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
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
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
Medcor’s new service operates with a combination of Medcor’s technology and licensed systems. It works on desktop computers, tablets and
For more information, watch the short video at this link https://youtu.be/CTUT5QeoQIg/, contact media@medcor.com or call 815-759-5442.
Medcor Launches New Telemedicine Service for Workers’ Comp Nationwide 24/7
ODG Announces Release of Job Profiler Powered by MyAbilities Into Its Industry-Leading Guidelines
AUSTIN, Texas, Nov. 28, 2018 /PRNewswire/ — ODG, an MCG Health company, (USA) has announced a partnership with MyAbilitiesTechnologies 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
Tel: 406-622-5516
Email: daphne.worrall@mcg.com
Name: Sarah Reid
Director of Operations MyAbilities Technologies
Email: sarah@myabilities.com
Related Links
SOURCE ODG
Related Links
Tips for Effective Use of an Interpreter in Workers’ Comp
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.
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/
©2018 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.
7 Strategies to Jump Start Workers’ Comp Delayed Recovery Claims
A company may have the best injury-management program possible, yet still, have claims that go south for no apparent reason. Sometimes called ‘creeping catastrophic’ these are claims that involve seemingly minor injuries that should heal fairly quickly and have the employee back at work in short order. For no apparent reason, these claims instead turn into long-term recoveries, with multiple treatments, surgeries, medications, along with exorbitant costs.
There are various reasons for delayed recovery claims. Typically, there are undetected psychosocial risk factors that come into play and render the injured worker unable to heal and return to function. Identifying, recognizing and intervening early in these claims is key to getting the worker back in action.
Delayed Recovery Claim Risk Factors
Chronic pain is the usual result of injured workers with psychosocial risk factors. For a variety of reasons, they have inadequate coping skills and develop persistent pain long after the injured tissues have healed.
Some of the more common psychosocial risk factors include:
- Catastrophic thinking — a belief that the worst possible outcome is the most likely. The person feels helpless to deal with her pain and exaggerates the threat of pain sensations.
- Fear avoidance/guarding behavior — the worker is unrealistically fearful of hurting himself more, so avoids almost all activity.
- History of depression and/or anxiety
- Perceived injustice — the person feels he has been unfairly harmed and assigns blame; to the employer, coworkers or someone or something else.
- External locus of control — the worker believes someone other than himself can and must heal him, usually the medical provider. The person assumes no responsibility for his own
The worker’s pain persists, despite all medical efforts to heal the injury. These workers often end up having multiple surgeries. The medical provider who does not understand psychosocial factors are at play suggests a variety of treatments to cure the employee’s pain. This further exacerbates the worker’s external locus of control and legitimizes the person’s distress.
Workers with delayed recoveries often end up on a variety of medications, typically including long-term opioid therapy. And still, the pain continues and may even worsen.
Early ID/Intervention to Prevent Delayed Recovery
These claims often slip through the cracks; meaning the people managing them, as well as the employer and payer, fail to realize the extraordinary timeline and treatments that have been provided for many months or even years. By then, this ‘minor’ injury has turned into a long-term, expensive claim.
Flagging these claims as early as possible is essential to prevent them from rapidly deteriorating. There are a multitude of ways to identify these claims early in the process.
At least one company uses a pain screening questionnaire that has been shown to identify at-risk injured workers as soon as two weeks after an injury. Several insurers and pharmacy benefit management companies have developed programs to key in on at-risk claims fairly soon after an injury. A program that alerts stakeholders to potential problems with a claim is far superior to waiting until someone notices long after the claim has consumed a plethora of treatments and dollars.
Once a high-risk claim has been detected, those involved should intervene using a team approach. Ignoring it is not the way to go. The claim can be kept on track, but only if receives prompt and focused attention.
When psychosocial factors are involved, an approach other than biomedical must be undertaken. A biopsychosocial approach looks at the whole person, beyond just the injury itself.
Functional Restoration
An integrated system that involves several different disciplines involved has been shown to work well in delayed recovery claims. That may include, for example, physical therapy, occupational therapy, case management, psychology, the treating physician, and the injured worker and his family.
