5 Ways to Get Started Reducing Workers’ Compensation Risk

5 Ways to Get Started Reducing Workers’ Compensation RiskA lot of employers strive to be a safer, more productive workplace for their employees. Every business would love to reduce costs and increase profit margins. The cost of workers’ compensation claims can have a significant impact on the company bottom line, particularly if you are self-insured or self-administered.

 

So how do you get started? Where do you start, or better yet when do you start? The answer is RIGHT NOW, and here is how:
 

  1. Know Where Your Risk Lies

 

Observe your workplace. Go through department statistics and see how they all compare to each other regarding losses. Perhaps 75 percent of your injuries occur in the shipping department. Go down there and talk with the supervisor. Find out what their issues are and why they think injuries are happening. Then, work together to solve the problem.

 

Another helpful thing to look at is your loss run. Talk to your carrier or adjuster and see if they notice any trends in injuries, or which people are getting injured. Maybe the newer hires account for a lot of the injuries. This may show that a focus needs to be directed towards training and safety right from day one of their employment.

 

Look at your business. What do you do? What are the risks involved? You could have risk in several areas, stretching from workers comp to automotive issues with your fleet and the drivers, to liability risk from customers in your store. Break it all down, and start to track your statistics. Identify issues, and work on thinking of ways you can reduce your injuries or occurrences from happening in the first place.

 

 

  1. Plan Your Attack

 

If you have identified a few areas in which you could improve by reducing injuries or claims reports, what do you do to fix it?

 

The answer lies in the resources you have all around you. The first step is to talk to your carrier. Chances are they have the loss-prevention specialists ready to help you work with what needs to be fixed, and how to fix it. Ergonomic professionals can be brought in to address your workstations, and suggest possible solutions to reduce exposure.

 

Utilize your medical clinic contacts to see if occupational physicians can watch employees doing their work to identify potential issues with certain movements or repetitive motion injuries. Or, maybe it’s time to consider having your own in-house occupational clinic for a proactive strategy. Utilize your local council, and have them come in to explain the risks and costs associated with potentially serious injuries, automotive accidents, failure to drug test your employees, etc. Any or all of these will help you get to your goal of reducing your exposure.

 

 

  1. Implement Your Solution Plan

 

Once you have identified what needs to be fixed, and how it should be fixed, now it is time to fix it. Get rid of that old equipment and bring in new equipment that has better safety features. They cost less to maintain and repair, and they are quicker to operate. Most new machines use less energy than the old ones, reducing your utility bills and creating worker ease of operation. Get some padding on the floor for workers to stand on during work at their workstations (also known as “fatigue mats”). This reduces strain on their feet and legs, and reduces body fatigue, potentially making them more productive after long hours at the workplace.

 

Whatever the fix may be, get it done — out with the old, in with the new.

 

 

  1. Measure Your Success Statistics

 

Once new equipment is installed, and in place, it is time to measure your reductions. Measure your numbers in a two, four, and six-month stretch. Did you see any drop in claim activity? Did claims increase, making your plan backfire? You have to see how you did, and most importantly, you have to give it time. Change is disruptive to employees, but they will get used to it. Give it time, and measure your numbers post-change against the ones you first noticed back when you were figuring out where your risk was coming from.

 

 

  1. Get feedback from your workers

 

After all, you have done, you left out the most important thing: To talk to your staff of workers about the changes. How do they feel it impacted their workday? Were the changes helpful, or did they hurt production? How do they feel at the end of the day? Do they feel less sore or are the new workstations worse than the old ones?

 

Ask as many questions as you can. This makes your staff feel that their input is important, and taken into account. After all who better to talk to about the changes that were implemented than those who were directly affected day after day?

 

 

Summary

 

It is hard to break old habits and accept change. Even though it is hard work to find out what your risks are, how to attack them, implementing your changes, measuring your success, and getting worker feedback, in the end, it will be worth it. Lean into the task; don’t try to tackle it all at once.

 

 

 

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.

Proper Claim Reporting Parameters for Self-Insured Employers

Proper Claim Reporting Parameters for Self-Insured EmployersSelf-insured employers (SIE) for workers compensation take on the role of claims management in exchange for the cost savings of self-insurance. Whether you elect to self-handle all of your workers’ compensation claims or to hire an independent third party administrator (TPA), you need to be able to verify claims are handled properly. Rather than reviewing the adjuster’s every activity and item of documentation, it is more time efficient if the SIE claims manager requires the adjuster to submit written reports on all efforts to move the claim forward.

 

 

First Report of Injury

 

The initial report, (First Report) and subsequent reports, (Status Reports) are submitted on a predetermined frequency schedule. Most self-insured employers opt for the First Report submission within 14-15 days of the report of the claim to the claims office. Sometimes a SIE elects to have the First Report submitted by the 30th day of the claim. Status reports are routinely placed on a 30-day reporting cycle, with older claims moved to a 60-day or even a 90-day reporting cycle, depending on the amount of activity on the claim.

