Weeding Out The Truth About Medical Marijuana

August 14, 2019 by

Medical MarijuanaMarijuana is illegal under federal law. But workers’ compensation stakeholders who think that gives them license to ignore the issue are making a huge mistake, according to experts.

 

The cannabis industry is growing by leaps and bounds and shows no signs of slowing. Most states now allow the drug in some form. Judges are increasingly siding with injured workers who want to be reimbursed for the drug.

 

Employers, especially those who do business in multiple states, need to know how to ensure a safe workplace, be fair to all employees and protect themselves from litigation. Staying abreast of the latest developments is key.

 

 

Some Basics

 

Terminology. Keeping up with the lingo can be exhausting, but payers who do have an edge when it comes to addressing the issue. Some important terms include:

 

  • THC: A cannabinoid that produces the ‘high’ that users experience
  • CBD: A molecule touted as having potential medical benefits without the psychoactive properties of THC.
  • Hemp: A strain derived from the species cannabis sativa, as is marijuana, but with lower concentrations of THC and more CBD. The Agricultural Improvement Act signed into law recently removed hemp from the list of Schedule I controlled substances and made it an ordinary agricultural commodity. CBD derived from hemp has recently become widely available.
  • Strains: There are hundreds of combinations, mainly from three strains:
  1. Indica — produces a more relaxing effect
  2. Sativa — is more energizing
  3. Ruderalis — has low levels of both THC and CBD.
  • Budtender: The person at a ‘dispensary’ who gives advice about which varieties may be more helpful to the user

 

 

Physical Effects

 

Whether and to what extent marijuana helps with various physical or mental conditions is a matter of debate, since the federal prohibition of the drug stymies research on it. But there is some evidence it may help alleviate chronic and neuropathic pain, cancer pain, and spasticity. Some people claim it can also help with anxiety, post-traumatic stress disorder, traumatic brain injury, depression or acute pain. There are conflicting studies about whether marijuana can serve as a viable substitute for opioids, but the most recent study suggests it does not.

 

High doses of marijuana, especially when it’s ingested as an edible, can have serious repercussions. Some users have gone to emergency rooms believing they are having a heart attack. In addition to the potentially positive impacts, the drug can also cause a variety of unpleasant symptoms, including:

 

  • Rapid, irregular heart rate
  • Anxiety
  • Lung irritation
  • Coughing, wheezing
  • Nausea, vomiting
  • Various exacerbations of serious psychiatric conditions such as depressions, bipolar illness, schizophrenia and other psychotic disorders.

 

 

Problems for Employers, Payers

 

Drug testing to identify marijuana users high on the job may be counterproductive. Since the drug stays in the body long after its effects have worn off, the tests can’t really determine if a person is impaired. Workers in safety-sensitive jobs are another story, as they are prohibited from performing their jobs if there is any sign of drug use identified.

 

However, for other workers, employers may notice certain signs that could indicate an employee is under the effects of marijuana:

 

  • Slowed responses and reflexes
  • Lethargy, drowsiness
  • Slowed perception of time; appearing in an almost dreamlike state
  • Unfocused
  • Impaired memory function
  • Red eyes or dilated pupils

 

Employers who suspect their workers of being high on the job must be careful about how they respond. Unless they have clear-cut policies that allow for drug testing when they suspect impairment, organizations can be accused of discriminating against certain employees. Working with an attorney and developing a solid policy that is communicated to all employees is imperative.

 

Another major concern for payers concerns the logistics for reimbursement. It’s not like other, FDA-approved drugs, where a physician prescribes a certain dose, number of pills per day and timeframe for use. Physicians in medical marijuana states can only recommend using the drug. It’s then up to the user, working with the budtender, to determine what might help.

 

The many different strains mean one purchase may be different from another. There are many inconsistencies in terms of the quality and purity as well as labeling — within states and even within communities.

 

However, as the pharmaceutical companies begin to derive purer and more targeted compounds from marijuana, we will likely see more employees using prescribed, rather than marijuana dispensary, formats which will reduce the rationale for using the latter, and will provide safer, efficacious and accurately dosed drugs.

 

The best advice from experts is to work closely with all stakeholders involved, including the injured worker. Working with the physician, for example, might persuade her to prescribe a treatment or medication other than marijuana. At the very least, it could help determine how much and for how long the drug will be used. Having more and better communication with the injured worker can provide insight into whether and why he believes marijuana is the best option and help determine the anticipated expense.

 

 

Conclusion

 

The issue of medical marijuana is not an easy one for workers’ compensation stakeholders right now, but it should not be ignored. Regardless of personal feelings about the issue, organizations are increasingly being forced to deal with it. Those who understand their states’ laws and the various nuances involved, and work with other stakeholders will be best prepared when it arises.

 

 

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: http://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.

Filed Under: Prescription Drug Use & Abuse

Common Mistakes That Get Employers In Trouble on Questionable Claims

August 13, 2019 by

Common Mistakes in Workers CompEvery self-insured employer has to contend with the occasional workers’ compensation claim the employer feels is of questionable validity.  The urge is often to ‘fight fire with fire.’  However great the urge is to give the employee ‘a taste of his own medicine,’ the employer must hold itself above taking the low road taken by the employee.  Just as there are laws in every state against insurance fraud, there are also laws in every state that have names such as “unfair claim settlement practices.”

