Orchestrate A Culture of Quickly Reporting Workplace Injuries

reporting workplace injuryAn important role of the claims management team is to coordinate with employers and defense interests to make sure quickly reporting workplace injuries is a top priority of your organization.  It is easier for claims to be evaluated and decisions regarding primary liability to be made in an effective and efficient manner when injuries are quickly reported.  There are many steps claims management teams can make to develop important work injury compliance steps, which includes the use of evolving technology.

 

 

Emphasis the Importance of Reporting Workplace Injuries

 

There are several steps that employers can make to ensure workers’ compensation claims are reported in a timely manner.  This starts with developing a culture of understanding on the part of the employees.  This goes beyond making sure the proper posters are displayed in the workplace:

 

 

  • Provide documentation on how work injuries should be reported and the information needed to make a report of injury; and

 

  • Ensure that the employer has a contact person to make sure the First Report of Injury is filed timely with the workers’ compensation insurer. In some instances, employers and their staff are unsure how the process generally works.  Making sure these persons understand the process is important.

 

All workers’ compensation insurance carriers and third-party administrators can provide information to their insured on these processes.

 

 

Ensure of Culture of Compliance from the Top

 

The best workers’ compensation programs at the employer level have a culture of compliance and consistency.  This means that senior-level leaders within an employer need to emphasize safety and ensure that reports are being dealt with ethically and honestly.  All employees need to be treated with respect and dignity.  Other steps can include:

 

  • Preparation, issuance, and posting of quarterly safety reports. State industrial commissions typically require the posting of job site injury information.  This should be viewed as the baseline requirements – do not be afraid to go beyond those requirements; and

 

  • Highlight improvements to safety within the workplace. This ensures that all employees understand the important role they play in the process.

 

 

Eliminate ‘Accident-Free’ Incentives

 

Employers often attempt to drive a culture of safety through creative programs that provide cash incentives for ‘accident-free’ days. These types of programs are a mistake because studies demonstrate they have an adverse effect where employees feel they cannot report a workplace injury.  In reconsidering these original programs, employers should focus more on a metric that encourages the timely report of work injuries.

 

 

Provide Effect Reporting Tools

 

Technology has created many opportunities for employers to ensure all workers’ compensation claims are reported by employees in a timely manner.  It also allows employees to provide greater detail, including documentary evidence that allows for quicker and more accurate decisions concerning primary liability.

 

One example of matching technology with efficient and effective work injury reporting is app-based technology.  The development of this technology is cheap, and it is easy to implement.  With a vast majority of employees having smartphones, it is something nearly anyone can upload and use.  Features that can be used on these apps include:

 

 

  • Easy communication with the injured worker and the claims management staff. Communications include information regarding primary liability determinations, request for documents and prior authorization requests; and

 

  • Payment status and direct deposit of indemnity benefits. This allows for injured workers to receive payments immediately, and avoids the uncertainties of mailing a check.

 

 

Conclusions

 

The workers’ compensation process starts with the reporting of workplace injuries. This is a process that causes confusion, delay, and frustration in the process.  Proactive members of the claims management team can work with their insured to improve the reporting process through reforms to internal processes.  It can also include the development and implementation of app-based technology to make the process efficient and user-friendly for all employees.

 

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©2018 Amaxx LLC. All rights reserved under International Copyright Law.

 

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

Compounded Medications — 6 Solutions to Address a Nagging Issue for WC

Compounded Medications — 6 Solutions to Address a Nagging Issue for WC“There is no such thing as an FDA-approved compound medication.” That statement from myMatrixx Chief Clinical Officer Phil Walls underscores one of the main criticisms of these medications; while the drugs within the mixtures may all be FDA-approved, the specific combinations have not been tested and verified.

 

Safety is just one concern, however. The other is cost; they generally are priced significantly higher than similar, FDA-approved drugs or the sum of their underlying medications.

 

Both the utilization and the average cost of compounded medications in the workers’ compensation system has decreased in recent years. However, there are still pockets of excessive use. Stakeholders need to maintain a steady and continued focus on efforts to curb the unnecessary use of these pharmaceuticals.

 

 

Problems Cited

 

Compounds are a mixture of drugs intended for a specific patient’s use. According to an FDA report, they are beneficial only in limited circumstances; such as when other medications have failed, a patient is allergic to some of the inactive ingredients or has difficulty swallowing.

 

The federal agency inspected compounding facilities and noted the following “troubling conditions” that could lead to widespread harm of patients:

 

  1. Toaster ovens used for sterilization.
  2. Pet beds near sterile compounding areas.
  3. Operators are handling sterile drug products with exposed skin, which sheds particles and bacteria, among many others.

 

 

Latest Stats

 

Compounded medications are not considered first-line therapy for pain or other common conditions of injured workers according to industry guidelines, such as evidence-based medicine guidelines from Work Loss Data Institute, American College of Occupational and Environmental Medicine, and many other state-specific guidelines.

