Michael B. Stack - Work Comp Roundup

Properly Designing and Implementing Transitional Duty Program Ensures Success

November 20, 2019 by Michael B. Stack Leave a Comment

The biggest mistake employers make with a transitional duty program is having a “sorta” light duty program. The employer recognizes a transitional duty program is an important way to reduce workers’ compensation cost and realize the importance of providing modified duty/light-duty work for an injured employee but does nothing about it until an injured employee is placed on light-duty work restrictions by the medical provider.

Big Mistake is Designing Program After Employee is Injured

For a transitional duty program to be effective, it needs to be properly established. This does not mean identifying a light-duty job for the employee once an employee has been injured. It means having a written policy on light duty work that is known to everyone in the company. When there is a written policy of providing transitional duty work, every employee will know that a light-duty or modified duty job will be available and required of them, if they are ever injured on the job. The supervisors and managers within the company should be educated on the details of the transitional duty program so they can properly explain it to any employee who is injured.

A transitional duty position should be designed for every current job within the company. The transitional duty job does not have to be in the same department as the injured employee’s original job. It can be anywhere in the company. The placement of the employee in a transitional duty position outside of the employee’s regular department is beneficial to the employee by broadening the employee’s skill base and knowledge of the company. Any training the employee needs to accomplish the transitional duty job should be provided during the first days on the temporary job assignment.

Transitional Program Should be Understood Throughout Company

All employees should understand that transitional duty jobs are temporary and are not a new permanent assignment for the employee. If the transitional duty is going to last more than 30 days, the employee should be moved to a second transitional duty job that allows for increased physical assertion, but still within the work restrictions set by the medical provider. The employee should be clearly told that as soon as the medical provider clears them to return to their regular duty job, they will be required to do so.

The business partners who are involved in the handling of the workers’ compensation claim need to understand that transitional duty is required of all injured employees who are able to work in some capacity. The nurse case manager and the designated adjuster or dedicated adjuster(s) assigned to your work comp claims should understand that your company will return all injured employees to work as soon as the medical provider states what work restrictions are necessary.

The medical provider, whether employer selected or employee selected, should be advised there is a transitional duty job available to the injured employee. The medical provider should be given both a copy of the physical requirements of the employee’s regular job and a copy of the physical requirements of the transitional duty job that will be available to the employee. If it is a non-emergency situation, the physical requirements or the regular job and of the transitional duty job should be given to the medical provider prior to the first medical visit. When this is not possible due to the need for immediate medical care, the physical requirements of both the regular duty job and the transitional duty job should be provided to the medical provider prior to the employee’s second medical appointment.

The employer should never allow the transitional duty job to interfere with the employee’s medical appointments, physical therapy appointments or other medical treatment. The supervisor in charge of the transitional duty job position should be provided the date of the next medical appointment immediately following the most recently completed medical appointment to minimize the interruption in productivity of the department where the injured employee is working.

Properly Designed & Implemented Program Ensures Success

The work comp coordinator within your company should coordinate the transitional duty position with the employee, with the supervisor of the transitional duty position and with the medical provider to be sure everyone is on board. Any issue that arises with the employee working in the transitional duty position can be addressed timely by the work comp coordinator. The work comp coordinator should also verify that the transitional duty job meets the work restrictions set by the medical provider.

The establishment and implementation of the transitional duty program before it is needed is the key to a successful program. By designing your transitional duty program to accommodate the needs of the injured employees, you will ensure the success of your transitional duty program.

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

Contact: mstack@reduceyourworkerscomp.com.

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

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

Two Key Tactics to Avoid “Creeping Catastrophic” Workers’ Comp Claims

November 18, 2019 by Michael B. Stack

We know that aside from traumatic injuries, the vast majority of workplace injuries heal as expected. However, we also know that roughly 20 percent of seemingly minor injuries turn into major problems, leading to complex medical treatments, long-term recoveries, and major expenses. These claims are often referred to as ‘Creeping Catastrophic’ Claims. The question is why do these types of claims occur?

There is no single answer since every injured worker is different. But we know that biological, psychological and social factors — or a combination of all three, are often to blame. Uncovering and intervening on those issues early in the claim cycle can pay dividends in the long run. Using the right approach at the right time can keep the claim on track for a favorable outcome.

Biological, Psychological & Social Factors

Factors that may have nothing to do with the injury itself may impede the recovery process and be a significant cause of Creeping Catastrophic claims. Biological factors, such as the person’s genetics, age or gender, may impact recovery. There may be mental or emotional health issues, beliefs, expectations or other psychological elements that have a bearing on the healing process. Social issues, such as financial strain, support systems and relationships can easily derail a claim.

Let’s say an injured worker takes a bus to and from work; however, no bus is available to him to the location of, or at the appropriate times for medical appointments. An injured worker in this situation won’t be able to get the treatment he needs and, therefore, cannot be expected to have a smooth recovery. Having this knowledge at the beginning of a claim allows claims managers and others to work with the injured worker and figure out some available options — rather than finding out this information weeks or months into the claim.