 

Unfair claim practices are any action taken by the self-insured employer that is unfair, discriminatory, deceptive, or misrepresent the facts.  Any inappropriate conduct by the self-insured employer can land the employer in legal trouble.  Also, if a particularly unfair practice is shown to occur with any frequency, the insurance regulatory authority will review their approval of your self-insurance status.

 

 

Common Mistakes That Get Employers In Trouble

 

While there is a wide array of inappropriate actions a self-insured employer can get into trouble for, we will discuss only the most common mistakes an employer might make that would be classified as an unfair claims practice.

 

  • Delaying the processing of a claim – the self-insured employer cannot refuse to process the Employer’s First Report of Injury form or delay sending the required forms to the employee or the required forms to the state agency that oversees workers’ compensation.

 

  • Delaying the necessary investigation of the claim – most states require the claims office to accept or deny the claim within a specific period of time.  If the claim is not accepted or denied timely, in most states the lack of a timely decision is acceptance of the claim.  Worst yet, if the employer does not investigate the claim within the frame specified by the state, the employee’s version of the claim facts is accepted without any rebuttal by the employer.

 

  • Misrepresentation of coverage – the self-insured employer is handling its own claims must provide the employee making an injury claim full information on available medical care and indemnity benefits, if indemnity benefits apply.  For example:  you cannot tell the employee there is a 30 day waiting period for indemnity benefits.  Or, you cannot tell the employee that required medical services are not covered.

 

  • Withholding payment of benefits – the self-insured employer who has accepted a claim, or has received an adverse ruling on a claim, cannot withhold payment of temporary total disability benefits or the payment of medical bills to coerce a quick settlement with the employee.

 

  • Needless duplications – the self-insured employer cannot bombard the injured employee with extra or duplicate claim forms, or have the employee repeat medical procedures that were completed properly.

 

  • Withholding an equitable settlement – if the workers’ compensation regulatory authority has ruled that workers’ compensation coverage must be provided, the employer cannot refuse to make a good faith effort to reach a prompt and fair settlement of the claim, regardless of how the employer views the validity of the claim.

 

  • Appealing all awards – the self-insured employer cannot make it a standard business practice to appeal all awards of workers’ compensation coverage in an effort to compel employees to settle for less than they would otherwise be entitled to.

 

  • Putting forth an unreasonable settlement offer – the employer cannot offer to settle a workers’ compensation claim for permanent partial disability or permanent total disability for less than the requirements of the state statutes.  The settlement offer must be based on the requirements of the law.

 

 

 

Unfair Claims Practices Acts Designed to Protect Employer & Employee

 

The unfair claims practices acts are not designed to compel a self-insured employer to pay fraudulent workers’ compensation claims.  The unfair claims practices act statutes are structured to compel the self-insured employer to investigate thoroughly all claims. These statutes mandate the employer to either accept an employee’s work comp claim or to provide the reasons and the documentation as to why the work comp claim is not owed.

 

When the self-insured employer is confronted with the questionable claim, the employer should investigate the claim completely gathering all information from the employee, the co-workers, witnesses, medical providers, past employers, past medical providers, state agencies, the Insurance Services Office, and all other sources.  A decision on the claim should be made timely, and the decision should be conveyed to the employee and the state agency.

 

By acting in an unbiased and factual manner, the self-insured employer will avoid any violation of the unfair claim settlement practices acts.

 

 

 

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: http://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.

Filed Under: Common Workers Compensation Mistakes

Improve Workplace Safety with Communication Systems

August 12, 2019 by

Improve Workplace Safety with Communication SystemsMany employers are concerned about workplace safety, but fail when it comes to communicating the message in an effective manner.  Due to the inability to communicate this important message, many accidents an injury occur every year.  Now is the time to re-examine how safety is communicated in your workplace and implement these steps.

 

 

It All Starts with Communication

 

An effective safety program requires two-way communication between the employer and employees.  This requires the following:

 

  1. Information needs to be shared with employees and feedback from employees on workplace safety hazards.

 

  1. All communication should be multilingual, if appropriate.  This ensures that all employees receive the message in a language that is familiar to them. Suggested formats for effective multilingual communication should occur at all employee safety meetings (all shifts) and include messages about safety via posters, newsletters, and videos.

 

It is important to engage employees by having a “safety suggestion box,” where employees can report unsafe conditions, and help improve workplace conditions.  Even anonymous suggestions should be taken seriously.

 

 

Conduct a Thorough Workplace Assessment

 

A review of safety in the workplace needs to be ongoing and continual.  When conducting an initial workplace safety audit, it is important to review the entire workplace and understand current trends.  It must involve managers and their employees who are called upon to analyze all worksite conditions to identify, and eliminate existing or potential hazards.  In some instances, employers may be required to have a safety committee.  The committee should be chaired by someone who can effectuate change and is comfortable speaking to people in all levels of an organization.

 

A proper workplace safety assessment should evaluate the following issues:

 

  • Review and understand the workplace for safety and health regulations;

 

  • Recognize safe work practices, physical hazards, and use of any hazardous materials with the workplace. Ensure these safety issues are clearly identified and correct postings from OSHA are displayed; and

 

 

The process also needs to be ongoing.  This should include a monthly review of all safety features within the workplace.  Be sure to make sure facility ingress and egress are clearly marked, first-aid kits are properly stocked, and fire extinguishers are properly maintained.