 

 

For consistency in reporting and ease in reading the reports, the establishment of a reporting format is standard protocol. The First Report is all inclusive covering all aspects of the claim. In the initial report, the adjuster discusses each of these areas:

 

  1. Coverage– policy number where applicable, policy dates, applicable deductible for loss location.
  2. Accident description– date and time of accident, location within the insured’s premise or if away from the premise, where and why away from the premise.
  3. Insured location– includes the department or unit, the street address and the type of work performed at the location.
  4. Employee – name, age, social security number (edited if required by state law), how long employed, years experience in the current job, number of dependents (if the number of dependents might impact the indemnity rate), prior injuries including both workers comp and non-workers comp injuries, summary or recorded statement when appropriate.
  5. Jurisdiction– the state where the injury occurred or federal benefits.
  6. Investigation – a discussion of the investigation and all the applicable information learned about the accident.
  7. Compensability– why the claim is compensable or why it is being controverted.
  8. Reserves– the expected cost of the claim divided into indemnity benefits, medical benefits, and expenses for the anticipated life of the claim.
  9. Nature of injury– the treating physician’s diagnosis.
  10. Medical care – the treating physician’s prognosis, the expected recovery time, plus any information on surgeries, hospitalization, and projected length of recovery.
  11. Indemnity benefits– the average weekly wage, the indemnity benefit rate, the availability of light duty work, the estimated return-to-work date.
  12. Rehabilitation and Physical Therapy – the reasons for rehabilitation, whether it is physical or vocational, the length of rehabilitation and the facility or provider of the rehabilitation service.
  13. Subsequent injury fund – in states where available, the anticipated amount that can be recovered from the state fund.
  14. Subrogation – whether or not there is a third party from whom the cost of the claim can be recovered, and if so, the identity of the responsible third party, the theory of negligence, the preservation of evidence, the employee’s right of recovery vs. the employer’s right of recovery.
  15. Action Plan– steps to be taken to move the claim forward and the potential barriers to resolving the claim. These are often called Specific Plans of Action (SPOA). An SPOA is a “real” plan, not just the adjuster saying they are trying to close the claim…
  16. Litigation– if the claim is being contested, the name and address of the defense attorney, the issues in contention, the probable outcome of the claim, and the anticipated legal budget.
  17. Future report date – when the claim will be reported again.
  18. Attachments– any pertinent information to the claim the adjuster believes the claims manager may wish to review or all documents to the claim if the reporting guidelines dictate same.

Note: If Nurse Triage is employed, a report from the triage nurse will be sent to the carrier automatically before the claim is even made. This type of immediate medical advise often obviates the need for medical care at a clinic or prescription medication, and the injury may never turn into a “claim.” This is especially true if the injury is treated with “self care” by the employee .e.g. ice your lower back, etc.

 

Status Reports

Status Reports normally do not repeat all the information covered in First Reports. It is standard protocol for status reports to be limited to the topics that have changed or are the subject of change. For instance, the status reports would not repeat the information on coverage, accident description (unless new information becomes known), insured location, employee, jurisdiction, compensability, or the nature of injury. ASK for the “grades” of your adjusters. Yes, “grades,” some TPAs score or grade the adjusters files each month and post the grades on the bulletin board! You want the adjusters with high grades!  If the adjusters do not have grades above 80, they are sent for remedial training; if their score is > 85 they receive a cash bonus and if higher than 95 they receive a larger cash bonus in their paycheck that month.

 

However, the status reports usually restates the reserves and explains any changes in the reserves, the status of the indemnity benefits, the status of the medical care, the progress in rehabilitation (when applicable), the status of the subrogation claim or second injury fund claim (when applicable), the status of the litigation (when applicable), the action plan and the next report date.

 

In essence, proper claim reporting is designed to provide the claims management of the self-insured employer with all the information needed to properly oversee the workers comp claims, without the claims manager having to actually handle the claims

 

Overcome Catastrophic Claim Settlement Resistance With Support

Overcome Catastrophic Claim Settlement Resistance With SupportAs much as some injured workers’ complain about workers’ compensation, the system has some perks like a nurse case manager and adjuster to help coordinate appointments, deal with the administrative burden, and check in to ensure everything is going smoothly on the claim. Giving up this support can be a paralyzing fear and prevent a claim settlement.  This challenge is particularly true in complex catastrophic cases.

 

The good news is professional administrators are becoming increasingly popular — even Medicare “highly recommends” using them. Some of these organizations are going the extra mile to provide true one-on-one help for injured workers with complicated needs.

 

 

Professional Administrators

 

Professional administrators handle many of the administrative tasks on behalf of the injured worker once they’ve settled their Workers’ Compensation claim.

 

Managing the settlement money, paying medical bills, and complying with government regulations such as Medicare reporting requirements can be a nightmare. The professional administrator acts as an advocate for the injured worker to ensure they successfully navigate the health care system post-settlement.

