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.





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



3 Common Defenses Against Illegitimate Workers’ Comp Claims

3 Common Defenses Against Illegitimate Workers’ Comp ClaimsMembers of the claim management team need to be proactive when reviewing their workers’ compensation injury files to make accurate determinations of claim compensability. A careful review is required, and only legitimate claims should be paid.  Failure to do so means workers’ compensation programs will incur unnecessary costs and excessive litigation in the future.  When doing these careful reviews, it is important to know the following common defenses against illegitimate workers’ comp claims.



Is the Injured Party an Employee?


Workers’ compensation programs are only responsible to cover employees of an insured.  In many instances, the issue of whether the injured party is an employee is clear-cut.  However, in cases such as construction cases or other specialized professions such as consultants, this is an issue that requires careful legal review.


The term “employee” is generally defined by statute or administrative rule.  Basic components of what constitutes an employee include the following elements:


  • A person who performs services for another for hire;


  • An alien (regardless of legal status), minor, apprentice, or members of state law enforcement agencies;


  • County assessors, elected or appointed officials who fulfill a function of city, county or state governments; and


  • Other individuals, regardless of compensation, who fulfill the function of a company – g. – volunteers.


When it comes to independent contractors,” a myriad of rules and case law interpretations can apply.  Factors to consider include:


  • The issue of “control,” and whether the employer controls the means and manner by which the work is performed;


  • The method of payment to the person. Just because someone receives a W-9 does not mean they are not an employee;


  • Determination as to who furnishes tools and materials used to perform a job or task; and


  • The ability to discharge the worker (or whether the job ends when the work is completed).


Intoxication Defense – The Bar is Not Necessarily the Limit


Alcohol and drug use continue to be an issue when it comes to workplace safety.  Use of these substances while performing work duties can result in a denial of primary liability if an injury occurs.  In order to successfully assert this defense, the employer and insurer must demonstrate the following:


  • The employee was intoxicated at the time of the injury; and


  • The intoxication was the proximate or legal cause of the injury.


While this looks relatively simply to assert with success, the reality is courts will scrutinize these matters.  Extreme examples in case law include a highly intoxicated construction worker obtaining workers’ compensation benefits after admitted he drank alcohol heavily just prior to a serve fall from height.  Kowalik v. Martinson Construction, slip op. (MN WCCA 7/8/04), sum aff’d 688 N.W.2d 332 (Minn. 2004).



Prohibited Acts Defense – Is it the Right Defense?


Rules are designed to be followed and ensure workplace safety and injury prevention.  It is commonly held that an employer/insurer may avoid liability for an injury under the following conditions:


  • Where an employer expressly prohibits the doing of a certain specific act;


  • The employee engages in the prohibited conduct in a manner of disregard, of which is not reasonably foreseeable to the employer;


  • The violation takes the employee outside the scope of his employment; and


  • The employee sustains an injury resulting from the prohibited conduct.


While this defense seems clear-cut, courts have generally required a high level of proof for them to be successful.  Common errors on the part of an employer include failure to have the specific prohibited act written into policy and communicated to its employees, and failure of the employer to enforce its safety and/or prohibited acts policies consistently.





Members of the claim management team are on the front lines of matters of high importance.  This includes investigation of a claim and issuing denials for illegitimate workers’ comp claims when appropriate.  When making these decisions, it is important for the claim handler to scrutinize the facts of the case and correctly apply the law.




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.

8 Tips to Investigate Work Comp Claims Like a Rock Star

8 Tips to Investigate Work Comp Claims Like a Rock StarMembers of the claim management team wear many hats.  One of these includes the need to investigate claims and make accurate factual and legal assessments regarding primary liability.  This includes both knowledge of the law and medicine in order to succeed.  While claim handlers cannot be expected to be masters of both, they can learn to become a rock star when handling these matters to promote an efficient workers’ compensation program.



Start with First Report of Injury


The First Report of Injury is usually one of the first documents that is generated following a work injury.  This form is generally specified by the state’s industrial commission, but can also take the form of a company-specific form.  It is also a document that is submitted to the insurance carrier following the report of the injury and serves as the basis for the claims investigation.


First Reports of Injury do have their limitations.  It is important to remember the following when reviewing it:


  • The form can become inherently biased as it is something usually prepared by an employer representative. Be sure to know who completed the form, when it was completed and obtain additional background information from the person completing the form; and


  • Make sure the form is completely filled Important information that should be included are the names of potential witnesses, the mechanism of injury and where the employee received medical care and treatment.


Always trust, but verify the veracity of information on this form.



Recorded Statements from the Employee and Witnesses


A top-notch member of the claim management team will also be proactive and complete when taking a recorded statement of the employee.  When performing this task, it is important to be mindful of the various state guidelines as to when this can take place.  Important tips to remember include:


  • Obtain as much detail as possible. This includes specific information about how the injury occurred.  This is especially important if the claimed injury involves a repetitive use type claim;


  • Avoid taking unnecessary statements. It may be an important consideration NOT to take a recorded statement if it is only being done to confirm the obvious; and


  • Questions as to admissibility may come into play later on down the road. Items to remember include having the employee review and sign a transcribed copy of the statement afterward in a timely manner.  Failure to follow these guidelines can prevent it from being admitted into evidence later on.


The evaluation and preservation of witness testimony is also important to workers’ compensation claims.  This is especially important when causation resolves around the alleged mechanism of injury.  Different rules and procedures may apply when it comes to these third-parties.  Obtaining cooperation may also be an issue to consider.