 

Compounds are available in many applications but are used in workers’ compensation most often as topical products for pain management. Usually, compounded medications are excluded from workers’ compensation formularies, and require prior authorization before they are dispensed to an injured worker.

 

State legislatures and organizations within the workers’ compensation system have taken steps in recent years to reduce the overuse of compounds, and they have been largely effective, according to the most recent Drug Trend Report in the workers’ compensation system from myMatrixx:

 

  • Spending on compounded medications declined 37.1 percent in 2017
  • It was the third year in a row that payer spending on compounded drugs has decreased
  • Compounds fell from the top 10 therapy classes
  • Utilization decreased 21.2 percent
  • The average cost of compounded medications decreased 15.9 percent

 

Along with the good news, however, are some disturbing reports.

 

Recent Problems

 

  • Pennsylvania. A recent report found that legislative reforms in the state resulted in cost savings on physician-dispensed drugs; however, they were offset by an increase in pharmacy dispensing of expensive compound drugs.

 

The legislation that took effect in December 2014 capped prices paid for physician-dispensed drugs and restricted physician’s ability to dispense opioids and other drugs to limited timeframes. The Workers Compensation Research Institute found there was an associated decrease in the number of injured workers who received physician-dispensed drugs. But they also found there was a “dramatic” increase in the prescription payments for compound drugs in the same years, which it attributed to the emergence of new pharmacies dispensing expensive drug products, especially compound drug prescriptions.

 

  • Texas. A loophole in the state’s drug formulary allowed compound prescriptions to be filled without obtaining preauthorization to confirm medical necessity. Regulators said the workers’ compensation system saw a 46.4 percent increase in compound prescriptions from 2010 to 2014, with the total cost of an average prescription more than doubling from $356 to $829.

 

 

Solutions

 

A new rule amended the Texas formulary to exclude any prescription drug created through compounding and required preauthorization for all compounded medications. That rule took effect July 1. Several additional states have adopted similar measures, including Arkansas, Oklahoma, Florida, Nevada and Tennessee, and the idea is being considered in other jurisdictions.

 

The National Conference of Insurance Legislators is considering model legislation with clearly established guidelines for the reimbursement of pharmaceutical products in the workers’ compensation system. It includes language that would limit compound medications and require a critical evaluation with a physician documented statement of medical necessity or a utilization review of the compounded pharmaceutical products.

 

Stakeholders can work closely with state regulators and legislators. Additional ways to address the issue of excessive use of compound medications include:

 

  1. Working closely with a pharmacy benefit manager to ensure compounds are used judiciously and only when preauthorized
  2. Payment limits. Placing reimbursement limits per each script or per each ingredient in a compound medication
  3. Limiting the number of ingredients or the total cost per script
  4. Retrospective review. Allowing employers the option to deny coverage for a compound medication that has not been preauthorized
  5. Network pharmacies. Allowing employers to direct injured workers to specific pharmacies
  6. Including compound medications in the list of medications allowed only with preauthorization

 

 

Conclusion

 

The overuse of compound medications has been a troubling area for workers’ compensation stakeholders for several years. Strategies to address the issue are effective but must be continually employed and updated to ensure the problem is appropriately managed.

 

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©2018 Amaxx LLC. All rights reserved under International Copyright Law.

 

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

Prepare To Effectively Manage Death Claims – And Hope You Never Have To

Prepare To Effectively Manage Workplace Death Claims – And Hope You Never Have ToIt is a horrible tragedy when an employee is killed at work.  While we hope this never happens, over 6,000 people are killed every year in workplace accidents.  This averages out to about 14 workplace death claims per day and nearly 100 per week.

 

The impact of an employee death is heart wrenching and impactful for an organization.  It is essential for members of the claims management team to understand how to effectively deal with workplace deaths.

 

 

Conducting an Effective Death Claim Investigation

 

It is important to conduct an effective and prompt investigation once someone is killed due to a workplace incident.  In addition to the steps normally taken, it is important to obtain the following information:

 

  • Reports regarding the incident. This includes police and ambulance reports.  Other important documents include OSHA generated forms and safety logs, along with information concerning any tools or equipment involved.  Make sure no evidence is destroyed.

 

  • Determine whom may be entitled to benefits. This includes the marital status of the deceased employee, information concerning their dependents and the location of where these people were living.  Questions often arise when the employee and their spouse are separated or are in the process of getting a divorce.  Domestic partnership status is also important to know and understand.

 

  • Validate important documents concerning family relationships. This is important in cases where marriage or parentage is not clear-cut.

 

Most workers’ compensation laws require a workplace death is reported to the state industrial commission within 24 to 48 hours of the incident.  Ensure the proper report is made in a timely manner.

 

 

Dealing With Other Special Issues

 

Determining issues of a spousal relationship or parentage can become complex issues.  This is the result of the chaining definition of what constitutes a family, dependents and the legalization of same-sex marriages.  When investigating these issues, members of the claims management teams should closely scrutinize the following issues:

 

  • Establishment of residence: In many jurisdictions, marriage to another person does not automatically qualify the spouse for dependency benefits.  If the couple is separated (even not in a legal sense), the survivor may be excluded from additional compensation;

 

  • Recognition of marriage: This issue can arise in several different instances.  The most common is couples who were married under “common law” in a jurisdiction that recognizes such practices but later moves to a location that does not recognize that form of marriage.