The team works in conjunction with one another and communicates among themselves and with the injured worker. Along with the person’s physical ailment, his psychosocial factors must also be addressed.
Among the interventions that are successful in treating injured workers with psychosocial factors are:
- Pain education. Recent research has shown that pain, specifically chronic pain, causes structural and functional changes in the central nervous system. Rather than a sensation, chronic pain is a result of the person’s biology, psychological makeup, belief system about pain, and interactions with the environment.
- Cognitive behavioral therapy. This is short term, typically involving a few weeks of sessions. It is goal oriented. Unlike long-term traditional psychotherapy, CBT teaches the injured worker different techniques to change his thinking and behavior, which ultimately teaches him how to cope with his pain.
- Mindfulness training. Mindfulness meditation teaches the person to bring his attention to experiences in the present, rather than ruminating about his pain and injury.
- This technique helps the worker gain more awareness of his physiological functions so he can ultimately control them. Instruments that provide information on the activity of certain bodily systems are used. People using biofeedback have been able to control their brainwaves, muscle tone, heart rate and pain perception.
- Exercise/activity. Movement is one of the most effective treatments to help patients with chronic pain.
- This can help the worker change his perceptions, thoughts and behaviors in guided practice.
- Relapse prevention training. Strategies such as coping skills, the individuation of triggers for relapse, and self-monitoring techniques can help the injured worker stay grounded and avoid the negative thinking and behaviors that contribute to his chronic pain.
Conclusion
Workers’ comp delayed recovery claims represent approximately 10 percent of claims, but consume 80 percent of medical and indemnity costs. Too often they go unnoticed until they become nearly out of control. By understanding how to identify or recognize them early and intervening with proven techniques, the worker can recover and regain function.
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/
©2018 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.
A Unique Perk For Workers with Limited or No Health Insurance
Some leading US companies offer a unique perk for injured workers who settle their claims with limited or no health insurance. They offer a service that gives these employees discounts on their medical care, support to navigate the health care system, and administration of their medical bills. It’s a way to give an injured worker an extension of their employee benefits while still maintaining control of their money after they’ve settled.
While this service is especially valuable for injured workers, it is not restricted only to them. Anyone can take advantage of these benefits to get a break on retail prices for prescriptions and other medical services along with support and advocacy. It’s a way to leverage the benefits of a post-settlement professional administrator without a formal agreement. Employers who can’t provide top-notch health insurance for their workers can direct them to these services as an alternative way to provide healthcare assistance.
The Benefits
Professional administrators offer significant price reductions for medications and medical treatments, as well as step-by-step guidance through the healthcare system — often via a 24-hour/7-day-a-week assistance to discuss healthcare issues. Injured workers with longstanding claims can find the comfort and peace of mind they need to finally settle their claims.
Injured parties with complex medical issues can sometimes be hesitant to end their relationship with the workers’ compensation system for fear of having to manage their money and health care needs on their own, as well as pay full retail price for prescriptions, doctor visits, and medical treatments. Working with a professional administrator after settlement can often be the answer for these employees.
Here’s how it works:
- An injured worker or independent individual who signs up for the service is given a benefit card which can be used to pay for pharmaceuticals and other medical needs.
- There is no obligation to use the card at any time, and the company cannot dictate when or how often the card is used, if ever.
- Discounts off retail prices are available when the card is used.
The professional administrator does not have control over any specific amount of money. Instead, the user allows access to his bank account for only those services paid with the card from the professional administrator. The company simply processes payments made on the card through the person’s bank account. The better companies also provide the user with a report that tracks all payments made through the card in a given time period, which can be particularly helpful for those who trace Medicare payments.
Who Benefits Most
In addition to injured workers who have settled their claims, those who can gain the most through the services of a professional administrator include:
- The uninsured. Those with no health insurance typically pay full price for their doctor visits, treatments, and medications; using a professional administrator results in significant savings to them. Additionally, they may want or need assistance locating providers and pharmacies as well as setting up appointments. Professional administrators provide these and other services.
