Contractor Liability In Workers’ Compensation

contractor liability in workers compensationThe issue of contractor liability in workers’ compensation is something members of the claim management team need to be aware of when dealing with claims.  This is especially true when handling claims in the construction industry or other job classifications that rely heavily on contractors to perform work.

 

 

Contractor Liability in Workers’ Compensation: Back to the Basics

 

As a general rule, employers (with some limited exceptions) are required to purchase workers’ compensation insurance for their employees.  In the setting of a general contractor, they typically do not have employees as people who work for them are generally classified as “independent contractors,” or subcontracted labor through another person or entity.

 

Notwithstanding this exception to the general rule, contractors may want to consider obtaining the benefits of workers’ compensation coverage should a judge or industrial commission determine an injured person is an “employee.”  Situations to consider include the following:

 

  • Uninsured contractor: General contractors can be found liable in workers’ compensation matters if a subcontractor does not have required coverages for their employees.  Although there is no employer-employee relationship, courts generally will look to the main contractor, as well as other intermediate contractors, for coverage.

 

  • Employee misclassification: This can occur in serval different circumstances, which include times when the misclassification is intentional (fraud), the nature of the relationship changes during the course of business or in instances of good faith dealings a finder of fact determines an employer-employee relationship exists.  The mistake of fact, even if it is unintentional, is not a defense.

 

  • Self-coverage: In many instances, a contractor will purchase coverage for themselves, and others working under them.  This can include independent contractors working directly for the contractor, and subcontractors and their employees and the independent contractors of a subcontractor.  This can sometimes come in the form of “ghost” or “shadow” policy, which covers medical and indemnity benefits under a workers’ compensation act, and also cover expenses related to legal representation in legal proceedings.

 

 

Avoiding Contractor Liability in Workers’ Compensation

 

The policy behind contractor liability in workers’ compensation is two-fold.

 

  • Avoids situations where a contractor is avoiding liability and the payment of workers’ compensation insurance at the expense of unskilled labor; and

 

  • Provides a certainty in benefit payment and reduction in tort litigation (eg – the Grand Bargain).

 

When a person working in a subcontractor situation is injured, that party should either have workers’ compensation insurance, if self-employed or for their employees.  If the subcontractor does not have workers’ compensation insurance, a cause of action may arise against the contractor immediately above that entity.  Liability will often also extend to the next immediate contractor if there is not the presence of insurance, etc.

 

Based on this complex statutory framework, members of the claim management team need to be diligent in their investigation.  Practice pointers should include the following:

 

  • Educate all insureds about the basics of contractor liability in workers’ compensation matters. This includes making them aware of the fact they may be responsible for persons unrelated to their business when involved in projects involving contracted labor.  This is especially prevalent in the construction industry;

 

  • Determine if any contractors and/or subcontractors are present at the injury site. Things can get complicated, so drawing a diagram may assist in determining liability for a work injury; and

 

  • Careful payroll audits when determining workers’ compensation insurance premiums. While most contractors and employers are honest when reporting the number of employees, wages and injury rates, there is a temptation to “game the system.”

 

When speaking with an insured about workers’ compensation insurance in a contractor/sub-contractor setting, it is also important to provide precise and correct answers.  Failure to do so can give parties with a false sense of security.

 

 

Conclusions

 

Workers’ compensation systems become complex when dealing with contractors.  It is important to educate insureds and provide them with accurate information.  This includes resources on how to avoid unnecessary risks and do so in an ethical manner.  It can also help avoid the unnecessary payment on claims when insuring a contractor who works with other entities.

 

 

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©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.

 

Effective Handling of Medical Only Workers’ Comp Claims

medical-only workers comp claimsMedical only workers’ compensation claims are sometimes viewed as being unimportant and routine.  This mindset can cause issues and lead to larger problems within a claim management team.  If left unchecked, it can significantly impact the ability of a claims team to handle a large number of claims and not settle workers’ compensation claims in a timely manner.

 

 

Medical Only Workers’ Comp Claims – Defining the Issue

 

Medical only workers’ comp claims are those that involve an injury where the employee only receives medical care and treatment, or the wage loss is confined to the “waiting period” under a workers’ compensation act.  In these claims, the employee’s medical care and treatment may be as short as one office visit, or as long as several years.  The important thing to remember is money is being spent and the claims need to be properly managed.

 

 

 

Avoiding Pitfalls in Medical Only Workers’ Comp Claims

 

Members of the claim management team that work on these claims are generally newer claim handlers with less experience.  The work may be monotonous, but it is still important.  Members that are working these claims should pay close attention to detail, which includes the following issues:

 

  • Ensure the injured employee receives prior authorization when necessary to receive medical care and treatment;

 

  • Understand requirements as it released to applicable medical treatment parameters and fee schedule payments; and

 

  • Review applicable claims to ensure managed care protocols are followed, if applicable.