 

Additional tasks include:

 

  • Finding and setting appointments with appropriate physicians and specialists
  • Taking care of all durable medical equipment needs
  • Ensuring that, at the very least, any payments for medical care don’t exceed the state’s medical fee schedule
  • Deciding whether recommended medical procedures should be undertaken

 

The role of the professional is to guide the injured worker through this process, by

 

  1. Coordinating medical care
  2. Processing medical payments
  3. Applying discounts to medical office visits, medications, and procedures
  4. Performing annual prescription reviews to assess medications that are prescribed
  5. Complying with government requirements
  6. Answering any questions of the injured worker

 

 

Post Settlement Help for Catastrophic Cases

 

While the services of professional administration are a tremendous benefit and offer peace of mind for the majority of injured workers who settle their claims, some need additional help and support. For them, a new service is appropriate.

 

Some professional administrators have developed teams of nurse care partners that specifically focus on injured workers with particularly complex medical situations; those who are brain injured, wheelchair bound, suffering from limb loss and depression and have difficulty with activities of daily living. Despite the shortcomings of the workers’ comp system, many in this situation are hesitant to settle their workers’ compensation claim for fear of losing the system’s support.

 

This innovative solution of providing nurse care partners provides a holistic focus on the injured worker. These partners will engage in conversations with injured workers, providing guidance and support about their treatment plan, medications, upcoming surgeries and any other concerns they have. This discussion allows the injured worker to make informed decisions about their healthcare, empowering them to take control of their lives. Additional benefits they provide include:

 

  1. Ensure monthly supplies of medications are provided on time
  2. Discuss potential post-surgical complications and recovery
  3. Provide insights into the long-term effects of medications and treatments related to the injured worker’s condition
  4. Assist injured worker in understanding their health care options, empowering them to make their own healthcare decisions
  5. Coordinate treatments for any unexpected complications that may arise
  6. Finding solutions to durable medical equipment needs
  7. Identify and discuss potential savings opportunities with the injured worker so they can make their own informed decisions
  8. Provide one-on-one support

 

 

Case Study: Henry* (case study provided by Ametros)

 

Henry* had lost both legs after a severe motor vehicle injury over two decades ago. In addition to his medical issues, he also suffers from depression, anxiety, and Post-Traumatic Stress Disorder.

 

Roadblock to Settlement

 

  • The only thing stronger than Henry’s desire to settle his claim was his concern over losing the support of the nurse case manager with whom he had developed a close relationship throughout the years.
  • He learned of the post-settlement assistance he could receive through a professional administrator and was encouraged to settle, though not fully convinced.
  • He knew he required an extra level of support.

 

Catalyst to Settlement

 

  • What ultimately changed Henry’s mind was learning about Ametros’ Health Navigator service and how its post-settlement care could impact his life.

 

Post-Settlement Care

 

  • As promised, Ametros sent a nurse, Melody, to meet Henry and conduct a wellness assessment in-person to understand all of his wants and needs. She established a direct line with Henry, built a rapport and let him know she would be available to help him navigate the complex healthcare system.
  • Before Henry settled his claim, Melody gathered all the medical information needed to make sure the transition would be smooth.
  • Henry settled his claim last December and Melody continued to act as Henry’s dedicated Care Partner.
  • Since then, Melody has been working with Henry closely. Initially, Henry contacted Melody multiple times each day with questions and concerns she could help address. His contacts are less frequent now, but he has come to trust and rely on her to be his advocate.

 

*name changed for privacy

 

 

Conclusion

 

Knowing that someone will be available to help navigate the complicated healthcare system leads many injured workers with long-standing claims to agree to settle. Now there is an extra layer of advocacy to help the most seriously injured take charge of their lives.

 

 

 

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.

How To Get the Most From A Workers Compensation Claim File Audit

How To Get the Most From A Workers Compensation Claim File AuditSelf-insured employers, insurers, third party administrators, and government entities all use workers’ compensation claim quality audits to measure the performance of the claim adjusters, supervisors, and over-all claim staff. Common uses of claim file audits include measuring compliance with Best Practices, verifying the accuracy of reserves, identifying leakage, preventing fraud, and improving subrogation recoveries. As self-auditing often results in the inability to see the forest due to all the trees, claims management frequently turns to an outside independent claim file auditor to ensure unbiased and objective opinions in the claim audit.

 

 

Both Closed and Open Claims Files Should be Audited

 

Critics of claim file audits often complain that audits are retrospective, as the Best Practices have already been missed or the leakage has already occurred. The critics are correct if only closed files are being reviewed. However, when open claim files are audited, and the audit results are acted on promptly, substantial savings can be had.

 

When open workers’ compensation claims are reviewed, issues that have been missed can often can still be corrected. This is true because once the claim is paid and closed, it is too late to investigate compensability, arrange for an earlier return to work, provide proper medical management, adjust incorrect reserves or negotiate a better settlement.