Another injured worker may have cultural issues that render her unable to work with particular medical providers. Again, knowing this early on can allow stakeholders to direct care or steer the worker to someone more appropriate, saving time, money and unnecessary suffering.

There are also injured workers who must care for an elderly parent, which may prevent them from going to physicians at certain times or strictly adhering to their medical regimens.

These issues are not the responsibility of the payer, yet ignoring them or failing to recognize them can turn a minor injury into a complicated nightmare. It is incumbent upon payers to do everything possible to find out and address any issues that could harm recovery.

Trust and Engagement

Injured workers are typically scared, confused, and possibly angry. Since they probably have no first-hand knowledge of the workers’ compensation process, they may feel out of control and powerless over the situation. Add to that the fact they are likely in pain, and it’s no wonder they may be less than forthcoming with their life issues that may impact a claim.

On the other hand, an injured employee who trusts the payer — or a representative of the payer, understands the process and feels that he is at the center of his recovery is much more likely to discuss non-injury factors that could significantly affect a claim. A biopsychosocial approach to managing claims can truly engage the injured worker, so he feels comfortable sharing certain aspects of his life outside of work or his injury.

Key to the approach is:

Timing
Genuine Communication

1) Timing. The first available opportunity for someone to speak with the injured worker is the right time, whether that is within the first two days, the first day, or the first hour of the injury. That is when the injured worker is trying to make sense of what has happened to her and what she can expect — before she has had days or longer to get ‘advice’ from family members, well-meaning friends or attorneys on TV. It is when she is most likely to listen to and if done correctly, trust the person speaking with her.

That first conversation with the injured worker should not be viewed as an unemotional session where the claims manager is firing questions, but instead should be an empathetic, interactive dialogue. The main focus should be explaining the process and the injured worker’s options, listening to and addressing her concerns and fears, and expressing genuine care and concern — and emphasizing that the goal is to help her heal and return to her job. It is the first step in building a relationship with the injured worker, not just a one-off, quick chat.

2) Genuine Communication. Often the best person to initiate this first conversation is the nurse case manager. He may have insight into the injured worker’s medical issues that can be discussed.

His approach should be easy, to try and establish trust with the injured worker. In discussing the workers’ compensation process, he may set expectations; for example, saying he expects the injured worker to call him after her medical visits. It lets her know that he is going to be with her for the long haul.

The initial and subsequent conversations should be just that — conversations. In addition to discussing the injury and the process the injured worker will go through, the discussion should also center around other things important to the person. Is there a spouse and/or children who may be experiencing some of the same fears and concerns as the injured worker? What are some outside activities that may be affected by the injury?

Learning about the injured worker’s life outside of work can also help in the recovery process. Once the nurse and/or claims manager has a better understanding of what is important to the injured worker, that information can be used as motivation to help with her recovery. For example, if she plays in a golf league once a week, the nurse or claims manager can share that information with other stakeholders and incorporated into the treatment regimen.

Conclusion

Injured workers are far too often left feeling out of the loop in their own recoveries. Including and engaging them early on and using a holistic approach empowers and motivates them to have a positive experience, and avoid the life-altering impact of a creeping catastrophic claim.

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: http://blog.reduceyourworkerscomp.com/

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

Filed Under: Claim Management

Look to Rated Ages For Realistic Settlement Amounts

November 12, 2019 by Michael B. Stack

A well-developed settlement plan can be a win-win for all parties to a workers’ compensation claim. The injured worker is assured of having enough money to meet his future medical – and possibly other – needs for a lifetime; the employer/insurer gets the long-term claim off the books with the knowledge that the employee will be financially set.

Several elements are imperative in designing a settlement that is fair to all parties involved, such as:

Structuring the Medicare Set Aside, to ensure Medicare’s interests are addressed
Properly projecting medical costs, to ensure the worker has enough money to pay for future care related to the injury while also making sure what is included is appropriate and not inflated
Pricing out future prescription drug costs
Providing a system of ongoing support after the settlement, such as professional administration

Another vital component to is make sure the injured worker has enough money while also avoiding unnecessarily high costs is the life expectancy of the injured worker. It’s a factor used to determine the settlement amount.

Life Expectancy and Age Ratings

Structured settlements are a component of a comprehensive settlement plan, and vehicles that provide periodic payments agreed to by the parties. They are money streams from annuities that guarantee future payments according to a determined schedule issued through life insurance companies.

As with life insurance, life expectancy is a prime consideration in determining a realistic amount. Imagine a 35-year-old person in good health who applies for a $50,000 life insurance policy, compared with a 50-year-old who applies for the same policy. Chances are the 35-year-old will live longer, and pay premiums, far longer than the 50-year-old. The insurance company, therefore, charges a higher premium to the 50-year old than the younger person. Annuities for structured settlements are figured in the same way.

But ‘life expectancy’ is not solely dependent on a person’s chronological age. It is an estimate of longevity that also includes such things as family history, the absence or presence of high-risk activities, and comorbid conditions. The 35-year-old who smokes, has diabetes, and heart disease may have a shorter life span than a 50-year-old who is physically fit and takes care of himself.

