Senior Editor - Work Comp Roundup

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

April 15, 2019 by Senior Editor

Living 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.

Author 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/

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: Workers Comp News

Detecting Workers’ Compensation Fraud

March 6, 2019 by Senior Editor

Workers’ compensation fraud continues to be a problem. Members of the claim management team need to be aware of this problem and develop a plan for its prevention. They also need to create a plan to remedy the situation. By taking steps to stamp out workers’ compensation fraud, programs will become more efficient and ultimately reduce costs program-wide.

Defining the Issue – What is Workers’ Compensation Fraud?

Malingering or showing signs of pain magnification is not workers’ compensation fraud. Instead, it is defined by state law, and investigated and prosecuted by a state agency. Other civil ramifications can also apply.

According to Webster’s Dictionary, “fraud,” occurs “when a person knowingly or intentionally conceals, misrepresents, or makes a false statement to obtain” workers’ compensation benefits or coverage, “or otherwise profit from the deceit.”

Workers’ Compensation fraud is not limited to injured employees. Employers can commit acts of fraud by:

Misrepresenting company payroll on underwriting forms;

Paying an employee cash or not accurately reporting wages;

Not accurately reporting their payroll staff; and

Intentionally not reporting proper employee work classifications.

In sum, an employer commits fraud anytime it intentionally undertakes an action to reduce the cost of its workers’ compensation insurance premium.

Common Examples of Workers’ Compensation Fraud by Injured Employee’s

There are numerous examples of workers’ compensation fraud committed by an employee in the context of a claim. Some of the more common examples include:

Filing a claim for an injury that never occurred, or occurred outside the workplace;

Delays in reporting a work injury with no explanation;

Reporting an injury that occurred during another activity, such and an employee intentionally inflicting an injury and making a claim for benefits;

Misrepresenting the nature/extent of a work injury to a medical provider; and

Making a claim related to an injury that occurred following a job termination, layoff, or end of seasonal work.

Danger Ahead – Common Red Flags of Workers’ Compensation Fraud

There are numerous red flags members of the claim management team should look out for when investigating a claim. It is important to work as a team and share information to help less experienced claim handlers detect it and avoid paying unnecessarily on a claim.

Employment changes and terminations: Be mindful of claims that arise at the same time an employee changes positions within an employer or is terminated/seasonally laid off. A complete review of whether the injury/incident was reported prior to termination or whether the employee was near the end of their unemployment benefits prior to reporting a claim is key.

Beginning of week injuries: It is often not a coincidence an employee is injured first thing Monday morning after arriving at the workplace. This should make anyone scrutinize a claim to determine if it in fact occurred over the weekend.

Unwitnessed incidents: This should be an area of concern when the claim is made by someone who would typically not be working in a particular area or performing a certain activity. A review of security video should be a part of any investigation to monitor the activities of the employee immediately prior to the incident.

Experienced claimants: These are individuals with a long and well-documented history of work injuries and other insurance claims. A review of an insurance bureau index can track claims histories of a person and be a part of an investigation.

Other red flags include employee’s who give differing stories, work other side jobs (often as independent contractors), or may be experiencing financial difficulties. It is also important to understand what hobbies or recreational activities an injured employee partakes in away from the workplace. This can include someone playing in a sports league or enjoys “extreme sports.” Proactive claim teams should have a plan in place to identify potential fraud issues and undertake a more exacting investigation.

Conclusions

Members of the claim management team need to be mindful of workers’ compensation fraud in all claims. In addressing this issue, there are many red flags a claim handler must be aware of before accepting a claim and paying benefits. By doing this, one can ensure that all valid claims are paid in a timely and correct manner. It can also improve program performance and efficiency.

Contact: mstack@reduceyourworkerscomp.com.

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

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: Fight Workers Comp Fraud & Abuse

Paul H. Sighinolfi Joins Ametros as Senior Managing Director

February 27, 2019 by Senior Editor

Wilmington, Mass. (February 19, 2019) – Paul H. Sighinolfi has joined the Ametros Senior Leadership team as Senior Managing Director. Bringing with him a wealth of knowledge and experience, he will provide thought leadership and lead regulatory and policy initiatives, while providing meaningful strategic direction and insight.

“Paul and I have known each other for several years. He brings years of experience and a unique perspective,” says Marques Torbert, CEO of Ametros. “We are happy to have him on board to help Ametros continue to innovate and provide thought leadership in our industry.”