 

A complete claim file audit not only provides a report on the correct or incorrectness of individual files, but also includes an aggregate report of the various claim handling procedures that have been reviewed. The most common way of tabulating or scoring an audit category is based on 100%. Usually, a score of 90% or higher is considered acceptable, and a score of 95% or higher is considered good. Hence, a score of 96% in the category of medical management would be good, but a score of 76% would indicate a lack of quality in medical management and the need for the adjuster to improve in this area.

 

When the claim file audit is limited to open files, the adjuster/supervisor/claims manager has the opportunity to correct files where an important part of proper claims handling has been missed. In the above theoretical example where the claims office scored 76% in the medical management category, the aspects of the medical management that have been missed could be completed. This would positively impact the overall medical cost of the claim and possibly also reducing the indemnity portion of the claim by getting the injured employee back to work faster.

 

 

Management Benefits By Identifying Weak Spots In Claims Handling

 

By identifying both individual files where claim handling errors occurred and by identifying claim handling categories where either an adjuster is weak or the entire claims office is weak, management benefits in several ways, including:

 

  • Management can focus training resources on specific issues, whether with a single claims adjuster or the entire claims office
  • Data provided can be used by claims management to support the need for procedural changes, additional personnel, or personnel restructuring
  • Reserving data can be used to verify the accuracy of, or the need to adjust coverage underwriting

 

By having an independent claim file audit, the self-insured employer, insurer, third-party administrator or government entity can use the information gathered to improve the overall quality of the claims handling, and in doing so, significantly impact the cost of workers’ compensation claims. For more information on how an independent claim file audit can improve claim quality and reduce the cost of claims, please contact us.

 

 

 

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.

4 Ways to Stay Vigilant On Specialty Medication Costs

The latest trend in medications for injured workers is good news indeed — for the most part. But one tiny area can add up to major dollars. Spending on specialty medications increased 3.8 percent in 2017, according to the latest Drug Trend Report from myMatrixx, an Express Scripts company.

 

The fact that these drugs represent less than 1 percent of all medications used by injured workers is by no means a reason to overlook them. Because of the high costs associated with specialty medications, payers need to stay vigilant in understanding and addressing this small but growing segment of pharmacy spend.

 

 

The Issue

 

HIV, osteoarthritis, high cholesterol, and hepatitis C are among the comorbidities that require prescriptions for specialty medications. Just over 2 percent of injured workers used one of these drugs last year, accounting for 0.6 percent of all prescriptions filled and 6.3 percent of total pharmacy spend.

 

The most used specialty drug for injured workers in 2017 based on per-user-per-year spend according to myMatrixx, was Truvada®, used to treat pre-exposure to HIV. The cost per Rx was $1,019.11. The overall use of medications to treat HIV increased by 17.6 percent — not too surprising considering the need for them to treat workers with occupational exposure to needle sticks.

 

However, the use of medications to treat osteoarthritis rose 21.6 percent, while the cost per prescription increased 1.1 percent. The medication Synvisc had increased utilization of more than 58 percent. Driving the increase was likely the fact that workers may use the drug for repetitive stress injuries caused by activities that stress the knee joint — squatting, kneeling or lifting heavy objects.

 

The most expensive medication on the top 10 list is Epclusa®, with a price tag per Rx of $24,510. However, the drug has been hailed as curing the disease.

 

 

Affected Workers

 

Workers in a variety of occupations may need specialty drugs.

 

  • Medical workers may contract HIV and hepatitis C from blood-borne pathogens due to exposures to needlesticks.
  • Coal miners are at risk of black lung disease
  • Outdoor workers are vulnerable to Lyme disease.

 

Other reasons workers may need specialty drugs include postoperative blood clots and organ failure.

 

 

The Drugs

 

The top 10 specialty medications for 2017 according to myMatrixx were:

 

Drug                           Therapy Class

Truvada®                    HIV

Isentress®                   HIV

Synvisc-One®            Osteoarthritis

Xolair®                       Asthma

Enbrel SureClick®     Inflammatory conditions

Enoxaparin                  Anticoagulant

Repatha SureClick®   High cholesterol

Enbrel ®                     Inflammatory conditions

Xyrem®                      Anti-cataplectic agents

Epclusa®                    Hepatitis C

 

 

What to Do

 

It’s important for claims handlers and injured workers to have a clear understanding of how and why they are using these medications. They often require special handling instructions, for example. While denying a specialty medication to an injured worker in need would not be prudent, organizations can rein in costs and prevent overutilization by ensuring the drugs are used appropriately and judiciously.

 

  1. Train. Injured workers and those involved with the claim should know what side effects may be present with each specialty medication. Injured workers should be well informed about self-administering the medications.

 

  1. Monitor. These injured workers often need ongoing clinical monitoring and more intensive help from pharmacists and other caregivers to ensure they are taking the medications as prescribed, as patient adherence is crucial.