Records, Records, and More Records


Obtaining documentary evidence can also be important to various workers’ compensation claims.  There are several types of documents and records a pro may consider when investigating a claim:


  • Medical records and authorizations: It is important to know and understand the medical condition and diagnosis of an injured worker.  It is also essential to ascertain any prior injuries or conditions that may be present.  A complete set of records is a must when it comes to the independent medical examination and ensuring proper expert foundation.


  • Industrial Commission records: Most states keep prior workers’ compensation records on file within the state agency responsible for overseeing the workers’ compensation act.  An authorization is likely required in order to obtain these records given state data privacy laws.  These records are key as they can contain a wealth of information on an employee’s prior medical history.


  • Central Index Bureau records: The Central Index Bureau (CIB or ISO report) is another important place to obtain background information on an employee.  These records also detail other information on prior insurance related claims.  While these records may not be admissible, they can likely lead to other discoverable information.





Being a great claim handler requires hard work and dedication to one’s job.  It also includes basic knowledge of knowing where and how to find information.  It is important to learn the various tricks of the trade to become a rock star when handling workers’ compensation claims.



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.


Medcor Announces the Acquisition of TalisPoint

Chicago-based Medcor, Inc., the leading health navigation firm, has acquired San Francisco-based Talisman Systems Group, Inc., the leading provider of network management services for workers’ compensation and other industries. Talisman will operate as an independent subsidiary of Medcor, retaining its leadership and TalisPoint brand and will remain based in San Francisco.


Medcor navigates patients to optimal care through onsite clinics and virtual health services, using evidence-based medicine, proprietary clinical systems and patented processes. Medcor clients include employers from a wide range of industries and insurance carriers. The TalisPoint system validates, updates and manages network data and produces referral documents for insurance carriers, claims administrators, provider networks and employers.


Through this acquisition, Medcor expands its innovative health navigation services. These begin with rapid, convenient access to health assessment at the onset of symptoms or injury, followed by guidance to appropriate care. Often, Medcor can provide the care directly or guide patients in self-care. When referrals into the healthcare system are necessary, Medcor’s systems help ensure patients receive the care they need and avoid overtreatment and unnecessary costs. Sophisticated algorithms help Medcor identify serious cases quickly. TalisPoint data helps connect patients with the right provider in the proper network to improve clinical and financial outcomes.


Medcor President and CEO Philip Seeger explained, “We are combining two best-in-class businesses whose services are very complementary to one another. This is a powerful way to bring more value to our clients; the fact that we already have mutual clients shows that our customers have independently come to the same conclusion. The high-quality network information that TalisPoint provides will help us more efficiently navigate patients to the right place, at the right time, to receive the right level of care.”


Talisman President and CEO Monique Barkett said, “TalisPoint allows for fast, accurate and up-to-date access of vendors and medical networks. This facilitates Medcor’s service delivery by providing person-specific information and pinpointing the exact facility and provider called for by Medcor’s care protocols. To stay at the forefront of our industry, we prioritize innovation to ensure our systems will continue to be best-in-class in the years to come. With Medcor, Talisman now has a proven information technology partner to help us develop the next generation of TalisPoint.”


The two companies share reputations for transparency, high customer service, and operating without conflicts of interest. For more information, watch the short video at this link https://youtu.be/AvAFzJJqjSI, contact media@medcor.com or call 815-759-5442.




Medcor operates 240 clinics at or near client worksites and provides virtual health services to over 309,000 worksites throughout the United States and Canada. Medcor serves clients across a wide range of industries, including private firms and government agencies. Medcor helps employers and patients navigate the complexities of healthcare to achieve better clinical and financial outcomes. Learn more at medcor.com.


Talisman’s core product, TalisPoint, offers web-based customized network management tools to assist users in selecting medical providers and other vendor types. Access to verified provider data is a key to effective communication between patients, providers and employers. Learn more at talispoint.com.




The Intersection of Medicine and Disability: A Doctor’s View & Other Top WC Tidbits

The Intersection of Medicine and Disability: A Doctor’s View

Whether we are a health care practitioner, an employer or a claims professional, disability is something we deal with on a daily basis. What are the nuances of a disability claim and how can the roles and responsibilities within these claims be better understood?

Dr. Iglesias breaks down what goes into a disability determination and how employers, claims administrators, and physicians can make better and more timely disability determinations that will benefit all the stakeholders in a disability claim.



Facetime With Phil — Introduction To Analgesics

What are the different drugs available and how does a prescriber make a choice? Join myMatrixx Chief Clinical Officer Phil Walls as he begins a discussion on Analgesics. In this vlog, Phil covers the basics on this topic and begins a deeper dive into the treatment of pain management.




Dan Anders: Building a Better Relationship with your MSA Vendor

Let’s face it. When you realize that settlement of a workers’ compensation claim will require a Medicare Set-Aside (MSA) you may let out an audible groan or even a choice profanity. An MSA will no doubt add cost and time to settlement of a claim. This is why it is so important to partner with a Medicare Secondary Payer (MSP) compliance vendor that can effectively work with you to limit those costs and reduce the time involved with the MSA to the greatest extent possible while still ensuring you are compliant with Medicare requirements.




Opioid Litigation Update

Two-thirds of the deaths from drug overdoses in the U.S. involve opioids. This has been declared a crisis in America. On this Ringler Radio podcast, host Larry Cohen and co-host, Heather Anderson discuss how the Beasley Allen law firm’s attorney Rhon Jones is joining forces with the Attorney General of Alabama in litigation to put a halt to this devastating crisis that touches so many lives today.