 

  • Parentage: The increased use of genetic testing has helped resolve some of these issues over the years.  However, questions may still remain if there was not legal recognition of the relationship prior to death.  Legal battles may ensue of the deceased employee is cremated prior to testing being performed.

 

 

Most Important: Demonstrate Care in Difficult Situation

 

Demonstrating care and empathy is critically important in the face of a tragic death claim. Steps to prepare your organization include:

 

  • Create a dedicated team to handle all workplace death claims. This will allow for others on the team to better allocate their time on other cumbersome files and allow for a more effective response.

 

  • Educate employers and other interested parties on workplace safety issues. This is especially true when working with employers who fall into high-risk categories.  This includes construction jobs that involve employees working at heights, the operation of dangerous equipment and machinery and those who work in the lumber and logging industries.

 

  • Go beyond what is required by the law. This can include random acts of kindness such as sending flowers to the next-of-kin.  Members of the claims management team should also avoid blaming the deceased employee – it was someone’s son or daughter who died.

 

  • Promote efforts that go beyond safety training. Encourage interested stakeholders to look beyond the incident and understand the events leading up to the fatal incident.

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©2018 Amaxx LLC. All rights reserved under International Copyright Law.

 

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

 

Conclusions

 

A workplace death is an event all employers hope they never experience.  However, it is important for members of the claims management team to be properly prepared.

Technology Can Make Return-to-work More Effective and Efficient

Technology Can Make Return-to-work More Effective and EfficientYou are all probably aware of many of the standard strategies that can be employed to ensure timely return to work during and after recovery from an occupational injury or illness.

 

 

Technology Can Make Return to Work More Efficient

 

But are there any newer technologies and approaches that can facilitate this process to make it more effective and expedited?

 

In a previous article, I discussed the critical need for an advanced form of “job description,” which we refer to as a digital job profile (DJP) containing a comprehensive physical demands analysis(PDA).  It bears repeating that the digital job profile is the cornerstone to understanding the explicit, quantitative demands of a job, and is utilized by all stakeholders in the claim management continuum. How can we return an individual to modified or full duty without knowing exactly what the job requirements are?

 

 

Psychological Component Can Play Greater Role Than Biological

 

Many of you are aware of the biopsychosocial model of injury or illness. In short, this is the recognition that non-physical factors highly impact functional restoration. In fact, many experts feel that the psychosocial components play a greater role than biological ones. You have undoubtedly noticed that the same type of injury may be devastating to one individual, while a more resilient person easily overcomes it. It is extremely helpful to predict whether your claimant is likely to be in the former or latter category.  If the claimant is fragile from a psychosocial perspective, many mitigation strategies can be employed to prevent the delayed return to work/life activities that inevitably accompanies these comorbidities.

 

Fortunately, there are automated, online screening tools available that allow you to enter claimant responses to a brief series of questions, and provide you with an immediate, calculated psychosocial risk level (high, medium, low). These validated tools may also recommend various interventions derived from the response pattern of claimants to the questionnaire. Some folks will benefit from cognitive behavior therapy, and others from family counseling, vocational guidance or psychiatric assessment. Risk screening helps to identify the level of risk, as well as appropriate strategies to help individuals better cope with the added stress of an injury or illness.

 

 

Share Digital Job Profile with Treating Clinicians

 

Now that you have shared the digital job profile with treating clinicians, allowing them to set rehabilitation modalities and goals, and have dealt with any potential psychosocial risks, what is the most efficient way to monitor progress and make decisions about return to work? Again, technology to the rescue!  One can send the digital job profile to a clinician, such as a physician or physical /occupational therapist, along with an online app that allows them to quickly and electronically document the capacities and/or restrictions and limitations related to any impacted body regions. This information is then instantly available to claim adjusters and nurse case managers and allows for quick determinations about a return to full or transitional modified duties, and at the end of treatment, this facilitates the “job matching” process. Automated algorithms can assess whether the claimant can return to their own job, alternate employment at the same company, or any other job contained within an extensive jobs database.

 

These processes streamline the recovery and return to work process by applying standardized objective functional metrics, validated screening and analysis tools, and integrated information-sharing among stakeholders. Additionally, they serve as an important defensive strategy given current ADAAA regulations and EEOC challenges.