There are many actuarial tables and ways to determine life expectancy. It is not, however, an exact science. Therefore, a person’s life expectancy may have many different estimates from different actuaries.

A realistic settlement amount should include an appropriate estimate of a person’s life expectancy. If the payments need to cover a shorter life expectancy, the cost of the benefits will be less than for someone with a longer life expectancy.

Life insurance underwriters can calculate life expectancy using medical records, address, and comorbidities. Because the process is not exact, structure settlement companies typically reach out to multiple life insurance companies for rated ages.

Any workers’ compensation claim being considered for settlement should include rated age estimates. It’s important to note that comorbidities that may impact life expectancy need not have any association with the person’s workplace injury. It is simply a medical assessment of a person’s life span.

Examples:

Let’s say the life expectancy of an average male is 77. So a 50-year-old in good health would have a life expectancy of 27 years. However, if that person has hypertension, alcohol abuse, and other physical issues, he may have a life expectancy of just 15 years. That would eliminate 12 years from the expectation of future medical and indemnity costs in the settlement.

For another, more specific example, let’s take a 22-year-old male with a myriad of comorbidities. Where the ‘normal’ life expectancy would be 55 additional years, let’s say it is reduced to 30 additional years. When calculating the reserves and future cost projections, 25 years are eliminated from the settlement value.

Using Rated Age Information

Armed with various rated-age estimates, the settlement can be figured in several ways:

Reduce the settlement amount. A settlement based on 34 years life expectancy would be much less than 57 years. So, a lower, more reasonable amount can be proposed to the injured worker.

Limit the exposure. This is a strategy payers can use to lower their risk. Rather than offering a lower amount, the proposed settlement says that if the injured worker passes away within a certain timeframe, an annuity will be refunded to the employer/insurer.

Don’t settle. If the rated age is significantly different from the normal life expectancy, it might make more financial sense for the payer to continue providing benefits for the injured worker’s lifetime.

Conclusion

Settling a workers’ compensation claim can be a complex process. It must be enough to give peace of mind to the injured worker and be affordable and realistic enough for the payer. Getting realistic estimates of a person’s life expectancy can result in a profound difference in the amount that is actually needed.

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

Contact: mstack@reduceyourworkerscomp.com.

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

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

Filed Under: Structured Settlements

Use Orebro Pain Questionnaire to Prevent Creeping Catastrophic Claims

November 11, 2019 by Michael B. Stack

Do you know that up to 80% of workers compensation costs are caused by only 5% of workers’ compensation claims. Hello, my name is Michael stack and I’m the CEO of AMAXX. Those exact figures, the 80% of costs are driven by 5% of claims, the exact numbers of 80% and 5% don’t really matter. I’ve heard a lot of different estimates could be 10% driving, 90% of cost or 15% driving 85% doesn’t really matter, so don’t get caught up too much in those numbers. The point is that a small percentage of claims drive a very, very large percentage of workers’ compensation costs and the other real wrinkle in that and the point of today’s video is to recognize that up to 50% of those costs, that huge bucket that we’re talking about are preventable, are preventable.

Small Injuries Become Big Problems

It’s those cases that end up with a really small shoulder injury. It should be pretty standard run of the mill type issue. The person gets fixed up, get them back to work, couple of weeks, they’re back in business. But it’s those claims where it’s this regular run of the mill type injuries that end up putting that person out of work for the rest of their life, causing a very major negative impact on that person’s personal life and of course, driving significant workers’ compensation dollars.

So how do we prevent that? How do we get in front of that? How do we identify those claims early on in that process so that we can prevent that very negative impact on that person’s life and of course, dramatically reduced the worker’s compensation costs. Now there’s several ways for us to do this. There are some informal techniques as far as just measuring that person’s resiliency at work. How resilient have they been are when they’re dealing with a regular run of the mill problem in their daily work life?

Are they really great at handling that problem or really poorly at handling that problem? How they deal with that as a great indication of how they’re going to deal with the challenge of an injury. So those little informal screening techniques and those work very well, and we just need to pay attention and tune into that a little bit better.

Formal Screening Technique – Orebro Musculoskeletal Pain Questionnaire

And then there’s formal screening techniques. And then what I want to talk with you about today is a really great formal screening technique called the Orebro Musculoskeletal Pain Questionnaire. So the Orebro Musculoskeletal Pain Questionnaire. Now this was invented by a psychologist in Sweden and the nice thing that you need to know about this is that it’s actually free to use, it’s free to use, it’s in the public domain. You can Google the Orebro Musculoskeletal Pain Questionnaire and you can find the test, you could find how to rate it and you can implement this yourself at your claims organization if you’re an employer working with your adjuster or case managers on how to implement this.

