The claim adjuster’s main role is to get an injured worker rehabilitated and back to work. The timeline on how this can happen depends on a multitude of factors, including the severity of injury, age of patient, prior injuries to same area, the diagnosis, and what the person does occupationally for a living. It is safe to assume a person who paints ceilings does a lot of overhead work. And if this person has 2 really bad shoulder surgeries, this worker is not going to be painting ceilings anymore.
Severe injuries and bad claims are going to happen. Sometimes there is no way around them. The main focus for risk management should be on the day to day, normal, medium-exposure lost time claims and how to save money on them. These are claims that have maybe 6-12 weeks of disability. These are the prime claims to be aggressive with and stop bleeding wasted claim dollars.
But, a lot of the responsibility lies with the employer. The employer controls a lot of the future for the injured worker. Here are 7 excuses adjusters hear from employers when the adjuster wants to get injured workers off of work comp pay and back to work making either the normal wage, or a modified one, depending on the program outline.
No light duty work available
This is always the easiest excuse. A certain way to stop an injured worker from returning is to say you do not have anything for them to do within the medical restrictions. This is OK, if you want the employee to hang out at home and watch TV and make a good percentage of the gross pay. But the point is to stop that from happening. Create a job for this worker to do. Granted, not every employer has light duty work. Smaller shops are at a disadvantage since the number of tasks to do can be limited, but be creative. Have them do some painting. Let them sweep outside. Have them plant flowers. Chances are employers can find something for the injured workers to do.
Afraid of aggravating the injury
Another great excuse is “I am afraid my injured worker will aggravate the injury when returning to work.” Sure, that is a valid concern. But the worker could be injured worse by falling down at home, by falling in the grocery store, or by falling out of a fishing boat. Whatever the risk may be, it is everywhere not just at the plant. So that is a very weak excuse. Yes the risk is there, but not if you as the employer plan accordingly, and be smart about putting the worker back on light duty.
Afraid of new injury
“What if the employee slips or falls? I am afraid of having the worker here while hurt. The employee could hurt something else and be off even longer.” Another classic excuse. Yes, that is correct. That could happen. But again that could happen anywhere. If the injured worker has a knee injury, do not have them working outside by the loading docks while it is raining so they have a risk of slip/fall. It comes down to common sense. Have the claimant do something safe, and easy to do. The point is not to have them riding the edge of risk everyday until full duty resumes.
Afraid of the injured worker hurting someone else
And the third one in the series of “I am afraid” is the injured worker injuring someone else. And yes that is also possible. But again, use that common sense when reviewing these light duty prospective jobs. Customize them to the injured worker to minimize risk of injury. Stop those claim dollars on lost wages from going out the window for no reason.
Injured workers cannot be productive
This one is a more direct assertion. This is so variable I do not think I have enough room to talk about it. It comes down to customization of the job to the injury. If the worker has a hand injury, I do not think the employee should be packing boxes and taping them while also carrying them out to the loading dock. A guy with an ankle injury should not be running parts and materials back and forth across the length of your factory. Everyone can be productive if the circumstances are favorable to what the strong points are. If the machine operator is injured and cannot run the machine, but you know he has a knack for inventory and ordering parts, let him do that. Be creative.
No job description
A personal favorite is when the employer states they do not have a job description to send to the doctor to get work restrictions. Of course you know what that person does for a job as an employer overseeing that employee for what maybe 17 years. To the adjuster, that translates in to “I do not feel like typing out what he does in an email.” The carrier/TPA cannot “force” the employer to do anything. It comes down to your own commitment to the program to save money. Every little bit will count, and every little bit will go towards that main goal of saving “x” by the end of the year . But you have to put the time in to get the benefit out of it. And, an employer could visit the employer’s facility yearly to observe all jobs.
Do not want to pay the worker the full wage to do a light duty job
Some welders for example that make a ton of money per year get paid the normal wage to answer a phone. That is a pretty good job to have! Remember, in most states you do not have to pay them the full wage. The employer can pay them what they would have made being off on workers compensation. Now that is a bit of a low-blow to the worker, but if you want to be that tight about your program then you can run it that way. Or, better yet drop their pay down to “x” per hour to do light duty, and let your carrier/TPA pay the worker a partial wage check. It is better than the worker sitting at home and getting full workers comp pay. This way, the employee is on light duty work for 2-4 hrs. per day, the carrier pays the rest, and the employer looks like a genius by how much this will save in the long run.
These are only some of the excuses heard to avoid a proactive transitional work program. At the end of the day, it is your job as the employer to set the tone for being proactive. Team up with your HR dept. and make those job descriptions. Be creative about light duty work and what a person can do, then base a wage on it. That does not mean your welder that makes $35/hr. always has to make that high of a wage. In light duty, maybe drop the rate across the board and if someone is owed a partial compensation wage check then that is okay. It is still better than letting the injured worker control the claim, since the only job would be to check the mail for a compensation check.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com. Contact: RShafer@ReduceYourWorkersComp.com.
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