 

 

Jacob Lazarovic MD, Medical Advisor at Amaxx LLC, Chief Medical Officer at MyAbilities. has considerable experience in managed care, including 18 years as chief medical officer at Broadspire, a leading TPA. His department produced clinical guidelines and criteria to support sound medical claim and case management practices; participated in analysis, reporting and benchmarking of outcomes and quality improvement initiatives; developed educational and training programs that updated the clinical knowledge and skills of claim professionals and nurses; provided expertise to enhances the medical bill review process; and operated a comprehensive and unique in-house physician review (peer review) service. He has been published extensively in industry journals and has held several senior medical management positions at companies including HealthAmerica, Blue Cross/Blue Shield of Florida and Vivra Specialty Partners

Health Navigation – Finding a Path to Better Health and Lower Costs

Health NavigationIf you or a loved one has ever been hurt or sick, you know well that healthcare and insurance systems are complicated; the challenges can seem endless and overwhelming.

 

Health navigation helps individuals and companies through these challenges. It includes clinical services, of course, but it’s much more than that. Knowing what services are needed, where to get them, and in what timeframe are critical elements to getting on the right path to recovery.

 

 

Fundamental Premise of Health Navigation

 

People can’t always tell at the onset how serious an injury or illness is. So, sometimes they go to an ER when they could have gone to a doctor’s office, or they go to a doctor’s office when they could have cared for themselves. Other times people underestimate or don’t recognize symptoms, and look back wishing they had realized how serious something really was – this regret can make them more likely to overreact the next time they are confronted with a health concern.

 

The fundamental premise of health navigation is getting people the care they need when and where they need it, which removes burdensome guesswork. A best-in-class health navigation provider should:

 

  • Have clinicians which navigate people to the right level of care at the right time, in the right place.
  • Have systems to help people determine the severity of each case and the best course of action for treatment.
  • Provide the needed care or guide patients in self-care whenever possible.
  • Make a referral when further care is required

 

People know overtreatments and over prescribing exist, but they don’t know how to tell when it is happening to them. What’s the best practice?

 

 

Evidence-Based Medicine

 

Evidence-based medicine is the best practice; it represents the science of proven medical effectiveness. Protocols, algorithms, and guidelines need to be built on evidence-based medicine. As a result, unnecessary treatments and prescriptions are avoided while required treatments are obtained right away.

 

People want to believe that all providers follow best practices, but still unnecessary care persists, including surgeries, prescriptions, therapy, and other interventions that contribute to high costs for everyone.

 

The healthcare and insurance systems have evolved to include many conflicts of interest, financial biases, and administrative costs. Effective navigation requires guiding patients to the right destination rather than following the momentum and pressures of a complex claims-driven system. Working with a provider who operates transparently and without conflicts of interest offers the key difference of advocating for patients rather than treating them.

 

 

Access to Care

 

It can take weeks to get an appointment. Lack of access to care drives frustration and drives people to go to more expensive options such as urgent care centers and ERs.

 

Clinics can and should be convenient and accessible, mobile units should go to patients, virtual health services should be available on-demand 24/7, and a telephonic triage service should be pre­loaded with clinics that accept walk-ins and new patients. In addition, staff should know the in-network providers in their patient’s communities, establish relationships, and have the tools necessary to gain appointments.

 

Serious illness and injury involves a lot of emotion, which affects people’s decision making. It feels awkward to tell a provider you want a second opinion or other options. It is not easy to know if a provider is in-network or out-of-network, and it is near impossible to find out in advance what services cost.

 

 

Decision Support

 

Navigation requires decision support – not just information, but recommendations. People need reassuring, they want to know the risks, and they appreciate assistance.

 

Health navigation gets people through the system to achieve better clinical outcomes and lower costs. That’s good for individuals, and it’s also good for their employers, who bear much of the cost of caring for their employees and their families, and who want their employees to be healthy and productive.

 

 

Author 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

 

 

 

 

The 8 Sections of Your Workers Compensation Insurance Policy

The 8 Sections of Your Workers Compensation Insurance PolicyEvery employer buying workers compensation coverage knows it is an insurance policy for the costs associated with injured employees, but few employers ever read the actual policy. The primary reason most people do not read the insurance policy is because it is written in “insurance speak” or legalese. The following is an effort to translate a generic workers compensation insurance policy into everyday English so more people can understand it.

 

 

A workers compensation insurance policy is actually divided into two parts. The first half covers what most employers think of in workers compensation. The second part is the “Employers Liability Insurance.” Part two is designed to cover instances where workers compensation insurance does not apply and an employee brings a lawsuit against the employer. Part one’s coverage and workers compensation statutes are so broad that it is rare for an employee to be able to bring a claim under Part two. For the purposes of this article, we will only be addressing what is typically found in Part one of the policy coverage

 

 

Section A – What the Insurance Covers

 

Workers compensation insurance will pay for injuries caused by accidents, or for illness/disease caused by being exposed to an unfavorable environment. Accidents and illnesses also include death. This section limits the coverage to the policy period. The injuries or illness has to be caused by conditions associated with the employee’s employment. If the work comp claim brought by the employee is for work-related illness, the employee’s last day of exposure to the conditions causing the illness must occur within the policy period.

 

 

Section B – What the Insurance Company Pays

 

The insurance company agrees to pay for all benefits as defined by the workers’ compensation statutes of the state where the employer does business. The insurance company agrees to make timely payment of these benefits.