So that’s what you need to know first, highly effective when they’ve done studies on this, and this has been proven and validated over years and years and they’ve actually sharpened it up and shortened up the form now. Now there’s only 12 questions. There used to be I believe 23 or 27 when they first started it. Now it’s down and it’s called a short form 12 or the SF 12. You administer this and it could be administered by a nurse case manager, it could be administered by the adjuster or could be a third party outside vendor that’s just administering and specializes in this type of thing. But it’s administered two to four weeks into the claim. So, there’s, you know, the person’s hasn’t gotten back to work yet. It’s not really going or getting off the ground or going the way that it’s supposed to, or they’ve been back to work, but they’re on modified duty and they’re not progressing as well as you would like to see them.

Gain Information to Get In-Front of High-Risk Claims

Or there’s just some other red flag indicators that you think, let’s get a little more info on this one because we want to get in front of this and we want to prevent that major creeping catastrophic impact on the personal life and cost. So a Orebro Pain Screening Questionnaire administered by the case manager adjuster, or third party vendor two to four weeks into the claim, gives us those early indicators that there may be some additional intervention that is needed on John Smith’s particular claim to help John get over whatever hurdle it is that’s preventing him from recovery. Look it up, use it, it’s free to use, and it’s highly effective.

Again my name is Michael stack. I’m the CEO of AMAX, and remember your work today in workers’ compensation can have a dramatic effect on your company’s bottom line as we’ve demonstrated today in this pain screening questionnaire, 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: http://blog.reduceyourworkerscomp.com/

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

Filed Under: Claim Management

Dealing with Idiopathic Injuries

November 7, 2019 by Michael B. Stack

Members of the claim management team are called upon to make important decisions at the inception of a claim. One of these decisions includes the investigation of idiopathic injuries and making determinations regarding primary liability. While this may take more time, failure to understand the mechanism of injury can result in extra time and money being spent.

Idiopathic Injuries Result From Unknown Origins

Simply put, idiopathic injuries are those that result from unknown origins that more likely than not are the result of workplace exposure, or related to a workplace injury. In its basic form, it is an injury resulting from a condition or disease an individual has that has nothing to do with their place of employment and is not easily explained.

A common example of an idiopathic injury includes an employee walking down a hallway free of imperfection – suddenly, their knee gives out. Was it work-related? Is it compensable under workers’ compensation? These types of injuries present several challenges for all interested stakeholders in the workers’ compensation system.

Employee: Proving up their case – receiving compensation for their work injury;

Employer: Preserving evidence that will be used in determining primary liability, and zealous defense of the workers’ compensation claim; and

Insurer: Diligent and proper claim investigation, and if necessary, making a legally defensible determination regarding liability.

Investigating Idiopathic Work Injuries

Investigating idiopathic injuries starts with a timely and accurate report of the work injury. For members of the claim management team, the following needs to occur to make the right decisions:

Encourage employers to have an open line of communication with their workforce. Make sure injuries are reported in a timely manner can help preserve evidence;

Accurate reporting is essential. Do not guess the weights of various objects or distances involved. Make sure everything is documented correctly; and

Preserve all evidence. This includes taking a photograph of conditions as they excited at the time of the incident in case they could change. Examples of this include a hallway that has carpeting, uneven surfaces, slippery surfaces that might be covered in ice; and stairwells.

Determine Exact Mechanism of Injury

The devil is in the details – attention to details is required. It is important to determine the exact alleged mechanism of injury. Document the best you can in terms of movements and motions made by the employee at the time of the injury. When you are able, make a contemptuous recording to “lockdown” someone’s version of events. Pre-existing conditions are also important to uncover. Other important factors to consider include:

Did an injury occur because of a work activity?

Was the employee performing work activity consistent with the claimed injury?

If there was, in fact, a work injury, what body parts are involved? Defining an injury by ICD-10 codes may also be important given the reporting requirements for Medicare and Medicaid coordination of benefit issues.

How long did the employee engage in the work activity for it to result in a work injury? Was it a substantial contributing factor in the disability and/or need for medical care and treatment/disability?

If not a specific incident-type injury, when did the injury culminate?

It is essential to provide this information to an independent medical examiner. Questions regarding these issues may involve a medical director, nurse case manager, or someone with an advanced understanding of medicine.

Other Considerations

Other idiopathic injuries in workers’ compensation can include workplace exposure to dusts, allergens, asbestos, and idiopathic pulmonary fibrosis. These claims can be difficult to defend as some jurisdictions have a statutory presumption, albeit rebuttable, which puts insured on the defensive – literally. These complex cases require the use of experts to successfully defend.

Conclusions

Idiopathic injuries create a series of challenges for members of the claim management team. Defense of these claims involves proactive actions from the defense interests to preserve evidence, determine with accuracy the circumstances surrounding the events leading up to the injury, and the injury itself. Failure to take these important steps can increase program costs and lead to excessive litigation.

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: http://blog.reduceyourworkerscomp.com/

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

Filed Under: Claim Management

What To Do If You Have An OSHA Inspection

November 6, 2019 by Michael B. Stack

The Occupational Safety and Health Administration (OSHA) is a creation of the federal government to ensure a “safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education, and assistance.” It has a significant impact on workers’ compensation claims in terms of workplace safety and injury prevention. Given its role, it is important for employers and other interested stakeholders to know how to respond to workplace safety inspections and post-injury response.