Ametros strives to enhance the lives of injured parties with innovative and affordable settlement solutions. Ametros focuses heavily on improving the health and well-being of injured workers ensuring that they live happier, healthier, and more productive lives post-settlement.

Sighinolfi is an attorney who brings over 30 years of experience in the workers’ compensation industry, most recently as executive director and chair of the Maine Workers’ Compensation Board. Previously, he was a partner at Rudman-Winchell, LLC., directing the workers’ compensation practice group. He also coauthored Maine Employment Guide: Workers’ Compensation and has been a frequent speaker throughout the country on various workers’ compensation topics.

“Paul’s experience as the head of the workers’ compensation system in Maine, in addition to previously serving as both a plaintiff and defense attorney gives him a complete view of all sides of our workers’ compensation system and makes him a wonderful fit for our company,” Torbert says.

The International Association of Industrial Accident Boards and Commissions (IAIABC) elected Sighinolfi to its Board of Directors in 2014, and he served as its Board Vice President until earlier this year. He is a fellow of the American Bar Association, College of Workers’ Compensation Lawyers, and was formerly on the Executive Committee of the Southern Association of Workers’ Compensation Administrators.

Additionally, Sighinolfi has served as a director on the boards of several non-profit organizations, including Ronald McDonald House Charities of Maine, the Bangor YMCA, and the Girl Scouts of Pioneer Valley.

Sighinolfi earned his master’s degree at Trinity College in Hartford, Connecticut and his law degree at the Columbus School of Law at Catholic University of America, in Washington, D. C.

“I’ve worked in many aspects of workers’ compensation, and I truly believe what Ametros is doing is on the cutting edge of the industry,” says Sighinolfi. “I’m thrilled to be joining the Ametros team.”

ABOUT AMETROS

Ametros is the industry leader in post-settlement medical administration and a trusted partner for thousands of members receiving funds from workers’ compensation and liability settlements. Founded in 2010, Ametros provides post-settlement medical management services with significant medical and pharmacy discounts along with automated payment technology and Medicare reporting tools. Headquartered just north of Boston in Wilmington, Massachusetts, Ametros may be reached at 877.275.7415 or via www.ametroscards.com

CONTACTS

Ametros
Melissa Wright, 978-381-4329
mwright@ametroscards.com

Filed Under: Professional Administration

WCRI’s Annual Workers’ Comp Conference Features Latest Research and Efforts to Address Opioid Epidemic

February 12, 2019 by Senior Editor

With more Americans dying from opioid overdoses than car crashes, the Workers Compensation Research Institute (WCRI) is devoting a session at their upcoming 35th Annual Issues & Research Conference to discussing the latest research and efforts to address the opioid epidemic. The conference is taking place February 28 and March 1, 2019, at the Renaissance Phoenix Downtown Hotel in Phoenix, AZ.

“The dangers of prescription drug misuse resulting in death and addiction constitute a top public health problem in the United States,” said WCRI CEO John Ruser. “We believe this session, which combines research and what is happening on the ground, will be of great value to our audience.”

During this session, WCRI’s Vennela Thumula will present the Institute’s latest research on correlates of opioid prescribing to injured workers, which can help public officials and other stakeholders better predict which injured workers are more or less likely to receive opioids. Next, Letitia Davis with the Massachusetts Department of Public Health will discuss the results from a recent study they published on factors that may contribute to differences in the rate of opioid-related overdose deaths among workers in different industries and occupations. Then, Jacqueline Kurth and Jason Porter of the Industrial Commission of Arizona will discuss efforts taken by Arizona Gov. Doug Ducey and the Commission to address the opioid epidemic in their state.

The theme of this year’s conference is “Breaking Down Barriers to Improve Injured Workers’ Outcomes.” It will feature the latest research from WCRI, engaging sessions on the latest trends, and examples of industry stakeholders coming together to tackle some of the system’s most important challenges. The following are a few of the session titles:

Challenges and Opportunities of Telemedicine
From Washington State to Washington, D.C. – a Model for Returning Injured Workers to Work
Group Health Deductibles and Workers’ Compensation
Has There Been an Erosion of Workers’ Compensation Benefits?
How Unions and Management Can Create Successful Return-to-Work/Stay-at-Work Programs
Moving the Needle: Innovative Employer Ideas

The WCRI conference is a leading workers’ compensation forum for policymakers, employers, labor advocates, insurance executives, health care organizations, claims managers, researchers, and others. Conference participants will leave with new insights, valuable networking contacts, and a better understanding of key issues in today’s competitive environment. To learn more or to register, visit https://conference.wcrinet.org.

