contracts

ametrosSetting up support with professional administration of medical funds after settlement is a clear choice.  It helps the injured person save money on their healthcare expenses and provides support in navigating ongoing care. The service is especially helpful for Medicare Set Asides because the administrator helps ensure the injured person’s Medicare benefits remain intact while protecting the injured worker, their attorney, as well as the payor from any potential mishaps.  In fact, Medicare “highly recommends” that injured individuals use a professional administrator after settlement.  (What is professional administration? Learn more)

 

When it comes to administration, all involved should have a thorough understanding of the administrator’s role and how it benefits the injured person. What can sometimes be less obvious is how to set up the administered account with an agreement that adequately governs it and how administration fits into and facilitates settlements.  The following concepts are essential to understand these agreements.

 

 

1. Who is involved? Parties to the Agreement 

 

Ideally, the agreement is between the injured person (also known as the “member”) and the administrator. It’s useful to get to know the administrator involved and to see if it is independent and truly has the best interests of the injured individual at heart. Conducting some background research, contacting the administrator directly, and asking for references are good starting points.

 

Tip: Be aware of administrators that operate other lines of related business.  This could create a conflict; for instance, if they work for the carrier/employer to provide low estimates of future medical allocation amounts, it does not make sense that they are also offering to work for the injured person to help them maximize their medical settlement funds.

 

The cleanest arrangement is a bilateral agreement between the administrator and the injured person where the administrator is focused on its duty to protect the injured person.

 

 

2. The Purpose of the Agreement / Responsibilities of the Administrator

 

The administration agreement should outline the benefits and services the administrator will provide.  These often include:

 

  • Placing the settlement funds in a separate, interest-bearing bank account under the member’s name
  • Securing discounts on medical bills where possible and paying medical bills on the member’s behalf
  • Tracking and providing complete reporting on all expenses
  • Filing any required government reports, such as Medicare Set Aside reporting

 

The responsibilities of the administrator should be clearly outlined.  If it is determined that the administrator is going to do something extra or different for the member, this should be included in the agreement.

 

 

3. The Bank Account

 

The administration agreement should provide detail on how the member account will be established. For utmost security, it should be a separate, individual bank account established in the name of the member.  In unique situations where the settlement is funded into a special needs trust, then the account may be required to be setup in the name and Tax ID number of the trust to ensure government benefits are protected.

 

Often times, included in the administration agreement is the standard information the bank requires. With complete security, the administrator is the custodian of the account and must authorize any disbursement.

 

Tip: The safest account is a separate checking or savings account. Be careful of any pooling of the injured person’s funds with money from other clients. This can have significant consequences because it:

 

  1. may result in their funds being invested in less liquid assets or that are at risk of losing value.  (Investment losses are not an appropriate use of MSA funds)
  2. may result in the loss of FDIC insurance of $250,000
  3. means their money and will likely be tracked manually by the administrator instead of the bank which could potentially lead to mistakes 

 

It’s important to know the member’s money is deposited at a reputable bank in a separate and secure account managed by a top-notch administrator. It is also important to choose an administrator that has multiple banking partners to ensure that large accounts that may be in excess of FDIC limits can be set up in the most protective way.

 

 

4. Beneficiary Designation

 

An important provision of the administration agreement is the beneficiary designation language. Similar to the setting up of a trust or estate plan, it’s important for the member and all parties involved to know where the administrator should send the remaining funds in the account when the member passes away.

 

Typically, the administration agreement follows the guidance provided in the master settlement documents.  If there is no designation of a beneficiary in the settlement documents or if the account is established after settlement, the administrator will defer to the member for whom they wish to designate.

 

Tip: this provision, like many others, can be negotiated as part of the overall settlement discussion, separate from the administration service.  The beneficiary of the administered account can be the member or their estate; it can also be a corporate entity like the carrier/employer/payor involved in the claim (frequently referred to as a “reversionary” party), or a non-profit or charity, etc.  During settlement negotiations, the defense and plaintiff parties can negotiate the terms of this part of the agreement to determine who or what entities benefit from the remaining funds; sometimes the designation of the funds or a portion of them can be subject to certain terms and conditions, just as they can apply to other aspects of the settlement.

 

Upon death, the administrator will typically require a grace period to make sure all outstanding bills are gathered and payments are made; then, the administrator will close the account and cut the check to the designated party or parties.

 

 

5. Rights of the Injured Person 

 

Finally, it’s important the member fully understands their rights when their account is being established. They should have a number of common rights and protections and should also be aware of any restrictions. Here are a few common items to consider:

 

  • Review of performance: the member should be able to review the work of the administrator and report any inaccuracy to have it addressed
  • Protection: The member should be held harmless for any mistakes made by the administrator due to negligence
  • Savings: the member should receive the benefit of discounts secured on their behalf by the administrator. If the administrator benefits in any way from discounts negotiated, they should be transparent to the member.
  • Open Network: the member should be able to seek treatment with any provider or pharmacy. While a network may be in place to help the member save money, administrators should not restrict the member’s access to care with any provider, pharmacy or facility.
  • Termination: it should be clearly stated whether termination of the agreement or a withdrawal of the funds is allowed. This can be negotiated as part of the overall settlement. Typically, if the member is the sole beneficiary, they can choose to terminate the administration agreement and receive all their reporting and a check for their funds.  However, if there are other designated beneficiaries, language in the settlement agreement may restrict their ability in order to protect all beneficiaries’ interests.

 

 

Fitting It All Together

 

Along the way, if you or the injured person have any questions, the administrator will be a valued resource to clarify the terms of the agreement or explain how the service works.  Not all settlements are alike, so sometimes it’s beneficial to request edits and tweak terms of the agreement to your liking.

