The experience modification factor in workers’ compensation, it can be an overwhelming and complicated number. There’s a lot of math involved, and that can be overwhelming to look at and interpret what it means. But at its core, it’s a predictor of your future losses of how you’d handled workers’ compensation claims. Just like your credit score, as a predictor of how well you’re going to handle debt in the future, of how well you’ve handled it in the past. It’s no more complicated than that, as far as what it means. But it impacts your pricing significantly, as far as your premiums are concerned in workers’ compensation, particularly if you’re in a guaranteed cost program.

Example – Calculating Minimum Experience Mod

Hello, my name is Michael Stack, and I’m the CEO of Amaxx. Today, I’m going to be walking you through a concept to calculate your lowest possible mod, or what’s also known as your minimum mod, and what that means as far as potential savings in your organization.

First thing let’s do, I want to take you to this example, and I want to show you how to calculate your minimum mod. It’s a very simple calculation. If you look here on the screen, what you’re going to see is an NCCI rating worksheet. There’s a whole bunch of numbers that are on the screen, but there’s only two that you need in order to calculate this minimum mod.

The first thing you’re going to do, is you’re going to look down here at this bottom part of the formula and you’re going to see the stabilizing value, and you’re also going to see your expected totals.

In order to calculate your minimum mod, or your lowest possible mod, also known as the mod that you would have, had you had zero injuries. The mod you would have if you have zero injuries and zero claim costs. So you would take that stabilizing value over your expected totals. Stabilizing value over your expected totals, and that’s how you calculate your lowest possible or minimum mod.

What To Do With Minimum Experience Mod

Now, the next thing then is to factor in what do you do with that? What does that actually mean as far as your organization is concerned? I want to take you to this example here on the board.

Here’s how your rating works in a guaranteed cost program. There’s a couple more elements, but I’m going to walk you through this, particularly if you’re in a high deductible or a loss sensitive plan as far as what that means for your total work comp costs, but this is a basic formula.

You take your payroll, in this case we use $10 million in payroll, times your class code rate. In this example, I just use 0.5 rate just to keep the numbers simple. This here is also known as your manual premium. So manual premium is your payroll times your rate. You may have a few different class codes, you may have different numbers of payroll in each class code, but ultimately it’s going to all factor in to what is ultimately your manual rate.

Then you take whatever adjustments are appropriate, in this case your experience mod. There’s also going to be some scheduled debits and credits at the discretion of your carrier, and that’s not in this formula here but that’s going to be in your ultimate total work comp payments formula. If you’re in a loss sensitive plan, those are going to factor in here as well. But just keeping this simple as far as this example, you take your manual premium times your experience mod and that’s your work comp premium in a guaranteed cost program.

In this example, your mod is 0.8. So if we go through some of the elements of an experience mod, 1.0 is considered average for the industry, whatever industry that you’re in. So the actuaries take, what are all the claim costs that happen for everyone in the trucking industry, what was the total cost, what was the average, and that’s a simplified version of how they come up with what is expected for that industry. All this is, is are you doing better or worse than average? Are you doing better or worse than average for your industry?

This one is 0.8, so you’re doing 0.2 below that 1.0, you’re doing better than average. Then it comes out to 400,000. So this is 500,000 times 0.8, and that gives you 400,000.

Reveal More Room to Improve Experience Modification Factor

The mistake that I see companies make a lot of times in this, is you say we’re at 0.8, we’re below 1.0, we’re doing really well. Good job for us. Hooray for us. Yay, we’re doing so great. We saved $100,000 from what we would be if we were at average for our industry. While that’s true, there’s a lot more to the story, and that’s where this minimum mod comes into play.

If you went through that stabilizing value over your expected totals, a lot of times, particularly the larger your organization is, the lower possible minimum mod you’ll have, and that has to do with the weighting value. We’re not going to get into that today. But the larger your organization, the lower lowest possible mod that you have.

Let’s say you do that calculation and your lowest possible mod is a 0.4. So you do the same calculation, the manual premium, which is 500,000, and you times that by 0.4, and you come up with 200,000 as you see here.

In essence, what this means is you’re paying twice as much as you could. You’re paying twice as much as you could if you had zero claim costs. What it does is it gives a very vivid example when you’re talking to your senior managers, when you’re talking to your clients as an insurance broker or any other service provider, to let them know how much room there still is to improve.

So when you’re patting yourself on the back here, and you’re throwing yourself a parade and a party for how well you’re doing, good job, just keep going. Keep implementing return to work programs, keep implementing injury response programs, keep implementing safety, wellness, injury prevention programs in order to continue to drive this number down, because there’s still a lot more room to grow. Don’t get lulled to sleep up here, because there’s a lot more improvements that can be made.

