Blog - Work Comp Roundup

Create a Safety Action Plan

January 15, 2020 by Michael B. Stack

Engaged employers need to keep a continual eye on safety within the workplace. According to the National Safety Council, 85 percent of all accidents could be prevented or reduced by having an effective safety program. To reach a high level of safety effectiveness a safety action plan is required. By creating a safety action plan, you remove the potential hazards and take the necessary actions to eliminate the hazards.

Taking the First Step: Hazard Identification

Safety concerns and hazards can be found in all types of workplaces. The safety manager will recognize many, but even safety professionals do not recognize all hazards. The loss runs produced by your insurer or third-party administrator is an excellent source to identify hazards that you might not think about and overlook. All company personnel should be encouraged to report any hazards they identify that have not been addressed by the safety manager. There are various types of hazards including:

Physical hazards: Machinery without guards, tow motors without back up sound warnings, inventory stacked haphazardly or too high, tools or equipment left where an employee could trip, etc.

Ergonomic hazards: Equipment or machinery placed incorrectly whether too high, too low, out of comfortable reach; processes that require the employee to twist back and forth; or that cause constant repetitive motions by the employee.

Chemical hazards: Improper ventilation, vapors from chemical processes, improper use of combustible materials.

Biological hazards: In the medical field, the improper disposal of needles and medical waste.

Taking Responsibility for Safety Issues

Every employer should treat safety as their responsibility and engage all employees in the process.

The employer should go a step further and hold the department supervisor or manager responsible for identifying the hazards within their work area.
The department manager should be given the authority to take the necessary actions to eliminate the hazards within the area of responsibility.

The next step in a safe workplace needs to be taken by management in eliminating the identified issues. The department manager must follow through and create an action plan to deal with the hazard. Some hazards can be fixed rather easily. For example, an action plan for the haphazard stacked inventory – unstack the inventory and stack it correctly. Other hazards will take planning and resources. This includes issues such as worn-out conveyor belt that poses a snag hazard for the employees. The hazard needs to be reviewed with the safety manager, and a plan to remove the hazard needs to become an immediate priority.

Implementing Safety In your Workplace

Whatever the nature of the hazard, once it is identified, timely, and appropriate action to remove the hazard is required. When a course of action can be implemented immediately, it should be. When the course of action has several steps, the implementation should be scheduled with a completion date set for each step to be implemented. The implementation and completion of the necessary course of action will reduce the risk of injury to the employees and reduce the company’s exposure to financial loss.

Removal or remediation of safety hazards require the following:

Use of financial resources;

Management taking necessary action to provide resources; and

Employees themselves will place a higher priority on safety.

Every action regarding workplace safety also required follow-up, refinement, and improvement. When a hazard is identified within one location within the company, the safety manager should check to see if the same hazard exists at other locations within the company. When the hazard exists at multiple locations, the hazard should be identified to all employees. The action plan and implementation of the action to remove the hazard should be completed.

The process of implementing a safety plan requires the creation of a list of potential hazards. This can be very helpful in the elimination of future hazards. The list of hazards can become the foundation of a safety inspection checklist:

Review of housekeeping policies to ensure slips and slippery surfaces receive immediate attention;

Proper instruction on handling large objects and heavier items that need to be moved;

Proper storage of all materials, especially chemicals and corrosive substances; and

Instruction of self-aid/first-aid and reporting workplace injuries.

Conclusions

A safety action plan is not a one-time occurrence, but an on-going process to prevent new hazards from developing and to prevent old hazards from returning. By having a safety action plan, you can reduce both your physical losses and your cost of workers’ compensation.

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

Contact: mstack@reduceyourworkerscomp.com.

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

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

Filed Under: Workers Comp Loss Prevention

3 Ways TPAs Use Analytics to Drive Better Claim Outcomes

January 14, 2020 by Michael B. Stack

Third-party administrators are often considered an integral part of the claims management process. Some would even call them claims process workhorses. Once a workers’ compensation claim begins, TPAs have a litany of things to do to help get the worker back on the job and the claim closed.

While such a service may seem invaluable, there is much more a TPA can do. Savvier TPAs become long-term consultative partners. By using advanced analytic tools in combination with a deep understanding of an employer’s unique situation, TPAs can help drive better outcomes for injured workers and their employers/payers. As stated by Mark DeLew, VP of Consultative Analytics at Broadspire, “a key role of the account executive is to understand the client’s objectives and then translate those with our analytic tools into Key Performance Indicators KPIs.”