The Cambridge-based WCRI is recognized as a leader in providing high-quality, objective information about public policy issues involving workers’ compensation systems.

About WCRI:

The Workers Compensation Research Institute (WCRI) is an independent, not-for-profit research organization based in Cambridge, Massachusetts. Since 1983, WCRI has been a catalyst for significant improvements in workers’ compensation systems around the world with its objective, credible, and high-quality research. WCRI’s members include employers; insurers; governmental entities; managed care companies; health care providers; insurance regulators; state labor organizations; and state administrative agencies in the U.S., Canada, Australia, and New Zealand.

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Filed Under: Workers Comp News

Effective Handling of Medical Only Workers’ Comp Claims

January 30, 2019 by Senior Editor

Medical only workers’ compensation claims are sometimes viewed as being unimportant and routine. This mindset can cause issues and lead to larger problems within a claim management team. If left unchecked, it can significantly impact the ability of a claims team to handle a large number of claims and not settle workers’ compensation claims in a timely manner.

Medical Only Workers’ Comp Claims – Defining the Issue

Medical only workers’ comp claims are those that involve an injury where the employee only receives medical care and treatment, or the wage loss is confined to the “waiting period” under a workers’ compensation act. In these claims, the employee’s medical care and treatment may be as short as one office visit, or as long as several years. The important thing to remember is money is being spent and the claims need to be properly managed.

Avoiding Pitfalls in Medical Only Workers’ Comp Claims

Members of the claim management team that work on these claims are generally newer claim handlers with less experience. The work may be monotonous, but it is still important. Members that are working these claims should pay close attention to detail, which includes the following issues:

Ensure the injured employee receives prior authorization when necessary to receive medical care and treatment;

Understand requirements as it released to applicable medical treatment parameters and fee schedule payments; and

Review applicable claims to ensure managed care protocols are followed, if applicable.

This process also requires the claim handler sets the proper reserves on a claim. In order to accomplish this goal, the claim handler needs a complete understanding of workers’ compensation protocols. It is also important to ensure the employee remains gainfully employed to avoid exposure for indemnity and wage loss benefits.

Move Cases Forward – Not Letting Dust Settle

All members of the claim management team need to act in an honest and ethical manner. This includes treating the injured employee with respect and dignity. All payments should be made when legally required. The importance of properly handling medical-only claims is echoed by a National Council on Compensation Insurance (NCCI) report that found the following:

About 80% make the transition within 12 months of the date of injury;

Medical-only claims that become lost-time claims cost an average of 40 times more than those that remain medical-only;

Carpal tunnel claims are the most likely claims to transition from medical-only to lost-time, with the probability of such a transition being approximately 34%;

The larger the incurred value (paid plus case reserves), the greater the probability of the claim becoming a lost-time claim; and

The probability of a claim transitioning increases with claimant age until age 65, and then it declines.

It Takes a Team to Manage (Medical Only) Claims

All members of the claim management team need to take a proactive approach to medical only claims. Even claims that are reserved at lower amounts – $500 to $1,000 – can reduce a program’s efficiency and effectiveness. Small dollar amounts allocated across countless files add up.

Claim Managers: Be a leader and work hard to make sure all members of the team are moving claims toward settlement. A file that collects dust impacts everyone;

Claim Handlers (more experienced and indemnity handlers): Provide guidance and assistance to newer members of the team. Make sure they know how to be efficient and effective. Mentorship can pay dividends across the team by building morale. It also demonstrates you are capable of handling more complex matters; and

Medical-only Claim Handlers: Pay attention to what is going on. Understand there is a learning curve so do not shy away from constructive feedback. Never be afraid to ask questions.

Conclusions

At the end of the day, the only good file is a closed file! This starts with a program-wide review of medical only claims. Make sure these files are properly reserved and files that can be settled are moved toward closure. It is also important for everyone on the claims management team to be involved and work together for the good of a program.

Filed Under: Claim Management

6 Things Employers Can Do to Reduce Lag Time

January 24, 2019 by Senior Editor

Lag time is the enemy of a successful workers’ comp claim outcome. When there is an injury at the workplace, you need to know what to do. A lot will depend on the actual type of injury. If the injury is severe and requires immediate surgery and in-patient hospital care, you are probably going to do all possible to get the claim to the carrier/TPA as fast as possible on the day of the injury.

