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

wcri conferenceWith 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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Effective Handling of Medical Only Workers’ Comp Claims

medical-only workers comp claimsMedical 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.

 

6 Things Employers Can Do to Reduce Lag Time

workers comp lag timeLag 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.

  1. 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.

 

 

 

  1. 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.

  1. 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?

  1. 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.

  1. 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.

 

 

  1. 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.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©2019 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

3 Essential Elements to Supervisor Response That Will Save 40 Percent

 

On-Demand-Blog-Ad-Supervisor

 

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/

 

©2019 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

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

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

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

ODG Announces Release of Job Profiler Powered by MyAbilities Into Its Industry-Leading GuidelinesAUSTIN, TexasNov. 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

 

Visit the ODG website

 

 

SOURCE ODG

 

Related Links

 

http://www.mcg.com/odg

Tips for Effective Use of an Interpreter in Workers’ Comp

interpreter in workers' compThe 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.

 

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center.

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: 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

Workers’ Comp Delayed Recovery ClaimsA 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:

 

  1. 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.
  2. 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.
  3. Mindfulness training. Mindfulness meditation teaches the person to bring his attention to experiences in the present, rather than ruminating about his pain and injury.
  4. 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.
  5. Exercise/activity. Movement is one of the most effective treatments to help patients with chronic pain.
  6. This can help the worker change his perceptions, thoughts and behaviors in guided practice.
  7. 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.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center .

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: 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

A Unique Perk For Workers with Limited or No Health InsuranceSome 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.

 

 

  • 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.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center.

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: 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

TORONTOOct. 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

 

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