 

 

Hazard Correction/Safety Work Order Tracking System

 

It is important to have a process in place to track safety issues and document corrective action.  This is an easy process to implement if used correctly and completely.

 

  1. Involve employees in this process – their knowledge of the jobs and tasks will ensure a quality assessment and will help get “buy-in.”  Plant maintenance employees are a great source for recognizing hazards.

 

  1. IMMEDIATELY correct hazards that are found.  Do not wait for the audit to be done. Develop corrective actions plans whenever needed.

 

  1. Develop a system for employees to report hazards.

 

  1. Review loss history to look for trends. “Near misses,” in which an accident did not occur, but could have, can give a good indication of inadequate hazard control.

 

  1. Let employees help develop ideas on how to control and eliminate hazards in their surroundings.

 

  1. Provide Personal Protective Equipment (PPE), when needed, and train employees on how to use it.  Consult OSHA regulations for specific requirements. In some instances, OSHA representative can assist in training employees and ensure compliance.

 

  1. Safety audits should be supplemented with safety inspections.  Inspections can be informal or formal, using a checklist.  Continuous inspections are performed by employees or supervisors as part of their daily routine.  Planned inspections take place periodically (weekly, monthly, or semi-annually) and are usually limited in scope, or specific to a site.  Intermittent inspections take place on an irregular basis and are usually not scheduled.

 

 

Conclusions

 

An effective workers’ compensation program starts with injury prevention and safety.  Interested stakeholders need to be mindful of these issues and communicate safety messages to all employees in an effective manner.  Safety should also include the involvement of all employees and a commitment to constant review and maintenance.

 

 

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: http://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.

Filed Under: Work Injury Prevention

Don’t Sabotage Your Return To Work Program!

August 7, 2019 by

Sabatoge Return to WorkGetting an injured employee back to work is an important way to reduce workers’ compensation costs and promote employee morale.  This is accomplished by an effective return to work program and promoting a safe work environment.  Notwithstanding these efforts by an engaged employer, policies are sometimes implemented that create perverse financial disincentives.  These can sabotage a post-injury return to work program, and encourage an employee to stay off work.

 

 

It All Starts with Effective Coordination

 

It is important for an employer to ensure their return to work program does not have a negative impact on disability pay programs.  To ensure this does not take place, it is important to take a step back and make sure there is proper coordination with the workers’ compensation program and one’s employee benefits and compensation program.

 

Common examples of this include instances where a benefits program provides a financial disincentive for an employee to return to work.  When designing your integrated disability management programs, keep this in mind the following factors:

 

  • Identify workers’ compensation savings that have yet to materialize even though your company has implemented a corporate return-to-work program. This should include a review of the long-term (LTD), and short-term disability (STD) benefits an employee can receive, and if they care to receive these benefits while being paid associated workers’ compensation wage loss benefits such as temporary total disability benefits.  In some instances, employees will receive more money if they were working when receiving both LTD/STD and workers’ compensation benefits.

 

  • Review and analyze credit disability insurance programs. This allows the injured employee to exclude payments on a mortgage, car payments, and other lines of credit when they are unable to work.  There are also reductions for things such as childcare, and other commuting expenses that can be taken into consideration.  This provides the employee with an “incentive” to not accept transitional work.

 

  • Examine how collateral resources impact your workers’ compensation program. Some of these include:

 

  1. Salary and Wage Continuation: Employers sometimes pay 100% of an employee’s salary instead of the employee collecting workers’ compensation wage loss benefits. A review of these programs should include a determination if they comply with the workers’ compensation law as only insurers should be making wage loss payments in some instances.

 

  1. Occupational Injury Pay Supplements: Other policies will pay supplemental benefits to “make up the difference” between workers’ compensation benefits and regular earnings. This has an impact on the payment of Temporary Partial Disability (TPD) benefits.

 

  1. Open-Ended Job Return: Job offers should never be open-ended. Allowing this encourages employees to remain off work, and can limit defenses available to wage loss claims.

 

  1. Vacation and Sick Time: Companies frequently allow vacation and sick time to accrue for employees on workers’ compensation, even if not required under state law. In other instances, employees can “borrow” sick time.

 

  1. Perk Continuation: Employers often maintain ancillary benefits and privileges such as car allowances, club, professional dues, and periodical subscriptions for employees off work due to a workplace injury.

 

  1. Loan Protection Policies: Individual insurance policies are available to pay mortgages and consumer loans. This often includes car loans, and credit card debts.

 

  1. Unemployment Compensation: In some jurisdictions, employees can receive workers’ compensation and unemployment benefits at the same time. Make sure you know the law on this issue.

 

  1. Pension and Retirement Plans: If these plans do not allow for offset of workers’ compensation benefits, an employee can receive workers’ compensation benefits and a full pension. This is a common pitfall for employers when an employee has a potential claim for Permanent Total Disability, or open-ended Temporary Total Disability claim.