On the other hand, if a guy comes in the office and says he hurt his arm but “it is no big deal,” chances are you are going to forget about it, not make a note about it. And when he comes back in 6 months and says surgery is needed tomorrow and will be off of work for 6 months, I do not think you are going to exactly recall the brief conversation with him 6 months prior.

Lag Time Is The Enemy

Lag time is also the enemy to every claims adjuster. It can affect every aspect of the claim, most importantly the compensability. For every day that goes by after someone is hurt without reporting it to the employer, or even worse he reported an injury to the employer who did not report it to the carrier/TPA, lag time is involved. Lag time is the time between date of injury and the date of reporting to the employer and from the employer to the carrier. Here are some tips to improve lag time. ASK FOR A LAG TIME REPORT FROM YOUR CARRIER. They should be giving them to you periodically, but if not, ask for it.

Have a system in place

Regardless of the size of the work population, you need to have a system in place. The employer is going to be faced with several different types of workers comp claims: report only, medical only, lost time, advanced lost time, and severe. A claim that is a “report only” or “incident only” should not carry the same urgency as a severe injury claim.

Every person in risk management will have a certain way of keeping records and reporting claims to the carrier/TPA. Organization is key. The system has to work, or else a claim will fall through the cracks. Get a separate file cabinet, dedicate a certain area of the office to claim paperwork, and keep separate email folders for claims. Whatever you do to create a working system stick with it. Think about prioritizing each type of claim and how each issue has to be addressed. Take it one step at a time and walk through what the responsibilities are and where you need to focus.

Get claims called in to the carrier/TPA

A rule should be made that any claim with medical treatment needs to have the State Injury report completed and sent to the carrier/TPA within 1-2 business days. Not only does this prevent lag time from happening, but it will give the adjuster a head start on the claim from early in the injury. This can apply to medical-only claims and non-severe lost time claims. Plenty of claims start off innocently enough as a simple medical only claim. But then, 3 months later after conservative treatment fails, the injured worker is heading for surgery, which is not a guarantee that the employee will be 100% in the near future. The earlier the adjuster is involved in the claim, the better chances you have of it not spiraling out of control. Plus after it is reported and called in to the carrier, that is one less thing to worry about.

Call claims in with correct and complete information

Adjusters dislike it when they receive an injury report and most of the information is missing. Or the injury description reads “back strain.” Maybe the place where the employee was treated is not known, or if the injured worker even went for treatment at all. Maybe you view date of birth, social security number, job title, and complete address, as trivial information. That is okay, but the adjuster needs that information, and it needs to be accurate. It cannot take long to pull a person’s personal information up on the computer, or email the Human Resources person to seek help with that portion of the claim. Any way that it can get done, do it and then get the claim sent. Incorrect or incomplete information produces lag time from when the adjuster receives the injury report to when the TPA makes a first payment on a claim. Or even when the adjuster can make contact with the worker. If you forgot the claimant’s phone number, and did not have a complete address, how can the adjuster contact the injured worker?

Include the hourly wage and the gross total from a year prior to the injury date to reduce lag time

If this claim will involve wage loss, the adjuster will need the wage records. Be sure to list the hourly rate for the injured worker, as well as the gross pay from one year backwards from the injury date. This will save the adjuster time, cutting down on the lag time between injury date and date of first payment. Most states will penalize the carrier for a delay in payment after an injury occurs if there is lost time. Due to this statute, the adjuster will be requesting wage records. So why not be ahead of the game and include the records with the claim forms that are sent? The adjuster will appreciate it. And of course it is one less thing you have to do.

Keep eyes and ears open on your work floor

As a risk manager or HR person, chances are you are removed from the work floor where a lot of injuries occur. But, the adjuster will be calling you to talk about the injury details. So you have to know about the machines, know the people running them, and also know who the employee’s managers are and how to talk shop with them. Your employees should know that the first contact person after an injury is their supervisor, and then that supervisor should be coming right to you to fill out the injury paperwork after they talked with the employee and sent them off for medical care. Make sure those supervisors know the importance of coming to you to report a claim. If the worker does not tell the employer about the injury, then you are not going to have a report to send.