 

Once all parties are confident in the terms of the administration agreement, most often, the administration agreement will be added as an addendum to the settlement documents.  This way, it is part of the overall settlement package and can be approved at settlement; in workers compensation cases, the judge often wishes to sign off on all aspects of the settlement, including administration.

 

 

Author Porter Leslie, President Ametros. Porter directs the growth of Ametros and works with its many partners and clients. He built his career leading customer-focused businesses in the healthcare and financial services industries. Prior to Ametros, Porter worked in investment banking, private equity and corporate development.

Porter earned a B.A. in Economics from Columbia University, as well as an MBA from the Wharton School and an M.A. from the Lauder Institute at the University of Pennsylvania. Porter is fluent in Spanish and Portuguese and resides in Boston with his wife, Ruth, and son, Camilo.

Responsibilities of a Workers’ Comp Claims Investigation Leader

workers comp claims leadershipCentral to successful leadership is attention to detail, solid work ethic and commitment.

 

Members of the claim management team and fully-engaged employers must exhibit these same traits when it comes to workers’ compensation claims.  All claims must be investigated promptly – by the book with no corners cut.  This process also includes the development of best practices to manage risk and control workers’ compensation program costs.

 

 

Responsibilities of a Claims Leader

 

There are several goals a good leader must undertake when developing a program.  This is something that can be done inside an insurance carrier or company.  Items to consider should include:

 

  • Develop a program to sniff out fraud. This program includes being proactive to prevent it from taking place and detecting it early on to mitigate program costs;

 

  • Update upper management within the organization on issues concerning the overall workers’ compensation program. This position should be able to effectuate and promote change;

 

  • Understand how to conduct an effective investigation. This is especially important in more complex claims or those which involved special or unique circumstances; and

 

  • Coordinate all efforts between defense counsel and the clients. This should include all interested stakeholders to promote an effective program.

 

 

Special Investigation Unit: Dealing with the Tough Claims

 

Not all workers’ compensation claims are the same.  Some claims are more difficult than others.  This can include instances where the employee sustains a severe injury, the circumstances surrounding the claim are suspect, but difficult to prove it did not occur or fraud.  Proactive claim management teams and employers can address these barriers by developing a “special investigation unit.”

 

Teamwork is key when working on special claims. It all starts with a dedicated leader who knows how to peel back the layers and get to the bottom of things.  Important characteristics of this leader should include:

 

  • Someone with law enforcement or military background. These are people who faced difficult challenges in the past and are resourceful;

 

  • A person who has a reputation for being fair and honest. Remember, all injured employees need to be treated with dignity and respect. Integrity is paramount;

 

  • Knowledge of the law and other applicable tools to complete the goal. An attorney can be considered for this role, but not necessarily required; and

 

  • A leader who can effectuate change within an organization.

 

 

Leading from the Front – Taking the Lead

 

The leader of a special investigations unit needs a strong supporting crew.  This can include assistance from the following departments:

 

  • Human Resources: This area brings an understanding of other applicable rules and regulations together to assist in claim investigation and help an organization avoid countless pitfalls;

 

  • Legal Department: An attorney can advise the unit on legal issues and provide advisory opinions, guidance and assist in the development of a legal strategy;

 

  • Medical: Having an on-call nurse or doctor who can assist in complex issues such as utilization review of medication or other procedures will drive down costs.  They can also assist in injury response; and

 

  • Management: It is important to include a representative from senior management. This person can help clarify the mission of an organization and desired results.

 

 

Conclusions

 

Workers’ compensation claims present challenges that call for special measures.  To be successful, proactive employers and insurance carriers can develop special units to tackle these matters head-on.  This includes engagement from a variety of areas within an organization to resolve claims and reduce workers’ compensation program costs.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center.

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: https://blog.reduceyourworkerscomp.com/

 

©2019 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

Living Values, Drug Trend Simulcast, MSA Metrics, and More Top WC News Tidbits

workers comp newsLiving Our Values — The President’s Award

Our claims professionals have critical interactions with clients, injured workers, insureds and business partners on a daily basis. Whether through an email, phone call or in person, every one of these conversations is an opportunity to restore the lives of those affected by losses. Since adjusters and other employees can often be the unsung heroes of the industry, leaders in claims organizations must make a special effort to highlight the contributions and successes, both large and small, of each employee.

 

 

Industry First: Drug Trend Report Simulcast: Thursday 4/18 @ 3:00 pm EST

The 2018 myMatrixx Drug Trend Report combines both legacy Express Scripts data and myMatrixx data providing a more comprehensive view of the industry than ever before. In this year’s report our readers will be able to see which drug categories are on the increase as opioid utilization declines. Our industry experts will guide you through the report and answer questions about, “What’s Next?” in the future of Workers’ Compensation.

 

 

Tower MSA Partners Presents A Premier Webinar: Leveraging Metrics And Msa Partner Relationship To Settle Claims

On April 24, Tower MSA Partners CEO Rita Wilson and Chief Compliance Officer Dan Anders will host a lively hour-long webinar that explains how to measure the performance of an MSA program and identifies the metrics needed. They also discuss ways to strengthen the payer/provider relationship in order to produce lower allocations on CMS-approved MSAs and quicker claims closures. Discussion points include:

 

  • How to measure your MSA program performance – what metrics should you use?
  • MSA drafting and review factors that impact MSA performance
  • Implement simple strategies to effectively work with your MSA partner and settle claims
  • Make your MSA provider part of your settlement team

 

 

What You Can Do to Prevent Atherosclerosis

Your good health has an enemy — atherosclerosis. Atherosclerosis is common. And its effects can be very serious. This condition can lead to strokes, heart attacks, and death.  But, you can take steps to protect yourself from this disease.