Workers’ Compensation Cost Reduction Starts with Better Medical Care

Seek the best possible care for employees with workers’ compensation injuries, because better care will result in fewer treatments and ultimately lower costs. So said Margaret Spence, president and CEO of C. Douglas & Associates in West Palm Beach, Fla., during a June 20 concurrent session at the SHRM 2017 Annual Conference & Exposition in New Orleans. Spence recalled one employer in the panhandle of Oklahoma whose workers were told they had to use doctors in the rural area. When Spence got involved with the handling of the firms’ workers’ compensation claims, the company concluded that the doctors in that area were less qualified and every employee was sent to Oklahoma City for treatment.




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.

Important Safety Improvements to Avoid Severe Injury or Death in Logging

Logging remains one of the most dangerous industries in the United States.  Every year approximately 800 American workers die as the result of workplace accidents.  The logging industry accounts for about 24% of these claims.  Most of these deaths are the result of employees working as fellers, limbers, buckers, choker setters, truck drivers, laborers and material machine operators.  Now is the time for all parties in the logging industry and their workers’ compensation insurers to take note and continually strive for safer work conditions.



The Dynamics of a Logging Work Injury


Work injuries in the logging industry fall into several general categories.  These include injuries resulting from falling objects, falls from heights and crane accidents.  Common injuries involve trauma to a person’s back/neck, fractured bones, TBIs/other brain injuries, paralysis, amputations, disfigurements and permanent scarring.  Beyond the physical component, the average workers’ compensation claim involving someone within the logging industry includes an underlying mental competent that includes psychological or psychiatric trauma.


The bottom line is clear – workers’ compensation injuries sustained by a logger are generally more severe and costly to a program.  Any steps that can prevent injuries or reduce costs following an injury have a significant impact on the sustainability of an employer’s bottom line.  Now is the time to take proactive action.



Moving Beyond the General OSHA Requirements


OSHA safety standards have a positive impact on making an inherently workplace safe.  Specific rules have been implemented under 29 C.F.R. §1910.266.  These regulations apply to all types of workplaces regardless of the end use of the forest products such as sawlogs, veneer bolts, pulpwood and chips.  Covered under these regulations include the following safety requirements:


  • Extensive first-aid training for all employees;


  • Requirements for the use of personal protective equipment;


  • Requirements that include the use of rollover and falling-object protective structures; and


  • Improved techniques for manual felling procedures. This includes instruction on how to properly undercut and back cut to prevent premature twisting and falling of trees.


In addition to following these safety requirements, employers and other interested stakeholders can take additional steps to improve workplace/site safety and prevent injuries.


  • Compulsory adherence to safety standards. This includes consistent enforcement of safety policies and termination of employment for repeat offenders.  Safety must also apply equally to all employees;


  • Continual evaluation of workplace performance when engaging in work duties. This includes an evaluation of felling techniques by loggers to ensure training is being used on work sites;


  • Proper maintenance of all tools and equipment. This includes a commitment to storing equipment in a location that prevents excessive wear and tear.  It also means fixing equipment when problems arise and not continuing to use it if safety is a concern; and


  • Commitment to safety with the implementation of a safety committee.



Avoiding Other Common Safety Hazards


Loggers are exposed to countless dangers on a daily basis.  Paying attention to one’s surroundings is only the beginning when it comes to injury avoidance.


  • Work boot safety: Loggers must wear steel-toed work boots.  Problems arise when boots are not labeled correctly to avoid potential electrical hazards or are subject to product recall;


  • Review of Safety Reports: Interested stakeholders can learn a lot about the anatomy of common and avoidable injuries by reading OSHA injury reports.  Learning how to avoid these issues is key; and


  • Education, education, education: Logging remains a dangerous occupation notwithstanding the inclusion of safety standards, regulations, and  Interested stakeholders need to make education a priority.





The nature of the logging industry makes it a hazardous workplace activity.  The result of an injury in this occupation is life-changing.  Interested stakeholders need to be proactive when it comes to workplace safety and strive to reduce the prevalence of injury and death through ongoing efforts.



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.

U.S. Workers’ Compensation Prescription Drug Spending Decreased 3.3 Percent in 2017

ST. LOUIS /PRNewswire/ — Workers’ compensation pharmacy spending decreased 3.3 percent in 2017, according to new data released by myMatrixx, an Express Scripts (NASDAQ: ESRX) company.

“By merging the core capabilities of Express Scripts and myMatrixx to deliver superior clinical expertise, market-leading client experiences and innovative technology-based solutions, myMatrixx is now uniquely positioned to serve workers’ compensation clients and injured workers,” said Phil Walls, RPh, Chief Clinical Officer for myMatrixx. “We’re doing more to help clients balance appropriate care for injured workers while keeping costs down.”


More than half of myMatrixx Workers’ Compensation plans reduced drug spending last year.



Curtailing the Opioid Epidemic


Spending on opioids declined 11.9 percent for workers’ compensation payers in 2017.


For decades, myMatrixx has championed safe and appropriate use of opioids through solutions that leverage data, educate those at risk for adverse events and ensure connectivity across the care continuum. In addition, many states have taken action to address the opioid crisis through a multifaceted approach involving state-specific formularies, opioid guidelines and limits on initial opioid dispensing days’ supply and/or morphine equivalent dose.


These factors resulted in 74.2 percent of workers’ compensation payers spending less on opioids in 2017 than in 2016.


“While a decrease in the utilization of opioids is a positive sign for the workers’ compensation industry, there is still work to be done,” said Brigette Nelson, senior vice president of workers’ compensation clinical management at myMatrixx.


myMatrixx research found dangerous drug combinations and long-term use of opioids still pose care and cost concerns. Nearly 40 percent of injured workers took an opioid along with a muscle relaxant, while nine percent took an opioid and benzodiazepine. Taking these medications together can increase the risk of side effects and death from respiratory depression.