- Those with high deductibles. People who have health insurance with deductibles in the thousands often must pay full price for their medical services and/or Payments made through the card are not credited to the deductible. However, the discounts offered through a professional administrator can result in substantial savings.
- Insureds with non-covered meds or treatments. Some insurance plans don’t include certain medications, or the discounts provided are insignificant. The discounts offered through the professional administrator may be greater.
- Those looking for alternatives to high co-payments. Depending on the insurance plan, there may be high co-payments for visiting certain specialists or purchasing some medications. The professional administrator’s discounts may be lower than the out-of-pocket co-pay.
The services of a professional administrator are not appropriate for everyone, but for many, it is an alternative to paying high prices and trying to navigate the system alone.
Conclusion
Only a small percentage of injured workers who settle their cases are using professional administrators. But that is changing, especially since CMS’s recommendation last year that injured parties seek third-party assistance/professional administration after settling their claims.
Now, some of these companies have expanded their services to allow anyone to tap into some of the benefits of a professional administration without a formal commitment.
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/
©2018 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.
Crawford Offers Streamlined Ergonomic and Return to Work Efforts with Innovative Software
TORONTO, Oct. 9, 2018 /CNW/ – Crawford & Company (Canada) Inc. today announces the integration of Crawford EmployerWORKS™ software with its human risk service line. Crawford EmployerWORKS is an innovative software platform powered by MyAbilities™. It was designed to streamline and standardize the collection, communication, and analysis of physical, cognitive and psychosocial demands tied to risk assessment and return to work efforts. As a tool for the adjudicators, case managers and workers’ compensation consultants of Crawford’s Human Risk division, Crawford EmployerWORKS further empowers our professionals to effectively and efficiently handle disability claims by ensuring a prompt and successful return to work and implementing proper measures to prevent workplace injuries.
“Specializing in occupational (workers’ compensation) and non-occupational (leave and disability) claims from a claim and case management perspective, our human risk division strives to identify and implement new, effective methods to manage such claims ensuring a safe, timely and sustainable return to work,” said Heather Matthews, senior vice president, Crawford Human Risk. “Crawford EmployerWORKS serves to simplify and enhance our communication capabilities with clients, reduce claim costs, and increase success rates tied to sustainable return to work solutions.”
Click HERE to access EmployerWORKS’ capabilities.
This analytical system leverages the vast Crawford EmployerWORKS database to identify typical job demands linked to specific job profiles while incorporating risk factors to assist in mapping out a sustainable return to work solution. Crawford EmployerWORKS also includes tools to identify barriers for return to work in the form of physician causation analysis and psychosocial factors.
“We believe that everyone – employees, employers, health practitioners and insurance companies – will benefit from better prevention, injury management and return to work solutions through advanced ergonomics, artificial intelligence and digital risk assessment technology,” said Reed Hanoun, CEO of MyAbilities. “The EmployerWORKS suite is a whole new take on human asset management. We truly believe that we will revolutionize the way industries manage their ergonomics and safety strategies and that they will never look back!”
Through the use of innovative technology, Crawford continues to adhere to its mission to restore and enhance lives, business and communities by leveraging the appropriate expertise and analytical tools to identify and remove barriers hindering injured parties from obtaining gainful and meaningful employment following an accident, injury or illness.
About Crawford®
Based in Atlanta, Crawford & Company (NYSE: CRD-A and CRD-B) is the world’s largest publicly listed independent provider of claims management solutions to insurance companies and self-insured entities with an expansive global network serving clients in more than 70 countries. The Company’s two classes of stock are substantially identical, except with respect to voting rights and the Company’s ability to pay greater cash dividends on the non-voting Class A Common Stock (CRD-A) than on the voting Class B Common Stock (CRD-B), subject to certain limitations. In addition, with respect to mergers or similar transactions, holders of CRD-A must receive the same type and amount of consideration as holders of CRD-B, unless different consideration is approved by the holders of 75% of CRD-A, voting as a class. More information is available at www.crawfordandcompany.com.