 

What is atherosclerosis? The inside walls of healthy arteries are smooth and clean. This makes it easy to transport the blood your body needs. But arteries can become clogged. Fatty substances like cholesterol can stick to artery walls. These deposits are called plaque. Plaque can eventually slow or block the flow of blood. This blockage is atherosclerosis.

 

 

How to Adjust Your Workspace to Reduce the Risk of Injury

Small inexpensive adjustments you can make to your workspace to increase blood flow and reduce the risk of injury.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center .

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: https://blog.reduceyourworkerscomp.com/

 

©2019 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Why Work Comp Claims Become Old Dog Claims

old dog claimsEvery self-insured employer who has been managing their own workers’ compensation claims program for 3 years or more have “old dog” claims, or for the politically correct folks, legacy claims. These claims include the injured employees who take longer than normal to reach the level of maximum medical improvement (MMI), the injured employees who have reached MMI but need on-going medical maintenance medical care, and the employees who are permanently totally disabled.

 

 

Claims Can Stay Open For Many Reasons

 

If you ask the third party administrator (TPA) adjuster why any particular claim is still open, the adjuster will recite the employee’s medical condition and possibly the industrial commission ruling on the particular claim. While the medical condition and/or the industrial commission ruling are factors in why the claim is still open, there are often many other factors and reasons that the adjuster does not recite (and frequently does not recognize). Some of the reasons that a work comp claim becomes an old dog claim include:

 

  • Inadequate initial investigation into the nature and extent of the injury
  • Inadequate claims training of the work comp adjusters
  • Inadequate medical management throughout the claim
  • A change of adjusters during the life of the claim resulting in a loss of continuity in the claim handling
  • The original adjuster, prior adjuster(s) and/or the current adjuster have had inadequate training on how to deal with complicated claims
  • The adjuster handling the claim has too many other claims assigned, causing the adjuster to miss opportunities when they occur to settle the claim
  • The TPA puts too much focus on closing claims, so the adjusters give priority to the smaller, easier to resolve claims
  • Other priorities keeps the adjuster from focusing on the legacy old dog claim
  • The TPA does not have a ‘home office examiner’ reviewing and providing guidance to the adjuster on the large or older claims
  • The claim is still being handled by a prior TPA who no longer values your business as the prior TPA is not receiving any new assignments

 

 

Legacy “Old Dog” Claims Can Be a Financial Burden

 

When legacy (old dog) claims drag on, they become a financial burden to the self-insured employer. As time goes by, the claims become a bigger and bigger drain on the financial resources of the company. If nothing is done to resolve the claim, it becomes a permanent drain on the company.

 

To move these claims forward, while mitigating the ultimate claim cost, an in-depth review (file quality audit) of each claim is needed. While the audit can be done internally, most self-insured employers do not have the resources needed to do the audit. Plus, a fresh set of eyes reviewing the claim will often pick up points previously missed. An outside, highly-experienced, independent claims auditor can review each legacy file and craft a detailed action plan with completion dates for each specific file.

 

 

Independent Claim File Audit Can Uncover Solutions

 

The independent auditor’s detailed action plan for each file should provide:

 

  • A review of the reserves to determine the adequacy of the current reserves and make reserve change recommendations to the ultimate value where appropriate
  • If the employee is not currently working, a recommended return to work process, whether it is with your company, or vocational training to work somewhere else
  • An analysis of the current medical situation and what future medical steps are necessary
  • A review of the litigation plan if the case is currently being litigated or appears headed into litigation
  • Confirmation or recommendations on compliance with state filing requirements
  • Recommendations on whether or not to attempt an all-inclusive settlement of the claim
  • Recommendations on whether or not to use a structured settlement of the claim
  • Recommendations on possible financial offsets (subrogation, social security disability, state disability, second injury fund or subsequent injury fund, recovery from the excess carrier, etc.)

 

While the independent, experienced claims auditor cannot undo the damage already done due to prior claim handling mistakes, the independent audit can assist you in mitigating future financial damage from the legacy old dog claims.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center .

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: https://blog.reduceyourworkerscomp.com/

 

©2019 Amaxx LLC. All rights reserved under International Copyright Law.

 

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

Five Easy Steps To Foster Loyalty And Positive Culture

Broadspire

Blog originally appeared at https://www.crawco.com/blog/five-easy-steps-to-foster-loyalty-and-positive-culture.

 

Developing a positive culture and inspiring loyalty requires a delicate and sometimes complicated balance between intentional interventions and behavioral modifications. In a day and time when the word loyalty has somewhat lost its meaning, maintaining a high retention rate and creating a positive work environment is critical and complicated.

 

Creation of a positive working culture, and the ever-elusive loyalty, requires leaders that are sincere, heartfelt and real. The best leaders are able to effectively communicate across the generational spectrum and inspire loyalty through their approachability, their communication style and their interaction at a guttural level.

 

The days of simply bringing in donuts once a month to foster and maintain an attractive work culture are long gone. Employees have higher expectations of their leaders, rightly so, in a landscape filled with alternative occupational options. Creation of a compelling family environment, with the right level of promise of career advancement, recognition, stability, growth, and development is critical.

 

 

How do we do this?

 

Unfortunately, there is no silver bullet. There is no single action or training program you can take and then step away. These traits, while innate in some people, can take work to uncover and, in some, may never emerge. However, that doesn’t mean the effort is not without its rewards. Your organizational culture and loyalty of employees are like a garden in many ways — it requires your constant, consistent and ongoing attention and dedication to grow, evolve, produce fruits and be sustainable. Take your eye off the goal for a week or month and your crops will wither and retract.