Understanding OSHA Basics

OSHA’s jurisdictions cover nearly every workplace and job site regardless of size or function. In terms of safety, they have the ability to inspect the workplace randomly or following a complaint that merits action. Common conditions that result in violation include the following:

Falls from heights and failure to implement requires fall protection systems;

Scaffolding and other elevated structures;

Use or manufacture of hazardous materials; and

Machinery and implementation or use of required safety guards.

The federal act also allows states to create their own OSHA programs. This act allows states to develop their own standards, provided they meet the federal minimums required under the Act. There are currently 22 OSHA approved programs that include: Alaska, Arizona, California, Hawaii, Indiana, Iowa, Kentucky, Maryland, Michigan, Minnesota, Nevada, New Mexico, North Carolina, Oregon, Puerto Rico, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, and Wyoming.

Given their role, OSHA can undertake programmed or unprogrammed inspections. “Programmed inspections” are those that involve enforcement of rules and regulations and occur on a regular basis. Inspections that are considered “unprogrammed,” are those that involved an employee complaint, identified imminent danger, or catastrophe.

Regardless of the type of inspection, it is important to prepare and know how to respond.

Knock, Knock – Who’s There? OSHA!

It is important to courteous and professional anytime you are working with someone from a government agency. An OSHA inspector is required to provide you with their identification and state the reason for their inspection. The nature of the visit should also be provided. Make sure everyone knows the process and procedure when someone arrives.

A typical OSHA inspection follows the following process:

Opening Conference: The purpose of this conference is to review documentation related to the site visit and determine what areas are going to be inspected. It is important to be professional and understand the basis for the site review. Important trade secrets may be disclosed during this process. Have the inspector sign a non-disclosure agreement, if applicable.

Walk-Around: This portion of the visit will include a review of the physical workplace, job site, or area of specified concern. An employer representative should always be with the OSHA inspector. Parameters of the inspection should be defined so interaction with employees can be limited. If the inspector takes a sample or measurement of something, it is important to verify the accuracy of the process. Document, document, document – and listen to what the inspector is saying.

Interview: A site inspection may also include an interview with employees. These should be monitored. Statements made by a supervisor or someone in authority are attributable to the employer. Interviews with general employees can be done in private. Always consult with an attorney if there is doubt.

Closing Conference: This will typically occur at the conclusion of the walk around and interview(s). The inspector will discuss their findings and possible courses of action. Listen to what is being said and do not argue.

Post-Closing/Penalties: Violations always require remedy and remediation. It may also include a penalty assessment. The consequences of a violation generally increase with the frequency and/or severity of the offense. There is a legal process to challenges any penalty.

It is important to remember that penalties can create an opportunity to better workplace safety and morale. Federal and state OSHA programs also provide employers with the chance to have inspectors to come in and review workplace conditions without the threat of penalty or sanction. If utilizing this method of review, renumeration is compulsory, and failure to make proper changes with result in fines.

Conclusions

OSHA plays an important role in making our workplaces safe. It is important for employers and other interested stakeholders to know how to respond to an inspection. The net result is reduced chances of workplace injury, and a safer work environment.

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: http://blog.reduceyourworkerscomp.com/

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

Filed Under: Safety and Loss Control

How long will my injured worker be out of work?

November 5, 2019 by Michael B. Stack

How long will my injured worker be out of work? How long will my injured worker be out of work? Hello, my name is Michael stack and I’m the CEO of AMAX and that’s a good question to ask and a common question to ask when one of your employees is hurt because you need to have that expectation for how long they’re going to be out and what their recovery time is. If you’re not a medical genius, it’s hard to know if someone hurts their shoulder and has a partial rotator cuff tear, what that actually means in terms of recovery time. I want to talk to with you today about how to know that information by using a really, really handy little tool to help you uncover some of these medical secrets to say, well I don’t really know how long it’s going to be out, but they’ve already figured it out.

Evidence-Based Medicine Injury Duration Guidelines

Other people have already figured it out and they tell it to you in a very simple and easy to use format in the form of evidence-based medicine, injury duration guidelines. And these are provided by two different companies or most commonly by two different companies. One’s called ODG guidelines provided by the work loss data Institute and then MD Guidelines provided by the Reed Group. So two great resources to tap into this and I want to cover very quickly, so take a look at the board here. So this is the evidence-based medicine injury duration guidelines for a partial rotator cuff tear. And you’ll see here there’s various categories and levels that you can look at. So whether the person’s in a sedentary job, medium, heavy, light, very heavy type of job, and then they give these guidelines as far as expected, physiological.