Be involved with the process

We have said it time and time again, the employer must be involved. Not only at the initial stages as indicated above, but throughout the whole process. To have an effective workers comp program, there must be proper reporting, proper light duty management, and proper monitoring on all aspects of the claim. You need to communicate with the carrier/TPA for claims reviews. Get up to speed with what is going on, and what the current lag times are. Set goals to reduce lag time from late reporting and keep track of the numbers. Fix your system where it needs to be fixed. There is no perfect blueprint that will work. A program as variable as this also needs to be flexible. Make changes as needed and track to see if they improve numbers or worsen them, and then make further changes. Create the program, and then be involved in it.

Summary

Carrier/TPAs despise lag time from late claim reporting. They keep track of it for a reason, because the greater the lag time and the later the adjuster is involved, the more the exposure risk increases. Take some of the key points listed above and see if they can be implemented into your risk management system. Keep track of the numbers. If you discover that you have a lag time problem, then you have the room and the resources to save a lot of claim expense money that is spent purely on late reporting. Like it is said, “The numbers don’t lie.” You will be amazed at how much money can be saved simply by getting that correct claim sent in to the carrier for immediate handling.

Contact: mstack@reduceyourworkerscomp.com.

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

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: Workers Comp Cost Containment Fundamentals

3 Essential Elements to Supervisor Response That Will Save 40 Percent

January 21, 2019 by Senior Editor

Can you name the one person throughout the course of a worker’s comp claim that within about 10 to 15 minutes of work can reduce your work comp cost, claim cost, by 40%, and reduce the duration by 58%? Hello, my name is Michael Stack, I’m the CEO of AMAX. And the one person I’m talking about is your supervisor. And according to Liberty Mutual Research Institute, some studies that they did, the impact of that supervisor, of how they respond to the claim when the employee initially reports it to them, if they respond positively and appropriately can reduce your claim costs, what they showed through research, by 40%. And reduce your duration by 58%. Pretty dramatic numbers for a short period of time.

Train Supervisors Doesn’t Have to be Difficult

So, what we need to do is we need to train these supervisors to respond appropriately. And really it’s not all that difficult. Only a couple of things that they need to know, they need to remember, they need to do at that time of injuring. And I’m going to lay these out for you here.

#1 Demonstrate Care

The first thing they need to do is they need to demonstrate care. Demonstrate care. “Hey, John, I’m sorry you got injured. What can I do to help?” And then listen and problem solve. Demonstrate care, listen, and problem solve.

#2 Give Employee Privacy

Number two then is you need to get them to a private place. You’re injured, you’re feeling a little bit vulnerable when you report that injury. You don’t want to check out your rib injury in front of all your gawping coworkers. So when that person is injured, take them to a private place. Bring them into the supervisor’s office, bring them into a first aid room if your organization has one. Take them to a private place so they can address their injury, get their wits back about them, and be able to move forward from there.

#3 Help Employee Obtain Medical Care

And then number three then is of course, get medical care. Get them the medical attention that they need. Best practice here is to use an injury triage provider, use an injury triage hotline, or an onsite clinic. More likely in most cases it’s going to be calling that nurse via telephonic care, through an injury triage provider. You give that nurse a call, it takes the onus off the supervisor, to have to make the decision of what to do. “Oh, you hurt your shoulder. I don’t know if that’s really a bad injury or not a bad injury.”

Have that nurse through the triage provider direct that person to the appropriate level of care. The way your supervisor responds to an injury can impact your costs by 40%, and your duration by 58%. This is something you need to pay attention to, and teach your supervisors how to do it appropriately.

Again, my name is Michael Stack, CEO of AMAX. And remember, your work today in workers compensation can have a dramatic impact on your company’s bottom line. But it will have a dramatic impact on someone’s life. So, be great.

Contact: mstack@reduceyourworkerscomp.com.

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

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: Management's Role in Workers Comp Tagged With: 3 Essential Elements, Supervisor Response

Medcor Launches New Telemedicine Service for Workers’ Comp Nationwide 24/7

December 12, 2018 by Senior Editor

Medcor, Inc., the nation’s leading health navigation firm, announces a new telemedicine service developed specifically for work-related injuries. Medcor Telemed™ will be available 24/7 in all 50 states, beginning January 14, 2019. This new service enhances Medcor’s existing injury triage service, already in use by more than 309,000 worksites, and will augment Medcor’s 240+ onsite and mobile clinics.