 

  1. Product Liability Actions: Employees injured due to defective equipment and machinery can file product liability actions. Mindful employers should examine these issues, preserve evidence, and pursue subrogation actions when able.  This is based on payments made to the employee receiving workers’ compensation benefits or settlements.

 

 

Conclusions

 

Employers should be commended for doing the right thing.  These actions sometimes create a disincentive for an employee to return to work.  When this occurs, the insured ends up paying higher workers’ compensation premiums.  Proactive employers need to strike the right balance between protecting their employees, while at the same time being mindful of their bottom line ethically and honestly.

 

 

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 the founder & lead trainer of Amaxx Workers’ Comp Training Center.

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://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.

 

Filed Under: Return to Work and Transitional Duty

Get Employees’ Heads Out of the Clouds While Driving

August 6, 2019 by

distracted drivingRoadway accidents have been the leading cause of workplace fatalities for the past 5 years. Distracted driving is one of the top reasons for roadway fatalities, after alcohol and speeding.

 

Research suggests that drivers only see about half of all the information in their driving environment when they are using a phone — whether it is handheld or hands-free. These drivers have a 17-percent higher risk of having an accident or near-miss on the road. Texting presents even more of a risk to drivers, making them 5 times more likely to have an accident or near-miss.

 

Sadly, while most people believe cellphone use increases the risk of accidents, most of us also don’t believe we are creating a risk by using a phone ourselves while driving — it’s the other drivers. But with education and strong policies that are strictly enforced, employers can prevent distracted driving-related accidents among their workers.

 

 

The Problem

 

Three types of distractions reduce a person’s driving ability:

 

  1. Visual — anything that takes the person’s eyes off the road
  2. Manual — anything that takes the driver’s hands off the wheel
  3. Cognitive — anything that takes the driver’s focus off driving

 

Cellphone use can include all three, especially handheld use. Educating employees on the dangers of cellphone use while driving can be effective.

 

A study of healthcare workers in Arizona resulted in a 50-percent decrease in distracted driving after an education and intervention program. It was explained to the workers, for example, that using a cellphone while driving is equivalent to driving with a blood-alcohol level of 0.08 — the legal limit for intoxication. Also, the average five seconds a driver’s eyes are diverted while texting and driving at 55 miles an hour is akin to traveling the distance of a football field while blindfolded.

 

Posters were placed throughout the facility where the employees worked, along with information brochures about distracted driving. More than half the workers later admitted they drove distracted but said they had changed their habits after the educational program. Six months later, more than half had still reduced or eliminated cellphone use while driving.

 

 

Policy Elements

 

In addition to giving employees the facts about distracted driving, organizations that implement strict policies have seen significant reductions in at-fault collisions.

 

The policy needs to be clearly written and communicated and appropriate for the company. Each employer’s policy may be slightly different from that of other organizations.

 

The policy does not need to be lengthy; one page is sufficient. It can start with a statement explaining why the company is implementing the policy. For example, it seeks to protect its workers and eliminate unnecessary driving risks, comply with all state and federal motor vehicle laws, reduce operational and financial risks, and strengthen the reputation of the company.

 

It should explain who and what it covers, including:

 

  • All employees
  • Company-provided cellphones, and other electronic devices that may be used while driving
  • Company-owned vehicles
  • Personal vehicles when used on company business
  • Work-related communications, whether in a company or personal vehicle and company or personal device

 

Restrictions can include the use of handheld or hands-free phones, computers, GPS tools or other electronic devices while the person is operating the vehicle — including while the vehicle is at a traffic light or stop sign. It should specify that the restriction on electronic devices includes answering or making calls, and reading or responding to emails, texts, tweets, or instant messages. The exception would be only when the car is parked in a safe location.

 

It may also state that phones must be turned off or silenced before starting the car. Employees should inform business colleagues, associates, and clients of the policy to explain why calls are not immediately answered or returned. They might be required to activate an automatic answering message that explains they are driving and not available.

 

The policy should conclude with the effective date and a required signature of the employee to acknowledge he has read and understands it.

 

Once the policy has been implemented, it should be reviewed often to make sure it addresses any new hazards or technologies.

 

 

Enforce the Policy

 

The policy should state that failure to comply will result in specific penalties. For example, it may say the person will initially be given two warning, while a third violation would be grounds for termination.

 

An effective method to ensure compliance with the policy is through cellphone blocking technology. This is available from many wireless services and companies that provide these apps. Basic systems can prevent calls or texts while a vehicle is in motion. Some systems can additionally block audio features and track a driver’s speed and other actions, such as sudden stops. Some also send information about the employee’s driving to employers.

 

 

Conclusion

 

Distracted driving is both deadly and preventable. A well-written, simple policy that restricts employees from using electronic devices while driving can go a long way to preventing roadway tragedies.

 

 

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 the founder & lead trainer of Amaxx Workers’ Comp Training Center.

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://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.

Filed Under: Wellness Programs and Workers Compensation

The Problem with Wellness Programs and 11 Ways to Make them Work

August 5, 2019 by

Wellness Programs in Workers CompContent for this article was derived from a webinar presented through Risk & Insurance by

 

  • Marcos Iglesias, Chief Medical Officer, Senior Vice President, Broadspire;
  • Monica Manske Sr. Manager of Workers’ Compensation and Employee Safety, Rochester Regional Health.