By deploying a holistic approach to manage opioid use, myMatrixx works with physicians, pharmacists and injured workers to mitigate the concerns of drug interactions or overuse.


Additionally, myMatrixx noted by the eleventh year of injury, the cost per injured worker reached $3,402.07, with $1,862.36 spent on opioid medications. Among those with age of injury of 10 years or more, more than half filled an opioid medication in 2017.



Compounded Medications Decline Further


For the third year in a row, spending on compounded medications decreased – a decline of 37.9 percent in 2017, falling out of the top 10 therapy classes.


While compounded medications continue to be a focus because of their high cost, it is clear that effective management strategies can reduce unnecessary costs and waste associated with clinically unproven ingredients.



Specialty Medication Utilization Remains Low, but Growing


Spending on specialty medications to treat conditions such as HIV and osteoarthritis increased 3.8 percent in 2017. While these drugs represent less than 1 percent of all medications used by injured workers, the extreme high cost per prescription requires payers to stay vigilant.


“Payers who have injured workers with occupational exposure to needle-sticks often include HIV medications on their formulary to ensure quick access to work-related HIV prophylaxis therapy,” Nelson said. “This therapy class saw the highest spending among specialty medications.”



Other Key Findings of the Workers’ Compensation Drug Trend Report include:


  • Generic fill rate increased to 85.6 percent across our workers’ compensation payers in 2017. Yet, payers could have saved $80.8 million through an optimal mix of clinically appropriate generic options.


  • The average cost of a physician-dispensed medication was $270.70, compared to $108.49 for a pharmacy-dispensed medication. This means plans paid a $162 premium for physician-dispensed medications which bypass pharmacist review at the point of sale. Of the medications dispensed by physicians, nearly half are used to treat pain.


  • On average, payers spent $1421.36 per injured worker for prescription medications in 2017.



About the 2017 myMatrixx Drug Trend Report


The 2017 myMatrixx Workers’ Compensation Drug Trend Report is among the industry’s most comprehensive analyses of workers’ compensation drug spending in the U.S. In its 12th edition, the research examines de-identified prescription drug use data of injured workers with a pharmacy benefit plan administered by myMatrixx. The report also includes analysis of state and federal government regulations and their impact on pharmacy-related challenges in workers’ compensation.


In calculating trend, prescription drug use was considered for legacy Express Scripts clients with a stable injured-worker base, defined as having a change in user volume of less than 50 percent from 2016 to 2017.


The comprehensive review of trends in prescription drug spending for workers’ compensation plans is available at myMatrixx.com



About myMatrixx, an Express Scripts company


myMatrixx® is a full-service workers compensation pharmacy benefit management company focused on patient advocacy. By combining agile technology, clinical expertise and advanced business analytics, myMatrixx simplifies workers’ compensation claims management. Located in Tampa, Florida, myMatrixx has positioned itself as a thought leader in the workers’ compensation industry.


For more information, visit myMatrixx.com


Media Contacts:
Phil Blando


Ellen Drazen



SOURCE myMatrixx

Related Links


The Christina Grillo Case and Lessons Learned: Why Families Facing a Medical Malpractice Lawsuit need a Structured Settlement

The Christina Grillo Case and Lessons Learned: Why Families Facing a Medical Malpractice Lawsuit need a Structured Settlement






Speaker 1:This is Ringler Radio, where you get all the latest news and information about settlement solutions, litigation, mediation, and structured financial security from Ringler, the largest and most experienced company of settlement consults in the United States.


Ringler has been helping injured people and their families since 1975. Ringler Radio is made possible in part by American General, Liberty Mutual, MetLife, Mutual of Omaha, New York Life, Pacific Life, and Prudential.


Now, join Ringler Radio host, Larry Cohen.


Larry Cohen:Hello, and welcome to Ringler Radio, everyone. I’m Larry Cohen, the head of Ringler Northeast Operations, and we’re certainly glad you could join us again today.


Well, Christina Grillo Sullivan was born on January 9, 1982. In what should have been a normal delivery for her mother, Josephine, turned into an emergency C-section, leaving Christina severely brain damaged, resulting in cerebral palsy, seizures, and blindness.


Soon after, Christina’s family filed a medical malpractice lawsuit, citing negligence by her physician. But Life Care Plans estimated the lifetime cost of medical care for little Christina to have been an excess of $20 million. The defendant’s attorneys offered a structured settlement, costing $1,267,000 that would have, over the lifetime of the child, paid out well over $100 million dollars. Quite a tax-free ability for Christina to be taken care of.


But Christina’s lawyers rejected the structured settlement offer, and settled the case for a lump-sum cash payment of $2.5 million, from which they took a $1 million fee and $77,000 in expenses.


They also failed to protect the availability of governmental benefits and sadly, as we’ve seen so often before, the money, unfortunately, was gone within a few years, and the family left to pick up the pieces and pay millions for medical treatment.


Christina’s family nurtured and cared for her relentlessly and lovingly at home for 32 years until she passed away on September 17, 2014. Today on Ringler Radio, Christina’s mother, Josephine Grillo Sullivan, now the executive director of the Christina Grillo Sullivan Foundation, will share with us how she’s honoring Christina’s life by assisting families living with a brain-injured loved one.


We’ll also discuss the high-profile and precedent setting case of Grillo Vs ] and what its outcome has meant for others who are faced with a choice, at settlement, of taking cash or structure.