What these TPAs do specifically, is help organizations come to realize:

Determine an Organization’s Objectives and Identify Opportunities to Improve
Define the Organization’s Goals and Priorities.
Manage Project with a Systems-Based Approach

Determine an Organization’s Current State and Identify Opportunities to Improve

Getting an accurate picture of where a company currently stands involves a team effort. The TPA needs experts from many different facets of the claims management process to truly understand what is happening in the organization. Nurse case managers, adjusters, quality assurance personnel, utilization review specialists, intake setup personnel, data conversion experts, and others are needed for this step.

The TPA account executive needs first to understand the organization’s current state and identify opportunities for improvement.

What is the overall health of the program?
Are return-to-work rates trending up or down?
What is the litigation rate?
What is the loss rate?
What percentage of claims are closed, and within what timeframes?

Drilling down to identify these key cost drivers is the start of realizing what is actually happening in the company. DeLew noted this analysis needs to be done “in collaboration with the cross-functional team of claims adjusters, team managers, nurses, and clients and to understand the root cause why.”

Once these are known and the reasons for them, the TPA can work with the organization to find areas for opportunities and the right solutions.

For each significant trend, the root cause must be determined. Interviewing those on the cross-functional team is a crucial part of the process to help come up with actionable items.

DeLew gave an example of a client who found its incurred claims costs were trending higher but did not know why. Broadspire introduced a virtual peer, a benchmark based on other similar companies within the same industry. Using a predictive model that took into account various factors, they drilled down for such things as age, body part, cause, and nature of the injury, and compared them with those of the virtual peer. They found that in this particular company, age was a big driver of increased costs.

Broadspire then went back to the cross-functional team to come up with potential solutions to the increased rate of older workers having workplace injuries.

Define the Organization’s Goals and Priorities.

Tools such as the virtual peer can help determine where a company is headed. Advanced analytics can be used to create a cost-benefit analysis to help an organization better understand what is likely to happen. Savings are then projected based on loss experience.

One potential area of focus is Return to Work. Looking at the average RTW date vs. the release date for injured workers can help to see the real cost of not getting injured workers back to work quickly.

The figures can also be presented by showing different regions of the country where the lag times, and hence, the costs may be greater or smaller. The result might be to discuss improving RTW rates in a specific area. Showing those in charge the costs of not getting an injured worker back is more likely to prompt buy-in from managers and others. Joel Raedeke, Senior VP of Consultative Analytics at Broadspire states, “this metric is one that we like because it clearly shows costly behavior and gives concrete data to drive action.”

Litigation is another area where advanced analytics from a TPA can help drive better outcomes. ‘Dollarizing,’ the litigation can help a company see its costs related to how quickly claims are litigated, as well as the impact of particular defense firms. “Statistics on how quickly claims are being litigated can help identify prevention opportunities. Then comparing the impact of defense firms on outcomes helps to mitigate costs even further,” said DeLew.

Using infographics and timelines can illustrate where the company is going. For example, let’s say a company wants to reduce its loss pick by 6 percent and decrease its open inventory by 22 percent. A year-long timeline can be set up. It may start, for example, with the TPA account executive aggressively pursuing claim closure with the cross-functional team, and setting meetings with the actuary to understand cost drivers. The ensuing months would then contain a variety of other steps to show how to achieve the goals. “Infographics and timelines allow us to visualize with a client stepping into that future state and the steps needed to achieve their goals,” said Raedeke.

Manage Project with a Systems-Based Approach

Emails and spreadsheets are the status quo for the industry, but not necessarily the best way. Trying to manage multiple projects with multiple people involved can be tedious and inefficient.

Account management can instead be done in a way that gives full visibility and track-ability in real-time. A system based approach eliminates the necessity to wait until the weekly meeting to get an update on what everyone involved is doing. “Better operating tools allow an account executive to efficiently manage a large team and achieve the goals of large projects,” said Raedeke.

Conclusion

Best in class TPAs that can an organization determine their current state of workers’ comp management, set realistic goals for improvement, and use a systems-based approach to project management using better operating tools and sophisticated analytics can help organizations vastly improve their outcomes and decrease their costs.

Contact: mstack@reduceyourworkerscomp.com.

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

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

Filed Under: Claim Management

Using Medical Disability Guidelines to Estimate Return to Work

January 13, 2020 by Michael B. Stack

Members of the claim management team face many challenges in handling their files in workers’ compensation claims. When an employee misses work, the team needs to make efforts to return that person to work, and also have a good idea when this will occur.