Obviously, there’s a lot more to talk about or we could talk about with the experience mod, but if you can understand this concept, understand how some of these numbers start to put together, it can put a lot more meaning behind what we’re doing in injury prevention and injury management.

Again, my name’s Michael Stack, I’m the CEO of Amaxx. Remember, your work today in workers’ compensation can have a dramatic impact on your company’s bottom line, just as we showed here, 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: http://blog.reduceyourworkerscomp.com/

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

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

The New Year provides employers an opportunity to re-examine the issue of ergonomics in the workplace.  Making sure that workplace ergonomics is in place for all employees not only improves workplace morale but can reduce the costs of workers’ compensation claims in the future.

What is Ergonomics?

Defined by Webster, ergonomics is the “the study of people’s efficiency in their working environment.”  This study includes a review of workstations and job functions to reduce muscle overuse, correct poor posture and eliminate injuries cause is repetitive work activities.  It can also include a review of policies and procedures that seek input from a varied of interested stakeholders—include the person perform a particular work function.  It is important to include a review of tools used on a daily basis and other intangibles including, but not limited to workspace lighting.

Implementing an Effective Review

A proper ergonomics review includes the use of different specialists and stakeholders.  Beyond using a qualified specialist, it is important to include input from company management and employees performing job functions.  This review can also include a review of available resources and budget constraints.

It is also essential to understand the demographics of your labor force.  Studies show that Americans are working into their later years.  This is resulting in more severe injuries from repetitive type injuries that lead to longer periods of disability.  Factors to consider when addressing this issue include:

• Age discrimination laws that prevent employers from engaging in unlawful labor practices;
• State and federal OSHA laws and regulations; and
• Addressing injury and post-injury response.

Return-To-Work and Ergonomics

A successful ergonomics review will keep in mind issues employer, and employees face when returning to work following an injury.  Some important matters to consider include:

• Modification of a pre-injury position to accommodate the restrictions of a recovering employee;
• The ability of an employee under work restrictions to rotate positions on a frequent basis; and
• Workstations that are easily modified to allow employees to move from one function to the next without disruptions in productivity.

These tasks are sometimes difficult to achieve.  Barriers to successful implementation include the inability of the claims management team to coordinate with employer representatives.  There is a need for all stakeholders to cooperate on these matters.  It requires clear communication and objective information from the treating physicians.

Injury Prevention

The prevention of injuries is a major feature of a successful ergonomics program that sometimes goes unnoticed.  Examples of this include adjustable workstations for employees that allow them to perform functions sitting and standing.  This not only leads to increased job satisfaction but is proven to reduce injury.  Some common injuries prevented from this type of modification include cervical spine strain, low back discomfort and upper extremity injuries such as carpal tunnel syndrome or ulnar nerve impingement.

Conclusions

An ergonomics review has many important benefits to all stakeholders concerned about workers’ compensation claim prevention or reduction.  This all starts with an effective implementation program.  Once this takes place, it is important to include all parties, including employees.

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/

©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.

Hey, there, Michael Stack here, CEO of Amaxx and founder of Amaxx Workers’ Comp Training Center.

Today is an exciting day in the Stack household. It’s back to school day. We have four children, a daughter going into second grade, a son going into first, another daughter in pre-K and a youngest son in first year of preschool. Everyone is excited, we did the first day of school pictures and the whole nine yards and they got on the bus just this morning.

Proper Sequence Is Critically Important

What if I told you that our seven-year-old daughter, instead of putting her into second grade, we actually enrolled her in Kennebunk High School? The odds of her being successful in that environment are basically very slim, if not, impossible. It’s not that the information taught at the high school level isn’t critical to her educational journey which hopefully then leads on to a successful life and career. It just that it’s taught out of sequence and she needs that foundational knowledge taught at the elementary level to be able to properly use and utilize that information.

Biggest Mistake Companies Make with BIG DATA

Now, I want to talk to you about a topic in worker’s compensation which is very popular: big data and analytics. I see a lot of companies making that same mistake. It’s not that the information or the tool of leveraging big data and analytics isn’t critical to your journey to a best in class work comp management program. It’s just that it’s typically implemented out of sequence and most companies don’t have those foundational, fundamental, necessary elements in order to be able to properly use and utilize the information both inputted into that big data tool and extracted from that tool. If you don’t know how you are measuring success, if you have no clear goals in your organization and a way to understand if you’re being successful or not and you’re spending all your time and resources researching and implementing this tool, then you’re out of sequence and I encourage you to go back and look at some of those fundamental elements in order to be able to properly use and utilize that extremely valuable tool.