Joining me today in this discussion as my cohost is my Ringler colleague Anne Lawter, from the Troy, Michigan office. Anne has nearly two decades of experience in medical malpractice and personal injury litigation.So with that, welcome to the show Anne. Thanks for being my cohost.


Anne Lawter:I’m very happy to be here with you and Josephine today.


Larry Cohen:Thank you.


Josephine, welcome to the show. It’s a pleasure and an honor to have you here. We’re really looking forward to hearing what you have to say, today, about your daughter and about what’s transpired with your foundation.


Josephine G. S.:Thank you for having me. I really look forward to being your guest, with Anne, and your listeners.


Larry Cohen:Terrific.


Josephine, let’s begin by having you tell us a little bit about Christina and the impact she had on you and your family. She seems like an unbelievably fascinating and wonderful girl.


Josephine G. S.:Well, how long do you have Larry and Anne?


Larry Cohen:(laughs)


You take as long as you want. I’ll stop you when it’s time. Go ahead.


Josephine G. S.:She was an absolute angel here on earth. I visually see her laughing and smiling. They were absolutely contagious, and that’s without ever speaking a word. She just inspired so many people around her. It’s where we are today.


It didn’t matter that she didn’t speak a word. She taught us so much, truly: what was important in life, which is unconditional love. I guess she really gifted us with her innocent trust and her dependency upon us.


I’ll tell you what, Larry: she really, really taught us how very, very precious this life is, and not to take one moment for granted. I just can go on and on about her, but she truly taught us about hope and faith and that’s truly what’s gotten me this far in this moment in life.


Larry Cohen:She was a blessing. For your family to have nurtured her as you did is wonderful to see and you to be commended for that too.


Anne Lawter:Josephine, I understand that Christina’s birth is what led to a medical malpractice case. Is that correct?


Josephine G. S.:That is correct.


Anne Lawter:If you could, just give us an overview of the main portions of the case.


Josephine G. S.:It was an evening that I had arrived at the hospital and the nurse on duty wanted to send me home. As I recall, she was saying I was having Braxton Hicks which is false labor pains. The doctor was asleep down the hall but the nurse didn’t want to disturb him. And that was until Christina’s heart rate started to drop. And then the last thing I remember there was that my body was going into shock and jumping up and down on the gurney. Then I had awoken to two nurses talking an saying that my precious baby wasn’t going to survive the night. It had taken over seven minutes to resuscitate here.


So I guess three weeks in the hospital neonatal unit, the doctor came up to me and said that they had done all that they could and that they were terminating life support. They were going to administer Christina last rites, and I’m sitting here thinking back as I do from time to time … There was a room off the neonatal unit and we were put in there, my family and I. We were all to say goodbye, and gently passing her from one loving family member to the other and we were just kissing her soft little newborn face.


But she surprised us all. She started breathing on her own and obviously was left here to do all the things that she has done for so many. We actually lived in Fort Worth at the time, in Arlington, and I had heard about a case, an attorney, and had gone to see him in Houston. He said if the baby was still alive to take the case. They had came back and said that the nurse was credible and the hospital had made an offer of $50,000 and they suggested that I take it.


Looking at both of them I just said there was just no way I could care for Christina over her lifetime. Two weeks later I get a phone call and they told me to come pick up my papers, that they were withdrawing from the case.


So that’s when I had located new counsel which was Tom and Tommy and they too delayed about two years until the hospital saw the motion to dismiss and then at that they prepared the case for trial.


Larry Cohen:You know Josephine, through this trauma of the injury to your daughter and through the birth etc., finally you received an offer from the defendants’ attorney which included a tax-free structured settlement as a part of it and yet your own attorney rejected that offer and decided to go with a lump sum settlement. Of course that decision had some severe consequences as you moved down the road. Tell us about the impact of that decision on your family as you moved along. What was the impact?


Josephine G. S.:To clarify to your listeners, the attorney decision to go with that lump sum settlement, it was so insufficient to cover her basic medical needs, but also was not conveyed in writing, nor did I have a clue what a structured settlement was or the benefit of the weighted age as I do today. That $1,267,579 was with a Cost of Living Increase (COLA) of 7.2%.


Larry Cohen:Wow.


Josephine G. S.:Yeah. That’s the looming increase. It would have paid Christina in excess of $200 million-


Larry Cohen:Yeah, with that kind of a COLA it’s amazing.


Josephine G. S.:And today, of course we all know how devastating that was not to have done that. The attorney’s fees would have been based on the cost of the structure, not the gross amount received, so actually Larry 40% of $2.5 is double the attorney fees. I guess that was their answer.


Larry Cohen:Wow. Wow. Am I right in that you were never given the opportunity to understand what a structure was? It was never really explained to you, is that right?


Josephine G. S.:No, not at all.


Larry Cohen:Wow.


Anne Lawter:So Josephine as I understand it, after that experience of taking that settlement, there came a time that you and your family had exhausted your funds and yourself and you instituted a malpractice case against the attorneys and that guardian ad litem for legal malpractice, regarding the fact that Christina’s case should have never been settled for a lump sum and the consequences that followed. Can you tell us about that?


Josephine G. S.:Yes I can. It was for the longest time, because we knew something was wrong, not until I spoke with an attorney named Todd who is in Dallas … He told me that he had never heard of a brain-damaged baby case not being settled with a structured settlement. Again, I had told him, “What does that mean?” And he kindly gave me the phone number of a structured settlement broker that has now become my friend over the past 25 years and that’s Mr. Neil Johnson.