Medical disability guidelines can assist an employer and the claim management team in planning for the future return of an injured employee. Medical disability guidelines are an essential planning tool because they provide an employer with a time frame as to how long an employee, on average, will be away from work. Large self-insured employers, TPAs, insurance companies as well as captives and associations that handle claims all use online medical duration guidelines.

Understanding Medical Disability Guidelines

Medical disability guidelines are simply that – a guideline. They do not offer the medical provider or employer a precise number, but rather a range of time the guideline’s user can anticipate the employee will be off work depending on the difficulty of work. Other important issues to consider include:

The range of time is based on a compilation of extensive data about numerous injuries;

The collection of data is sorted by the nature and the extent of injury;

The greater extent of data, the more accurate a disability duration prediction is; and

The field of occupational medicine continues to grow and expand, providing a constantly evolving and growing accumulation of data.

It should be noted that medical disability guidelines are designed to provide physicians, employers, and employees with ranges and guidance, not precise answers. Guidelines often have a minimum recovery time, a maximum recovery time, and an optimum/average recovery time. The specific employee’s willingness and inclination to return to work can be measured in three ways:

Restrictions;

Limitations; and

Willingness to tolerate the symptoms brought on by the injury.

Working with Medical Providers on Return-to-Work

The medical provider will set restrictions on what the employee should perform. While the employee may be capable of doing the activity, to do so could pose a risk to the employee and possibly others. An example of this is an employee with an injured arm might be capable of driving a dump truck, but there is a risk the injury could impair the employee’s ability to do so, posing a risk to both himself and others.

The medical provider will also take into consideration of limitations of the employee. These limitations include:

Limitations based on a functional capacity evaluation; and

When the employee should be able to reach their optimal performance level.

For example, an employee with an injured back will not have the physical capability to lift heavy objects. Limitations are normally in place for what would be considered the average time a person will be off work.

Dealing with An Employee’s Work Restrictions

Restrictions placed on an injured employee should closely conform to the minimum column of the medical disability guidelines while the limitations will often correlate with the optimum recovery time in the guidelines. The maximum amount of time an employee should be off work is reflected by the concept of tolerance. The greatest variance in the medical disability guidelines arises from the willingness of the employee to tolerate the symptoms of the injury. The medical provider may look at the medical disability guidelines and establish what is the normal recovery time for an injured person who has a particular nature and extent of injury. Individual factors such as fatigue and pain can impact an employees’ disability duration.

Personal factors can also play a role in the recovery and disability duration including:

Comorbidities (diabetes, obesity, etc.), which can distort the disability duration; and

The employee’s motivation to return to work will influence their tolerance level. These motivational factors can include income (satisfied with the tax-free income of workers’ compensation), job dissatisfaction, self-esteem, health insurance provided by the employer, etc.

These are not medical reasons for disability but impact the employee’s willingness to tolerate injury symptoms, and therefore whether or not the employee disability duration falls within the medical disability guidelines. The maximum time frame is often placed at the 90^th percentile, where 90% of the people with the type of injury involved have returned to work.

Conclusions

The medical disability guidelines are evidence-based disability durations. They are multidisciplinary in scope with their findings continuously updated to reflect an improvement in medical care and medical practice. They are best used to answer the question, “how long will the injured employee be off work.”

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

Contact: mstack@reduceyourworkerscomp.com.

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

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

Filed Under: Return to Work and Transitional Duty

Understanding Work Comp in the Healthcare Industry

January 8, 2020 by Senior Editor

Interested stakeholders in the healthcare industry face many unique challenges in terms of finding affordable workers’ compensation insurance coverage. This is especially the case when it comes to those who operate hospitals, clinics, and nursing homes. These challenges include rising premiums based on the nature and extent of work injuries and accompanying restrictions on activity that serve as a barrier when it comes to getting an injured employee back to work.

Understanding Nursing Homes and Work Comp

Nursing homes can be found in every state. Many are privately owned and managed, but regional and national nursing home companies are gradually increasing their share of the market. The workforce of the nursing home will consist of:

Registered nurses (RN);

Licensed practical nurses (LPN);

Nurses’ aides;

Administrative staff;

Food service; and

Housekeeping

The primary workforce issue is often the training and turn-over among the nurses’ aides.

Dealing with Work Injuries at Nursing Homes

Safety is normally emphasized in nursing homes to protect both the patients and the staff. Nursing homes are built to protect the patients and staff, which tends to lower the risk of injury.