 

The advice I provide to anyone wishing to create, foster and grow a culture that inspires loyalty is to do so through intentional, purposeful acts. Just as we schedule meetings, client visits, and 1x1s, schedule time to attend to your organizational garden. Acknowledgment, remembrance, recognition, building up — big words that take very little time and reap great rewards. Reaching out on a human level, remembering and acknowledging service dates, anniversary dates, a great sales closure or finalization of a project — these things matter. They matter more than we realize — to all employees. From early career to mid-career and late career, no one is immune from needing recognition and praise for a job well done. Taking time, rather MAKING time, for these interactions is pivotal in establishing a working environment where employees feel valued, impactful, necessary and loyal to the vision and brand.

 

There are five steps that will set you out on the road to success. While these may seem easy and simple, consistency is key – doing it once a week or a month will not cut it. Making this a part of your DNA and who you are as a person in the work environment consistently will result in team members that are loyal and a far more positive and welcoming work culture:

 

  • Make eye contact as much as possible — with everyone
  • Say “thank you,” verbally and in writing, for specific things
  • Remember personal things shared with you and refer back to them
  • Be present in conversations — listen far more than you talk
  • Follow-through and follow-up — be reliable

 

Connect with people on a real level, treat everyone with respect and you will, in turn, gain their respect. This takes no money and no complicated reward programs — only your purposeful and consistent time.

 

Author Kelly Dieppa, Broadspire, Vice President of Disability & Leave Operations. Broadspire is Crawford’s Third-Party Administrator (TPA) specializing in servicing the claims needs of corporations, brokers and insurers who wish to take greater control over the claims process, indemnity spend, data capture, and to access meaningful management information. With industry-leading claims management, case management, medical bill review, pharmacy programs, physician review services and preferred provider networks, Broadspire can have a positive impact on employee productivity as well as costs.

How to Build Your Return to Work Program

return to work workers compensationA successful transitional duty/return to work program is much more than having an injured employee answering the telephone or sweeping the floors. Unfortunately, too many employers see a transitional duty program, also known as a return to work program as a “make work” situation for both the employer and the injured employee. This approach to a return to work program often ends in frustration for both employer and employee.

 

Employers who recognize the advantages of a formal return to work program are the employers who benefit the most from having one. A transitional duty program reduces the time the employee is off the job, and by providing physical activity for the employee, speeds up the recovery process. The employer receives a reduction in the cost of both medical benefits and indemnity benefits. Other advantages of an employee working in a modified duty position include:

 

  • The employee is able to contribute some productivity toward the company’s goals while the employee who is sitting at home contributes no productivity
  • The employee has higher morale knowing a job is waiting for him/her when they are healed as opposed to the employee being at home wondering if the company will have a job for him/her when he/she is healed
  • The employee who is physically active on the job recovers from an injury faster than an employee who is physically inactive at home
  • The employee does not develop a ‘disabled’ mindset and does not learn to expect to be paid for doing nothing
  • Employees who know that their company has a formal return to work program are much less likely to submit a fraudulent work comp claim

 

 

Develop Transitional Duty Job Description Before Injury Occurs

 

To build your own return to work program (or to improve your existing return to work program) start with examining the job requirements of each position within the company. A transitional duty work description should be developed for each type of job. By having a ready to go transitional duty job description before an injury occurs there is no delay in bringing the injured employee back to work in a modified duty position.

 

In physically demanding jobs where musculoskeletal injuries are common, some employers develop two transitional duty job descriptions for each position. The first transitional duty job description is for severe restrictions and limitations on the physical capabilities of the employee and the second job description for employees with less severe work restrictions.

 

 

Transitional Job Should Not Be Limited To Original Position

 

Too many employers make the mistake of limiting the transitional job to a variation of the injured employee’s original job. The transitional job can be anywhere in the company, it does not have to be in the same department or the same location. The transitional job that is different from what the employee was doing before the injury will broaden the employee’s skill set making the employee more valuable to your company in the future.

 

 

ALL Employees Should Participate in Transitional Duty

 

For the return to work program to be successful, the employee must cooperate and be a willing participant. The best way to ensure the employee’s cooperation and participation is for the employee to know ahead of any injury that all injured employees are automatically enrolled in the modified duty return to work program. The fastest way to destroy your return to work program is to be selective in who participates. If you pick and choose which employees will be provided transitional duty and which ones will not, you create a situation where the injured employee feels he/she is being singled out. This hurts morale and often leads to the employee hiring an attorney, which complicates the resolution of the claim.

 

As noted above, all employees should know that the company has a transitional duty program requirement for all injured employees. All supervisors and managers should be trained on how the return to work program works. The injured employee’s supervisor should be provided the work restrictions of the injured employee following each of the employee’s doctor appointments. This will allow the supervisor to verify the employee’s transitional duty work assignment meets the doctor’s restrictions.

 

The first day the injured employee is back on the job, the transitional duty work restrictions should be reviewed with the employee. It should be explained to the employee that the transitional duty job requirements will change each time the treating doctor reduces the employee’s work limitations. This prevents the employee from developing the idea that he/she is going to permanently have an easier position.

 

If the transitional duty position requires any training for the injured employee, the training should be provided during the first days the injured employee is in the temporary position.

 

 

Transitional Duty Should Be Temporary

 

The transitional duty position should be temporary. If the injured employee has not been released to full employment after 30 days, the work restrictions should be reviewed with the medical provider. Whenever possible, the employee should be given more work within the most recent work restrictions. If the work restrictions are not decreasing, the nurse case manager or the adjuster should be determining why the injured employee is not improving medically.

 

The employee’s attendance at medical appointments is of utmost importance. The transitional duty job should never be allowed to interfere with the employee’s medical appointments, even when the employee has multiple physical therapy appointments each week.

