Senior Editor - Work Comp Roundup

If You Are Not Preventing Work-Related Injuries, You Are Causing Them

August 21, 2019 by Senior Editor

In the world of safety, day to day, operations revolve around trying to prevent injuries. Proper lifting techniques, guarding on machines, and other safety measures are constantly being scrutinized to prevent work injuries from occurring. If you are working on preventing injuries, you are stopping them at the root cause.

“That Will Never Happen At My Company” Is The Wrong Thinking

What if you have no real safety program, or no loss control techniques? Well, to be blunt, you are just waiting for the next injury to occur. Why would any company want to wait around for the next injury to happen? Most employers think that the worst injuries will never occur at their plant because everyone uses their heads when working and everyone practices using proper safety when operating machinery. This is far from the truth.

The truth is, risk of injury is everywhere at every moment of the day. Each worker has the responsibility of operating safely. Unfortunately, this is not the way it works. Workers get caught in their routines, and their attention can get diverted away from what they are doing at the current time. This distraction can, and will, lead to injury.

Also to blame are poor training programs. If you have a lot of new hires, they may start off learning bad habits from their veteran employees that are training them.

But the new hires are not the only ones to blame. Veteran workers can also become injured because they pay less attention to their work routines. They think because they have worked there a long time and know the machinery that they can get away with more. Examples such as removing machine guarding, improperly using machines, or not wearing safety equipment are usually to blame. These are easy corrections to a widespread problem.

So if this is the case, who is policing the veterans to make sure they are performing the jobs the proper way? Are the supervisors on the floor enforcing safety each day? Are there disciplinary measures in force for those that break the rules? If so, are these measures always enforced or is it just some of the time? Does your supervisory program ever have any type of audit or follow-up to make sure management is actually supervising their workers or are they just babysitting them and turning the other way to keep production levels where they want them to be?

Worker Accountability is Key To Safety Success

Slip and fall injuries are very common. Who is in charge of making sure the carpets are in good shape? Who is in charge of making sure any fatigue mats in front of machines are free from wear and tear? Are workers falling in areas that they should not be in the first place? Why are they allowed in these areas? Who is in charge of being responsible for these areas? If your answer is that you do not know, then you have a problem.

Are any management personnel soliciting feedback from the employees that are working these jobs each day for hours and hours, week after week? What are their thoughts on how you can perform each job in a safer manner? One of your best resources for safety is your employees. Sure can be great to bring in an outside expert to review each job and comment on how they could be performed better and in a safer manner. However, if you are not soliciting feedback from your staff, then you are missing out on a great opportunity for safety ideas.

Worker accountability is key. Each worker has a duty to perform. Each supervisor has a duty to supervise and enforce rules. Each safety person appointed to that position has a duty to review tasks and implement safety measures. Why has accountability been pushed to the side?

Consider Indirect Cost of Workers Comp When Evaluating Bottom Line

In my experience, worker accountability, responsibility, and safety are often pushed aside due to production demands. The focus is on the bottom line, and on quality, rather than on safety. Everyone turns a blind eye to hidden indirect costs of injuries. If you have a few injured workers, other workers must pick up their slack. This hurts their production and the production of the work floor as a whole. More corners then get cut to keep up with production demands.

It is the classic iceberg effect. Executives see work comp claim costs only at the surface. They see the medical and wage loss expenses as the only “expense” of a work comp claim. The indirect costs hidden under the surface are so much worse. Decreased production, increased strain on remaining workforce, decreased morale, increased hazards, increased shortcuts, decreased quality, etc. All of these have a larger cost to the company as a whole rather than just medical and wage loss expense.

When you are thinking about your safety program and accountability, think of the hidden costs beneath the surface. A proper guard on a machine could cost $10,000, but what are the costs to someone being injured because the guard is not there? Chances are, that cost is going to be 10x more expensive.

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

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://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: Workplace Safety

Protecting the Injured Employee in Workers’ Compensation is Paramount

June 17, 2019 by Senior Editor

The injured employee is the reason workers’ compensation laws exist. Without employees and their sacrifice, businesses would not accomplish their goal. Now is the time for every member of the claim management team to approach claims with this critical mindset.

Forget the Golden Rule – Follow the Platinum Rule!

The “Golden Rule” taught us to “treating others as one’s self would wish to be treated.” This is a common denominator handed down in both secular and religious societies. The problem with this Rule when applied to workers’ compensation claims is it view things from the perspective of the claim handler. Now is the time for members of the claim management team to put themselves in the shoes of the injured employee, and follow the Platinum Rule – To treat others as you would want to be treated!

By adopting this mindset, one will realize the following:

Being a true professional in every sense of the word is essential;

Treating all employees – regardless of ability with the respect and dignity they deserve is essential; and

Engaging every claim with good faith, fair dealing, and placing ethics at the pinnacle of every decision is essential.

Protecting the Injured Employee Through Injury Prevention

Members of the claim management team can be proactive when it comes to preventing injuries in the workplace. This can include educating their insureds on best safety practices. Their obligations also extend to their post-injury response. Here are some important steps include in every workers’ compensation claim:

Avoid unfair claims practices and bad faith denials;

Complete a timely and thorough investigation of all injuries;

Not exploited the financial vulnerabilities of policyholders;

Not make unreasonable demands on the policyholder during the claim process; and

Take all reasonable steps to preserve evidence.

Employers also play a role in this process. It must include promoting a culture of safety. Steps should include:

Evaluate workplace ergonomics continually;

Allow regular breaks for employee – especially those performing repetitive tasks;

Ensure the proper use of machinery, tools, and safety equipment – never cut corners; and

Lead by example!