 

Access the On-Demand Webinar here

 

 

Over the past few years we have heard it claimed that wellness programs can generate a 3 – 1 return on investment for employers. But many organizations that implement them become frustrated by the lack of significant – if any – benefits and may feel their money has been wasted.

 

Wellness programs are not a panacea. Some elements of typical wellness programs are questionable or even harmful, from a medical standpoint. Faced with high healthcare and workers’ compensation costs, organizations are seeking ways to help their employees and improve their bottom lines. Experts say with proper design, effort, time, and realistic expectations, employers can see positive impacts from wellness programs.

 

 

The Facts

 

The overall health of the average America is not ideal; “deplorable,” is how some would describe it. Chronic health conditions, which comprise 7 of the top 10 causes of death, are common, deadly and disabling – yet preventable. The Centers for Disease Control and Prevention says if we eliminated poor nutrition, sedentary lifestyles, and use of tobacco products, we could eliminate 80 percent of heart disease, stroke and diabetes, and 40 percent of all cancers. Improving the health and wellbeing of the employee population is far beyond the abilities of any single employer and will require massive changes in society.

 

But employers can take steps to help their employees make incremental improvements in their overall health and wellbeing. More than half of small employers and the vast majority of large employers are trying.

 

The problem comes when companies that undertake these efforts see no gain. One year into the program, it’s not unusual for companies to see no improvement in health outcomes or productivity and no difference in the number of sick days employees take.

 

One recent study showed the only difference after 12 months was that employees who were included in the program were overall happier than others. There were no measurable health changes, however. Another recent well-publicized study of employees at BJ’s Wholesale Warehouse found no reductions in healthcare costs and no difference in clinical measures after 18 months.

 

Dr. Marcos Iglesias, the chief medical officer for Broadspire, said some wellness programs include recommendations that don’t follow evidence-based medical guidelines. One he cited from the Midwest encouraged all employees to undergo a colonoscopy, which is not medically recommended for everyone, is expensive and unpleasant. Another suggested self-breast exams and testicular exams, which he said are also not advised or recommended for everyone. Iglesias said the frequency of preventive screenings in most wellness programs on the market do not follow medical evidence, and in some cases may do more harm than good.

 

Weight management programs, while well-intentioned, frequently advocate crash-dieting principles. Also, they may cause emotional harm by constantly reinforcing the message that the employee needs to lose weight or stop smoking.

 

The penalties for non-participation in the program or failing to meet certain clinical measures may be seen as coercive or punitive, especially for workers who cannot participate – the disabled and single parents, for example. According to Iglesias, employees who do not participate in wellness programs forfeit an average $670 per year.

 

 

How to Impact Employee Health

 

All this begs the question, what can employers do to impact the health and wellbeing of their employees?

 

The first step is to understand what a wellness program is and what elements to include, based on the organization. There are myriad definitions of what actually constitutes a ‘wellness program.’ Generally, it is a benefit to employees that focuses on lifestyle and prevention to help employees improve their health and/or stay healthy. It may include a variety of elements such as fitness activities, smoking cessation and weight loss programs, health assessments, disease management, nutritional guidance, and lunch and learn educational sessions, for example.

 

No two wellness programs are necessarily alike and the most effective ones evolve with changes in the organization. The webinar outlined a series of ‘musts’ in designing or improving wellness programs that can make a difference for organizations.

 

  1. Seek input from inside and outside the organization.
    1. Unless an organization is comprised of wellness experts, it can benefit from consultants who are brought in to provide input.
    2. A wellness program should be a benefit to all employees – not just those who are already-fit and healthy. Their needs and desires may be different. Creating a cross-functional team comprised of various employees can serve as a guide to the elements that should be included. Surveys can also be used to identify their needs and satisfaction levels, once the program has been implemented.
  2. Clearly define the goals of the program.
  3. Explore and determine the amount needed to be budgeted and human resource commitment.
  4. Find the right space.
    1. If onsite fitness will be included, an area needs to be designated.
    2. Additionally, there should be an area for educational services and preventive programs. It should be welcoming and attractive to employees and their families.
  5. Show compassion, care, and foresight for employees in the design and approach of the program. Consider the specific needs of all employees, including those with outside obligations that may prevent them from participating in after-hours programs.
  6. Continuously evaluate the program. Again, seek engagement of a cross-section of employees to determine how effective the program is.
  7. Make it a carrot, not a stick. Center the program on employees. Offer a variety of activities that meet their needs. That may involve expanded hours for certain programs, or allowing workers to use work hours to participate.
  8. Have realistic expectations. Acknowledge that it may not be able to move the needle toward optimal health and wellbeing for all employees, but that some improvement is a benefit to workers and the organization and that it will take time.

 

For existing programs that appear to be ineffective,

 

  1. Conduct a SWOT analysis. Collaborate with a cross-sectional team of employees to determine what is and is not working, and if any new needs have evolved; what, if any external forces are impacting the program.
  2. Identify what to measure. Looking to workers’ compensation costs to determine the program’s effectiveness may not make sense because of its long tail.
  3. Determine if there is the appropriate amount of HR support for the program, since these are often add-ons and, therefore, not administered by a designated person.