 

  1. Use specialists. Specialty pharmacies are better equipped and should be utilized for handling these medications, as they typically offer services not available at retail pharmacies. For example, on-staff nurses and physicians who are experts in the conditions and treatment are likely to be available only in specialty pharmacies.

 

  1. Engage physicians. Nurse case managers and other caregivers should work with treating physicians to make sure the injured worker is getting the proper medications and treatment. Some medications, including Repatha for high cholesterol, are appropriate only for a small number of patients and must be appropriately managed for patient safety and costs. Cancer medications are not usually included in workers’ compensation formularies and therefore may require prior authorization.

 

 

Conclusion

 

Specialty medications represent just a fractional component of prescriptions filled by injured workers, yet their costs can be nearly prohibitive. Since they offer an important lifeline for injured workers who truly need them, it’s important to see they are prescribed only where appropriate and are taken as prescribed.

 

 

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.

After Traumatic Injury, Workers’ Comp Can Thrive and Other Top News Tidbits

After Traumatic Injury, Workers’ Comp Thrives with This Return-to-Work Strategy

A workplace accident can leave a worker with a spinal cord injury, an amputation, severe burns or a brain injury, turning their world upside-down. The physical toll is obvious if a worker is missing a limb or immobile. But the psychological hurdles often are hidden.

Recovery can be fraught with emotions, fear and anger among them. This complicated tangle — and the way a person handles it — can reduce the odds that a person will ever re-enter the workforce.

 

 

Facetime with PhilFacetime With Phil — All About NSAIDS — A Category Of Drugs That Can Be Used To Treat Pain

All NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) cause side effects to a certain degree. It is important for a prescriber to look at a patient holistically in determining what version of the drug is right for them. Join myMatrixx Chief Clinical Officer Phil Walls in his discussion all about NSAIDs, which takes a deeper dive into these type of drugs and how to determine what is the best choice for an injured worker.

 

 

Ringler Radio: Inside the Post-Settlement Process

The post-settlement process can be complex, especially when it comes to medical care for injured parties and their families. Finding a reliable team of people to make the process seamless is key. RinglerRadio host, Larry Cohen with Porter Leslie, President of Ametros, and Attorney Paolo Longo, Jr., a partner in the Orlando office of Bichler, Oliver, Longo & Fox, discuss how to simplify ongoing medical expenses and ease the hassle of the healthcare system.

 

 

Tower MSA Partners’ focuses its WCI-TV segments on settling claims

For the fourth consecutive year, Tower MSA Partners is sponsoring WCI-TV, the televised coverage of WCI 2018. “Our theme this year is ‘Knocking Down Barriers to the Settlement of Claims,’” said Dan Anders, Tower’s Chief Compliance Officer.

Unreasonably high pharmacy costs, inappropriate use of opioids and other drugs, vague references to possible future surgeries, and jurisdictional challenges pose some of the common obstacles to settling claims. In other cases, injured workers are afraid of exhausting their settlement dollars or losing the support of their adjuster or nurse case manager.

 

 

Dehydration and Heat Stroke

Dehydration and heat stroke are two very common heat-related diseases that can be life-threatening if left untreated. What is dehydration? Dehydration can be a serious heat-related disease. It is also a dangerous side effect of diarrhea, vomiting, and fever. Children and people over the age of 60 are particularly susceptible to dehydration. What causes dehydration? Under normal conditions, we all lose body water daily through sweat, tears, breathing, urine, and stool. In a healthy person, this water is replaced by drinking fluids and eating foods that contain water.

 

 

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.

3 Reasons and 5 Ways to Speed Up Workers’ Comp Claim Lag Time

3 Reasons and 5 Ways to Speed Up Workers’ Comp Claim Lag Time

Determining lag time is one of the easiest things to measure in workers’ compensation. Yet many organizations put little if any effort into it. More than likely they don’t see the value in tracking that particular metric.

 

But those that do report better outcomes for their injured workers and significant dollars saved for their bottom lines. There’s substantial research to back them up.

 

 

Why Workers’ Comp Claim Lag Time Matters

 

Lag time refers to the time period from the moment of injury until it is reported to the insurance carrier. For example, if an injury occurs on Oct. 1 and the insurer receives notice of the claim on Oct. 3, the claim will have a report lag of two days.

 

Tracking a company’s lag time is fairly simple, since every claims handler or adjuster has the information. The goal is to have shorter lag time, as several studies reveal tremendous cost differences.

 

Kemper Insurance Study

 

Kemper Insurance did a study and found that a claim reported within 30 days is 48 percent higher on average than a claim reported within 10 days of an injury.