Getting the Injured Employee Back to Work

Interested stakeholders need to take the lead on return-to-work issues and dispel the common myths that prevent employers from protecting their MVPs. Common misconceptions of injured employees include:

Injured employees are lazy – they sit around all day and do nothing;

Injured employees would rather stay at home;

Injured employees will only get re-injured – we need to get a voluntary resignation on every workers’ compensation claim; and

Injured workers receiving Social Security Disability are not allowed to return-to-work.

FACT: A vast majority of injured employees would rather get back to work. Getting them back to work can reduce program costs.

The challenge of effective return-to-work requires all interested stakeholders to move past the physical, educational, medical, and emotional barriers inherent in the workers; compensation system. Important steps to consider include:

Communication with the injured worker. This can include having a dedicated liaison for any employee off work. Employers can buy goodwill by returning phone calls from an employee not able to work due to restriction. They should also be proactive in initiating contact with an employee.

Communication with treating doctor. A return-to-work liaison can also serve as a point of contact with the employee’s treating physician. This can also include making certain communications between the physician and workers’ compensation insurer is taking place.

Providing legitimate written job offers. The requirements of job offers vary in each jurisdiction. It is important specific elements are satisfied. There are other legal requirements where consultation with an attorney may help facilitate this objective.

Interested stakeholders should also consider learning more about, and implementing a “Work on Loan” program, or hiring an injured employee through the Social Security Administration’s “Ticket to Work” program.

Conclusions

Employees are of paramount importance to every workers’ compensation program. Treat them respect and dignity. To run an effective and efficient program, interested stakeholders need to understand their claims, assess and evaluate risks, and look for opportunities to engage all parties in the process.

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: Management's Role in Workers Comp

Stop The Bleeding! Control Workers’ Comp Leakage

May 8, 2019 by Senior Editor

Self-insured employers and insurers understand that workers’ comp leakage costs money. The overpayment of medical cost, indemnity benefits and claim expenses is a waste of money and weakens the overall financial stability of the employer or the insurer. What to do about workers’ comp leakage is a frequent topic of discussion.

When there is no doubt that a payment should not have been made (example: a non-recovered duplicate payment), it is referred to as hard leakage. When a payment is made that is questionable and is subjective (example: a higher than normal settlement), it is referred to as soft leakage.

Employers and insurers frequently attempt to mitigate both hard and soft workers’ comp leakage by providing additional training to the claims staff. Additional training definitely has benefits and will reduce leakage, but additional training normally addresses only the issues the work comp supervisor or claims manager has identified. This approach will often continue to overlook different types of leakage that is not on the company’s radar.

Independent Claims Auditors Bring Perspective

To identify leakage that is being overlooked, companies have been turning to independent claims auditors who bring in an outside perspective when reviewing claim files. Senior management often recognizes adjusters, supervisors and even claims managers have a built-in conflict of interest in identifying every source of leakage – the more leakage they identify, the lower their level of competency appears to be.

The independent claims auditor can be completely objective, as the independent claims auditor does not have to worry about the impression the results of a workers’ comp leakage audit will create. The outside auditor is looking for the financial mistakes (leakage) in an effort to assist the insurer or self-insured employer to lower its overall claims costs without the worry that senior management may be critical of the adjuster’s/ supervisor’s/claims manager’s performance.

Hard Workers’ Comp Leakage

The independent claims auditor will identify types of hard workers’ comp leakage including:

Payment of non-compensable claims
Payment of claims occurring outside of the insurance policy period
Failure to utilize the medical bill fee schedule for all medical bills covered by the schedule
Payment of the same medical bill, including overlapping medical bills, more than once
Incorrect calculation of the employee’s average weekly wage
Incorrect calculation of the employee’s indemnity benefit
Incorrect calculation of the number of days or weeks of indemnity benefits owed
Incorrect handling of the waiting period and the retroactive period
Erroneous payment of indemnity benefits after the employee has return to work
Failure to properly calculate the impairment rating value
Failure to utilize the pharmacy benefit management program
Failure to apply offsets including unemployment benefits, social security benefits, over governmental programs
Failure to identify and pursue subrogation
Failure to obtain Second Injury Fund recoveries
Failure to obtain reinsurance company recoveries
Failure to arrange for modified duty work when approved by the medical provider
Payment of temporary total disability benefits when temporary partial disability benefits are owed
Overpayment of medical mileage
Over reserving of the long-term claim resulting in a higher than appropriate experience modification factor with Underwriting

Soft Workers’ Comp Leakage:

The independent claims auditor will identify possible soft workers’ comp leakage including:

Failure to thoroughly investigate the claim prior to acceptance of compensability
Failure to complete the Insurance Services Office inquiry
Failure to properly evaluate future medical benefits when settling a claim
Poor settlement negotiations
Failure to properly manage defense counsel
Failure to properly utilize medical case management, either overutilization or underutilization
Failure to utilize medical triage
Failure to settle dispute claims at the optimum cost point

Controlling Workers’ Comp Leakage Can Mean Large Savings

Controlling leakage is frequently the difference between an insurer or self-insured employer making or losing money. While no claims operation will eliminate all leakage, a five percent (5%) leakage factor on a small self-insured program with $20 million in paid claims each year is an extra $1 million dollars spent, and 3% leakage on a $100 million a year paid out by an insurer is an extra $3 million dollars spent.

The above lists of how leakage occurs in workers’ compensation are not complete. There are various other ways leakage can occur. For a workers’ comp leakage audit to provide the maximum benefit to the insurer or self-insured employer, an auditor with a high level of expertise in workers’ compensation is needed.

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: Claim Management

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.

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: 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.

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 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.

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

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