Physical hazards and causes of injury to nursing home employees include:

Lifting and moving of patients, the most common cause of work-related injuries;

Musculoskeletal injuries; and

Needle sticks and dealing with infectious diseases communicated via bodily fluids.

Medical care for workers’ compensation injuries in this line of work is readily available because most states require a duty nurse to be on duty at all times. Minor work-related injuries, including cuts, bruises and abrasions, can be treated by the on-staff nurse or by other nurses on duty. For more severe injuries, medical facilities are often located nearby.

Reducing Indemnity Benefits in Healthcare Settings

The cost of indemnity benefits for workers’ compensation injuries at nursing homes averages approximately the same as work comp benefits for all industries. Occupational diseases and associated disability benefits occur infrequently among nursing home employees.

Some categories related to nursing homes that would have the same or similar work comp issues include:

Hospitals including acute care hospitals;

Home health services;

Retirement centers;

Boarding homes; and

Assisted living facilities.

While many of the jobs in this industry require the ability to lift patients (heavy lifting), accommodation may be possible. Equipment such as mechanical lifts and friction-reducing devices decrease both the frequency and severity of the injury and make temporary accommodation easier to accomplish. A union contract may serve as a barrier to return-to-work issues in some instances. It is important to keep these issues in mind when negotiating a labor contract and to seek cooperation from union representatives on these issues.

Notwithstanding this matter, there are ways to get injured healthcare employees back to work in a timely and efficient matter. Possible temporary transitional work includes:

Office Workers: Look for ways to accommodate prolonged sitting and standing as needed, or to elevate a broken limb. Lifting beyond physician assigned abilities could be done by another employee.

RN, LPN & Nurses’ Aides: Utilize other employees to do the “heavy” lifting of patients or equipment. Provide equipment to make patient transport non-strenuous.

Food Service: Identify tasks within the cafeteria or snack bar within physician assigned abilities such as light cleaning or working the cash register.

Other Employees: Consider placement at an Information Booth to help visitors with directions or assistance.

Light Janitorial: Employees can use a broom and long handle dustpan to clean up spills and litter.

Conclusions

Engaged stakeholders in the healthcare and nursing home industry need to be creative in managing workers’ compensation claims and reducing program costs. This required them to seek creative solutions to manage medical care based on the severity of the work injury, and look to get an employee back on the job within their restrictions. This may require compromise, but will promote savings in the long run.

Contact: mstack@reduceyourworkerscomp.com.

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

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

Filed Under: TPA and Claims Administration

Injury Prevention With Ergonomics Creates Money

January 7, 2020 by Michael B. Stack

Tom Cruise famously shouted, “Show me the money,” in the movie Jerry McGuire, as he was attempting to get his client to the very top of his career. In the same regard, interested stakeholders and employers seeking to save money in their workers’ compensation programs are usually saying, “Show me what it saved the other guys and what it will save me.”

If the employer believes there is a safe workplace and a good loss run, then it can be a hard sell. Notwithstanding good results, everyone should always seek to do better when it comes to their programs. This includes improving safety and improving ergonomics in the workplace.

Injuries do happen. Here are some examples of companies benefiting from the installation of an ergonomic/safety program. Stakeholders should be asking themselves if there is room for improvement in their offices and workspaces.

Large Scale Construction Company

A company began to notice large spikes in musculoskeletal disorders among its employees. To combat this problem, they hired and implemented a pilot program at one of the company’s larger construction sites that consisted mainly of a customized stretching and strengthening program for the workers based on the specific jobs they were performing at that site.

RESULT: After implementing the program, employees logged over 104,000 hours at that pilot jobsite without any reported work-related musculoskeletal disorders. That is 2,600 – 40-hour workweeks. The employer went from having a significant outbreak of a specific type of injury, to almost wiping it out.

Local Graphics Company

An employer was concerned about rising workers’ compensation costs instituted a comprehensive ergonomics program using employee-led management teams to identify ergonomic risk factors for workplace injuries and establish training and controls to reduce the risk drivers.

RESULT: Within four years, this employer experienced positive results and savings:

25% reduction in the number of work-related injuries;

39% decrease in the number of back injuries; and

Overall result in lost work time days by 25%.

The key here is that the employer used an “employee-led” approach. By using their employees as resources, they were able to know what was taking place at their workstations day after day. These employees had legitimate concerns, which resulted in solutions that worked.