 

 

The Hartford Insurance Study

 

The Hartford looked at 53,000 permanent partial and temporary claims and found the cost of a claim increases with each passing week before the incident is reported. Compared to an injury reported within week:

 

  • Within 2 weeks the claim was 18 percent more expensive
  • Within 3 weeks the claim cost 29 percent more
  • Within 4 weeks there was a 31 percent cost difference
  • Within 5 weeks, the claim was on average 45 percent more expensive

 

 

NCCI Study

 

NCCI’s study found “the closure ratio — the ratio of the number of claims closed within 18 months of the report date to the total number of claims — is inversely related to the median claim cost … the highest closure ratios are for claims reported in Weeks 1 and 2. Claims reported after Week 2 are less likely to be closed at 18 months…”

 

The study also found that median claims costs were lowest for claims reported after the day of the accident but within two weeks. It noted that claims reported on the actual day of the accident can be costly, as these are often the most serious injuries and require emergency care.

 

Additionally, longer lag times were associated with:

 

  • Greater attorney involvement —12.8 percent after more than 1 week, increasing to 148 percent more than 5 weeks after injury.
  • More use of lump-sum payments
  • Lower paid-to-incurred ratio at 18 months
  • Lower closure rate at 18 months.

 

The data indicates that claims with a lag time of more than two weeks are more complex, take longer to close, and have longer disability durations.

 

 

Why Workers’ Comp Claim Lag Time Is Important

 

There are many possible reasons that increased lag times result in increased costs. Experts speculate some include:

 

  1. An injured worker may visit a primary care physician rather than an occupational physician who understands return-to-work and other elements of the workers’ compensation system.
  2. The worker may feel he and his injury are being ignored, that the company doesn’t care about him. That could drive him to seek an attorney.
  3. Quicker reporting means faster medical treatment which results in faster RTW rates.

 

Tracking lag time helps you and others at your organization better understand how well your program is working. You can use it, along with the available research to show the cost savings you are achieving by having shorter lag times.

 

Organizations with multiple divisions can compare the lag times for each to show which are doing a better job of getting injuries reported quicker.

 

Improving Workers’ Comp Claim Lag Time

 

Getting injuries reported to the carrier as quickly as possible takes a concerted effort and should be embraced by everyone in the organization. The employee needs to report the injury immediately and the supervisor must complete the necessary paperwork to get the report to the carrier as soon as possible. Senior managers should consider the issue a priority as well.

 

Getting the buy-in of all involved takes some education, so everyone understands the value in shorter lag times and the process required. Injured workers should be made aware that reporting an injury sooner means they will get medical attention and care they need immediately. Supervisors and managers need also to understand the financial impact of shorter lag times.

 

There are several ways to ensure better lag times:

 

  1. An employee brochure. This should explain the workers’ compensation process and be provided to all personnel.
  2. One-pager. A short notice that explains the process for reporting an injury should be available to all employees. It can be posted in areas where workers congregate, placed in company vehicles, and even provided on the back of a lanyard.
  3. Employee training and retraining. In addition to providing written material, new hires should undergo training on proper incident reporting. This should be repeated as retraining annually.
  4. Supervisor education. All supervisors and managers should be well versed on the process required once an employee reports an injury. This can even be part of their performance reviews.
  5. Make it easy. A complicated reporting process is more likely to incur longer lag times. There should be a single contact within the organization to report injuries when a supervisor or manager is unavailable, such as a single phone number.

 

 

Summary

 

Improving and tracking lag time are fairly simple processes and can have a tremendous impact on the company’s bottom line. The sooner an injury is reported, the sooner the worker will receive medical care and return to work, and the better off the organization will be.

 

 

 

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.

Effective Workers’ Comp Claim Investigation Techniques

Effective Workers’ Comp Claim Investigation TechniquesMembers of the claims management team are called upon to investigate claims and make determinations of primary liability and the necessity of medical care and treatment.  This requires them to perform tasks on numerous occasions quickly and effectively.  It also includes the ability to be creative while cost-efficient.  Here are some tips to consider in order to succeed at this difficult task.

 

 

Obtain the First Report of Injury

 

The FROI contains important pieces of claims information that can be useful when starting an investigation on a claim.  While the information might not be accurate, it can lead to important information on the background of a claim.  Information to obtain from the FROI include:

 

  • Body parts injured during the incident;

 

  • Names and addresses of medical providers related to the work injury;

 

  • The mechanism of injury;

 

  • Location of the injury; and

 

  • Potential witnesses.

 

While the FROI is not necessarily accurate, it can be valuable for claim development purposes.  It can also assist when it comes to understanding inconsistencies in the claimant’s recorded statement and future deposition.

 

 

Other Accident or Injury Reports

 

In many instances, there are other accident or injury reports that are generated following a work injury. This can include reports from the owner of the premises at which the injury took place, reports from law enforcement and emergency medical service providers and other interested parties.  Information obtained from these reports can move a claim investigation forward in a cost-efficient manner as they are usually free to obtain.

 

Accident reports also contain additional information that is helpful to an investigation.  This includes photographs and videos of the incident.  Information received from these reports can be priceless, especially if they contain information that contradicts allegations made by the injured worker.