Medcor navigates patients to optimal care by using evidence-based medicine, proprietary clinical algorithms, and patented processes. Medcor serves employers across a wide range of industries, including many Fortune 100 and 500 companies, as well as government agencies, TPAs and insurance carriers.

Medcor’s President and CEO Philip Seeger said, “We designed our new service to address the challenges telemedicine faces in occupational health. This service will improve outcomes, reduce costs and provide a positive user experience for patients, their employers and for the treating doctors.” Mr. Seeger added, “Avoiding the conflicts of interest so common in medicine is a tough challenge to address, and it is a cornerstone of all Medcor’s health navigation services.”

Sophisticated algorithms programmed into Medcor’s system identify cases that are appropriate for telemedicine; high-acuity conditions that require in-person care and diagnostics are directed to the appropriate offsite facilities. Identifying the needed level of care saves time and expense. Vice President and General Manager Matt Engels oversees the new service. He said, “Medcor Telemed is an early intervention opportunity to guide low- and moderate-acuity injuries onto the right path to recovery and to jumpstart the claims management process. Our system connects patients to physicians seamlessly with wait times measured in minutes and without advance scheduling. Medcor Telemed is staffed by a team of hundreds of physicians to ensure coverage across all states day and night. Our physicians are trained and experienced in telemedicine and oriented to Medcor’s best practices in occupational health.”

Patients and physicians benefit from Medcor care navigators who stay with the injured worker through the entire telemed process, from registration to resolution. The navigators handle technical and administrative aspects of the session. They document and clarify key workers’ compensation information, such as return-to-work status and restrictions for modified duty. At the end of each session, the navigator facilitates carrying out treatment orders from the physician. The system automatically processes reports for all the stakeholders.

Medcor’s new service operates with a combination of Medcor’s technology and licensed systems. It works on desktop computers, tablets and smart phone apps, which can be downloaded at the time of service. Medcor has already provided more than 2.5 million injury triage and other telehealth visits, which represent a solid foundation of experience for its new telemed service.

For more information, watch the short video at this link https://youtu.be/CTUT5QeoQIg/, contact media@medcor.com or call 815-759-5442.

Filed Under: Workers Comp News

ODG Announces Release of Job Profiler Powered by MyAbilities Into Its Industry-Leading Guidelines

December 3, 2018 by Senior Editor

AUSTIN, Texas, Nov. 28, 2018 /PRNewswire/ — ODG, an MCG Health company, (USA) has announced a partnership with MyAbilities Technologies to incorporate a unique new product option, the ODG Job Profiler, into its industry-leading medical treatment and return-to-work (RTW) guidelines.

The ODG Job Profiler is an innovative software platform powered by MyAbilities™ which will be made available as an add-on to the ODG by MCG User Interface. The ODG Job Profiler adds job demand data across every industry and occupation by providing a comprehensive database of physical, cognitive, and environmental demands specific to over 30,000 jobs spanning nearly every industry. This solution helps insurers, third-party administrators (TPAs), and employers identify and mitigate the risk of injury by creating a customized Physical Demands Analysis (PDA) for each job function, adjusting disability duration guidelines according to job demands.

Case managers, claims adjusters, site managers, and clinicians will be able to collaborate around job-specific lost-time goals and activity modifications, with the shared goal of expediting return-to-work while implementing proper measures to prevent workplace injuries.

“The ODG Job Profiler offers a valuable complement to our treatment, return-to-work, reserving, and risk-analytics tools, supporting a comprehensive, evidence-based solution set. Innovative and technology-enabled, it enhances efficient collaboration and communication between payer, employer, and provider around what matters most: function. The art and science of return-to-work have never been better,” said Phil LeFevre, Managing Director of ODG.

“We are convinced that all stakeholders will experience better injury prevention and management by using the ODG Job Profiler which is empowered by the congruence of advanced ergonomics, artificial intelligence, digital job-matching, and risk assessment technology. The ODG Job Profiler revolutionizes claim and human asset management by creating a new industry-standard paradigm,” said Reed Hanoun, CEO of MyAbilities.

About MyAbilities

MyAbilities is a technology company delivering workplace risk mitigation and injury management strategies using Artificial Intelligence (AI) and robust data analytics.

MyAbilities develops software solutions to help employers assess their jobs, identify risk and prevent injuries using proprietary AI, computer vision, analytics, ergonomic risk analysis, and injury prevention strategies. Post-injury, MyAbilities support claim administrators with an evidence-based claim and medical management software for the resolution of injuries and illnesses in workers’ compensation, and disability programs to reduce costs of claims and expedites return-to-work. More information is available at http://www.myabilities.com.

