Plan for a Happy New Year with Safety First

A safe workplace should be the hallmark of every successful workers’ compensation program.  Changes made to improve workplace safety should never be static.  Changes followed by monitoring and constant improvement must only boost workplace morale and reduce workplace injuries in the new year.  Here is a list of changes that can be made to improve safety and lower workers’ compensation program costs.

 

  1. Commitment to Safety by All Interested Stakeholders: Companies with lower work injury rates are successful because leadership has made a commitment to providing a safe workplace.  This commitment includes a message being delivered from upper management, and consistent implementation.  Leaders who practice what they preach see buy-in from the workforce.

 

  1. Constant Review of Safety Practices and Procedures: Policies are only as good as the piece of paper they are written on.  In some instances, a policy may sound like a good idea but is not practical upon its implementation.  All policies should be subject to review on a quarterly basis.  Input should also be solicited from the people who are impacted the most – the employee.  Allow everyone to be a part of the process.

 

  1. Review Workplace Ergonomics: Those interested in reducing workplace injury should have all work activities reviewed for proper ergonomics.  This includes a review of activities performed on the production line and front office.  While it might take an investment of money, the possibility of a profitable return in terms of lower workplace injuries pays dividends.  Simple fixes include having employees limit repetitive motions, installing proper flooring, mating, and lighting.  Cross-training also adds value to an employee’s knowledge and value.

 

  1. Install Proper First Aid Kits: All employees should have access to proper first aid kits.  They should be stocked to fit a variety of common work injuries and monitored to make sure they are replenished in a timely manner.  This should be done on a monthly basis when other safety equipment is checked, such as fire extinguishers.  Consider adding advanced life-saving equipment such as portal defibrillators in the workplace, and make sure everyone knows how to use and operate them.

 

  1. Review Workplace Safety Plan: All workplaces should have a safety plan in place.  This includes worksites that are not required to have them.  Start the new year off on a positive note to make sure it is updated, and all employees are aware of what to do.  This includes incidents such as fires, severe weather, and active workplace intruder situations.  All exits and egresses should be secure and properly marked.

 

  1. Review Workers’ Compensation Policies and Procedures: All employers should make their employees aware of procedures related to work injuries.  This includes basic information such as how to properly report a work injury, why it is important to report incidents in a timely manner, and contact information for the insurance carrier.  Managers should also receive instruction on how to report a work injury to the insurance carrier, along with other responsibilities.  Additional steps should also be taken to make employees feel comfortable when reporting a work injury.  Emphasize a zero-tolerance policy when it comes to harassment, intimidation, and discrimination when an employee reports a work injury.

 

 

Additional Steps for Workplace Safety

 

A safe workplace also includes proper instruction for management.  This includes providing managers with information on the following issues:

 

  • Common workplace injuries, and steps to take to prevent them from occurring;

 

  • Communication of safety-related issues at all team meetings; and

 

  • Points of emphasis when it comes to a safe workplace.

 

 

Conclusions

 

A new year is coming, now is the time to re-commit yourself and company to a safe workplace.  A commitment to safety starts from the top and trickles down to all employees.

 

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

The A B C’s of Workplace Safety

There are many ways interested stakeholders can reduce workers’ compensation costs in their programs.  Running a more effective program and reducing costs starts with a safe work environment that can be as simple as the A B Cs…

 

Avoid unnecessary risks in the workplace.  Educate all workers on how to be safe.

 

Be aware of common pitfalls that drain program costs.  This includes not making sure all employees are aware of safety.

 

Caution all employee’s to be careful during the workday.

 

Do not delay in reporting work injuries.  Provide resources for employees to report claims and provide appropriate First Aid.

 

Employers are usually the party required to complete the state-mandated First Report of Injury.

 

Falls in the workplace lead to serious work injuries.  Always make sure employees are provided with the proper safety equipment.

 

Get an ergonomic workplace assessment for all employees.  Repetitive use injuries are common in any occupation or job.

 

Help all injured employees in their return-to-work efforts.  Studies show the best way to reduce workers’ compensation costs is to get people back in the workforce as soon as possible.

 

Idiopathic work injuries are generally not compensable.  A careful investigation is required to determine if this is the case, so liability can be denied in a timely manner.

 

Just because an employee claims a work injury does not mean it is always compensable.  A proper investigation starts immediately after the injury occurs.

 

Keep your First-Aid kit properly supplied.  This can be the responsibility of a safety committee member to check safety supplies frequently.

 

Letting garbage sit around the workplace can result in injuries.  Encourage all employees to clean up messes – even if they are not responsible for it.