 

 

Recorded Statements of the Employee

 

Most jurisdictions allow the workers’ compensation insurance carrier to take a recorded statement of the employee following a work injury.  It is important to follow the applicable statutes or rules to preserve evidence for future use.  A well recorded statement should follow a script to ensure all important questions are asked.  A seasoned member of the claim management team will also learn how to probe for information in a friendly and courteous manner.  When taking a recorded statement, listen carefully to what is being said and ask probing questions.

 

 

Authorizations for Medical and Other Records

 

Although workers’ compensation claims investigations are generally excluded from state and federal health care privacy laws, it still remains important to obtain properly executed authorizations when requesting medical, employment and other records.

 

  • Medical: It is important to obtain a complete set of medical records for an injured party.  This should go beyond what is directly related to the work injury.  Obtaining a complete set of medical records can lead to other areas of investigation and allow your independent medical examiner to have a complete and accurate background of a claimant.

 

  • Employment: These records are used for a variety of reasons.  Not only will it serve as a source to calculate the employee’s average weekly wage, but it will also allow one to understand an employee’s transferable job skills better and identify areas of vocational limitation.

 

  • Industrial Commission: Records regarding prior workers’ compensation claims are generally stored at a state’s industrial commission.  These records include not only details of prior workers’ compensation claims, but the names of former employers and medical providers.

 

 

Other Sources of Investigation

 

There are countless other areas to investigate as part of any workers’ compensation claim.  Sources of research and investigation should include:

 

  • Social media: Checking to see public activity a claimant has on social media is a must. Be cautious as ethical and legal issues can arise when claims investigation break laws to trick someone into giving you access to their accounts.

 

  • Central Index Bureau Check: This is a clearinghouse where insurers and self-insured companies file reports of claims. It allows members to later search for information on prior injury claims based on one’s name and Social Security number.  Costs may apply for these searches.

 

  • Surveillance: This is another tool that can be used. However, there can be significant costs associated with the hiring of a private investigator to research background information on a claimant and take undercover video.

 

 

Conclusions

 

The modern workers’ compensation claim handler needs to be creative when it comes to investigating a claim.  Technology has provided them with numerous resources to obtain information quickly, and in a cost-effective manner.  Performing a diligent investigation can reduce program costs and limit claims litigation.

 

 

 

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.

5 Workers’ Comp Communication Strategies to Ramp Up Your Program

5 Workers’ Comp Communication Strategies to Ramp Up Your ProgramDo you ever feel like the message just isn’t getting through to employees about your workers’ compensation program? They don’t understand what to do if they are injured, don’t seem to trust you or the company to do right by them, and have unrealistic expectations?

 

You’re not alone. Those are some of the biggest challenges employers cite in implementing their injury management programs. Thankfully, several low-cost, easy-to-implement strategies can ensure your workers understand the system and are on the same page with you.

 

 

Why Communication is Important

 

In addition to the frustrations that you feel when communication with injured workers is not smooth, it also costs you money. Research studies show a direct link between poor communication and workers’ compensation claims outcomes.

 

For example, Liberty Mutual found a decided difference in outcomes when supervisors responded positively rather than negatively to a worker reporting an injury. Positive responses, along with an injury triage system to report injuries were associated with an average of 40 percent lower claim costs and 58 percent shorter disability durations.

 

Supervisors’ responses that were deemed as ‘negative’ and drove poor outcomes included:

 

  • Lack of support
  • Blaming the worker
  • Expressing anger
  • Questioning the validity of the injury
  • Encouraging the worker not to file a claim

 

Positive outcomes were reported when the supervisors were flexible and open to talk with the worker, responded quickly, and expressed genuine interest in the worker’s overall well-being. Setting realistic expectations was cited as one of the most important best practices to communicate well with the injured worker.

 

Return-to-work coordinators said they were most effective in their jobs when they practiced:

 

  • Active listening
  • Communication
  • Ability to relate well to other stakeholders
  • Problem-solving
  • Having confidentiality

 

These so-called soft skills were more strongly associated with positive outcomes than having technical knowledge of the workers’ compensation system. The first step to change supervisors’ negative responses to positive ones is to show them the financial impact each has. Beyond that, there are several ways organizations can demonstrate genuine caring for their injured workers.

 

 

Effective Communication Strategies

 

Injured workers need to have at least a general understanding of how the workers’ compensation process works. This can be accomplished through

 

  1. Employee brochure. This proactively sets employees’ expectations in the event they are injured. It should communicate briefly how the program works, including the transitional duty program and RTW. It should clearly state that the company will take care of them and help them return to work. It should be written in a positive tone.

 

  1. Wallet card. Once an employee does become injured, he most likely will have forgotten the details in the employee brochure. A simple wallet card or posted notice should be readily available and should explain the post-injury steps:

 

  • How to report the claim
  • How and where medical care will be provided
  • The RTW process
  • Expectations for weekly meetings with you and/or others

 

Injured workers are often frightened and confused. The actions undertaken immediately following the injury set the tone for the entire process. Several tactics put the claim on the path for a positive outcome.