About MyAbilities
MyAbilities is an Ontario-based healthcare data analytics company, focused on process automation for workplace safety, ergonomics and injury management. With its AI data-driven Software-as-a-Service (SaaS) offering, we help employers, insurance companies, healthcare providers and injured workers by preventing workplace injuries, expediting the return to work of injured workers, and reducing the cost of claims while promoting a healthy and fit workforce. More information is available at http://www.myabilities.com.
SOURCE Crawford & Company (Canada) Inc.
For further information: For more information, contact: Heather Matthews, Senior Vice President, Human Risk, Crawford & Company (Canada) Inc., Tel: 519.578.5540 Ext. 2672, Email: Heather.Matthews@crawco.ca; For media inquiries, please contact: Gary Gardner, Senior Vice President Global Client Development, Tel: 416.957.5019, Email: Gary.Gardner@crawco.ca
Related Links
http://www.crawfordandcompany.com
3 Common Defenses Against Illegitimate Workers’ Comp Claims
Members of the claim management team need to be proactive when reviewing their workers’ compensation injury files to make accurate determinations of claim compensability. A careful review is required, and only legitimate claims should be paid. Failure to do so means workers’ compensation programs will incur unnecessary costs and excessive litigation in the future. When doing these careful reviews, it is important to know the following common defenses against illegitimate workers’ comp claims.
Is the Injured Party an Employee?
Workers’ compensation programs are only responsible to cover employees of an insured. In many instances, the issue of whether the injured party is an employee is clear-cut. However, in cases such as construction cases or other specialized professions such as consultants, this is an issue that requires careful legal review.
The term “employee” is generally defined by statute or administrative rule. Basic components of what constitutes an employee include the following elements:
- A person who performs services for another for hire;
- An alien (regardless of legal status), minor, apprentice, or members of state law enforcement agencies;
- County assessors, elected or appointed officials who fulfill a function of city, county or state governments; and
- Other individuals, regardless of compensation, who fulfill the function of a company – g. – volunteers.
When it comes to “independent contractors,” a myriad of rules and case law interpretations can apply. Factors to consider include:
- The issue of “control,” and whether the employer controls the means and manner by which the work is performed;
- The method of payment to the person. Just because someone receives a W-9 does not mean they are not an employee;
- Determination as to who furnishes tools and materials used to perform a job or task; and
- The ability to discharge the worker (or whether the job ends when the work is completed).
Intoxication Defense – The Bar is Not Necessarily the Limit
Alcohol and drug use continue to be an issue when it comes to workplace safety. Use of these substances while performing work duties can result in a denial of primary liability if an injury occurs. In order to successfully assert this defense, the employer and insurer must demonstrate the following:
- The employee was intoxicated at the time of the injury; and
- The intoxication was the proximate or legal cause of the injury.
While this looks relatively simply to assert with success, the reality is courts will scrutinize these matters. Extreme examples in case law include a highly intoxicated construction worker obtaining workers’ compensation benefits after admitted he drank alcohol heavily just prior to a serve fall from height. Kowalik v. Martinson Construction, slip op. (MN WCCA 7/8/04), sum aff’d 688 N.W.2d 332 (Minn. 2004).
Prohibited Acts Defense – Is it the Right Defense?
Rules are designed to be followed and ensure workplace safety and injury prevention. It is commonly held that an employer/insurer may avoid liability for an injury under the following conditions:
- Where an employer expressly prohibits the doing of a certain specific act;
- The employee engages in the prohibited conduct in a manner of disregard, of which is not reasonably foreseeable to the employer;
- The violation takes the employee outside the scope of his employment; and
- The employee sustains an injury resulting from the prohibited conduct.
While this defense seems clear-cut, courts have generally required a high level of proof for them to be successful. Common errors on the part of an employer include failure to have the specific prohibited act written into policy and communicated to its employees, and failure of the employer to enforce its safety and/or prohibited acts policies consistently.
Conclusions
Members of the claim management team are on the front lines of matters of high importance. This includes investigation of a claim and issuing denials for illegitimate workers’ comp claims when appropriate. When making these decisions, it is important for the claim handler to scrutinize the facts of the case and correctly apply the law.
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/
©2018 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.