Look at Simple Chart To Find Your Answer

So how long should it take that person’s body to physically heal for them to be able to be back to work in these different categories of jobs. So pretty general categories, but you could know where your forklift driver fits versus where your office worker fits. If you know what I’m saying, so let’s take a look here. So you’ve got your minimum, your optimum, and then your maximum physiological time that will be required for that person to return to work and you’ve got zero and it goes up to 21,42, 85 etc. And you can just figure out on that little chart there of what that looks like for you. So if you asked yourself that question, how long will my injured worker be out of work? Go ahead and take a look at this chart and have that expectation. Here’s what I also want you to realize, and this is if you’re not familiar with some of this, it will kind of probably surprise you, is that when you look at this, you see these guidelines even for the very heaviest positions of the heaviest light do or heaviest job required here, the maximum out of work time physiologically is 85 days for the most physically demanding jobs that are available.

50%+ Employees are Not Back to Work Within Maximum Expected Recovery Time

If you look at what the actual data says in both ODG and MD guidelines provide this actual data, you will see that actually only 5% of people are back to work within 18 days, so 5% of people are back to work within 18 days and the median so meaning 50% more and 50% less are back to work in 95 days, so more than 50% of people aren’t back to work within the maximum amount of time required for physical healing. Now that should put you on edge to say, what are we doing wrong? Why are we missing this? Look at some of this data, leveraging some of this data and you’ll see that if you have this type of injury, almost all of your people should be back here in some sort of light-duty job within at most four days and that should be your goal.

Getting them in that transitional duty position to start healing. Then continuing to progress them back towards their medium heavy and light duty positions, evidence-based medicine injury degree. Injury duration guidelines are a very handy and useful tool for you to implement into your work comp management program. If you’re using them, use them more. Tap into them, leverage them more if you’re not using them. I recommend starting today.

Again, my name is Michael stack and CEO of AMAXX, and remember your work today in workers’ compensation will 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: http://blog.reduceyourworkerscomp.com/

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

Filed Under: Workers Comp Cost Containment Fundamentals

Vocational Rehabilitation Qualified Rehabilitation Consultant Misconduct

October 30, 2019 by Michael B. Stack

Vocational rehabilitation and working with a Qualified Rehabilitation Consultation (QRC) can reduce workers’ compensation costs and get an injured employee back to work in a timely manner. Problems can arise when the QRC starts acting like an advocate for the injured employee. Members of the claim management team and other interested stakeholders need to be on the look-out for QRCs gone wild – and ensure they are working for the rehabilitation plan, and not the employee.

What are QRCs?

QRCs are trained vocational rehabilitation consultants than assist employees in post-injury return-to-work and medical management activities. Requirements for QRC registration are typically governed by administrative rules established by an industrial commission. They are appointed following a work injury where the employee’s injury is severe enough to require extended time off work. They should have a solid medical background, and understanding of the labor market and empowering employees to return to suitable gainful employment.

Acting in the Best Interests of the Rehabilitation Plan

QRCs will meet with an injured employee at appointed times set forth in statute or rule and determine the vocational goals. This includes an assessment of various factors, which can include:

The nature and extent of the employee’s injury;

Restrictions and other limitations placed on the employee post-injury;

Transferable job skills and ability of the employee to return to work;

Ability of the date of injury employer in returning the employee to work, including in a light-duty capacity.

QRCs are required to be neutral parties and not an advocate for the employee. The best interests of all parties need to be carefully balanced and taken into consideration.

Qualified Rehab Consultant Misconduct

QRC misconduct is defined by statute or rule in each jurisdiction. There are general principles that govern the conduct of a QRC. Proactive members of the claim management team need to be on the look-out for these factors and take appropriate action against a QRC that steps outside their role.

Failure to perform rehabilitation services with reasonable skill because of negligence, habits, or other cause. This can include a number of different factors and behaviors. It can be something as basic as missing meetings or appointments, and consistently not returning telephone calls in a timely manner. It can also include failing to properly supervise QRC interns and support staff;

Engaging in conduct that is likely to deceive, defraud, or harm the public;

Fraudulent billing practices, or failing to properly bill for vocational rehabilitation services; and

Engaging in adversarial communication or activity. This can include behaviors such as offering opinions on the facts of the case, litigation strategy, requesting information not related to the rehabilitation plan, failing to report all relevant information, and not complying with authorized requests for information.

QRCs need to take their responsibilities seriously. Let the attorneys advocate for their client(s).

Removing a QRC From the Rehabilitation Plan

Each jurisdiction has the mechanisms and standards for removing a QRC from the rehabilitation plan and installing a difference vocational assistant. Most states look at the “best interests of the parties” when making such changes. Factors for consideration include the following:

Loss of trust of the QRC. Claim handlers making this argument should provide concrete evidence on how the QRC has “picked sides” in a dispute – become an advocate for the inquired employee;

Duplicative time and costs that may be incurred as the result of the removal/change in QRC. This is an argument that can be made when the claim management team opposes the change in QRC;

Reputation and years of experience and complexity of assignments by the individual; and

Geographic location of the QRC. In some instances, one QRC may be better than another if the employee relocates.