 

 

Conclusion

 

The idea of a wellness program should not be to create wellness superstars but to impact workers’ overall health. Organizations that carefully consider the needs and desires of their workforces spend time properly developing the program, and continuously evaluate and tweak it may see some benefits to their workers and bottom lines.

 

Author:

 

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: http://blog.reduceyourworkerscomp.com/

 

Contributor:

 

Dr. Marco IiglesiasDr. Marcos Iglesias is senior vice president and chief medical officer of Crawford & Company’s global TPA, Broadspire. He has more than 25 years of experience in workers compensation, disability evaluation and treatment, and insurance leadership. In addition to being a physician, executive, national speaker and author, Iglesias is known for his compassion for patients, progressive and inspirational leadership, and integrated approach to injured worker care. Iglesias has a special interest in the prevention and mitigation of delayed recovery and disability. He is driven to help ill and injured workers live active, productive and fulfilling lives, which has led him to develop innovative, comprehensive disability management solutions that focus on returning workers to pre-injury function.

 

 

Monica ManskeMonica Manske, Sr. Manager of Workers’ Compensation & Employee Safety; Rochester Regional Health. Rochester Regional Health is the leading provider of comprehensive care for Western New York and the Finger Lakes region. From harnessing research and technology, to helping patients redefine the odds—we are leading the evolution of healthcare. It’s a commitment to health that exceeds expectations, reaching beyond the present into what’s next. Formed in 2014 with the joining of Rochester General and Unity Health systems, now, as one organization, Rochester Regional Health brings to its mission a broad spectrum of resources, an ability to advocate for better care, a commitment to innovation and an abiding dedication to caring for the community.

 

 

 

©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.

 

Filed Under: Claim Management

TPA Best Practices: Loss Reporting, Claim Assignment, Assignment Procedure, and Coverage Verification

August 1, 2019 by

TPA Best PracticesPicking the right third-party administrator (TPA) takes time.  Failure to pick the correct one can result in increased costs to a workers’ compensation program.  There are many important factors to consider beyond a TPA having the right price.   In the first part of this series, we looked at selecting a TPA on how they make initial contact with the injured employee and other parties following a work injury, and the methodology of their initial claim examination.  Additional factors that need to be considered also include a deeper dive into how losses are reported, claims are assigned, and coverage is verified.

 

 

Nothing Succeeds Like Success…

 

Leading TPA’s success comes from the division of labor into four areas:

 

  1. Loss Reporting: Prompt loss reporting is a key aspect when it comes to timely loss notification. Prompt reporting has three advantages:

 

  • Immediate contact with all parties involved in a workers’ compensation claim results in reduction of claimant representation, and litigation. Contact with all parties includes the employee, employer, witnesses, other interested stakeholders;

 

  • Prompt investigation: This includes several different items to consider immediately after a work injury.  This includes making sure the employee receives medical care and treatment, identifying witnesses, preserving physical evidence, and getting information about the injury from the employee; and

 

  • Reduction of overall cost per claim: This promotes efficiency in any program.

 

 

  1. Claim Assignment: An effective assignment process helps to ensure proper handling of claims at the appropriate technical level. The claim assignment process may include gathering additional information beyond what is available in the First Report of Injury.  It includes other aspects such as making sure the proper forms are filled with the state industrial commission and asking the right questions.  TPAs can practice a team approach by:

 

  • Distributing the work to the most appropriate level of technical expertise; and

 

  • Obtain the highest possible efficiency possible by effective internal communication, use of regular file reviews, and communication with the insured.

 

 

  1. The Assignment Procedure: Upon receipt of a First Report of Injury, a four-step process must be initiated to promote best in class services:

 

  • Supervisory evaluation of the First Report of Injury to ensure it is properly classified. Examples include “medical only claims,” claims involving lost time; and catastrophic injury claims;

 

  • Supervisory review and direction to the appropriate claim handler. Claim management teams should have specialized units for various claims and situations.  The examination of fraud can also take place in these units;

 

  • Creation of a Central Index Bureau referral for lost time claims and medical-only as required. It is important to know the claims history early in the process; and

 

  • Case management services should be utilized as appropriate. (It should also be noted the claim classification and technician assignment can change throughout the life of the claim if a significant change in complexity level occurs.

 

 

 

  1. Coverage Verification: This starts with confirmation of the client’s self-insured  It also must include verification of a client’s policy of insurance, limits of coverage, and effective dates.  Coverage issues are recognized, investigated, and addressed with the carrier before it becomes an issue after a work injury.

 

 

Conclusions

 

Best in class service starts with paying attention to details and ensuring all of the “i’s are dotted, and t’s are crossed.”  It also includes making sure that claim handlers work as a team and have the resources to success.  This results in claims that are handled in an effective manner.

 

 

 

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: http://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.

Filed Under: Claim Management

TPA Best Practices: Initial, Ongoing Contacts, and Investigation

July 31, 2019 by

TPA Best PracticesThird-party administrators (TPA) perform many important functions in workers’ compensation claims.  It is important to make a reasoned decision when selecting the right TPA.  Failure to do so can result in a chaotic program that does not serve the best interests of the client, nor does it ensure the injured employee receives best in class service.