 

Be sure to share your transitional duty program with all of your business partners – especially the triage nurse, the treating doctor, the work comp adjuster, and the nurse case manager. With everyone knowing that transitional duty is a requirement at your company, you will get better buy-in from all parties.

 

By incorporating each of these recommendations into your return to work program, you will build a more successful return to work program.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center .

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: https://blog.reduceyourworkerscomp.com/

 

©2019 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

Keeping Up With Clinical Trends – Use Of Hepatitis C Medications In Workers’ Compensation

Kathy-Tiemeier myMatrixxHepatitis C, a viral infection of the liver caused by the hepatitis C virus (HCV), can be spread through contaminated blood and other body fluids. The infection can range in duration from a few weeks (acute) to a life-long illness (chronic). Between 75% and 85% of the people who become infected with hepatitis C will develop the chronic form1, CHC, which now affects more than 3 million people in the U.S.2 CHC may lead to chronic liver diseases, including cirrhosis and liver cancer. With the 2011 arrival of newer therapies to treat HCV (specifically direct-acting antiviral therapies, or DAAs), alcohol-related liver disease now has surpassed HCV as the leading cause of liver transplantation in the U.S., and HCV as an indication for liver transplantation is expected to continue its decline.3

 

 

I have received a request for a medication to treat hepatitis C. Will you please tell me why hepatitis C drugs might be needed to treat an occupational injury?

 

While we don’t see a lot of hepatitis C patients in workers’ compensation, it may be appropriate for claims under certain situations. Occupational exposure to hepatitis C could result from needlesticks in some injured worker populations, such as healthcare personnel, first responders and other municipal workers. The risk of HCV infection following a needlestick or sharps exposure to HCV positive blood is approximately 0.1%.1Injured patients who received blood or organs from an HCV-positive donor also could be infected.

 

Unlike for hepatitis A and hepatitis B, no vaccine currently is available for hepatitis C.1 Further, not enough evidence is available to support the effectiveness of post exposure prophylaxis, or PEP, after potentially being exposed to HCV.4

 

 

Recommendations from the Centers for Disease Control and Prevention (CDC)5:

 

  • PEP is not recommended for hepatitis C.
  • PEP following an occupational needlestick does include antiviral drugs for human immunodeficiency virus (HIV) and vaccination for hepatitis B, however.
  • Pre-existing chronic infection:
    • The occupationally exposed worker should be tested within 48 hours of exposure to determine the presence of antibodies to the hepatitis C virus (anti-HCV).
    • Anti-HCV will be present if the exposed worker has previously been infected with hepatitis C. If positive, further testing and referral to care for pre-existing CHC infection may be needed.
  • Infection as a result of the occupational exposure:
    • Those who test negative within the first 48 hours should be tested for HCV RNA three or more weeks after exposure to determine whether HCV then exists in the exposed worker’s bloodstream, with referral for care for a positive test as a result of the occupational exposure.6
    • Patients may spontaneously clear an acute infection up to six months after exposure. Therefore, all exposed workers who test positive in less than six months should be tested again at least six months after exposure to determine existing infection status.

 

 

Are the newer hepatitis C drugs much different from the older ones and why are they so expensive?

 

In addition to the cost of treatment, the choice of medication treatment protocol should take into account the genetic makeup, which is known as the “genotype”, of the virus. Hepatitis C has seven recognized viral genotypes1. Knowing the genotype is important to determine the most appropriate medications once a person has been diagnosed with CHC. In the U.S., about 70% of CHC cases are genotype 11, which has a lower response rate to older hepatitis drugs like ribavirin and injectable pegylated interferon, than other genotypes.7

 

DAAs, the newer treatment options for CHC, are available in oral form, so they are more convenient to use. They are much more expensive than earlier drugs; but they produce substantially higher cure rates than the older medications, more than 90% for many patients in as little as eight weeks. Before DAAs were introduced, the success rate for previous HCV therapies was only about 41% and severe side effects often were associated with using them.8

 

Curing an exposed worker of the HCV infection prevents chronic liver disease and possible liver cancer or transplantation. In addition, DAA medications are effective for most patients without requiring multiple courses of therapy. Even at their high initial cost compared to other drugs, they typically cost much less than managing liver cancer or undergoing a transplant along with their corresponding follow-up treatments.

 

 

I have heard some of the newer hepatitis C drugs have generics. Can you provide details?

 

Yes. Authorized generics to Harvoni® (ledipasvir 90mg/sofosbuvir 400mg tablets) and Epclusa® (sofosbuvir 400mg/velpatasvir 100mg tablets) became available early 2019. Gilead Sciences, Inc., the manufacturer of both medications, made them accessible through a newly created subsidiary, Asegua Therapeutics LLC. The Average Wholesale Prices (AWP) for the generics are significantly less than the brand name medications.

 

 

Do DAAs have any drawbacks?

 

Treatment for CHC is evolving quickly, and so are treatment guidelines. The promising news is the DAAs that cure hepatitis C offer hope of eliminating it in the near future. Unfortunately, however, data from the CDC indicate the number of new HCV infections is on the rise. From 2010 to 2015 the number of acute hepatitis C cases reported to the CDC nearly tripled – mainly from increased injection-drug abuse. Improved case detection contributed to this increase as well, but to a much lesser degree. 9 Symptoms are often mild and vague in acute cases, making diagnoses difficult.

 

Not every patient is cured after one course of DAA treatment. A small percentage fail the initial therapy and need another round, usually with a different set of drugs. Hepatitis C will recur for some treated patients and others may be re-infected after CHC has been cured.