Conclusions

QRCs play an essential role in vocational rehabilitation and getting an injured employee back to work. Claim handlers need to be diligent in making sure the QRC is doing their job and being an advocate for the rehabilitation plan, and not a party. Failure to do so will result in an employee being off work for a longer time, and more money spent on vocational rehabilitation costs.

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: http://blog.reduceyourworkerscomp.com/

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

Filed Under: Medical & Pharmacy Management

Closing Down Vocational Rehabilitation Workers’ Comp Cases

October 29, 2019 by Michael B. Stack

Vocational rehabilitation is an essential workers’ compensation benefit for employees suffering from the effects of a work injury. It not only helps the employee understand their medical care and treatment, but provides them with assistance in getting back to work. This reduces the money spent on a workers’ compensation claim and improves program efficiency. Members of the claim management team need to examine their files to ensure this benefit is being provided in a responsible manner. When there is no longer a benefit to the employee, steps must be taken to discontinue services.

When is Vocational Rehabilitation Appropriate?

Vocational rehabilitation services are provided to employees who are qualified under a workers’ compensation law. This is a benefit that did not come into acceptance in most jurisdictions until the 1970s. It is generally not available to an employee unless they have been off work for an extended period of time.

In order to qualify, a consultation is usually performed by a Qualified Rehabilitation Consultant (QRC), and a recommendation is made regarding the employee’s status. Factors generally considered include:

Whether the employee is permanently precluded or is likely to be permanently precluded from engaging in their usual and customary occupation or from engaging in their pre-injury job;

Whether the employee is reasonably expected to return to suitable gainful employment with the date of injury employer; and

Whether the employee can reasonably be expected to return to suitable gainful employment through vocational rehabilitation services by taking into consideration the treating physician’s opinion regarding the employee’s ability to work.

Vocational Rehabilitation is Being Provided – Now What?

During vocational rehabilitation, the QRC will issue regular progress reports. It is essential that the claim handler monitors vocational rehabilitation once it has been approved. These reports outline the services being provided and the progress the employee is making in recovering from the work injury. Important issues to consider when reviewing periodic reports are as follows:

New or continuing physical limitation that significantly interferes with the completion of the rehabilitation plan;

Whether the employee is participating fully with the plan; and

Whether the goals of the plan should change, or be modified.

Steps should be taken to termination vocational rehabilitation services if it appears the employee will not benefit from ongoing assistance from the QRC.

Do Not Pass Go: Shutting Down Vocational Rehabilitation Services

Each jurisdiction has the prescribed method one must follow in order to terminate the rehabilitation plan, and discontinue ongoing services from the QRC. While the process may differ, there are general requirements that are considered when putting an end to vocational rehabilitation serves.

A new or ongoing physical disability that significantly interferes with the completion of the rehabilitation plan. This is sometimes the case when the employee has a significant setback in their medical care or new injury or disability that is not related to their work injury;

The employee is not cooperating with the vocational rehabilitation being provided by the employee. Common examples include missing medical and physical therapy appointments, or failing to keep in contact with the employer and/or QRC; and

The employee is not participating effectively in the implementation of the rehabilitation plan.

The focus of the arguments made to terminate ongoing vocational rehabilitation services is whether the employee would benefit from additional vocational rehabilitation assistance. The party seeking to cease these services has the ultimate burden of proof. Grounds for stopping these services that are absolute usually include:

An employee who has returned to work with a negligible wage loss, or without a wage loss. Expectations of near-term future earnings can also be taken into consideration;

Settlement of a workers’ compensation case, which closes out future vocational rehabilitation services;

The employee is no longer making themselves available for services;

Death of the employee.

The closure of a rehabilitation plan generally requires a form to be filed with the industrial commission.

Conclusions

Members of the claim management team must closely monitor every workers’ compensation benefit being received by an employee. This includes keeping abreast of the employee’s status and cooperation with vocational rehabilitation benefits. While this is a useful benefit, steps should be taken to terminate it if evidence supports the conclusion the employee would not likely benefits from ongoing vocational rehabilitation services.

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: http://blog.reduceyourworkerscomp.com/

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

Filed Under: Medical & Pharmacy Management

Maximize ROI of Workers’ Comp Management Improvements with the Right Insurance Structure

October 28, 2019 by Michael B. Stack

TO LEARN MORE ON THIS SUBJECT:

HOW TO DETERMINE WHICH WORKERS’ COMP INSURANCE STRUCTURE IS RIGHT FOR YOU

Registration – How to Decide Which Insurance Structure is Right For You

How does a company maximize the return on investment of implementing work comp management best practices?

Hello, my name is Michael stack and I’m the CEO of AMAX and the short answer to that question of ‘how does this company maximize their ROI’ is to start with the right insurance structure, whether that be guaranteed cost, or a retro or a captive, high deductible program or self-insurance policy. But the question is how does a company then determine what is the right insurance structure for them? So often I see this done in the marketplace so incorrectly and only a small percentage of the time is this actually done right. Most of the time it’s just sort of done Willy Nilly and you’re just guessing or the insurance broker says, Hey, I’ve got this really awesome retro policy with this XYZ carrier and I think you’re perfect for that.