 

  1. First-day phone call. If a friend has been in an accident or is suddenly injured, you would probably contact him to let him know you are thinking about him, find out how he is doing and see if there is anything you can do to help. Injured workers are no different. A supervisor, or manager who has a positive relationship with the worker should call the worker as soon as possible, preferably the first day. The conversation does not need to be more than a few minutes, but it should include messages such as

 

  • We are sorry this happened
  • We want you back at work as soon as you are able
  • How are you doing?
  • Do you need me to contact your family, bring you anything you may have left at work?
  • Are there any questions about the workers’ compensation process I can answer for you?

 

The person making the call should make sure the worker knows what to expect — whether a claims adjuster and/or case manager will be in contact, how medical care will be provided for him, and that his job will be waiting for him when he returns.

 

  1. Get-well card. In addition to the initial contact from the supervisor or manager, coworkers should also convey their well wishes to the injured worker. The easiest way to do this is by sending a simple get well card, signed by the worker’s colleagues. Their messages can be simple expressions of support.

 

  1. Weekly Meetings. Communication with the injured worker should not stop after the initial contact. There should be ongoing, regular meetings via phone or in person if possible. these conversations serve two purposes:

 

  1. They let the injured worker know you are there to help.
  2. They help you gauge how well the worker is recovering.

 

These conversations should continue to express well wishes and focus on the worker’s progress. The supervisor or manager can ask:

 

  • How the worker is doing
  • How his medical care is going — whether he likes his providers and if they are responsive to his needs
  • What activities he is or is not able to do
  • What questions or frustrations he may have

 

 

Conclusion

 

The workers’ compensation system has many moving parts and complications. By communicating well with injured workers, you can eliminate many of the frustrations and realize better outcomes and lower costs.

 

 

 

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.

Powerful Work Comp Claim Strategy Because You DO NOT Know Everything

You don’t know everything about workers’ compensation. You do not know everything about workers’ compensation. And neither do I. Hello. My name is Michael Stack, CEO of Amaxx. If you’re going to accept that statement, that no one really knows everything there is to know about workers’ compensation, then you can do very well with a concept that I’m going to be teaching today, which is the weekly claims roundtable.

 

 

Leverage Shared Knowledge to Drive Positive Outcomes

 

Workers’ comp could be very simple, but it could also be very complicated, particularly as you get into individual claims handling. The biopsychosocial factors, the additional risk factors, the environmental factors. All these complicated things that go into making us up as individuals, as humans, throw in an injury, throw in a whole bunch of different stakeholders, and you can have a very hairy and complicated claim and trying to figure out the exact best thing to do with that particular individual can often be a daunting task.

 

Let me tell you about this weekly claims roundtable. It is an extraordinarily effective system to partner with your claims handling team, to be able to tackle these very complicated claims and come up with a plan to properly handle them to create the best outcome at the lowest possible cost.

 

 

Weekly Claims Roundtable Agenda

 

Let me give you a real quick agenda and tell you exactly how this can work so that you can implement this strategy within your organization. Three things that you’re going to cover, and this is the basic agenda:

 

  • Basic claim information
  • Claim status
  • Action plan

 

This is your three-part agenda for your weekly claims roundtable. Discussion in each claim should last between five and 15 minutes, tapping into the expertise, tapping into the experience, tapping into the prospective of your claims handling team, which could include your employer, it certainly could include your insurance broker, your insurance adjuster, your claims handling account representative from that organization, it could be a medical advisor, it could be an attorney, it could be other relevant stakeholders as it makes sense. But that’s the basic … That’s the core group of individuals that are going to be meeting on a weekly basis to go over these claims, five to 15 minutes. Come prepared to knock these things out and talk about this action plan.

 

 

Share Ideas & Perspectives to Create Plan For Best Claim Outcome

 

Let’s review this agenda very quickly. Basics. What’s the basic claim information? What’s the name? What is the date of the injury? What type of injury? Where does this claim kind of currently stand? What is the status? Is this individual back to work? Are they not back to work? How many days have they missed? How many days have they been on modified duty? Do they have a surgery coming up? Are they going through physical therapy? Are they seeing a specialist? Whatever that current status is of where this claim currently stands. Then, finally, talking about the action plan. Based on where this thing currently stands, based on what’s going on in the claim, let’s discuss as a group, share ideas, share perspectives, share experiences, share knowledge to create the best possible action plan to create the best possible outcome.

 

Implement this weekly claims round table in your organization. Start small. Start with a handful of claims. Start with your most difficult claims and build from there. Because, remember, your work today in workers’ compensation, it can have a dramatic effect on your company’s bottom line. But it will have a dramatic impact on someone’s life. So, be great.

 

 

 

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.

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