I can remember meeting with Neil in an Italian restaurant over in Dallas and over two hours he explained in detail what a structured settlement was and the benefit of a rated age and what that would have meant to the value of Christina’s settlement. Larry and Anne, I left that meeting in tears. I wasn’t angry, I was just saddened that someone could do something so unconscionable.


I had filed a cause of action [inaudible 00:11:50] because I was unable to find counsel that would represent Christina because everyone that I had spoken to was fearful of retribution with judges and other attorneys in the future. So the two-year statute of limitations was tolling so I filed a lawsuit.


The odd thing is Neil, he believed in us and researched and found one of the companies that actually has quoted a structured settlement in the underlying case. So I actually went to go and deposition John [Camp 00:12:26]. He was a defense attorney for the hospital. When I was asking him the question, “Was Christina ever offered a structured settlement?” And Larry and Anne, just sitting there and looking across at this attorney for the hospital … He just snapped his pencil in half like it was a twig and he looked me in the eye and said, “As I sit here today, I do not recall.”


I was just-


Larry Cohen:Yeah, sounds like he knew the bad news was coming. It’s interesting.


Josephine G. S.:Right, right.


Larry Cohen:You know Josephine, what’s resulted from your fight against your attorneys for doing what they did is given rise to what’s now commonly called the Grillo waiver. It’s a document that acknowledges in writing that the plaintiff understands the potential consequences of accepting a lump sum settlement in lieu of a portion of it being structured. I kind of think it’s akin to informed consent, where you really understand what you’re turning down if you want to turn it down, or what you’re getting if you decide to accept it. That seems so logical today but obviously wasn’t back there when you were in need of something like that. It’s through your situation that people in the future are not going to have to suffer through that circumstance like you did. At least something came out of that that hopefully will help others.


Josephine G. S.:And I sit here and I smile. I smile that her little life was for a reason and it was to help so many actually become better loved and taken care of by their families. Because, Larry and Anne, a family taking care of someone like Christina, it is so tolling on everyone. If the funds would have been there … You think about it, just momentarily, that life could have been different, but actually when you do think about it a little bit more it’s where it needed to be. Because if we had not have experienced that  we wouldn’t be here today and she would not have already started to help thousands of people.


Larry Cohen:Your story’s a humbling one, it really is, for all of us, to have gone through what you did and taking care of Christina for those many years. It’s as I say, a humbling story.


We’re going to take a quick break right now, and we’ll be right back in a minute right here on Ringler Radio with more with Josephine Grillo Sullivan. We’ll be right back.


Speaker 1:This is Ringler Radio, brought to you from Ringler, the nation’s leading provider of fair settlement solutions. Did you know that Ringler is involved in a third of all structured settlement cases in the country? Ringler advisors work with all the parties in a lawsuit settlement to find the best possible financial solution for the people involved. Everybody wins. There’s a Ringler consultant in all the major cities in the US. No one had more experienced experts in the settlement business than Ringler. Check out our website at www.ringlerassociates.com for the best information for injured parties, attorneys, and claims professionals to find the Ringler advisor nearest you.


When it’s your interest at stake in a lawsuit settlement, you want only the best, most objective financial plan. You can count on Ringler advisors to create customized plan that meets the financial needs of you and your family for the future. Visit ringlerassociates.com to learn more.


Larry Cohen:Welcome back to Ringler Radio. Glad you could join us. I’m joined today by my co-host Anne Lawter and our special guest, Josephine Grillo Sullivan, executive director the Christina Grillo Sullivan Foundation. Josephine, you and your family, your husband Craig and your son Christian, have devoted your lives to the memory of Christina in many ways. Of course one of them is the mission to influence legislation to encourage structured settlements. You even set a precedent with the second court of appeals case opinion holding guardian at litems accountable for breaching their fiduciary duty.


Talk to us a little bit about how you’re looking to change the law when it comes to structures versus lump sum payments when people have to make that pretty momentous decision.


Josephine G. S.:That process actually had been started by the passage of Senate Bill 731 in 1999. For three legislative sessions, that’s six years, we fought for that legislation that would make it mandatory for a structured settlement to be presented in writing when it involved a minor child or a non-competent adult. That was in a 76 Texas legislative session. It was passed and codified into Texas Section 139.001-5. Larry, I believe that probate courts truly, truly have too much power without accountability. I actually have proposed a five-member oversight panel when it comes to the health, safety, and wellbeing, consisting of a physician, a lawyer, two citizens, and legislative member because the abuse of the probate system has been well-documented and persons are being stripped over their rights with limited recourse.


Larry Cohen:Well I know who to nominate as one of the citizen members of that commission. (laughter) That’s for sure.


Josephine G. S.: 


Anne Lawter:That sounds like a great idea, Larry. Josephine, you had an opportunity to be right there with the legislature and give testimony. You and Christina both testified at the time that the law was being discussed. Can you tell us about that experience and how it affected you to be able to take Christina with you to talk to the legislators?


Josephine G. S.:I guess it was just one of the many times she was by my side, again for the six years we traveled back and forth to Austin and other hearings across the state of Texas. To describe it, she was instrumental in I think them actually listening and seeing because when you have someone that is severely brain-damaged, it actually … You’re creating an awareness. I don’t think people can really completely understand until they walk or see your shoes, just for a bit. So it was very important and the response was what was needed, when she was traveling with me.


Larry Cohen:Christina’s memory also takes shape, Josephine, in the form of your foundation’s work to support families with brain injured loved ones. I know we all want to hear about that, and also tell us about the Life Care Resource Guide. These are pretty inspirational things you’re doing.