8 Tips to Investigate Work Comp Claims Like a Rock Star
Members of the claim management team wear many hats. One of these includes the need to investigate claims and make accurate factual and legal assessments regarding primary liability. This includes both knowledge of the law and medicine in order to succeed. While claim handlers cannot be expected to be masters of both, they can learn to become a rock star when handling these matters to promote an efficient workers’ compensation program.
Start with First Report of Injury
The First Report of Injury is usually one of the first documents that is generated following a work injury. This form is generally specified by the state’s industrial commission, but can also take the form of a company-specific form. It is also a document that is submitted to the insurance carrier following the report of the injury and serves as the basis for the claims investigation.
First Reports of Injury do have their limitations. It is important to remember the following when reviewing it:
- The form can become inherently biased as it is something usually prepared by an employer representative. Be sure to know who completed the form, when it was completed and obtain additional background information from the person completing the form; and
- Make sure the form is completely filled Important information that should be included are the names of potential witnesses, the mechanism of injury and where the employee received medical care and treatment.
Always trust, but verify the veracity of information on this form.
Recorded Statements from the Employee and Witnesses
A top-notch member of the claim management team will also be proactive and complete when taking a recorded statement of the employee. When performing this task, it is important to be mindful of the various state guidelines as to when this can take place. Important tips to remember include:
- Obtain as much detail as possible. This includes specific information about how the injury occurred. This is especially important if the claimed injury involves a repetitive use type claim;
- Avoid taking unnecessary statements. It may be an important consideration NOT to take a recorded statement if it is only being done to confirm the obvious; and
- Questions as to admissibility may come into play later on down the road. Items to remember include having the employee review and sign a transcribed copy of the statement afterward in a timely manner. Failure to follow these guidelines can prevent it from being admitted into evidence later on.
The evaluation and preservation of witness testimony is also important to workers’ compensation claims. This is especially important when causation resolves around the alleged mechanism of injury. Different rules and procedures may apply when it comes to these third-parties. Obtaining cooperation may also be an issue to consider.
Records, Records, and More Records
Obtaining documentary evidence can also be important to various workers’ compensation claims. There are several types of documents and records a pro may consider when investigating a claim:
- Medical records and authorizations: It is important to know and understand the medical condition and diagnosis of an injured worker. It is also essential to ascertain any prior injuries or conditions that may be present. A complete set of records is a must when it comes to the independent medical examination and ensuring proper expert foundation.
- Industrial Commission records: Most states keep prior workers’ compensation records on file within the state agency responsible for overseeing the workers’ compensation act. An authorization is likely required in order to obtain these records given state data privacy laws. These records are key as they can contain a wealth of information on an employee’s prior medical history.
- Central Index Bureau records: The Central Index Bureau (CIB or ISO report) is another important place to obtain background information on an employee. These records also detail other information on prior insurance related claims. While these records may not be admissible, they can likely lead to other discoverable information.
Conclusions
Being a great claim handler requires hard work and dedication to one’s job. It also includes basic knowledge of knowing where and how to find information. It is important to learn the various tricks of the trade to become a rock star when handling workers’ compensation claims.
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/
©2018 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.
Medcor Announces the Acquisition of TalisPoint
Chicago-based Medcor, Inc., the leading health navigation firm, has acquired San Francisco-based Talisman Systems Group, Inc., the leading provider of network management services for workers’ compensation and other industries. Talisman will operate as an independent subsidiary of Medcor, retaining its leadership and TalisPoint brand and will remain based in San Francisco.
Medcor navigates patients to optimal care through onsite clinics and virtual health services, using evidence-based medicine, proprietary clinical systems and patented processes. Medcor clients include employers from a wide range of industries and insurance carriers. The TalisPoint system validates, updates and manages network data and produces referral documents for insurance carriers, claims administrators, provider networks and employers.
Through this acquisition, Medcor expands its innovative health navigation services. These begin with rapid, convenient access to health assessment at the onset of symptoms or injury, followed by guidance to appropriate care. Often, Medcor can provide the care directly or guide patients in self-care. When referrals into the healthcare system are necessary, Medcor’s systems help ensure patients receive the care they need and avoid overtreatment and unnecessary costs. Sophisticated algorithms help Medcor identify serious cases quickly. TalisPoint data helps connect patients with the right provider in the proper network to improve clinical and financial outcomes.