 

This process also requires the claim handler sets the proper reserves on a claim.  In order to accomplish this goal, the claim handler needs a complete understanding of workers’ compensation protocols.  It is also important to ensure the employee remains gainfully employed to avoid exposure for indemnity and wage loss benefits.

 

 

 

Move Cases Forward – Not Letting Dust Settle

 

All members of the claim management team need to act in an honest and ethical manner. This includes treating the injured employee with respect and dignity.  All payments should be made when legally required. The importance of properly handling medical-only claims is echoed by a National Council on Compensation Insurance (NCCI) report that found the following:

 

  • About 80% make the transition within 12 months of the date of injury;

 

  • Medical-only claims that become lost-time claims cost an average of 40 times more than those that remain medical-only;

 

  • Carpal tunnel claims are the most likely claims to transition from medical-only to lost-time, with the probability of such a transition being approximately 34%;

 

  • The larger the incurred value (paid plus case reserves), the greater the probability of the claim becoming a lost-time claim; and

 

  • The probability of a claim transitioning increases with claimant age until age 65, and then it declines.

 

 

It Takes a Team to Manage (Medical Only) Claims

 

All members of the claim management team need to take a proactive approach to medical only claims.  Even claims that are reserved at lower amounts – $500 to $1,000 – can reduce a program’s efficiency and effectiveness.  Small dollar amounts allocated across countless files add up.

 

  • Claim Managers: Be a leader and work hard to make sure all members of the team are moving claims toward settlement.  A file that collects dust impacts everyone;

 

  • Claim Handlers (more experienced and indemnity handlers): Provide guidance and assistance to newer members of the team.  Make sure they know how to be efficient and effective.  Mentorship can pay dividends across the team by building morale.  It also demonstrates you are capable of handling more complex matters; and

 

  • Medical-only Claim Handlers: Pay attention to what is going on.  Understand there is a learning curve so do not shy away from constructive feedback.  Never be afraid to ask questions.

 

 

Conclusions

 

At the end of the day, the only good file is a closed file! This starts with a program-wide review of medical only claims.  Make sure these files are properly reserved and files that can be settled are moved toward closure.  It is also important for everyone on the claims management team to be involved and work together for the good of a program.

 

Overcoming Telemed Challenges for Occupational Health

telemedicine workers compTelemedicine has great value when used appropriately, and its promises are attractive: immediate access and convenience (anywhere, anytime!), early intervention, lower cost than other models, and quality services.

 

However, telemedicine has potential pitfalls. At Medcor, we’ve devoted considerable time and talent to assessing these pitfalls and navigating our way to a telemed solution for occupational health that works.

 

 

Reality of Telemedicine Today

 

An honest look at the telemedicine landscape today shows us that telemedicine adoption in occupational health is slower than the hype may lead us to believe. For example, contrary to some expectations, many tech-savvy Millennials prefer an in-person provider visit rather than a virtual one for their healthcare.

 

Also, just like other medical delivery models, telemedicine can be subject to misuse as well as inconsistent results and service levels. There isn’t yet enough published data to quantify results and quality. Overprescribing, unnecessary treatments, delayed return to work, conflict around OSHA recordables, causation, denied claims, creeping catastrophic claims, opioid addiction, and litigation are problems that do not go away just because the provider is accessed by video instead of in person!

 

 

Challenges for Occupational Health and Telemedicine

 

Recognizing the challenges is key to overcoming them.

 

Technology. Using telemedicine to treat work-related injuries can present layers of technological complications at the workplace. Internet access is needed, which means that appropriate bandwidth must be available, firewalls have been anticipated and won’t be a hindrance, and patients can access the facility’s wifi. Hardware for the virtual visit is also a consideration: Can patients use their own personal smartphones, or do they need access to an employer desk­ top? Tech support is another challenge: Who will help patients troubleshoot any difficulties?

 

In terms of technology, there are also challenges of system infrastructure: Do virtual visits need to be scheduled? Does the system rely on callbacks? How are medical records, reports, billing, data security, and patient privacy handled?

 

Scope. First aid cases don’t need a provider, either in person or through tele­ medicine. Life threats and emergencies require in-person care without delay. Furthermore, telemedicine cannot meet clinical needs when hands-on assessments and treatments are required, such as imaging, labs, palpations, sutures, splints, irrigation of eyes, etc.

 

Yet many cases are appropriate for telemedicine – identifying which of these cases are eligible for care through telemedicine is another challenge.

 

Coverage. To offer promised convenience and access, a telemedicine system must have many providers avail­ able to respond to calls. In small-scale systems, a few in-house or select providers handle the coverage – but they may be spread thin and have other duties and patients. Wait times increase and service is limited after hours (e.g., nights and weekends). When alternate coverage is used, results are inconsistent. In large-scale programs, multiple providers are needed across multiple states. Multi-licensed providers are the go-to solution, but when one of those providers is in a session with a patient (or not on duty), patients in multiple states are affected.