 

 

Section C – The Right to Defend Claims

 

The insurance company reserves the right to determine which claims it will pay willingly and which claims it will contest. In exchange for the insurance company making this decision, the insurance company agrees to pay the cost of defending the employer from any claim brought against the employer. This allows the insurer to investigate and settle claims as it deems appropriate. It also includes the insurer’s right to not to defend a claim if it is not covered by the policy.

 

 

Section D – Additional Things Paid By Insurance

 

The insurance company agrees to pay the cost associated with the claim in addition to benefits provided by the work comp laws. This includes such things as:

  1. Attorney fees and expenses.
  2. Surveillance and extraordinary investigative expenses.
  3. Medical management expenses (triage, nurse case managers, etc).
  4. Court cost.
  5. Employer’s expenses incurred at the request of the insurer, excluding loss of earnings.
  6. Appeal bonds.
  7. Any other expenses incurred by the insurer.

 

 

Section E – When There Exists Other Insurance

 

If the employer has a self-insurance retention or large deductible, the insurer will not pay until the employer has met its financial responsibility under the policy. Also, (this rarely happens), if the employer has other workers compensation insurance that will pay for the employee’s injuries, the insurance company will not pay more than its share of the benefits.

 

 

Section F – What the Employer Must Pay

 

The insurance policy makes the employer responsible for payments when the employer:

 

  1. Intentionally fails to comply with a safety law or regulation.
  2. When the employer has serious and/or willful misconduct.
  3. When the employer knowingly employs someone in violation of the law.
  4. When the employee brings a claim against the employer for discharging, coercing or discriminating against the employee for bringing a work comp claim.

 

Also, if the insurance company is compelled to make a payment in one of these situations, the employer agrees to reimburse the insurance company for all cost associated with the situation.

 

 

Section G – The Right of Recovery

 

In exchange for the insurer paying the work comp claim, the employer and the employee agree the insurer will have the right to recover the cost of the claim from a third party who is at fault for the injury (think auto accident or equipment malfunction).(WCxKit)

 

 

Section H – Legal Stuff

 

This section includes several miscellaneous conditions including:

  1. Most states consider notice to the employer of a work comp claim to be notice to the insurer.
  2. An employer’s bankruptcy does not relieve the insurance company from paying the work comp claims.
  3. The insurance company agrees it is primarily responsible for any benefits owed under the policy.
  4. The legal jurisdiction is the state where the employer is located.
  5. The insurance company agrees the policy conforms to the applicable law.
  6. The insurance company agrees to pay any special taxes or assessments that arise due to the issuance of the insurance policy.
  7. Anything in the policy that conflicts with the state law is modified to comply with the state law.

 

Not every workers’ compensation policy will follow this generic outline, but the above outline should assist you in understanding your workers’ compensation insurance policy.

 

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©2018 Amaxx LLC. All rights reserved under International Copyright Law.

 

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

Say It In 5 Minutes to Motivate Risk Management Change and Align Resources

In the risk space, whether you are operating as a Chief Risk Officer focused on all organizational risk or a Traditional Risk Manager focused on hazard risk, you are working in or designing a risk system that is required to move people and processes to action.

 

To move people and align resources to action, the most valuable thing a risk leader can do [whether it is a global message on your Enterprise Risk Management initiative or a targeted message on your hazard risk program] is to package the message and “SAY IT IN 5 MINUTES”. Risk initiatives are complex; they involve many stakeholders and processes. For any message to be effective it must successfully negotiate through organizational obstacles, politics and silos. Risk programs will not move forward if the message is not clear and stakeholders cannot understand and connect to the why, how and expectations.

 

 

Process More Important Than The End Product

 

Risk leaders have an incredible opportunity to demonstrate value by committing to putting “the message” into a 5 minute Corporate Risk Video.

 

By making this commitment, risk leaders will soon learn that going through the process is even more important than the end product. By committing to this “5 MINUTES”, it forces them to listen to and consider the perspective of all stakeholders and it requires capturing a meaningful story that all can see and embrace, one founded in purpose and has value that will be around for many years.

 

If you can effectively capture the heartbeat and include stakeholders in the process, you will be able to begin driving passion into an organization from the backroom and owners and employees will ultimately drive the risk process.

 

This exercise will support your culture and this process of being clear & concise will translate into the on-going branding that your risk initiative requires.

 

 

5 Steps to 5 Minute Message

 

Your 5 minutes need to be more than an emotional/feel good story. You will get the most out of it by incorporating the following 5 Steps:

 

 

1) Decide what you want your message to do – What action are you looking for? Make the commitment to go past the informative story to one that motivates and drives action.

 

Put yourself in the seat of every stakeholder and be realistic.

 

  • Will they get your message?
  • Will it motivate them to action?

 

This is the first test of the value of your risk program. If your program message is built on policies and procedures you put in place and your goal is purely compliance, your audience will see this and likely tune out within the first 30 seconds.