 

Making safety rules is important, and the first step to avoiding work injuries.  The next step is consistently enforcing them for all employees.

 

Never miss a deadline when it comes to filing a workers’ compensation document.  Failure to do so can result in penalties assessed to a workers’ compensation program, higher insurance premiums, and the payment of additional benefits.

 

Open blades and moving machinery are dangerous.  Make sure all safety equipment is in place and functioning correctly on a daily basis.

 

Prepare for all types of emergencies – think outside the box.  What is your company’s safety plan to deal with severe weather, workplace violence, harassment, or acts of God (e.g. – flooding, earthquakes or tornados).

 

Questions need to be asked constantly to improve workplace safety.  A safety officer or committee can be a great resource for employees wanting to learn more.

 

Required workplace safety posters alert employees to common dangers.  Some of the required posters are available to employers for free through state labor and industrial commissions.

 

Set up regular safety training.  While it is important for new employees to learn about the dangers of a workplace, it is especially important for even seasoned employees to be made aware of ongoing risks and dangers.

 

Talk about workplace safety at every company meeting.  This not only reinforces important messages, but it demonstrates a stakeholder’s commitment to safety.

 

Unlit areas and workplaces are dangerous.  This can include slips/falls and even eye strain.  Make sure that all employees have adequate lighting.

 

Violence in the modern workplace is an important issue to address.  This includes teaching employees how to recognize the signs of depression or isolation in a coworker.

 

Walkways and stairwells are common places for injuries.  It is important to make sure these surfaces are free of debris and have proper lighting.

 

Xerox machines can cause work injuries.  Yes, even paper cuts could be compensable.  Make sure all cuts and wounds are properly irrigated and bandaged.

 

You play an important role in workplace safety.  Never pass up the chance to improve your workplace.

 

Zzzzzzzzz.  Getting a good night’s sleep is important.  Countless work injuries are the result of employee drowsiness.

 

Everyone needs to make a commitment to workplace safety.  It not only reduces workers’ compensation costs but also promotes workplace morale.

 

 

 

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: http://blog.reduceyourworkerscomp.com/

 

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

 

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

4 Quick Tips to Get Adjusters to Follow Account Handling Instructions

For more training, register for:

HOW TO SCRIPT WINNING ACCOUNT HANDLING INSTRUCTIONS

Registration: How to Script Winning Account Handling Instructions

 

 

A well-done set of account handling instructions can be the very foundation on which a highly successful employer and claims handling organization can work together as a partnership to drive positive injured worker outcomes and drive down workers’ compensation costs. Hello, my name is Michael Stack and I’m the CEO of AMAXX. While that statement is true about the account handling instructions, if they’re not followed, they’re not worth the paper they are printed on. If they’re not followed, they are not worth the paper they are printed on. So, the question then becomes, if you put in the time to create this great set of beautiful account instructions that no one is following, what good are they?

 

 

Adjusters Need to Follow Account Instructions

 

And then the second question is, how do you actually get adjusters to follow those account instructions? I’m going to give you a couple of quick tips here. To dial into some of this mindset of how to approach this and how to make them just that more effective so they can, in fact, be that foundation which we talked about earlier.

 

So I want to give you three quick tips here about how to design these and then how to get cooperation from those adjusters. Three things you want to make them clear, you want to make them concise. And number three, you want to make them easily understood, clear, concise and easily understood.

 

Many companies will have 10, 20, 30, 50, or 60 pages worth of account instructions. And when you are the one that wrote them and participated in writing them and you look at them and you’re overwhelmed and have a difficult sometimes understanding what the heck is in those, the chance of your adjuster team, being able to pick them up and understand and be able to execute on them effectively is very, very low.

 

 

Clear, Concise, and Easily Understood

 

So make them clear, make them concise and make them easily understood. When you’re designing those, take a look at what you have. If it’s this thick, you’re not going to be effective and you need to dial that in to sharpen it up and you need to take another look at it with these three things in mind.

 

And then the other question on this is if you are wanting to get participation from your adjuster team when you’re designing this, ask for their input, ask for their input. When you are designing these and finalizing them, if you can get some cooperation in the beginning of this partnership from that claims handling team, when you’re designing them, clear and concise and trying to make them understood, maybe there’s stuff that you think, Oh, that’s obvious as can be. But to them it just doesn’t, it just doesn’t make a lot of sense in how we would actually function.

 

 

Work Successfully Together

 

Get that input from your claims handling team, dial these things in together, and then you can build that partnership together and work successfully together. And again, my name is Michael stack. I’m the CEO of AMAX. And remember your work today in workers’ compensation can have a dramatic impact on your company’s bottom line, but it will have a dramatic impact on someone’s life. So be great.