Nationwide Manufacturing Company

This employer experienced an increase in injury rates at its upper-Midwest production facility in the early 1990s, as the worker population and seniority rates changed. A comprehensive approach to injury prevention was developed, focusing on:

Ergonomic training;

Ergonomic retrofitting; and

On-site stocking of frequently used ergonomic items such as hand tools, floor mats, footrests, and anti-vibration gloves.

RESULT: The employer reported a significant reduction in lost time and/or restricted workdays as a result of the program. The key is taking a step back, identifying the risk factors, finding out what options are available to reduce the risk, and implementing them. The more you are working at full capacity, the better the production, the stronger the profit margin.

Food Processing Company

This employer noted an increase in musculoskeletal disorders identified at a specific location. To combat these numbers, the employer instituted an on-site medical management program to reduce the number and severity and these injuries. The medical management team consists of an on-site physical therapist to assist with job placement and job analyses, as well as follow up on the doctor prescribed treatment of work-related injuries. The occupational health nurses, physicians, and therapists met together at least annually as a group to discuss the successes of the program as well as to recognize any areas of improvement.

RESULT: This program was successful because it produced a better job placement program. The following improvements were made:

Job modification process became personalized to the injured employee;

Communication between various interested parties such as therapist, doctor, team member, and management team were streamlined, which resulted in faster recovery times; and

In some cases, it led to the prevention of work-related injuries/illnesses.

Conclusions

There are no more excuses for not implementing a safety team or program after reviewing these examples. Each of these stories is a great example of identifying a problem, establishing a plan to correct it, and tracking the successes of your implementations. Your broker/carrier/TPA has resources to get you started in the right direction. The sooner the program is implemented, the sooner to begin saving on claims.

Contact: mstack@reduceyourworkerscomp.com.

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

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

Filed Under: Workplace Safety

Ask One Question to Set Return to Work Expectations

January 6, 2020 by Michael B. Stack

Study Reference: The Relationship Between Work-Disability Duration and Claimant’s Expected Time to Return to Work as Recorded by Workers’ Compensation Claims Managers https://www.ncbi.nlm.nih.gov/pubmed/27460477

Hey there, Michael Stack here, CEO of Amaxx and Happy New Year to you as we start this fresh decade in January of 2020. Now, one of the cool things about this time of year as you’ve likely done some planning or some goal setting or setting some expectations for what you want to happen in this year and in this decade to come and maybe reflecting on what went well in the past year or the past decade that we just left behind.

As we started on this new year, I want to give you one quick tip and far as worker’s compensation return to work, a piece that you could integrate into your return to work program and just have that much more accurate expectations. If we think about James Allen’s book As a Man Thinketh, he says that basically what we think about has the greatest odds of actually happening and that is very true in workers’ compensation as well.

When Do You Think You’ll Return To Work?

There was a study in 2016 that looked at the correlation between the expected return to work times and then what actually happens and you’ll see a link to that study below here and I want to have you ask this question, when do you think you’ll return to work?

When do you think you’ll return to work? And the answers will be very accurate as far as the correlation. That’s what this study proved, and I’ve got to run through these numbers here quickly. It was 43% that expected they would be back to work. I’m sorry this is wrong. In less than seven days were accurate. So, 43% had the expectation. They said, yeah, I’ll be back to work in less than seven days. And they were accurate with their assessment. 22% said, yeah, I think I’m going to be back to work in greater than seven days. And they were accurate with their assessment. These are not ‘johnny on the spot’ as far as, okay, 95% of the time. But there’s a significant correlation and that’s the point of getting that understanding of what their expectation is and this one was the most accurate.

Expectations Predict Reality

This one was for people that expected that they would be out of work in greater than a hundred days or 181 days. There were actually returned room to work in seven days or less, so greater than 180 days. My expectation is I’m going to be out of work probably at least six months, you know, I can’t see myself getting back to work before then. Virtually none of them were back to work right away.

The point is, ask that question upfront, ask that question. When do you think you’ll be back to work? And you will get a pretty good indication as far as how to tailor your claims management strategies to that expectation to either help them along and confirm that, hey, you think you’re going to be back, let’s make sure you’re back. If you think you’re going to be out a lot longer, maybe we’re going to need some extra services on this such as nurse case management, etc, to help that claim move further along.

Happy new year to you. I’m excited for this year for you ahead to implement these best practices and see some of those tremendous results, because 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.

Contact: mstack@reduceyourworkerscomp.com.