 

 

2) Be clear on your identity – Successful companies are driven by a mission which is the reason for existence from the front room (C-Suite) of the organization. This mission describes the purpose and overall intentions. It supports the company vision and serves to communicate the purpose based on core values. Company leaders put time and resources into this because, if done properly, it will be the heartbeat that drives what everyone does.

 

The problem is that corporate heartbeats (values, vision and mission) do not naturally translate passion into risk initiatives. Before writing the script, make sure that you are clear on the risk program purpose and values and be clear in your mind what this looks like.

 

What it looks like must come out in your message. Risk Leaders have an opportunity to create a heartbeat and drive passion into an organization. Your 5 minutes will have no value if your message is not founded on values that translate into a vision and mission that gives your program passion and meaning. Safety values, vision and mission are core to your risk system design.

 

 

3) Define the why, the how and the expectation – Risk statements typically have a lot of buzz words and unrealistic goals. For example, in the hazard risk area, although “Zero Accidents” is a term many use, it often leaves stakeholders frustrated because the challenge is tossed out without valid support or a plan to meet this goal.

 

Although your 5 minutes can be packaged to look pretty, if you are not addressing the why, how and expectation in a way that is obtainable, people will not connect and your message will just be another story that does not get a second look and does not drive them to action.

 

 

4) Include stakeholders – Best practice risk programs have roles and responsibilities for all parties. This is the opportunity to define all stakeholders’ roles and responsibilities, to get their perspective and include them in the message and the final edit. Saying it in 5 minutes is something stakeholders from each of your 3 Lines of Defense can contribute to and should be able to celebrate and support when it is completed.

 

 

5) Match the Video with the Script (your people in action) – This is the risk leader’s opportunity to tell the message in a way it has never been told. Each word is important and the video shots supporting the message are extremely valuable as well as the words and phrases that you emphasize. Scripts break your message into the hook, introduction, your value and message on the why and how and provides the expectation and conclusion. The hook gets their attention and ensures the audience is listening and the conclusion is your call to action.

 

 

“Say it in 5 minutes” is all about leadership. You cannot expect to engage and move people and processes to support your plan if your passion and your message are not understood or clear. The time you spend developing your 5 minutes can be one of the most valuable things you can do to impact your program.

 

 

Author Mark Bennett, Founder of Risk Innovation Group (RIG), is dedicated to helping large employers face the complexities of risk through innovative Enterprise Risk Management (ERM) practices. ERM programs don’t just help large employers manage business risks more effectively; a well-developed ERM program can protect and create value as well as improve business performance and generate a strong competitive advantage.  Contact: m.bennett@riskinnovationgroup.com

 

 

3 Workers’ Comp Payroll Deductions Most Often Missed by Employers.

3 Workers’ Comp Payroll Deductions Most Often Missed by Employers

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If any of your workers are getting overtime, are those extra dollars included in your workers’ compensation premium calculations? If you answered ‘yes,’ you may be artificially inflating your payroll; i.e., paying higher premiums than is warranted.

 

Overtime, double time, and severance pay are typically allowed as deductions for workers’ compensation premium calculations. Yet companies large and small often overlook these three points. Knowing what deductions are allowed in your jurisdiction(s) and understanding how to apply them can save payers big dollars — immediately.

 

 

Accurate Payroll & Class Codes

 

Injury management is the area where most workers’ compensation cost-cutting strategies are focused, and with good reason. Reining in workers’ compensation costs through safety efforts, effective return-to-work programs, and best practices in medical management are proven to contain overall costs. But risk management is only part of the equation.

 

If you’re not reviewing your payroll (remuneration) and class codes for accuracy, you may be missing significant opportunities to quickly and easily reduce workers’ comp costs. Depending on the jurisdiction, there can also be an opportunity for deductions from uniform allowances, to officer excess and gratuities, to employer-provided perks. Ask your premium auditor or audit manager to reveal deductions you are allowed to take and still have an accurate assessment of your risk.

 

 

The Big 3

 

A majority of jurisdictions allow deductions for

 

  • Overtime pay
  • Double time pay
  • Severance pay

 

Workers’ compensation premiums are designed to assess risk exposures appropriately. But paying someone double time to work on a Sunday, for example, doesn’t double his risk of injury; nor days paying out a golden parachute to a worker who has left the company. Taking allowable deductions can drastically lower your payroll — and your workers’ compensation premium.*

 

*Note: Compared to a guaranteed cost structure, employers in a high-deductible program may not be as greatly impacted by payroll deductions due to the significant latitude carriers possess with adjustments and credits/debits in the premium formula.

 

 

How to Do it

 

Getting the most out of allowable deductions is dependent on accurately presenting your payroll. Your workers’ compensation premium is based on your gross payroll (remuneration) including, for example, salaries, commissions, bonuses, vacation, holiday and sick pay.

 

Overtime and other payments can be excluded. But it’s important to exclude only premium portion greater than the standard rate:

 

Here’s how to figure your payroll with overtime deductions:

 

Say your company pays overtime — time-and-a-half — for someone who works on a Saturday and double time for working on Sunday. A worker who makes $10 per hour would get $15 for working on a Saturday and $20 for working on a Sunday. Let’s say he worked 8 hours both days.