The Right Insurance Structure for the Right Employer

Or, Hey, I’ve got this really awesome captive because I know captives really well and I specialize in captives and I think everyone should be in a captive and you should be going to captive to. In short, what often happens is that if an insurance broker is a hammer, everyone looks like a nail and if that hammer is a captive program or if that hammer is a high deductible program or if that hammer is a retro program or even if the hammer is a guaranteed cost program, where all you know is guaranteed costs, every single company you look at looks like they should fit into that program, which is not the right way to do it at all. You need to raise yourself up and have a higher level of professionalism in the marketplace to analyze an employer’s needs or if you’re an employer yourself to analyze your own needs and be able to ask the right questions to your insurance broker and risk advisor team.

So I want to talk about today is these four cornerstones of risk financing, what they look like and how you start to go about making this decision because when we’re talking about maximizing the return on investment, why are we implementing from a senior management standpoint, why are we doing all this work with return to work? Why are we working and our injury response systems? Why are we working on building out our medical networks and building this adjuster team and building out this partnership with all our whole risk financing, our risk management team? Why are we doing all that stuff? Of course, it’s to impact those injured workers, but particularly from a senior manager standpoint, it’s all about that bottom line and that’s what’s going to fuel, if you hit that bottom line right, then you’ll really be able to fuel that injured worker being able to really take care of them as well.

4 Cornerstones of Risk Financing

Let’s talk about these four cornerstones and what they are, and again, this is how you’re going to go about really starting to make an analyze this decision. I’m going to write these out here first.

These four cornerstones are:

Risk tolerance
WC Management Best
Predictability of your risk
Financial Impact

So these are the four cornerstones and I’m just going to run through these again very quickly cause this is all about changing the mindset and if you can get out of this video to change your mindset of how you examine this from being a specialist in retro programs where everyone looks like they fit into a retro program, to now being a professional in the marketplace to now determine via these four cornerstones and asking these questions and having this perspective and how you look at this to change up that, how that looks like for you.

Determining Risk Tolerance

Okay, so risk tolerance, how comfortable is an organization with this variability of risk? Are they really risk-averse and they want to be very conservative, they want to be very predictable. We’re going to write a guarantee cost check and we’re going to know that in our budget and that’s going to be solid and we can predict that out and we’re in great shape or can they handle a little bit more variability as far as what’s going to happen with their losses? That’s sort of question number one. What helps you then be more comfortable taking on more risk is these two things right here. These two things are going to help you be more comfortable in taking on more risk. One is if you know, whoops, I wrote best twice there. If you know you’re doing really well in your return to work program, you know you’re doing really well in your injury prevention program, you’ve really cranked that up, you’ve dialed everybody in, you’ve gone through the supervisor training, your supervisors know how to respond to injuries appropriately.

You’ve built out your claims handling team with your adjusters and you’re just cooking with gas. You can take on a lot more risk because you know you that you’ve reduced it on your own side. Same thing with this predictability of risk number. This is a big, big factor in this decision-making process. If you’ve ever going retro or high deductible or kept over self-insured, you start to look at this law of large numbers to say, well, how likely are we to now incur these losses? How likely based on actuarial data, big numbers based on this predictability of losses, how comfortable are we in this section? You’re going to get some help. You’re going to get some help from an actuary most likely to help you have this predictability of risk and the more comfortably without that, the more risk you can take on. So big two pieces here.

And then, of course, the financial impact is understanding that financial impact, both tax implications from your different structures and then that risk-reward feature as well as the more risk that you take on. Obviously, the more reward and organization it’s going to take.

Change Perspective of Risk Financing Decision Making

This is a very complex topic as you start to unfold it. And as you start to dig deeper into this. But again, the point of this video today is to change your perspective on how you look at this, to raise up your level of professionalism. To say that this decision is it about the market. This decision is about what’s best for the client, and if you are the client, if you are the employer client to now have these four things, your risk tolerance, how well you’re doing it, management of work comp, the predictability of risks, and then the financial impact on your organization.

Those are the four cornerstones of now you how you start to go about making this right decision to maximize that return on investment and get, my name is Michael stack and the CEO of AMAXX, and remember your work today in workers’ compensation can have a dramatic impact, as we’ve talked about here 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: http://blog.reduceyourworkerscomp.com/

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

Filed Under: Buying Workers' Comp

Properly Designing and Implementing Transitional Duty Program Ensures Success

Two Key Tactics to Avoid “Creeping Catastrophic” Workers’ Comp Claims

Look to Rated Ages For Realistic Settlement Amounts

Use Orebro Pain Questionnaire to Prevent Creeping Catastrophic Claims

Dealing with Idiopathic Injuries

What To Do If You Have An OSHA Inspection

How long will my injured worker be out of work?

Vocational Rehabilitation Qualified Rehabilitation Consultant Misconduct

Closing Down Vocational Rehabilitation Workers’ Comp Cases

Maximize ROI of Workers’ Comp Management Improvements with the Right Insurance Structure

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