 

Coverage challenges also include having providers who understand the ins and outs of occupational health and work-related injuries as well as having providers who are skilled at conducting virtual patient encounters.

 

User Experience. Users are affected by the challenge of technology, scope, and coverage. They also often have unrealistic expectations. User proficiencies differ, too, as do their education level, technical experience, age, personality, and willingness to try. Moreover, people who are using telemedicine are patients – they are either sick or injured. These are moments when people are not at their best. The stress they may feel from their health concern can influence their experience of telemedicine. The most common technical support issue in telemedicine is caused by people who, in the stress of the moment, have forgotten the password on their smart­ phones and therefore can’t access the telemedicine system.

 

User experience can also be influenced by how users feel throughout the process. Patients can feel alone or even overwhelmed at different stages. The level of assistance users need varies just as their proficiencies and expectations vary.

 

 

Solutions Moving Forward

 

For telemedicine to deliver beneficial outcomes for employers and patients, we’ve found an accurate assessment needs to be made first regarding the needs of the organization and its potential telemedicine users. This enables selecting the right system and setting expectations realistically and honestly, knowing that telemedicine is not a magic solution for all work-related injuries. Telemedicine will yield the best outcomes only when its use is clinically appropriate for the health concern in question. The use of telemedicine, therefore, needs to include a system to determine appropriateness on a case­ by-case basis.

 

We’re working to ensure our telemedicine adopts the best practices that have been established in our other lines of business, namely evidence-based medicine, and attentive customer service so that telemedicine is an all-around successful endeavor. By emphasizing clinical outcomes and user experience telemedicine challenges can be surmounted.

 

 

 

Curtis Smith MedcorAuthor Curtis H. Smith, Executive Vice President, joined Medcor in 1995. He helped develop Medcor’s injury triage system and holds several US and foreign patents on injury assessments methods.  Smith has taught and practiced in EMS as paramedic and dispatcher.  He currently supports Medcor’s business development and marketing teams. http://medcor.com. Contact: csmith@medcor.com

Don’t Make Two Mistakes In A Row in Workers’ Comp Return to Work

 

 

workers compensation return to work

An object in motion will stay in motion unless acted upon by an unbalanced force. That’s Newton’s first law of motion. “Don’t make two mistakes in a row,” a quote by Beverly Buffini, from one of the podcasts I listen to called The Brian Buffini Show.

 

Hello, my name is Michael Stack. I’m the CEO of Amaxx and those two exact opposite statements and concepts are both vitally important for you to understand personally as the leader of your work comp program or as the educator of your clients, as well as for your injured employees themselves in the success of your program.

 

 

Newton’s Law of Motion in Workers’ Compensation

 

What I want to do today is break down those two concepts, what they are and how they work together to drive your program and yourself to greater success. Let’s first talk about this law of motion and kind of what it means. We all kind of know that, right? You’re kind of going in a certain direction and you just kind of keep going in that certain direction unless you don’t, unless you stop, unless there’s some reason for you to change course.

 

Same is very much true in work comp. Let’s take a look at these return to work rates and this comes from a Washington State L & I study published in the IAIABC return to work paper that they published several years ago. This is a probability that your injured worker is going to return to work ever, probability that they ever return to work at all. Here’s the numbers and you can see how dramatically they start to drop off, 92.8% probability they return to work in some capacity in their lifetime if they’re back to work in less than 12 weeks. Pretty high likelihood that they’re going to be back to work if they get back to work pretty quickly.

 

After 12 weeks, this drops off a cliff, 55.4% of people ever return to work if they haven’t been back to work in 12 weeks. Critical concepts to now start to understand. This ball is in motion, this ball is in motion, this ball is in motion, this ball is in motion, and then after 104 weeks, less than 5% chance they ever return to work at all if they’ve been out of work for that entire time. The ball is in motion. It’s an important thing to critically understand that if you don’t change it for some reason, intervene before here, get those numbers up here, your employee is going to be likely out of work forever, causing permanent and lasting damage to their entire life, as well as making that claim very expensive.

 

 

Don’t Make Two Mistakes In A Row

 

This other concept I heard on this podcast, The Brian Buffini Show. I’ve been following Brian Buffini for 15 plus years. Great lessons, great information as far as business success, personal success, living a balanced life. Check it out if you are interested in that type of thing. But listening to this concept when they’re talking about teaching volleyball. His wife Beverly was a Olympic volleyball player and they’re teaching their daughters about how to be successful in volleyball. This concept which resonated with me, resonated with my wife, is just don’t make two mistakes in a row. Everyone’s going to make mistakes, you’re going to miss the ball, you’re going to drop the ball in some capacity in our lifetimes, but if you don’t make two in a row, you now start to avoid this ball going downhill in all phases of your life, personally as well as your work comp program.