 

To determine accurate payroll, you would deduct the $5-per-hour extra he made on Saturday and the $10-per-hour extra he made on Sunday. To calculate the exclusion:

 

Saturday                                  8 Hours x $5 =   $40

Sunday                                    8 Hours x $10 = $80

 

Total amount excluded from payroll = $120 ($40 for Saturday and $80 for Sunday)

 

You only need to pay premium on the worker’s regular $10-an-hour rate for the extra hours he worked, not the additional dollars.

 

Employers need to maintain payroll records that show the regular rate of pay, the overtime earnings, and a summary by type of operation performed, in order to get credit for the overtime excess.

 

It’s also important to understand that increases in wages are not eligible for exclusion. If you increase a worker’s base wage, that increased amount would need to be included in the payroll.

 

For severance pay, the calculation is easy. You can exclude these dollars paid to someone who no longer worked at the company to the extent it does not include pay for time worked or accrued vacation.

 

While these deductions may not seem significant, they can add up quickly and result in major savings.

 

 

Conclusion

 

You want to make sure your employees are properly covered for any work-related injuries they incur. However, you don’t want to pay any more workers’ compensation premium than necessary.  Knowing and applying allowed deductions can go a long way to dramatically reducing your workers’ compensation premiums while still paying the appropriate amount.

 

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©2018 Amaxx LLC. All rights reserved under International Copyright Law.

 

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

Overcome Financial Fears Which Prevent A Successful Workers’ Comp Settlement

Overcome Financial Fears Which Prevent A Successful Workers’ Comp SettlementMany injured workers who settle their workers’ compensation claims struggle with how to ensure they’ll have enough money throughout their lives. There are many issues to consider in addition to continuing medical care – paying monthly bills, funding a child’s education, and unexpected expenses that may arise. There may also be concerns about complying with various government programs, such as Medicare and future tax implications.

 

Partnering with an expert settlement consultant is a must for any injured worker thinking of settling his workers’ compensation claim. There are many issues to consider and personal decisions to be made. A competent, experienced professional who spends time getting to know the injured worker and his loved ones can provide invaluable insight and guidance in the process.

 

 

Decisions, Decisions

 

Many people expecting a large sum of money opt for a large cash windfall over a long-term plan.  Sadly, despite their best efforts to preserve it, many of these individuals find the money is soon depleted. Statistics show this happens all too often.

 

Injured workers who settle their workers’ compensation claims are no different. But those who have the benefit of working with an expert can realize the myriad options involved in a settlement regarding how, when and what amount of money they can collect to meet their specific needs.

 

As an example, we’ll take a hypothetical case.

 

John is 57 years old and has been receiving workers’ compensation benefits for 7 years after being severely injured in a work-related accident. John is tired and frustrated with the workers’ compensation system and would like more control over his medical decisions. However, he has significant worries about the settlement amount. He doesn’t know how much would be appropriate to cover his lifetime medical costs and is concerned that he will run out of money too soon. He also has several outstanding debts that must be repaid soon. And he has a family and is worried he won’t have money to address their needs, now and in the future.

 

Finally, there is the issue of Medicare. He’s been told his medical care would need to be funded through a special fund to ensure Medicare is not forced to pay for treatment that should be covered through workers’ compensation. He doesn’t quite understand that or what his obligations would be.

 

 

The Solution

 

John and injured workers like him could have much improved, empowered lives — if they had an experienced, capable settlement consultant available to help. Such an expert could spend time with John and his family and sort out their various needs:

 

  • Money to pay off immediate expenses
  • Medicare and its requirements
  • College education funding for his children
  • Wedding expenses for his eldest daughter and her boyfriend
  • Funds to eventually help care for his aging parents

 

What John and many others may not understand are the various legal changes over the years that have made a long-term settlement plan much more appealing. For example, the government allows structured settlement payments to be income tax-free if they are the result of a physical injury, sickness or wrongful death. Congress has established specialized annuity contracts to meet the special needs of injured people, and to address the concern that too many people spend their money quickly. The idea is to incentivize injured workers and their families to take their settlement money in a series of guaranteed future payments.

 

Contrary to what some may believe, there is also the option to take some of the money upfront, and/or as a future lump sum payment. There are no constraints on how the money is paid. For example, it can be

 

  • Monthly
  • Quarterly
  • Semi-annually
  • Annually
  • Any combination

 

The amount paid is also adjustable. There could be a set amount for a few years, then increasing payments to handle anticipated future needs. The money can also be paid out over the person’s lifetime, or set up to continue being paid to heirs upon the person’s death.

 

In the case of ‘John,’ the settlement could be set up to receive money upfront to pay off his debts, then a stream of steady payments and influxes of larger sums at various points in the future to take care of his family’s needs. A competent settlement consultant can also put John in touch with other professionals such as:

 

  • Lifetime medical care management.
  • Lien resolution
  • Financial planning.
  • Tax consequences.
  • Government benefit programs.
  • Legal issues.
  • Retirement planning.
  • Insurance concerns.