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

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

Filed Under: Return to Work and Transitional Duty

Reduce Work Comp Costs Through a Safety Professional

December 18, 2019 by Michael B. Stack

Interested stakeholders are always seeking to reduce workers’ compensation program costs with a focus on safety. Safety measures are critically necessary to ensure work-related accidents do not occur. If and when accidents do occur, you must have post-injury procedures in place to quickly address that accident, provide medical care to the employee if necessary, and return the employee to work in a modified or full-time duty position as soon as possible. This includes designing a program that will enable you to manage both safety and workers’ compensation costs.

Effective Tools to Reduce Program Costs

The same tools you used to build your safety program can also be used in managing your workers’ compensation program. Since a strong safety program is in place, once all employees are trained in as to signage, workplace safety, toolbox safety, handrail safety, etc., a post-injury response training program can also be developed. Since communication is such a large part of safety, effective methods can be also be developed.

Use templates that are adaptable to develop a workers’ compensation policy such as an employee brochure, post-injury response documents, letters to medical people and claims handlers, a communication strategy; and

Assess how your workers’ compensation management program mirrors your safety program to acquaint yourself with the myriad factors impacting your program costs. This should include using a workers’ compensation tool that is driven by metrics to allow interested stakeholders to understand where injuries occur, and how they can be prevented.

Using the Right Metrics to Make Effective Decisions

There are many tools available to insurance brokers, third-party administrators and online that allow interested stakeholders to evaluate their workers’ compensation programs and make better decisions. Factors to consider include:

Sales to Pay for Accidents Calculator: Using these metrics will allow a company to dramatically illustrate workers’ compensation costs. It will allow management to understand key drivers and draw education conclusions.

The Transitional Duty Cost Calculator: This calculator, in the same way, shows how implementing a modified duty program can save the company immediately. Management and other stakeholders can manipulate data to see how changes in their return to work efforts improve production, and reduce program costs.

What to Do Next

Stakeholders in workers’ compensation programs should be open to receiving recommendations. This should be in the form of a prioritized list developed from the assessment. A plan of action is also necessary, and should include a calendar plan with identified action items, and cost estimates. It may also include the involvement of a company finance officer to ensure the plan receives adequate resources to do the job management gave you based on your company’s “safety experience.”

Issues companies should consider going beyond need to include:

Instituting a strong post-injury response procedure;

Instituting transitional duty program;

Reviewing your claims handling practices to ensure claims handlers are responsive and plugged into your situation;

Bringing injured employees back to work; and

Launching a communications program for the employee population (this includes writing a workers’ comp policy, a brochure detailing the policy and post-injury response procedures, and a get-well component for keeping the lines open without-on-comp employees

In terms of returning employees back to work, considerations should include:

Designing modified duty positions as part of your transitional duty program for employees out a work for a short period of time.; and

Convening file reviews to develop remedial action plans for those employees who are out of work for long periods of time. File reviews would typically take place at the insurer’s worksite. Participants should include the claim handler, and a qualified vocational consultant. Discuss each case and decide the next steps for bringing the case to resolution.

Conclusions

Effective workers’ compensation programs need to focus on all interested stakeholders. This includes an evaluation that keeps the employer profitable, but at the same time focuses on employee safety. Keep metrics that need to be analyzed and used when preparing an effective plan.

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

Contact: mstack@reduceyourworkerscomp.com.

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

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

Filed Under: Safety and Loss Control

Create System to Gather All Needed Workers’ Comp Claim Information

December 17, 2019 by Michael B. Stack

Garbage in; Garbage out! If you are putting garbage into your workers’ compensation program, it goes without saying the results will not be pleasant. Now is the time to focus on gathering all the necessary information to obtain high-quality results in order to pay claims appropriately, and improve efficiency.

Create a System That Creates Repeatable, High-Quality Results

A significant improvement in the world of claims management over the years is the implementation of an electronic system for entering and managing claims. Used by employees of the Carrier/TPA, this is an automated system that assigns risk if certain conditions are present. These systems allow for the following:

Claims professional to gather more information in less time;

Provides for appropriate follow-up on responses to high-gain issues; and

Assists in the evaluation of information systematically.

System Guides the Questions So Nothing is Missed

The person receiving the claim for the Carrier/TPA will have questions that need to be answered. If the answers are positive for certain criteria, the system will assign the claim a risk number within certain values from the software. The higher the score, the more risk is assigned to the claim. The system will be used initially for 3-point contacts to the injured worker, the employer, and the medical provider. Positive responses to certain criteria will pop up other questions to ask which ensures the adjuster does not forget anything that can be crucial to the claim.