Josephine G. S.:Well the Life Care Resource Guide actually takes into account the medical diagnosis of an individual. What we do as a foundation, because the stress of family helping to support that person … We actually help them because it’s so daunting. We have volunteer nurses, therapists, and they actually go in and look for the resources around their demographic area and that’s how we create their life care plan. The therapies, the equipment, do you need dealers, doctors, hospitals, day-habs? It’s just whatever is needed for that family to be able to take care of their loved ones.


Larry Cohen:That’s interesting, Josephine. That’s tremendous work you’re doing for the brain injured families. I’m sure they appreciate everything that your foundation and the Life Care Resource Guide can provide for them.


On your foundation’s website, there’s an interesting yellow butterfly which we’ve learned has some special significance, but I’m not sure what that is. So talk to us about Christina and the significance of the yellow butterfly. What is that?


Josephine G. S.:Well Larry, they say that our Heavenly Father allows our loved ones that have gone to heaven to come through the veil. It started after Nina had gone to heaven. From time to time when we would be at the point of such unbearable grief, a yellow butterfly would come and appear. I guess the first time was at a football game, oddly enough, ’cause Nina went everywhere with us. She loved to cheer on her brother’s college team and to encourage him because he was so devastated after losing her. He was about to graduate from college. So we went to the football game, trying to make it as normal as possible and went and even stood in the handicapped section where she used to stand, where we rolled her up in her wheelchair. And here comes this yellow butterfly, and I started crying.


I guess to me it was a symbol that maybe she was saying, “I’m okay. I’m here.” And it had landed on the railing where her wheelchair used to sit. There was a lady standing next to me and she hugged me and I explained to her. If you can imagine … Of course a football stadium’s all concrete. It’s not like there’s trees or anything around that a butterfly would show up. But there again, here comes another football game and here comes this yellow butterfly landing on the same spot. So to me it was more Christina saying, “You know Mom, I’m okay. I’ll always be here with you.” And it just to this today really means a lot.


Larry Cohen:Oh, no question. It gives you goosebumps, that story. It’s really amazing. And you know you hear stories like that, and I think it all comes down to having faith that things are a little bit better up there. I think that’s what she is telling you. That’s a very interesting and heartfelt story.


Josephine G. S.:I really would love to share with your listeners, the one day … Because there is an angel that the butterfly is in the wing of the logo … I was running on the beach one day … I’m a runner. And I just couldn’t bear to see Craig crying over the loss of Nina and when I got back in the car, just shut the door and was yelling at the top of my lungs. And it’s so out of nature for me to do that, but I guess grief took over. Asking her where she was … That day we were actually donating one of her wheelchairs. So we had gotten back in the car and drove back home and got the wheelchair out and was putting it in the car of a lady that actually has helped us for many years. She started crying and then I started crying uncontrollably, and then there goes Craig.


Then all of a sudden she says you know, “Look up.” And I would invite your listeners to go to the website. It was the shape of an angel cloud. There wasn’t another cloud in the sky. It was absolutely breathtakingly beautiful. There again, it was another sign that … “You know Mom, you’re on the right track. We’re doing okay, and keep going.”


Larry Cohen:It’s amazing stories.


Anne Lawter:Yes, Josephine. The perseverance that you and your family have shown in carrying on Christina’s legacy is amazing and the work that you’re doing to help other families that take care of brain injury victims is just amazing. Can you tell us how if someone wanted to get involved with the foundation and volunteer, how they could do that?


Josephine G. S.:I surely can. I just wanted to say one more thing in regards to her logo. Her loving brother Christian actually did those strokes of love on his tablet and created that logo. I wish I had more time to tell you about Christian, because what an amazing young man and what an amazing brother he was to her and still is.


Larry Cohen:Well you know they have an amazing mother too, don’t forget that.


Josephine G. S.:Thank you. And in regards to, Anne, thanking you for how people can assist Christina’s foundation, the foundation that bears her name and the foundation that has helped so many not only changing the structured settlement industry but allowing structured settlement brokers to assist so many. If you could please go to her website, because the foundation is helping so many families and we just need their support, and through donations. It’s www.tcgsf.org. Because we’re a 501(c)(3) public charity, anything that you donate can and will be tax exempt as allowed by law. I guess not only as the executive director but as a mom who loved and cared for her daughter for so many years, almost 33 incredibly blessed years, this is the way that you can honor Christina. Become a Nina moment, and please go to her foundation and donate.


if you want to talk to me personally, I would love that. You can dial the 1-866-637-8392, that’s extension 21. And my email address is Josephine@tcgsf.org and I would love to hear from you. Again, Anne and Larry, I cannot thank you enough for allowing me to be a part of Ringler Radio and I just-


Larry Cohen:It’s our pleasure, believe me. This has been an inspirational show. It’s not just educational but inspirational and I think all of our audience would respond positively to that statement. Anne I know is someone that’s been in this industry, and we all deal every day with these issues of, “Are they gonna take a structure or are they gonna take a cash settlement?” We’ve seen the pain that comes from those who don’t really have the decision explained properly to them. I think what you’ve done Josephine, not just through your foundation helping others, but also through the toughness and the fight, having to file the pro se litigation even, that just shows the spirit you’ve had. You really helped a lot of people. I just want you to know that.


Josephine G. S.:The appeal case, as well, it was just-


Larry Cohen:Oh yeah, oh yeah. No question about it.


Anne Lawter:Josephine, having practiced as an attorney for almost two decades, I just cannot commend you enough for having the courage to be able to take something on yourself and having the courage to move forward with that or striving to make a difference in others’ lives as you have. My heart just bursts with joy in knowing what a major contribution you and Christina have made.