 

 

Summary

 

Life is complicated and planning for a lifetime of medical management and financial stewardship from a workers’ compensation settlement is overwhelming and difficult. Working with a settlement consultant who understands the fears, needs, and concerns of the injured worker can both save significant settlement costs and bring peace of mind that lasts a lifetime.

 

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©2018 Amaxx LLC. All rights reserved under International Copyright Law.

 

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

Educate Stakeholders on Effective Alternatives to Opioids

Educate Stakeholders on Effective Alternatives to OpioidsA combination of ibuprofen and acetaminophen does a better job of relieving acute pain than opioids. Despite clear evidence that the combination of the less dangerous medications provides equal or greater pain relief, many physicians still prescribe opioids for injured workers with pain.

 

This statement was just one point made in a recent session at the Workers’ Compensation Institute’s Annual Conference in Orlando presented by:

 

  • Marcos A. Iglesias, Chief Medical Officer of Broadspire
  • Mark Pew, senior VP for Product Development & Marketing at Preferred Medical.

 

 

The Problem

 

The opioid epidemic in the U.S. has been well documented in recent years. Researchers say Americans consume more opioids than any other country, regardless of the myriad physical and psychological problems associated with their unnecessary use.

 

While stakeholders in the workers’ compensation system have made progress in curbing the unnecessary use of opioids in recent years, it will take a concerted effort of educating providers as well as employees about chronic pain, and effective treatment alternatives said Iglesias and Pew.

 

Findings released by the Society for Internal Medicine on a one-year comparison of patients with chronic low back pain who were treated with either opioids or ibuprofen included:

 

  • No difference in function
  • Those given opioids had statistically worse pain control

 

Among the side effects of opioids are

 

  • Drowsiness
  • Confusion
  • Nausea
  • Constipation
  • Euphoria
  • Slowed Breathing

 

Because opioids repress the respiratory system, using them can result in hypoxia — a condition in which too little oxygen reaches the brain. It can lead to coma, permanent brain damage or death. The drugs can be especially dangerous when combined with other medications, such as benzodiazepines, certain antidepressants, some antibiotics, and sleeping pills.

 

 

Expectations

 

Even in the face of the research and statistics, many providers continue to look to opioids as the gold standard for pain management. One of the biggest problems is the mindset of western medicine and civilizations.

 

“There is an expectation in the U.S. that we shouldn’t feel pain, we are reducing the supply of opioids, but not limiting the demand,” Pew said. “There needs to be an effort in this country to educate people and change their minds about pain, so they realize opioids are not the answer” added Iglesias.

 

Eliminating all pain forever is just not realistic for many people. But they can — and do — learn to cope with their pain and live happy, normal, and functional lives.

 

 

Education

 

In addition to realigning expectations, education is key to reducing unnecessary opioid use. Many people may not be aware of the extent of the problem. “One-third of individuals that are taking an opioid do not know they are taking it,” Iglesias explained. “There needs to be more awareness in the population.”

 

Additional points stated include:

 

  1. Locus of control. Unlike in some other countries, many people in the U.S. have a passive acceptance of medical treatment and believe somebody or something should take care of the problem. Typically, many think a pill is the answer. However, drugs often mask the problem rather than addressing the root cause.
  2. Employers can take actions to improve the fitness levels of employees. Encouraging more walking, providing healthier foods in vending machines and making all programs free of charge are suggestions to get started.
  3. Self-advocacy. Injured workers and others should be encouraged to take charge and be responsible for their medical care.
  4. Reduce unrealistic expectations. Employers can work with medical providers to create and send a letter to injured workers outlining what to expect after an injury occurs. It can include suggestions on how to manage pain and some options.
  5. Sleep hygiene. Sleep is crucial for recovery from injuries. There are a variety of non-pharmacological recommendations to help people get more and better sleep.
  6. Education on dealing with depression can go a long way in helping injured workers cope with their pain and injuries. They should be encouraged to work with the Employee Assistance Program, if applicable, or given community resources that may be helpful.
  7. Behavioral techniques. Cognitive behavioral therapy (CBT) has been shown to be one of the most effective ways to help people cope with chronic pain. It is short term, skill-based, and typically does not incur a psychiatric diagnosis. Along with CBT, additional behavioral techniques include:
    • Mindful meditation.
    • Deep breathing skills.
    • Increased physical activity.
  8. Focus on function rather than pain. Focusing on pain only makes the level of pain increase. Discuss function rather than pain with an emphasis on progress.
    • Iglesias example “you told me you picked up the mail, last time we talked you weren’t able to get off the couch.”

 

Conclusion

 

The persistent opioid crisis has taken years to develop and will take a multifaceted effort to reduce and eliminate.  An improved focus by employers and payers on the education of opioid alternatives is a positive step toward better treatment and outcomes.

 

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©2018 Amaxx LLC. All rights reserved under International Copyright Law.

 

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

 

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