 

Another major concern related to the development of new HCV therapies is the emergence of resistance to DAA drugs. Drug resistance occurs when the hepatitis C virus no longer responds to treatment. This challenge to chronic HCV treatment is developing rapidly and it already has shown clinical impact on available DAA regimens. Drug-resistant viruses most frequently develop when drug doses are below therapeutic levels. However, they can also emerge when DAA therapy fails.10,11

 

 

CONCLUSION

 

As stated previously, within workers’ compensation, the prevalence of hepatitis C is rare. However, the higher cost of new drug therapies can make a significant impact on workers’ compensation payers even if only used by a small portion of their injured worker population. Curing the infection is important, though, to prevent progressive liver damage that can result in debilitating and costly outcomes.

 

 

  1. Centers for Disease Control and Prevention. Hepatitis C questions and answers for health professionals. https://www.cdc.gov/hepatitis/hcv/hcvfaq.htm#section1. Last updated April 30, 2018. Accessed Dec. 7, 2018.
  2. U.S. Department of Health and Human Services. Office of Population Affairs. Hepatitis C. https://www.hhs.gov/opa/reproductive-health/fact-sheets/sexually-transmitted-diseases/hepatitis-c/index.html. Last reviewed April 10, 2018. Accessed Dec. 7, 2018.
  3. Cholankeril G, Ahmed A. Alcoholic liver disease replaces hepatitis C virus infection as the leading indication for liver transplantation in the United States. Clin Gastroenterol Hepatol. 2018;16(8):1356-1358. doi: 10.1016/j.cgh.2017.11.045.
  4. Hughes HY, Henderson DK. Postexposure prophylaxis after hepatitis C occupational exposure in the interferon-free era. Curr Opin Infect Dis. 2016;29(4):373-380. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5527758/. Accessed Dec. 7, 2018.
  5. Centers for Disease Control and Prevention. Information for healthcare personnel potentially exposed to hepatitis C virus (HCV). https://www.cdc.gov/hepatitis/pdfs/testing-followup-exposed-hc-personnel.pdf. April 2018. Accessed Dec.7, 2018.
  6. American Association for the Study of Liver Diseases and Infectious Diseases Society of America. HCV testing and linkage to care. https://www.hcvguidelines.org/evaluate/testing-and-linkage. Last updated May 24, 2018. Accessed Dec. 7, 2018.
  7. NIH Consensus Statement on Management of Hepatitis C: 2002. NIH Consens State Sci Statements. 2002;19(3):1-46. https://consensus.nih.gov/2002/2002HepatitisC2002116html.htm. Archived. Accessed Dec. 7, 2018.
  8. Pharmaceutical Research and Manufacturers of America. Twenty-five years of progress against hepatitis C: setbacks and stepping stones. http://phrma-docs.phrma.org/sites/default/files/pdf/Hep-C-Report-2014-Stepping-Stones.pdf. December 2014. Accessed Dec. 7, 2018.
  9. Centers for Disease Control and Prevention. Viral hepatitis. https://www.cdc.gov/hepatitis/statistics/2015surveillance/commentary.htm. Last updated June 19, 2017. Accessed Dec. 7, 2018.
  10. American Association for the Study of Liver Diseases and Infectious Diseases Society of America. HCV resistance primer. https://www.hcvguidelines.org/evaluate/resistance. Last updated May 24, 2018. Accessed Dec. 7, 2018.
  11. Downward E. Drug resistance. HepatitisC.net. https://hepatitisc.net/treatment/drug-resistance/. Last reviewed March 2018. Accessed Dec. 7, 2018.

 

Kathy-Tiemeier myMatrixxAuthor Kathy Tiemeier, RPh, DAIPM, myMatrixx, Senior Clinical Account Executive. myMatrixx, an Express Scripts company, offers best-in-class pharmacy services for workers’ compensation programs that include: formulary and network management, utilization management, claims processing, home deliver and specialty pharmacy care and physician outreach programs. Working with the financial and risk management leaders of organizations, myMatrixx helps reduce the pharmacy cost associated with injured workers through innovative programs, business analytics and robust clinical protocols and expertise.

 

To learn more about our Clinical programs, email Clinical@myMatrixx.com.

10 Steps Every Adjuster Should Perform In a Workers Comp Claim Investigation

TEN Steps Every Adjuster Should Perform In a Workers Comp Claim InvestigationWhen you go online and read your adjuster’s file notes about your claims, do you know what to look for to be sure the adjuster is performing a quality claim’s investigation on your claim files? If not, read on and learn what the adjuster should be doing to be sure you are being protected from unnecessary workers compensation cost.

 

 

ONE:

The first thing the adjuster should do in the claim investigation is to verify coverage. Before the adjuster accepts the claim, the adjuster should check to be sure there is coverage. The verification of coverage should be the first adjuster’s note in the claim file notes.

 

This would include:

 

 

  1. The policy number.
  2. The policy dates to verify the policy is in enforce for the date of the accident.
  3. The state(s) covered under the given policy number and policy period.
  4. Any endorsements to the policy that would change the coverage.
  5. Any exclusions to the policy that would change the coverage (for example – a particular location of the employer is excluded from the coverage).

 

 

TWO:

Once the adjuster has confirmed there is coverage, the next step in the investigation is to begin the contacts. With workers compensation, the first contact attempt should not be the employee; it should be the employer. The reason for this is the employee will only provide information the employee considers beneficial to himself. The employer will often provide information that will assist the adjuster in the direction of the claim. The employer might advise that no one saw the accident and the claim is highly questionable, or the employer might advise that seven fellow employees saw the injury occur.