 

If you can understand those two concepts, that the ball is going to stay in motion and if you make a mistake, if something goes wrong, if things are starting to go off the tracks, they’re going to continue to go off the tracks unless you do something about it, unless you’re intentional about it, unless you’re aware that if you’re making that mistake, oh okay, let’s not make two in a row. Or you have a bad part of your day, let’s not have that continue and ruin my entire day or my entire week or my entire month or my entire year in this capacity.

 

Two important concepts to understand, that things are going to stay in motion and if they’re going positively you want that to continue. If you make that mistake, you need to intervene and get things going on the right track.

 

Again, my name is Michael Stack. I’m the CEO of Amaxx and remember your work today in workers’ compensation can make a dramatic impact on your company’s bottom line, but it will make a dramatic impact on someone’s life. Be great.

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©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.

6 Things Employers Can Do to Reduce Lag Time

workers comp lag timeLag time is the enemy of a successful workers’ comp claim outcome. When there is an injury at the workplace, you need to know what to do.  A lot will depend on the actual type of injury.  If the injury is severe and requires immediate surgery and in-patient hospital care, you are probably going to do all possible to get the claim to the carrier/TPA as fast as possible on the day of the injury.

 

On the other hand, if a guy comes in the office and says he hurt his arm but “it is no big deal,” chances are you are going to forget about it, not make a note about it. And when he comes back in 6 months and says surgery is needed tomorrow and will be off of work for 6 months, I do not think you are going to exactly recall the brief conversation with him 6 months prior.

 

 

Lag Time Is The Enemy 

 

Lag time is also the enemy to every claims adjuster.  It can affect every aspect of the claim, most importantly the compensability.  For every day that goes by after someone is hurt without reporting it to the employer, or even worse he reported an injury to the employer who did not report it to the carrier/TPA, lag time is involved.  Lag time is the time between date of injury and the date of reporting to the employer and from the employer to the carrier. Here are some tips to improve lag time. ASK FOR A LAG TIME REPORT FROM YOUR CARRIER. They should be giving them to you periodically, but if not, ask for it.

  1. Have a system in place

 

Regardless of the size of the work population, you need to have a system in place.  The employer is going to be faced with several different types of workers comp claims: report only, medical only, lost time, advanced lost time, and severe.  A claim that is a “report only” or “incident only” should not carry the same urgency as a severe injury claim.

 

 

Every person in risk management will have a certain way of keeping records and reporting claims to the carrier/TPA.  Organization is key.  The system has to work, or else a claim will fall through the cracks. Get a separate file cabinet, dedicate a certain area of the office to claim paperwork, and keep separate email folders for claims. Whatever you do to create a working system stick with it.  Think about prioritizing each type of claim and how each issue has to be addressed.  Take it one step at a time and walk through what the responsibilities are and where you need to focus.

 

 

 

  1. Get claims called in to the carrier/TPA

 

A rule should be made that any claim with medical treatment needs to have the State Injury report completed and sent to the carrier/TPA within 1-2 business days.  Not only does this prevent lag time from happening, but it will give the adjuster a head start on the claim from early in the injury.  This can apply to medical-only claims and non-severe lost time claims.  Plenty of claims start off innocently enough as a simple medical only claim.  But then, 3 months later after conservative treatment fails, the injured worker is heading for surgery, which is not a guarantee that the employee will be 100% in the near future. The earlier the adjuster is involved in the claim, the better chances you have of it not spiraling out of control.  Plus after it is reported and called in to the carrier, that is one less thing to worry about.

  1. Call claims in with correct and complete information

 

Adjusters dislike it when they receive an injury report and most of the information is missing.  Or the injury description reads “back strain.” Maybe the place where the employee was treated is not known, or if the injured worker even went for treatment at all. Maybe you view date of birth, social security number, job title, and complete address, as trivial information.  That is okay, but the adjuster needs that information, and it needs to be accurate.  It cannot take long to pull a person’s personal information up on the computer, or email the Human Resources person to seek help with that portion of the claim.  Any way that it can get done, do it and then get the claim sent.  Incorrect or incomplete information produces lag time from when the adjuster receives the injury report to when the TPA makes a first payment on a claim.  Or even when the adjuster can make contact with the worker.  If you forgot the claimant’s phone number, and did not have a complete address, how can the adjuster contact the injured worker?

  1. Include the hourly wage and the gross total from a year prior to the injury date to reduce lag time 

 

If this claim will involve wage loss, the adjuster will need the wage records.  Be sure to list the hourly rate for the injured worker, as well as the gross pay from one year backwards from the injury date. This will save the adjuster time, cutting down on the lag time between injury date and date of first payment.  Most states will penalize the carrier for a delay in payment after an injury occurs if there is lost time. Due to this statute, the adjuster will be requesting wage records. So why not be ahead of the game and include the records with the claim forms that are sent?  The adjuster will appreciate it. And of course it is one less thing you have to do.