Processing claims through a system like this allows the claim handler to understand the “pain points” of a claim when it arrives at their desk. This will better direct their investigation and reduce unnecessary or excessive time spent on a claim.

Encourage Claim Handlers to Follow Best Practices

The implementation of a bonus system is another tool to use. Carriers/TPAs often use a bonus system to reward adjusters, and these bonuses revolve around timeliness of their contacts, resolution of their claims, and overall reserve savings by proactive claims handling. This encourages the claim handler to follow best practices.

Claims practices can also be classified based on their system score. Medical only claims or minor lost-time claims can be routed to the appropriate adjuster, instead of going initially to a senior level claim handler. Other inefficient claim handling processes include assigning a claim based on what information is listed in the injury report. This process can be inefficient if the injury report was completed in error. Time and money can be saved when each claim handler is making the highest and best use of their day.

Using Outside Service Providers When Necessary

Outside service providers can be used immediately in certain circumstances. These assignments can include:

Field Nurse Case Manager: These service providers should be used in instances where the employee will require significant or extended medical care and treatment. This can equate to large cost savings as this month can include crucial moves within the claim, preventing missed work when a return to work could have been possible.

Medical Specialist: Claims involving complex injuries can be referred to a specialist at the onset of a claim where the identified injury will likely require surgery or extensive physical therapy. Instead of waiting for the paperwork the case manager can get it at the appointment and send it to the claim handler the same day, instead of when the actual medical reports come in with the bill weeks later.

Conclusions

Several technological advancements are going on within the claim industry. As an employer, you should be open to new technology, and trying new things in order to be more proactive in the claim process. Oftentimes the claim handler is very set in their ways, and there can be some resistance to the introduction to new techniques and new technology. These advancements are made to help all parties involved to make the process more streamlined and more effective for the claims profession.

Contact: mstack@reduceyourworkerscomp.com.

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

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

Filed Under: Claim Management

Case Study: $5,000 in Savings from Non-Profit Return to Work Option

December 16, 2019 by Michael B. Stack

The longer an injured worker is out of work, the less likely he is ever to return. Statistics show an employee who is out of work for 6 months has only a 50 percent likelihood of going back, and the number increases exponentially after that. There are many reasons this occurs.

Disability Mindset

Being out of the work environment means losing touch — with colleagues, the daily routine, and the feeling of being productive, which for many, is vitally important to maintain a sense of self-worth. Depression and frustration, not to mention pain, can set in and quickly turn to anger.

Instead of focusing on the recovery process, injured workers who are out for long periods of time may turn their attention to retaliation. Instead of thinking about healing and returning to their pre-injury normal lives, these workers may instead start to embrace their ‘new normal’ lives. They develop a disability mindset and start to direct their energies to ways they can stay permanently out of the workforce.

Work as Therapy

There is a plethora of research that demonstrates returning to the workforce in some capacity increases the worker’s engagement in the recovery process, and improves his emotional and physical health. But many organizations either don’t subscribe to this idea, or they are unable to accommodate these employees.

Too many employers have the attitude that they don’t want an injured worker back unless they are 100 percent recovered and fully able to completely step back into their position. Unfortunately for these employers, statistics bear out the fact that returning workers in some capacity leads to better outcomes and saves money for the employer.

In some cases, it’s difficult or even impossible to find modified or light-duty work for the injured employee at the worksite, due to the nature of the work and/or the worker’s injuries. One solution that wise organizations are taking is to partner with nonprofit and charitable organizations. Employers that take this approach see their injured workers recover within the expected timeframe and back at work, saving them unnecessary costs and headaches.

Case Study: (Provided by Broadspire): $5,000 in Savings From Non-Profit Return to Work Option

Challenge:

A worker who sustained multiple wrist injuries from an occupational accident had an extended recovery. His employer was able to provide him with light-duty work — for a while. However, when the employee needed a third and final surgery, his company could no longer accommodate him.

A Broadspire field case manager quickly noticed the injured worker was becoming depressed. The situation could have easily and quickly spiraled downward.

Solution:

Broadspire’s ‘Worker on Loan’ program is designed for exactly this type of situation, where an injured worker’s employer has no opportunity for light-duty work. After the field case nurse reported the injured worker’s situation, the Broadspire adjuster contacted the employer who agreed to try the Worker on Loan Program.