 

 

Keys to Effective Contact

 

A three-point contact system results in establishing and maintaining effective communication with all key parties to the claim to facilitate the investigation, claim control, and explanation of benefits.  This includes the following:

 

  • The claim handler will verbally contact the injured employee or attorney, if represented, the employer and the treating physician by the end of the next business day following receipt of the loss to the TPA;

 

  • When unable to reach an injured employee within one business day, a letter will be sent asking the injured employee to call;

 

  • The claim handler should make at least two attempts to contact the applicable parties within 3 days following receipt of the loss. A letter will be sent if unable to reach the parties; and

 

  • If contact cannot be achieved due to circumstances beyond the control of the claim handler, the claim file should be appropriately documented.

 

The contact process should continue throughout the life of a claim.  The following steps should be taken during a claim until it reaches its conclusion:

 

  1. Ongoing contacts with the employer, the injured employee and the medical provider;

 

  1. All contact efforts should be detailed in the claim notes. It is not written down contemporaneously, it did not happen;

 

  1. The claim handler should vary calling times to increase the chance of a successful contact;

 

  1. Significant changes in the injured employee’s condition should be documented in the claim notes; and

 

  1. If the injured employee is off work or on transitional duty, contact should be maintained, at maximum, every 30 days by the claim handler and/or medical case manager.

 

 

Medical-Only Claims

 

Medical only claims require contact just like any other claim.  Important steps that need to occur to be effective include:

 

  1. The medical claim analyst verbally contacts the employer by the end of the next business day following receipt of the loss report;

 

  1. The medical claim analyst sends letters to the employee and medical provider by the end of the next business day following receipt of the loss report; and

 

  1. On transitional duty claims with lost wages or a reduction in hours worked, three-point contact is verbal for all three contacts areas.

 

 

Effective Claims Investigation

 

Prompt and thorough investigation provides the framework for timely analysis of coverage, compensability decision, effective claim management, pursuit of cost containment opportunities, and the timely issuance of claim benefits.

 

  1. The scope of the investigation considers the type of accident, complexity of injury, and compensability issues. Investigation applies to all claims other than those designated as medical-only claims through the assignment process;

 

  1. Initial investigation is completed within 14-calendar days of receipt of the loss report. This TPA utilizes a proprietary claim advantage system, an evidence-based decision tree software tool, to support investigation and prioritize claims. The claim-handling process continues to re-evaluate the exposure as the case progresses and allows for the development of a goal-centered strategic plan of action; and

 

  1. Identification and investigation of potential subrogation or second-injury fund maximize recovery potential and reduces client/carrier loss cost. All claims with potential subrogation are handled by a claim handler who teams with licensed subrogation partner to evaluate and pursue recovery opportunities.

 

The TPA, as a matter of sound business practice, and in recognition of its public policy obligations, has a duty to identify and resist all fraudulent claims. When the evidence supports withholding benefits, such claims are promptly rejected, and aggressively defended.  When the evidence is inconclusive, the claim is promptly adjusted.

 

 

Conclusions

 

TPAs play an important role in the claim management process.  It is important to understand how a TPA communicates with parties following a work injury and investigates claims.  Examining these factors allows the insured to run an effective workers’ compensation program and provide better services to the injured employee, and all interested stakeholders.

 

 

 

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: http://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.

Filed Under: Claim Management

12 Ways to Foster and Sustain Employee Engagement

July 30, 2019 by

Employee EngagementInjured workers who feel engaged with their companies typically recover faster, have lower-cost claims, and rarely – if ever – seek attorneys, compared to other workers. Instead of an adversarial relationship, these employees trust their employers and, in turn, the workers’ compensation system. Engaged employees who become injured at work go through the workers’ compensation process the way it was designed.

 

 

Getting employees to engage with their organizations is not a one- or two-step process. But it also doesn’t need to be unreasonably complex. Companies that think of their employees as team partners and valued customers from day one have an easier and less expensive time of it.

 

 

Pre-Hiring

 

Employee recruitment and hiring methods can set the right tone for employees to feel engaged with their companies.

 

  1. Employee referrals. Job applicants who are referred by current employees are among the most engaged workers. Building trust with new employees who already feel they have an ‘in’ with the company is much easier than starting from scratch with someone who is not familiar with the organization or its culture.
  2. Community outreach. Short of in-house referrals, partnering with local institutions, goes a long way to help job applicants feel an affinity with a company. More than just responding to a blind ad, those who seek employment through organizations they know and trust are more likely to have positive feelings about the company from the very beginning. Some companies are reaching out to local colleges and even high schools to recruit new talent, especially with the exodus of baby boomers.
  3. New technology. Using new technologies is another way employers can gain the trust of new, especially younger recruits, in several ways.
    1. Younger workers are comfortable with new technology, as they’ve grown up with it.
    2. Artificial intelligence, robotics, machine learning, and the like can be implemented to handle the more repetitive, mundane tasks of a job, leaving the new worker to undertake more important and challenging tasks.
    3. Educating recruits on the advantages of new technologies, including that these are there to help not replace workers, lets them know the company cares about them beyond just being a faceless job holder.

 

 

Once Hired

 

During the onboarding process and initial employment, employers can focus on making sure the new recruit feels connected. Having an inviting culture is key. Employees who truly believe the company cares about them are more inclined to be engaged, then those who do not.

 

Employers can demonstrate they have a caring, supportive culture in a variety of ways.