  1. Keep eyes and ears open on your work floor

 

As a risk manager or HR person, chances are you are removed from the work floor where a lot of injuries occur.  But, the adjuster will be calling you to talk about the injury details.  So you have to know about the machines, know the people running them, and also know who the employee’s managers are and how to talk shop with them.  Your employees should know that the first contact person after an injury is their supervisor, and then that supervisor should be coming right to you to fill out the injury paperwork after they talked with the employee and sent them off for medical care.  Make sure those supervisors know the importance of coming to you to report a claim. If the worker does not tell the employer about the injury, then you are not going to have a report to send.

 

 

  1. Be involved with the process

 

We have said it time and time again, the employer must be involved.  Not only at the initial stages as indicated above, but throughout the whole process.  To have an effective workers comp program, there must be proper reporting, proper light duty management, and proper monitoring on all aspects of the claim.  You need to communicate with the carrier/TPA for claims reviews.  Get up to speed with what is going on, and what the current lag times are.  Set goals to reduce lag time from late reporting and keep track of the numbers.  Fix your system where it needs to be fixed.  There is no perfect blueprint that will work.  A program as variable as this also needs to be flexible.  Make changes as needed and track to see if they improve numbers or worsen them, and then make further changes.  Create the program, and then be involved in it.

 

 

Summary

 

Carrier/TPAs despise lag time from late claim reporting. They keep track of it for a reason, because the greater the lag time and the later the adjuster is involved, the more the exposure risk increases.  Take some of the key points listed above and see if they can be implemented into your risk management system.  Keep track of the numbers.  If you discover that you have a lag time problem, then you have the room and the resources to save a lot of claim expense money that is spent purely on late reporting.  Like it is said, “The numbers don’t lie.”  You will be amazed at how much money can be saved simply by getting that correct claim sent in to the carrier for immediate handling.

 

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©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.

Mental Health Workers’ Comp Claims

Mental Health Workers’ Comp ClaimsReducing costs is challenging when it comes to mental health workers’ comp claims. This is based on a number of different factors that separate these claims from common physical ailments and injuries.  In order to be successful in reducing workers’ compensation program costs, members of the claim management team need to take extra steps in determining liability and making sure the claim is properly defended if there is a dispute regarding causation, and reasonableness and necessity.

 

 

Understanding Mental Health Workers’ Comp Claims

 

Workers’ compensation laws originally covered only physical injuries.  As social norms changed, so did the concept of what constitutes a “personal injury.”  As laws developed, mental health workers’ comp claims gained acceptance and allowed employees to receive wage loss and medical benefits for claims that did not involve traditional physical injuries.

 

The laws in jurisdictions vary, so it is important to understand how the law applies, the required standards and medical support necessary for a mental health workers’ comp claim to be found compensable.  There are two general categories of mental injuries claims:

 

  • Physical/Mental Injuries: This injury originates with a physical injury (specific incident or workplace exposure), and morphs into a psychological and/or psychiatric claim.  Common examples include an aggravation and/or acceleration of an underlying condition that is worsened as the result of the physical trauma.

 

  • Mental/Mental Injuries: This is an injury that results from work-related mental stress or stimulus that produces in many cases symptomology or ailments deemed to be compensable.  An early example of this type of claim comes from Wisconsin where students at a high school demanded a guidance counselor be removed from her position.  The counselor developed a severe neurosis tension state that was eventually determined to be compensable.  School District No. 1, ILRC, 62 Wis. 2d 370, 375, 215 N.W.2d 373, 376 (1974).  Compensability in other instances has included cases where the employee merely observed someone else being injured at work.  International Harvester v. LIRC, 116 Wis.2d 298, 341 N.W.2d 721 (Wis. Ct. App. 1983).

 

 

Determining Issues of Compensability

 

It is important to note the legal standard for these types of injuries varies.  There are common themes that run through statutes supporting these types of claims that a member of the claim management team must keep in mind when making determinations of compensability and whether denying the matter is appropriate:

 

  • Whether the mental condition arose from a situation greater than the “day-to-day” emotional stress one would otherwise experience;

 

  • Whether the alleged mental condition really exists based on objective medical evidence; and

 

  • Whether the workplace exposure or conditions as compared to everyday life is a substantial contributing factor in the mental health condition and/or disorder.

 

Some jurisdictions require additional medical evidence to support a claim for a mental health injury.  Examples of this include a requirement the mental diagnosis must be given by a licensed psychiatrist or psychologist, and/or meet the described criteria found in the Diagnostic and Statistical Manual of Mental Disorders (DSM).  Limitations can also be placed on these claims if the underlying condition is the result of disciplinary action, work evaluation, job transfer, layoff, demotion, promotion, termination, retirement or other good faith actions of an employer.