About ODG

ODG, an MCG Health company, (www.mcg.com/odg) provides unbiased, evidence-based guidelines that unite payers, providers, and employers in the effort to confidently and effectively return employees to health. The clinical guidelines and analytical tools within ODG are designed to improve and benchmark return-to-work performance, facilitate quality care while limiting inappropriate utilization, assess claim risk for interventional triage, and set reserves based on industry data.

About MCG Health

MCG, part of the Hearst Health network, helps healthcare organizations implement informed care strategies that proactively and efficiently move people toward health. MCG’s transparent assessment of the latest research and scholarly articles, along with our own data analysis, gives patients, providers, and payers the vetted information they need to feel confident in every care decision, in every moment. For more information visit www.mcg.com or follow our Twitter handle at @MCG_Health.

For media inquiries, please contact:

Name: Daphne Worrall
Title: Marketing Manager, ODG by MCG
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Tips for Effective Use of an Interpreter in Workers’ Comp

November 6, 2018 by Senior Editor

The need to use an interpreter in workers’ comp has increased with the changing dynamics of the American workforce including those individuals who do not fluently speak English – whether it be as a primary language, limited use or no working knowledge at all. The use of an effective translator to assist when communicating with non-English speaking people during the claims investigation process is beneficial for improved claim outcomes.

English as a Primary Language – A Changing Dynamic

There is no “official language” in the United States. Although roughly 30 states have enacted laws making English (American English) the official language for business purposes, our country remains a melting pot filled with numerous languages and dialectics. Recent estimates indicate about 350 languages are spoken in the US. This creates many challenges when a work injury occurs. Members of the claims management team and other interested stakeholders need to be aware of these issues and use interpreters to make sure their claims are properly investigated, and the information is received accurately.

Goals of Using an Effective Interpreter in Workers’ Comp

Using an interpreter is a relationship where all parties need to be on equal footing and involvement. It is important to set the right tone at the beginning of the process.

Get to know the interpreter. Understand how they interpret – simultaneous or consecutive. When using consecutive translation, get a good idea of the length of sentences or phrases one should use. Patience is key.

Set expectations for best practices. Understand a good interpreter in workers’ comp is not an advocate for either party. They should never be used to add persuasion or in a coercive manner.

Set timelines for translation. Translation services are taxing physically and mentally. A good interpreter will need frequent breaks. Understand these limitations and respect them.

Signs of a Good Interpreter

Finding a good interpreter in workers’ comp can be a challenge even if it is a language that is common. Because work comp claims involve legal matters, it is important to use a court certified interpreter in all instances. This includes translations taking place during recorded statements, witness interviews, depositions, independent medical examinations/independent vocational evaluations and hearings. Characteristics of a good interpreter will include the following:

Interpretation of every word: Accuracy is key. When an interpretation is “word for word,” it ensures the information is being relayed completely and avoids issues for appeal.

Not providing one-word answers when there was clearly a longer answer: When this takes place, it is noteworthy that accuracy is not valued. It may be time to stop what is taking place and locate a new interpreter. This might mean stopping a deposition and re-setting the proceeding. Although there are additional expenses, it will avoid problems down the road.

No side conversations: It is important that all parties are involved in a conversation and what is being shared by the non-English speaking person is provided to all. In some instances, an interpreter may need to ask a question to clarify a term being used. If this is the case, it is important for the interpreter to note this and translate the “side conversation” completely.

Be aware of regional dialectics: This is something that should be discussed well in advance of using an interpreter. As is the case in English, words in other languages have different meanings to people in different regions.

Other Barriers and Challenges

It is also important to understand people from other cultures may have misconceptions on the American legal system. Examples of this may come from people who immigrated from oppressive regimes and governments. They may have a distrust of the legal system in the United States based on prior experiences. Other cultures may also view someone with a personal injury differently. Best practices in claims management must include cultural competence. Remember to treat all people with respect and dignity.

Conclusions

While there is an added cost, members of the claims management team cannot avoid the demand to use an interpreter in workers’ comp for an injured worker with limited use of the English language – or none at all. These costs can translate into savings when done correctly. This includes using a qualified court-certified interpreter, getting to know the person and using one in the right (and necessary) circumstances.

Contact: mstack@reduceyourworkerscomp.com.

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

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: Uncategorized

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