 

 

THREE:

The initial contact with the employer should be the same day the accident is reported, or at least within 24 hours of the report of the claim. The adjuster’s file notes should reflect more than “called the employer.” The contact details that should be included in the file notes include:

 

 

  1. The facts of the accident.
  2. The identification of any witnesses.
  3. A discussion of any subrogation issues.
  4. Any knowledge the employer has of a prior claim.
  5. Verification of the information on the Employer’s First Report of Injury.
  6. The disability status of the employee.
  7. A description of the employee’s job duties.
  8. The length of time the employee has worked for the employer.
  9. Confirmation of lost time if the injury was reported after the initial waiting period for indemnity benefits.
  10. The availability of modified duty for the employee.
  11. If applicable, a request by the adjuster to the employer to provide the necessary documentation of the employee’s wage history.

 

 

FOUR:

The initial contact with the employee should immediately follow the initial contact with the employer. The employee contact should also be the same day the accident is reported, or at least within 24 hours of the report of the claim. The file notes should reflect the initial contact with the employee covered:

 

 

  1. The facts of the accident.
  2. The identification of any witnesses.
  3. A discussion of any subrogation issues.
  4. Any prior injury claims of the employee (both workers comp and any other injury claims).
  5. Verification of the information on the Employer’s First Report of Injury.
  6. Any additional information not on the Employer’s First Report of Injury that would be needed to file the ISO index on the employee.
  7. The disability status of the employee including information on the nature of the injury, the treatment and the prognosis.
  8. The employee’s attitude toward the employer and returning to work.
  9. A summary of the explanation of benefits and the future course of action the adjuster will take.

 

 

FIVE:

The investigation should also include the contact of any witnesses. The initial contact with the witness(es) should be the same day the accident is reported, or at least within 24 hours of the report of the claim. The file notes on the contact with the witnesses should reflect the facts of the accident as told by the witness(es). All witnesses should be asked to identify any other witnesses.

 

 

SIX:

The first contacts part of the investigation should also include contact with the office of the medical provider. This allows the adjuster to verify the nature and scope of the injury, the diagnosis, and the prognosis, plus the adjuster can make arrangements for all medical bill and medical reports to be sent to the adjuster. This information on this part of the adjuster’s investigation should also be reflected in the file notes.

 

 

SEVEN:

If the adjuster has any reason to question the compensability of the claim, or if there is the potential for subrogation, or if the employee’s injuries are severe, the adjuster as a part of the, should obtain a recorded statement from the employee during the initial contact. The file notes should reflect a summary of this part of the investigation.

 

 

EIGHT:

The claim investigation encompasses much more than just the initial contacts with the employer, employee, medical provider, and any witnesses. The work comp claim investigation should also include:

 

 

  1. A medical authorization in those states that require one for workers comp.
  2. Obtaining the current medical records.
  3. Obtaining past medical records if the employee has a history of prior injury claims.
  4. A wage statement for the calculation of indemnity benefits.
  5. The filing of the ISO index.
  6. A police report, OSHA report of any other governmental record related to the injury.
  7. A recorded statement from the employee’s supervisor if there is a compensability question.
  8. Engineering report or other documentation to support subrogation when applicable.
  9. Information on any responsible third parties when subrogation is possible.
  10. Any other information that will have an impact on the outcome of the claim.

 

 

NINE:

If the only file notes on the investigation read something like “called employer, no questions about the claim,” the adjuster is not doing a proper investigation. Even if the injury was witnessed by a dozen co-workers, the adjuster who is doing a proper investigation would still cover all the key points noted above. Even in the most valid of claims, the adjuster should still learn the employee’s diagnosis and prognosis, and when the employee will be back on the job. If the adjuster is not asking when the employee can return to work full duty or on modified duty, the claim investigation is incomplete.

 

 

TEN:

All the information obtained during the claim investigation should be summarized in the file notes for your review. If the adjuster is not doing so, ask that the file notes are properly documented. After all, with workers compensation, you will eventually pay the cost of the employee’s claim through your insurance premiums. You should know if you are getting the proper claim investigation that you are paying for.

 

 

 

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

Contact: RShafer@ReduceYourWorkersComp.com.

Workers’ Comp Roundup Blog: https://blog.reduceyourworkerscomp.com/

 

©2019 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

 

 

Intervention Claims In Workers’ Compensation

Intervention Claims In Workers’ CompensationIntervention claims play an important role in workers’ compensation claims and come from many different sources.  These include various government interests (e.g., Medicare, Medicaid, Veterans Administration) and private sources such as health insurance providers and carriers, disability benefit carriers, and attorneys.  The list is endless.

 

To control workers’ compensation costs, it is important that members of the claim management team and attorneys identify these interests promptly and resolve them either via a hearing on the merits or settlement.  Failure to do so can add time and expense on a claim.

 

 

Policy Reasons for Resolve Intervenors

 

Many states allow interested parties and potential intervenors to have a role in the workers’ compensation process.  The policy behind this is to promote the judicial economy and promote efficiency.  A classic example of this could be a workers’ compensation claim that involves multiple medical providers, intervenors and government agencies that pay benefits in conjunction with a work injury.  Instead of having many hearings and conferences, the matters are consolidated into one process.  It also provides for certainty and consistency in the result.

 

 

Placing Potential Intervenors on Notice

 

Establishing a best practice is important in the identification and handling of intervention claims.  It should be the responsibility of all parties to the claim to coordinate and place these interested parties on notice.  Failure to do so can lead to a potential intervenor not being aware of a matter and result in a delay.

 

The process for giving notice to a potential intervenor is usually defined by statute, rule or case law.  This usually includes:

 

  • Providing notice via written communication mailed to the potential intervenor and including all pertinent documents and pleadings;

 

  • Information concerning the potential intervenor’s rights and responsibilities; and

 

  • Required steps to formally intervene and become a party.

 

This process also includes the ability of the defense interests to dispute the claims made by a potential intervenor.  Even if a potential intervenor is added to the case, the new party still carries the burden of proof, which can possibly include the burden of establishing the injured employee suffered a compensable work injury.