 

 

Special Considerations When Investigating Mental Health Workers’ Comp Claims

 

Like physical injuries, psychological and/or psychiatric claims require members of the claims management team to investigate the “mechanism of injury” when determining issues of initial compensability and reasonableness/necessity of claims.  This includes:

 

  • Obtain a complete set of medical records for the employee and make additional inquiries regarding medical care and treatment related to the employee’s mental health and any history of family/personal counseling;

 

  • Investigate treatment for chemical dependency issues. This should not be limited to the employee, but members of their immediate family; and

 

  • Reviewing issues concerning other factors that may impact the alleged injury and time off work. Factors to consider include periods of unemployment, bankruptcy, gambling problems, and other financial losses.

 

 

Conclusions

 

Issues concerning mental health will continue to dominate workers’ compensation claims as we learn more about it and its impact on one’s well-being.  The result is members of the claim management team will need to better understand how it can impact a claim and seek to run a better program to control costs.

 

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©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.

 

3 Essential Elements to Supervisor Response That Will Save 40 Percent

 

On-Demand-Blog-Ad-Supervisor

 

Can you name the one person throughout the course of a worker’s comp claim that within about 10 to 15 minutes of work can reduce your work comp cost, claim cost, by 40%, and reduce the duration by 58%? Hello, my name is Michael Stack, I’m the CEO of AMAX. And the one person I’m talking about is your supervisor. And according to Liberty Mutual Research Institute, some studies that they did, the impact of that supervisor, of how they respond to the claim when the employee initially reports it to them, if they respond positively and appropriately can reduce your claim costs, what they showed through research, by 40%. And reduce your duration by 58%. Pretty dramatic numbers for a short period of time.

 

 

Train Supervisors Doesn’t Have to be Difficult

 

So, what we need to do is we need to train these supervisors to respond appropriately. And really it’s not all that difficult. Only a couple of things that they need to know, they need to remember, they need to do at that time of injuring. And I’m going to lay these out for you here.

 

 

#1 Demonstrate Care

 

The first thing they need to do is they need to demonstrate care. Demonstrate care. “Hey, John, I’m sorry you got injured. What can I do to help?” And then listen and problem solve. Demonstrate care, listen, and problem solve.

 

 

#2 Give Employee Privacy

 

Number two then is you need to get them to a private place. You’re injured, you’re feeling a little bit vulnerable when you report that injury. You don’t want to check out your rib injury in front of all your gawping coworkers. So when that person is injured, take them to a private place. Bring them into the supervisor’s office, bring them into a first aid room if your organization has one. Take them to a private place so they can address their injury, get their wits back about them, and be able to move forward from there.

 

 

#3 Help Employee Obtain Medical Care

 

And then number three then is of course, get medical care. Get them the medical attention that they need. Best practice here is to use an injury triage provider, use an injury triage hotline, or an onsite clinic. More likely in most cases it’s going to be calling that nurse via telephonic care, through an injury triage provider. You give that nurse a call, it takes the onus off the supervisor, to have to make the decision of what to do. “Oh, you hurt your shoulder. I don’t know if that’s really a bad injury or not a bad injury.”

 

Have that nurse through the triage provider direct that person to the appropriate level of care. The way your supervisor responds to an injury can impact your costs by 40%, and your duration by 58%. This is something you need to pay attention to, and teach your supervisors how to do it appropriately.

 

Again, my name is Michael Stack, 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.

 

 

 

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: https://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 5 Building Blocks Of a Positive Corporate Culture: Part III

Strong company culture is not only a pleasant place to work, but it has also been associated with better financial success. Such companies also have fewer workplace injuries, better employee engagement when there are injuries, and quicker return-to-work rates.

 

With statistics showing most employees are either not engaged or actively disengaged in their work, it means organizations need to take steps to improve their company cultures. Vulnerability and Purpose are the final two building blocks of a positive corporate culture in our 3 part series.

 


See additional articles in 3 part culture series:


 

  • Vulnerability

 

Showing your vulnerability goes a long way in gaining trust from others. It puts you on the same level as the other person.

 

A dramatic example of the power of vulnerability came during an airline tragedy in 1989. United flight 232 was about an hour out of Denver en route to Chicago when the engine in the tail of the DC-10 blew, destroying the three hydraulic systems pilots use to move flight control surfaces and steer the plane.  While 111 people were killed, 185 survived — largely because of the efforts of a DC-10 instructor who happened to be on the plane flying home for the weekend.

 

Trained for catastrophic failures, Dennis Fitch told the flight crew “tell me what you want and I’ll help you.”  The pilot and two co-pilots put Fitch to work helping to bring down the plane. None of the flight crew worried about their status or that of Fitch; they were focused only on working collaboratively and trying any and every idea possible.