Medcor President and CEO Philip Seeger explained, “We are combining two best-in-class businesses whose services are very complementary to one another. This is a powerful way to bring more value to our clients; the fact that we already have mutual clients shows that our customers have independently come to the same conclusion. The high-quality network information that TalisPoint provides will help us more efficiently navigate patients to the right place, at the right time, to receive the right level of care.”
Talisman President and CEO Monique Barkett said, “TalisPoint allows for fast, accurate and up-to-date access of vendors and medical networks. This facilitates Medcor’s service delivery by providing person-specific information and pinpointing the exact facility and provider called for by Medcor’s care protocols. To stay at the forefront of our industry, we prioritize innovation to ensure our systems will continue to be best-in-class in the years to come. With Medcor, Talisman now has a proven information technology partner to help us develop the next generation of TalisPoint.”
The two companies share reputations for transparency, high customer service, and operating without conflicts of interest. For more information, watch the short video at this link https://youtu.be/AvAFzJJqjSI, contact media@medcor.com or call 815-759-5442.
Medcor operates 240 clinics at or near client worksites and provides virtual health services to over 309,000 worksites throughout the United States and Canada. Medcor serves clients across a wide range of industries, including private firms and government agencies. Medcor helps employers and patients navigate the complexities of healthcare to achieve better clinical and financial outcomes. Learn more at medcor.com.
Talisman’s core product, TalisPoint, offers web-based customized network management tools to assist users in selecting medical providers and other vendor types. Access to verified provider data is a key to effective communication between patients, providers and employers. Learn more at talispoint.com.
The Intersection of Medicine and Disability: A Doctor’s View & Other Top WC Tidbits
The Intersection of Medicine and Disability: A Doctor’s View
Whether we are a health care practitioner, an employer or a claims professional, disability is something we deal with on a daily basis. What are the nuances of a disability claim and how can the roles and responsibilities within these claims be better understood?
Dr. Iglesias breaks down what goes into a disability determination and how employers, claims administrators, and physicians can make better and more timely disability determinations that will benefit all the stakeholders in a disability claim.
Facetime With Phil — Introduction To Analgesics
What are the different drugs available and how does a prescriber make a choice? Join myMatrixx Chief Clinical Officer Phil Walls as he begins a discussion on Analgesics. In this vlog, Phil covers the basics on this topic and begins a deeper dive into the treatment of pain management.
Dan Anders: Building a Better Relationship with your MSA Vendor
Let’s face it. When you realize that settlement of a workers’ compensation claim will require a Medicare Set-Aside (MSA) you may let out an audible groan or even a choice profanity. An MSA will no doubt add cost and time to settlement of a claim. This is why it is so important to partner with a Medicare Secondary Payer (MSP) compliance vendor that can effectively work with you to limit those costs and reduce the time involved with the MSA to the greatest extent possible while still ensuring you are compliant with Medicare requirements.
Opioid Litigation Update
Two-thirds of the deaths from drug overdoses in the U.S. involve opioids. This has been declared a crisis in America. On this Ringler Radio podcast, host Larry Cohen and co-host, Heather Anderson discuss how the Beasley Allen law firm’s attorney Rhon Jones is joining forces with the Attorney General of Alabama in litigation to put a halt to this devastating crisis that touches so many lives today.
Workers’ Compensation Cost Reduction Starts with Better Medical Care
Seek the best possible care for employees with workers’ compensation injuries, because better care will result in fewer treatments and ultimately lower costs. So said Margaret Spence, president and CEO of C. Douglas & Associates in West Palm Beach, Fla., during a June 20 concurrent session at the SHRM 2017 Annual Conference & Exposition in New Orleans. Spence recalled one employer in the panhandle of Oklahoma whose workers were told they had to use doctors in the rural area. When Spence got involved with the handling of the firms’ workers’ compensation claims, the company concluded that the doctors in that area were less qualified and every employee was sent to Oklahoma City for treatment.
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/
©2018 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.