 

  1. Health and well-being. Whether it is physical, emotional, or financial health, organizations can demonstrate they are genuinely concerned about their workers, through employee assistance programs and other avenues.
  2. Resilience training. Employees on the front lines, especially customer service representatives, can be barraged by negativism day in and day out. This can take an emotional toll on even the most resilient person. Helping incoming employees improve their resilience skills also makes them feel more a part of the team.
  3. Fun environment. The work needs to get done. At the same time, however, the atmosphere does not need always to be strict and rigid. Allowing workers to experience lightness is OK. For example, allowing them to decorate their work areas for Halloween or holding the occasional pizza party during lunchtime can be great stress relievers and help workers feel connected and engaged.
  4. Mentoring. New workers typically feel alone and somewhat anxious about coming into the new environment. Pairing them with a more seasoned, non-managerial worker helps them acclimate not only to the job requirements but the overall workplace community.
  5. Personal growth. Organizations that prevent workers from exploring new opportunities may find their workers leaving. Instead, find out what goals and dreams workers have and allow them to experience other parts of the company that may fit their desires. Work rotation, for example, allows workers to learn about other parts of the organization and allows them to grow while feeling more engaged with the company.
  6. Transparency and Employees don’t live in a vacuum. They talk to other people, pay attention to the news and social media, and will likely know if something unusual is going on, whether it’s bad or good news. Instead of keeping employees in the dark, organizations are advised to stay ahead of any news about the company and communicate it with them. This also ensures whatever news an employee sees on social media doesn’t spiral out of control.
  7. Include remote workers. As more employees work from home or other remote locations, employers may struggle with ways to engage them. But these workers can feel connected to the company through virtual means. Mentorships programs, for example, can extend to remote workers. Highly-engaged small groups can be established online, where workers frequently communicate with one another. Virtual meetings via webcams can be held. Online company newsletters can keep remote workers informed, especially if they are also encouraged to contribute to them.
  8. Create a diverse and inclusive mindset. All employees should feel comfortable with their coworkers and unafraid to shares their views – even if they differ from those of their coworkers. Meetings should include workers from all parts of the company, from the mailroom to the C-Suite, and all workers should be allowed and encouraged to express their opinions.
  9. Seek employee feedback. Anonymous employee surveys that elicit honest opinions about the company can identify areas where changes can be made to improve engagement.

 

 

Conclusion

 

Employees who feel engaged with their companies and fellow workers are happier, more productive, and less likely to leave for greener pastures. When they become injured, they are more likely to adhere to their treatment plans and, therefore, recover and return to work more quickly. And they are far less likely to seek out legal counsel. Organizations that understand this and work to make their employees feel connected are more likely to see better bottom lines.

 

 

 

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: http://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.

Filed Under: Hiring Practices

Eliminate ‘MSA Fear’ In Upcoming WCI Session in Orlando

July 29, 2019 by

msa fearAmong the biggest fears of many people you may know are heights, snakes — and MSAs. Workers’ compensation stakeholders often want to avoid the very idea of Medicare Set-Asides.  Among their concerns are

 

  • Fees for MSA preparation
  • MSA professional administration
  • Cost of the MSA
  • Requirements to obtain additional medical documentation
  • Time involved
  • Submitting the MSA to the Centers for Medicare and Medicaid Services
  • Failed settlements due to rejected MSAs

 

For injured workers, their concerns about MSAs may be the biggest thing keeping them from settling their claims.  The fear of running out of money too soon is often stronger than their dislike of the workers’ compensation system. Knowing they will have to navigate their own healthcare with no support from adjusters and/or case managers can also generate concerns. Finally, there is the uncomfortable prospect of having to administer their own MSA funds, or turning that task over to someone else

 

With so many parties apprehensive about MSAs, it’s no wonder many workers’ compensation claims go unsettled for years.

 

On Aug. 14, a panel of experts will discuss the fear of MSAs and how to overcome them to allow settlements to move forward. The session, Allaying the MSA Fear at the Time of Settlement, takes place during the 74th annual Workers’ Compensation Educational Conference (WCI), Aug. 11 – 14 at the Orlando World Center Marriott.  I’ll have the pleasure of moderating the session.

 

With expertise in MSAs, structured settlements, and professional administration, the speakers include:

 

  • Kris Sallee, Claims Manager-Eastern Region, American Airlines
  • Daniel Anders, Chief Compliance Officer, Tower MSA Partners
  • Marques Torbert, Chief Executive Officer, Ametros
  • Joe Bornstein, Structured Settlement Consultant, Arcadia Settlements Group

 

Using real case studies, the panelists will demonstrate how to approach settlements logistically by using an intervention-driven method to develop MSA allocation, professional administration to protect MSA dollars and support the injured party after the settlement, and a structured settlement to extend the dollars over the person’s lifetime.

 

The speakers will provide practical solutions to ‘MSA fear,’ and show how using each type of expert creates a synergy that allows for a smooth settlement process when an MSA is involved. They will also address the risks of not submitting an MSA for CMS review. And they will take questions from attendees.

 

 

 

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 the founder & lead trainer of Amaxx Workers’ Comp Training Center .

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://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.

Filed Under: Medicare Set Asides (MSAs)
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