 

 

Response in Workers’ Comp is Typically Rigid

 

The workers’ compensation industry’s response to injured workers is typically very rigid. Physical restrictions are set and those handling the claim dictate what happens each step of the way. Think about how that could be different if there were collaboration and stakeholders made themselves vulnerable to the injured worker.

 

What if the employer, nurse case manager, or claims handler said to the injured worker, ‘tell me what you want and I’ll help you.’ Such a small shift in attitude demonstrates that you are a partner with the injured worker, rather than an adversary. Offering to pick up something from the office, or call a family member, or even getting a glass of water could be seen as helping.

 

Such collaboration could extend to return-to-work efforts. Instead of simply relying on the medical restrictions, you could say to the worker ‘tell me what you think you can do, and we’ll develop lite duty work.’ It’s a way of working with the injured worker, instead of being on opposite sides. It starts with vulnerability.

 

 

  • Purpose

 

All the other building blocks to a winning corporate culture come down to purpose; that is, what is the purpose or reason a company exists? What is the purpose of employees who go to the organization every day? Ideally, it is to work for something larger than just ourselves.

 

 

Majority of Workers Do Not Have Greater Purpose

 

The Gallop poll showing the engagement — or lack of — among employees in their work shows the majority of workers do not have a greater purpose in mind each day. It even showed that 18 percent of employees were actively disengaged and would go out of their way to do something that would negatively impact their companies. By using the previous four steps to create a caring, compassionate, strong culture, companies can change the attitudes of their employees.

 

As demonstrated in the study of preschoolers who were drawing, motivation must come from within. External rewards, such as additional money, are the least impactful.

 

The Nordstrom company has a great example of how an organization encourages purpose among its workers. The single rule told to employees is; Use good judgment at all time. That speaks not only to the company’s well known excellent customer service but also extends to how injured workers and their claims are managed. Managers, supervisors and injured workers all know what their purpose it.

 

 

Conclusion

 

Employees who are not only allowed but encouraged to work outside the rules and be creative are much more likely to feel a stronger sense of connection appreciation and connectedness to their organizations. Autonomy, mastery, belonging, vulnerability and purpose are the building blocks to create a winning corporate culture in which workers take pride, leading to fewer injuries and faster return-to-work.

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©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 5 Building Blocks Of a Positive Corporate Culture: Part II

Strong company culture is not only a pleasant place to work, but it has also been associated with better financial success. Such companies also have fewer workplace injuries, better employee engagement when there are injuries, and quicker return-to-work rates.

 

With statistics showing most employees are either not engaged or actively disengaged in their work, it means organizations need to take steps to improve their company cultures. Mastery and Belonging are two of the five building blocks of a positive corporate culture.

 

With statistics showing most employees are either not engaged or actively disengaged in their work, it means organizations need to take steps to improve their company cultures. Vulnerability and Purpose are the final two building blocks of a positive corporate culture in our 3 part series.

 


See additional articles in 3 part culture series:


 

  • Mastery

 

Pride in doing something well is one of the highest factors that motivates human beings. The proof of this has been borne out by several studies, including one involving preschoolers in 1970.

Children who were found to spend much of their free time drawing were divided into three groups:

 

  1. Group one students were told they would receive a blue ribbon with their name on it if they continued to draw
  2. Group 2 students were not told in advance, but received an unexpected ribbon for continuing to draw
  3. Group 3 students were neither offered nor given any reward

 

The group that continued to draw the most every day was not the first group. The promise of a blue ribbon was not a good incentive for them. In fact, the frequency of their drawing decreased. The second and third group drew the most. The reason: their motivation to draw came from within, rather than externally.

 

The same is true for adults in companies. Those who are offered more compensation or other incentives often do worse than others because their own drive to accomplish whatever the goal is has been diminished. Building a winning corporate culture involves empowering people to do their best work because they want to.

 

The workers’ compensation system is often an enemy of a strong corporate culture. Rather than feeling empowered and in control, injured workers are typically forced to adhere to a multitude of rules and regulations and given little to no voice in their own situations. Organizations can change that attitude by including injured workers in discussions about their claims and medical care and helping them feel like they too are part of the solution.

 

One idea is to ask an injured worker what he believes he can do work-wise while he recovers. This takes some pressure off supervisors to find light duty work and helps the injured worker feel more motivated to do something he wants.

 

 

  • Belonging

 

All of us need a sense of belonging. Whether it is to a relationship or organization, we want to feel like we are part of something bigger. Companies with strong cultures know this and leverage many strategies to foster it.

 

The power of inclusion has been shown in Australian studies of patients treated for suicide attempts. Following their release from hospitals, some of the patients were sent a series of postcards expressing support.

 

The idea of the postcards was simply to increase social connectedness, to create a concrete expression that someone still cares about the patient. They included statements such as, “it’s been a short time since your visit and we hope things are going well for you. If you wish to drop us a note, we’d be happy to hear from you.”