 

 

Pitfalls in Adding Potential Intervenors

 

All interested parties should avoid the following pitfalls when notifying potential intervenors of their rights.

 

  • Notifying potential intervenors too early: Best intentions sometimes result in mistakes.  This includes notifying a potential intervenor before treatment actually occurs or treatment can be processed.  When placing a part on notice, make sure enough time has elapsed so they will be able to identify the claim(s).

 

  • Notifying potential intervenors too late: Most jurisdictions allow for a 30 to 45-day time period for a party to search the pertinent billing records, identify associated treatment and make the correct filings with the court.  There needs to be enough time for the potential intervenor to accomplish these tasks.

 

 

 

Overcoming Other Barriers

 

 

Cooperation is key when it comes to placing all potential intervenors on notice.  This is something all interested parties and their attorneys should accomplish constructively.  Common barriers that go beyond parties not working together can include:

 

  • HIPAA regulations: Federal and state privacy laws place limits on the disclosure of medical information. While HIPPA does specifically exclude state workers’ compensation matters, the overly cautious and uninformed can create a delay.

 

  • Internal Privacy Policies: A medical provider may have additional safeguards in place, which is permitted in certain instances under HIPAA.  This can include the requirement a specific release authorization be used before the disclosure and release of an injured employee’s medical records.

 

  • Debt collection rules/regulations: The federal government and states have a myriad of debt collection guidelines that need to be taken into consideration.  Under the Fair Debt Collection Practices Act, a collection agency is limited in their ability to communicate with an injured employee and other parties.

 

 

Conclusions

 

The identification, notice, and resolution of intervention claims in an essential part of many workers’ compensation claims.  It is important that all interested stakeholders understand the rules of the road and guidelines that cover these matters.  Failure to do so can result in additional litigation and unnecessary expenses.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center .

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: https://blog.reduceyourworkerscomp.com/

 

©2019 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

Course and Scope of Employment: Questions of Compensability

course and scope of employmentIssues of compensability are factually driven and require attention to detail by members of the claim management team.  This is extremely important in cases where the claim comes down to whether the injury was in the “course and scope of” employment.  The correct decision can only be made when the individual claim handler has a good understanding of the law and knows how to apply it to the facts.

 

 

Case Study:  The Workplace Fall

 

Frank Rizzo is a day laborer for Acme Construction Company and dresses for success by wearing his steel-toed work boots and favorite blue jeans.  Given his hard work, he is invited to a corporate meeting and was told to “dress like a boring c-Suite professional.”  Frank is excited and goes out and purchases a $1,000 suit and wing-tipped dress shoes.  While the shoes make his feet uncomfortable, he attends the meeting.  The meeting was exciting, and he is looking forward to prime rib for lunch.  While walking down a hallway to the banquet room, his right knee buckles and now needs a total knee replacement.

 

Personal injuries “arising out of and in the course and scope of” employment is generally compensable under workers’ compensation laws.  Frank was on the clock at the time of the meeting, but the question remains as to whether the “course and scope of” element has been satisfied.  The hallway Frank was walking on did not have any slippery surfaces and was free of imperfections.

 

Is the injury compensable?  These are questions claim handlers must answer daily.

 

 

Questions of “Risk” and “Position”

 

Courts across the country answer questions of “course and scope of” on a regular basis.  The result is a maze of tests interested stakeholders must confront to evaluate a claim and whether to accept it:

 

  • Increased Risk Test: Under this test, courts will examine whether the employment creates a “special hazard” that gives rise to the work injury.  If this is the case, there is a necessary causal relationship between employment and work injury.  Common examples of this include instances where something is located in the workplace that increases the risk of injury.  Idiopathic injuries (those that are unknown or without explanation) are typically found not to be compensable and are denied.

 

  • Positional Risk Test: This test examines whether the employer placed the employee in a location or “position” that gave rise to the work injury.  Under this rather low threshold, just being at work and sustaining an injury can give rise to a claim being compensable.

 

 

Applying the Standards – Differing Results

 

The application of these two tests would likely give rise to different results in the scenarios outlined above.

 

  • Increased Risk: The injury likely would not be compensable. Although the employee was asked to wear clothing and footwear he normally did not wear, nothing in the workplace exposed Frank to a heightened risk of injury.  The defect-free surface would be an important factor.  There is also no explanation as to why his knee gave out.

 

  • Positional Risk: Frank was required to be at the meeting.  It is also important to note he was specifically asked to dress in a certain manner, and testimony at hearing that his new shoes were uncomfortable are important.  Although the walking surface was defect-free, his presence in the workplace gave rise to the injury.  A court applying this test would find it compensable.

 

Based on the divergent results, members of the claim management team should understand the importance of how to evaluate the risk.

 

 

Investigating Troublesome “Course and Scope of” Claims

 

Members of the claim management team need to peel back the layers when investigating matters like Frank’s claims.  This should include the following areas:

 

  • Knowledge of the applicable legal standard – “positional” or “increased” risk;

 

  • Obtain a detailed statement from the employee and possible witnesses. Is there an explanation for why or how the injury occurred? This is key;

 

  • Determine the type of surface involved in the injury and its condition at the time the incident occurred. Documentary evidence such as photographs and security video should be preserved; and

 

  • Instructions on workplace attire such as footwear, etc.

 

 

Conclusions

 

Claim handlers are called upon to make daily decisions on whether to accept a claim and commence the payment of workers’ compensation benefits.  Not making the correct decisions can lead to increased costs on claims.  This includes money spent on litigation costs, sanctions/penalties and setting incorrect reserves.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center.

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: https://blog.reduceyourworkerscomp.com/

 

©2019 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

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