 

 

 

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: http://blog.reduceyourworkerscomp.com/

 

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

 

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

The Clear Indicator To Start Working on Settling a Workers’ Comp Claim

 

For more in-depth Settlement Training check out:

 

THE PROCESS TO SUCCESSFULLY SETTLE MORE WORKERS’ COMP CLAIMS

https://workerscomptraining.com/registration-settlement/

 

 

There is a point within the Thanksgiving dinner when you know you have had too much.

 

Hello, my name is Michael stack and I’m the CEO of AMAX and happy Thanksgiving to everyone. This Thanksgiving week as we celebrate this great holiday where we come together as a family, give thanks and also have a really great meal. But there is that point when you say, hey, I have had too much Turkey, too much stuffing, too much mashed potatoes and gravy, and your body gives you that very clear indicator that that’s enough and you need to do something else, some other course of action needs to happen.

 

 

Need to Have Clear Indicator to Start Settlement Process

 

Similar in workers’ compensation, we need to have these very clear indicators when we’re talking about settling a case. That’s the context of today’s training, settling a case. What does that clear indicator that we need to start thinking about it? So where’s that clear indicator we need to start thinking about, okay, boom, that’s enough Turkey. Okay, boom. That’s the indicator that my case is ready to be thought about going on this path towards settlement. And how many put some of those wheels in motion?

 

So I want to talk with you today about those very clear indicators of what they are so that you can start and have that very clear indication, that very clear trigger that now we need to start thinking about settling this case and the first one that I want to give you is that the individual is consistent and stable, so consistent and stable and this is in their medical treatment and in their prescriptions; and their pharmacy and how that treatment, that course of treatment is going. So, if there’s a surgery coming up or they just recovered from a surgery, not a great time to start thinking about settling. They’re still within this process. They’re still within what we have guaranteed in the work comp industry that we’re going to take care of these people to get them to this phase, to get them consistent, get them stable in their medical and in their pharmacy.

 

 

Consistent and Stable in Medical and Pharmacy

 

Indicator number one is that they’re consistent and stable and that is that same thing when you say, whew, that’s enough Turkey, that’s enough stuffing. It’s very clear for you. This should be very clear for your work comp cases as well that they’re consistent and they are stable within this bucket. I’m not even going to give you any more because I want to have this be such a very clear indication. This is also the time to start thinking about your Medicare Set Aside as well. Your MSA. This is the time when to reach out to your MSA vendor, have them start getting engaged in this process as well, and then as you start moving along this further process of settlement, you’re engaging your settlement advisors, you’re engaging your post settlement administrator, your professional administrator within this process.

 

There’s a lot more to this, this early identifier is just the tip of the iceberg in this four-step process to settlement, and I want to encourage you to check out this full-length training.

 

 

THE PROCESS TO SUCCESSFULLY SETTLE MORE WORKERS’ COMP CLAIMS

https://workerscomptraining.com/registration-settlement/

 

 

Successfully Settle More Cases

 

It’s very valuable to really get this consistent process cooking along called the process to successfully sell more cases. You’ll see a link below to order to check out that course. It’s a tremendous course dialing into this. This is the first step indicator that they’re consistent and that they’re stable. If you can have that clear indicator, then start the recipe and start that roadmap towards settlement.

 

You will drive more successful win-win outcomes for your work comp cases. My name is Michael Stack and I’m the CEO of AMAXX. Happy Thanksgiving to everyone. I hope you enjoy a great holiday this week!

 

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

Properly Designing and Implementing Transitional Duty Program Ensures Success

return to workThe 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.

 

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

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

creeping catastrophicWe 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:

 

 

 

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.

 

 

 

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: http://blog.reduceyourworkerscomp.com/

 

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

 

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

Look to Rated Ages For Realistic Settlement Amounts

rated agesA 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.

 

 

 

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: http://blog.reduceyourworkerscomp.com/

 

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

 

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

Use Orebro Pain Questionnaire to Prevent Creeping Catastrophic Claims

 

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.

 

 

 

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: http://blog.reduceyourworkerscomp.com/

 

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

 

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

Dealing with Idiopathic Injuries

Dealing with Idiopathic InjuriesMembers 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.

 

 

 

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: http://blog.reduceyourworkerscomp.com/

 

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

 

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

What To Do If You Have An OSHA Inspection

osha inspectionThe 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.

 

 

 

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: http://blog.reduceyourworkerscomp.com/

 

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

 

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

 

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