 

The researchers found that the low-cost postcard intervention reduced the number of suicidal attempts per individual by nearly 50 percent, which they described as “clinically and statistically significant.”

 

Employees also respond well to gestures that show they are a part of the organization. Such actions let workers know they are noticed and valued by others in the company.

Employers don’t need to spend large amounts of money or other resources to foster a sense of belonging. What is key is the continuous reinforcement of these measures.

These can include:

 

  • A get well card sent to an injured worker as soon as possible.
  • A phone call or visit with the injured worker the day he is injured or the next day.
  • Weekly contact with the injured worker, to discuss his situation and needs.
  • A small bouquet of flowers sent weekly, rather than a large bouquet sent just one time.
  • A small, $5 gift card for Starbucks.

 

Reinforcing the sense of belonging is vital — for all employees but especially for injured workers who are inherently feeling left out. One risk manager decided to increase the connectedness of injured workers by taking each of them out to lunch while they recovered. Out of 12 employees, 10 were back at work within two weeks.

 

 

Conclusion

 

Feeling like we are a part of something greater than ourselves is something all humans desire. When the work environment promotes this, employees are more engaged and motivated to be the very best they can be for their organizations. Using the 5 strategies to improve a company’s culture can go a long way to making this happen.

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©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 5 Building Blocks Of A Positive Corporate Culture: Part I

Why do employees go to work every day at a particular organization? Is it the paycheck? The people? The work itself? Or something else entirely — the environment, perhaps?

 

If it’s the company culture, you’re in business! It means your employees are more likely to stay for the long term, less likely to incur injuries, more willing to cooperate and engage in their healing if they are injured, and unlikely to stay out of work for very long. A strong, positive corporate culture is key to keeping workers happy — especially if and when they are injured.

 

Savvy organizations understand that and know the 5 strategies that must be carefully implemented to create a winning corporate culture.

 


See additional articles in 3 part culture series:


 

 

  1. Autonomy/Safe Culture

 

Micromanaging people and forcing them to adhere to strict sets of rules and regulations do not produce creative, out-of-the-box thinking that puts companies ahead of the competition.  What is needed is effective collaboration among workers. Synergy is the key.

 

Groups of workers can achieve amazing results when they feel safe to share their ideas and are focused more on working together rather than one-upping other workers. This has been proven in the popular, Marshmallow Design Challenge.

 

Design engineer Peter Skillman came up with the idea of looking at group interaction through an exercise replicated at many companies. It begins with four components:

 

  1. 20 sticks of uncooked spaghetti
  2. One yard of tape
  3. One yard of string
  4. One marshmallow

 

Teams of 4 each are given 18 minutes to create the tallest possible free-standing structure using only those ingredients. Skillman and others have undertaken the study with many groups; such as CEOs, lawyers, recent business school graduates, and kindergarteners. The winners are always, hands down, the kindergarteners. Their structures are on average 26 inches tall. Among the worst performers are recent MBAs, with a dismal average structure of just 10 inches.

 

 

5-Year Old are Better at Collaboration Than Business Students & CEOs

 

Why are 5-year-olds better at collaboration than other, older more experienced groups? As Skillman himself has said; “none of the kids spend any time trying to be CEO of Spaghetti, Inc.”

 

It is not that the kindergarteners have better skills than those in the other groups, it is that they interact more effectively. The business school students are engaged in managing their statuses within the group, figuring out where each fits into the picture. Instead of focusing on the task, they are spending their energy on the pecking order of the group. By contrast, the kindergarteners work together enthusiastically, trying new ideas, moving quickly, and helping one another toward the solution.

 

Navy SEALs work together in much the same way. Each is dependent on the success of the other. If one fails, they all fail — or even die.

 

Creating an atmosphere where workers feel free to truly share their input without fear of repercussions requires breaking down silos and encouraging each and every person in the organization to speak up. Employees who feel valued by a company are more apt to feel comfortable contributing to the greater good. Skillman suggests the following to help workers feel autonomous and safe:

 

  • Allow them to learn by doing and discovering problems that can’t be predicted in advance.
  • Simultaneous iteration enables a free flow of good ideas.
  • Multiple iterations usually beat a commitment to making the very first idea work; i.e., practice makes perfect
  • Encourage wild ideas.

 

Organizations can encourage autonomy by giving employees time on which to work on something not necessarily related to their normal jobs, but something they are interested in doing. This helps set expectations and can also lead to the creation of light duty work for workers who become injured.

 

 

Conclusion

 

Employees who are not only allowed but encouraged to work outside the rules and be creative are much more likely to feel a stronger sense of connection appreciation and connectedness to their organizations. In addition to autonomy; mastery, belonging, vulnerability and purpose are the building blocks to create a winning corporate culture in which workers take pride, leading to fewer injuries and faster returns-to-work. Parts II & III take a look at those strategies.

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©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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