Josephine G. S.:Thank you so much. I will tell you, last night we had our second practice for the adaptive tennis program that we just started with the Special Olympics. At the end, because those children are so intellectually and physically disabled, at the end when you’ve got the smiles and the success and their parents are cheering them on, even if it’s just to hit a ball one time with the tennis racket, it just enlightens your heart. At the end when they took the picture, and the reason I’m saying this, is I had gotten everyone in the stands. We all got together and it was like one, two, three, and then everyone said, “Nina!”


Larry Cohen:Oh wow.


Josephine G. S.:The picture was taken and it was absolutely beautiful. So I will end on that note-


Larry Cohen:No question, no question. That’s terrific. Terrific way to end it. And I just want to say again, Josephine, tremendous having you here and I’m glad you gave out all the information to how to reach you and the foundation. Anne, if someone wanted to reach you, how would they do that?


Anne Lawter:They can reach me in the Ringler office in Troy at 248-457-1212 or at alawter@ringlerassociates.com


Larry Cohen:Terrific. All of you out there, you can reach any Ringler associate. You can find them, you can even look at their pictures if you want, by going to the Ringler website, ringlerassociates.com. On that website you’re going to find tremendous amount of information, helpful information, the kind of explanatory information that we only hope that at one point back in the day that Josephine might have had.


Josephine, you’ve been an inspiration to us. If you want to hear any of the Ringler Radio shows, ringlerassociates.com, ringlerradio.com, legaltalknetwork.com, or an iTunes where you can download the show and listen at your leisure and hopefully be inspired by Josephine as we all were today.


So with that I want to say thank you Josephine for being a tremendous guest and inspiring all of us. And as I said before, humbling all of us too at the same time. Thank you very much for being here.


Josephine G. S.:Thank you both and many blessings to you both as well.


Larry Cohen:Thank you. And Anne, thanks for being a great co-host.


Anne Lawter:Yes, thank you Larry and thank you Josephine.


Larry Cohen:And for the rest of you out there, be inspired and go have a great day. Bye-bye.


Speaker 1:The views expressed by the participants of this program are their own and do not represent the views of, nor are they endorsed by, Legal Talk Network, its offices, directors, employee, agents, representatives, shareholders, and subsidiaries. None of the content should be considered legal advice. As always, consult a lawyer.


Thanks for listening to Ringler Radio, celebrating more than a decade of podcasting, and over two million listeners. Think of Ringler, the objective settlement advisors with more than 140 consultants in 60 cities nationwide. Visit ringlerassociates.com today.



4 Things to Consider in Complex Work Comp Causation Cases

work comp causationMembers of the claims management team are challenged daily to run an effective operation.  One of these issues claim handlers confront are questions of medical causation before admitting primary liability on a workers’ compensation claim.  Unfortunately, most members of the claims management team do not have a medical degree, but they do have many resources at their disposal to meet these challenges and make even complex decisions with certainty.



To Admit or Deny Primary Liability


Questions of medical liability for a work injury are often more complex than those that involve a “legal” basis for denial.  When reviewing questions of medical causation, claim handlers need to consider the following issues:


  • Evidence of clinical medical findings to substantiate a work injury;


  • Evidence of the requisite workplace exposure—which are often complicated by claims or repetitive use allegations; and


  • Medical literature that connects or links the work activity to the alleged injury.


In many instances, claims handlers are left to rely on training, experience and gut instinct to make decisions.  Time is of the essence given statutory parameters following receipt of the First Report of Injury.  Failure to do so can result in admissions against interest and/or penalties.



4 Things to Consider in Complex Work Comp Causation Cases


Members of the claims management team need to be proactive when it comes to admitting or denying a workers’ compensation claim that boils down to issues concerning medical causation.  There are important steps one can take to make a reasonable and well-informed decision.


  • Investigate the mechanism of injury: This consideration includes the question of “how” an injury occurred.  The claim handler will have medical records that detail how the injury took place.  In other instances, they may have the opportunity to conduct a more in-depth investigation.  This can include a recorded statement from the injured worker or witnesses.


  • Determine the exact medical diagnosis: This includes obtaining as many medical records as possible immediately following the work injury.  This starts with learning where the employee received post-injury care and the names of prior medical providers.  In many instances, state and federal privacy laws allow claim handlers to receive medical records without a signed authorization.


  • Review all diagnostic tests and studies: Reviewing the reports from medical studies can provide insight into the origin of an injury.  Examples of this include injuries to the upper extremities, shoulder areas and cervical spine.  A review of EMGs, CT scans and MRI can narrow the point of injury and its origin.


  • Roundtable with the claims team: This is a value resource to review the facts and question the plausibility of a claim. Roundtable sessions with a claims management team are important for many reasons.  This includes the ability of claim handlers to learn from each other’s experience and plot claim strategy.  It can also be an opportunity to poke holes in the employee’s version of events and plan a defense.



Battle of the Medical Experts


In many litigated claims involving injury causation, there is a “battle of the experts.”  While the employee always carries the burden of proof, many jurisdictions view the evidence in a light most favorable to the employee.  The result in the need to provide the medical expert with as much information as possible prior to the adverse examination.  A well written IME report and excellent bedside manner for courtroom testimony is a must.





In every workers’ compensation claim, a strong defense starts with the claim handler working the file.  This requires that person to use their skills and resources to conduct a diligent investigation and examine the important issue of medical causation.  Claim handlers have many resources.  By using them, they can position their file load for success and reduce costs in their workers’ compensation program.




Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is 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/


©2017 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.

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