In this instance, Habit for Humanity was able to provide work for the injured worker. It turned out to be a great fit, as the employee’s former job was in construction. The field case manager soon reported that the worker’s mood improved significantly. Once he started working with the revered organization, he was able to feel productive and help others.

Results:

This case perfectly illustrates the value of work as a viable response to an injury. Instead of going into a deep depression and staying out of work indefinitely, this injured worker was actually able to return to full-duty at his normal job — nine weeks earlier than planned! The result was a win-win for the injured worker, the employer, and Habit for Humanity, which got the benefit of his expertise.

Total Savings = $5,000

Conclusion

Keeping an injured worker engaged with the workforce is vital to achieving the best outcomes. Collaborating with nonprofits is a perfect answer for companies that understand this but may not have light-duty options available.

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

Contact: mstack@reduceyourworkerscomp.com.

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

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

Filed Under: Claim Management

Traumatic Brain Injuries and Effective Workers’ Comp Claims Management

December 11, 2019 by Michael B. Stack

Growing awareness of traumatic brain injuries (TBI) requires members of the claim management team and other interested stakeholders to learn, and understand more about these complex injuries. This includes having a firm grasp on conditions associated with injuries to the head, common diagnostic testing, signs of injury, and proper investigation techniques.

What is a Traumatic Brain Injury?

Traumatic Brain Injuries do not fit one specific pattern or mechanism. It can include a variety of physical and psychological effects that result from blows to the head, or whiplash type events. The signs and symptoms of a TBI can vary, including the onset of symptoms shortly after the event. Common signs of a TBI include the following:

Loss of consciousness for a few seconds, up to a few minutes;

No loss of consciousness, but a state of being dazed, confused, or disoriented;

Headache;

Nausea or vomiting; and/or

Fatigue or drowsiness.

A person’s motor skills can also be impacted following a TBI.

Expected Medical Care and Treatment

Medical care required to treat a TBI should not be a “one size fits all” approach. People react differently, and so is the healing process. Common medical procedures associated with a TBI include:

Computerized Tomography (CT scan): This is a scan that uses a series of x-rays to study the brain. It can uncover evidence of bleeding on the brain, clots, and bruises;

Functional MRI (FMRI Scan): This is a specialized MRI that helps a medical provider discover and measure brain activity. I can also uncover areas of the brain suffering an injury;

Intracranial Pressure Monitor: Bleeding on the brain and swelling of tissue from a TBI causes pressure on the skull. This instrument measures the pressure inside one’s skull; and

Neuropsychological Testing: There are various tests medical providers can conduct to study the impact an injury has on the brain. This testing can be short, or last over the period of several days. It can also help assess the cognitive, emotional, and behavioral impact of a TBI.

This list is not all inclusive. Members of the claim management team should always question the reasonableness and necessity of medical care, and make sure all treatment advances the injured employee toward a full recovery.

Common Signs of Traumatic Brain Injuries

It is important to remember that not all TBIs are the same. A TBI can also result from a “minor” incident, and does not require the person to lose consciousness. A variety of symptoms are associated with a TBI:

Confusion or amnesia;

Loss of memory or problems performing basic motor functions; and

Tiredness, or a loss in appetite.

The Glasgow Coma Score is a tool used when a TBI involves the loss in consciousness. It is a test performed on initial examination to estimate the severity of the injury, and best direct medical care and treatment. This test is based on special awareness, verbal orientation, and motor response. The higher the scores, the less severe the injury. TBIs classified as being “mild” can generally be treated at home. Lower scoring injuries require hospitalization, and in severe cases immediate surgery to relief pressure on the skull.

Investigation Tips and Tricks

There are many important questions and pieces of information one must gather when investigating a TBI in the context of workers’ compensation. At a minimum, the following information is essential when investigating these claims:

Mechanism of injury: Determine if the head struck and object and the force of the strike. Knowing the object the head struck is also important;

Severity of injury: Information to receive should include whether there was a loss of consciousness, and if so, for how long. It is also important to determine the Glasgow Coma Scale information, if applicable; and

Symptomology: It is important to obtain information on the physical, cognitive, and behavioral/emotion symptoms of the employee immediately following and after the injury. This information should be documented in medical records.

Conclusions

Our understanding of Traumatic Brain Injuries is changing the landscape of workers’ compensation. Members of the claim management team need to investigate this information in order to make proper claim handling determinations.

Contact: mstack@reduceyourworkerscomp.com.

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

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

Filed Under: Medical & Pharmacy Management

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Traumatic Brain Injuries and Effective Workers’ Comp Claims Management

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