Again, I’m Michael Stack with Amaxx and your work in workers’ compensation cannot only dramatically reduce your workers’ compensation cost but it will dramatically impact someone’s life. Be great.

To Learn more, check out The Step by Step Process to Master Workers’ Comp in 90 Days

Author Michael Stack, CEO Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is 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/

©2017 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.

Hey there. I’m Michael Stack, CEO of Amaxx and founder of the Amaxx Workers’ Comp Training Center. I grew up a Cubs fan in Valparaiso, Indiana, which is just outside of Chicago. While running a company, and with my wife, raising four kids, sitting down to watch a game very, very rarely makes the top of the priority list, except, of course, when they won the World Series last year. So I don’t have time to do that but I do want to know how well they’re doing. How well is their season going? So, every once in a while I’ll just slip over to ESPN and I’ll check the standings to give indication of how well the season is going and it gives me very comprehensive snapshot look. Turns out they just moved in to first place. So, their season, hopefully, seems to be on the right track.

Snapshot Leading Indicator of Program Success

But, in baseball, just like in workers’ compensation, there are a million statistics that you can track and dive into the most minute detail, but how do you know in work comp how well your program is going? What is that comprehensive, leading indicator to let you know whether or not your program is on the right track?

Return to Work Ratio

I want to introduce you to the return to work ratio and I’m gonna show you how to calculate it. Take a look at this board here. What you’re doing in this ratio is you’re tracking the number and the percentage of your injured workers that return to work within zero to four days. You are tracking the number and percentage of your injured workers that return to work in zero to four days. The best in-class programs will be at 95% or better. The best in-class programs will be at 95% of injured workers returning to work in zero to four days. So, let’s take a look very briefly at this quick example of how you track this and how you calculate it. You’re taking the injury date and you’re comparing it simply to the return to work date. How many days was that individual out of work? So, you can see here very simply on this example. Zero days, three, 20, 30 and 60.

Then here’s what you’re going to do with this next. Once you have the information then you graph it in Excel or a similar type program to visually represent in a snapshot, just like looking at the standings how well you’re doing. What you’re shooting for is 95% or better of your employees returning to work within zero to four days. Your programming when you graph it out and the best in-class program will look something like this, the graph that you represent. Where you might be right now is more like this. The vast majority of your employees are coming back to work in 30 days, 45 days, 60 days, 150 days. It doesn’t matter where you start, it’s a matter of understanding where you are, then you can analyze what are those factors that are causing that challenge and you can work to get just one employee back to work one day sooner. Little by little, little by little your graph starts to change from looking something like this, to something like this.

Most Comprehensive Leading Indicator Available

The return to work ratio, the most comprehensive indication of your program. It tracks things like how well you’re reporting your claims, how well are you getting your injured workers to the right medical treatment at the right time, how well are you getting those restrictions from those medical providers and feeding them into your return to work program, how well are you crafting transitional duty jobs and presenting those, communicating them properly to your employees. The return to work ratio factors all of those elements and more. I highly recommend it’s something that you implement and track in your program. Again, I’m Michael Stack with Amaxx and remember your success in workers’ compensation is defined by your integrity, so be great.

Learn more with How to Measure Workers’ Comp Success with 5 Critical Metrics.

Author Michael Stack, Principal, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is 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/

©2017 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.

When you are the one in control of your business’s workers comp program, it is important to assess it periodically to make sure the program is running within reasonable cost to the company.  There are several different steps to take in order to assess costs.  The process may be time consuming, but well worth the effort if it can reduce claims and keep costs to a minimum.

Whether you are starting your business’s initial workers comp program or you are new to the already established position, these tips can help lower your workers comp costs.

• Review the current workers comp insurance policy. Check payroll information and class assignments to make sure you are getting the right rate.  If you are unsure, contact your insurance agent or underwriter for clarification.

• Brush up on state and federal laws. Before preparing or revising your workers comp program, be sure your new plan will fall within state and federal guidelines for each of your business’s locations.  Your best option for finding out information is to contact each state’s insurance department.

• Study company loss data. Which areas have the most claims?  Are conditions better in one location than another?  Loss data can sometimes help pinpoint problems that can easily be remedied.

• Prepare self-evaluation questionnaires. Send questionnaires to all employees in every area of the business.  Find out how they feel about company procedures by asking open-ended questions.  Encourage thorough answers by eliminating questions that could be simply answered with a yes or no.   Follow up with phone interviews for more in-depth answers.

• Review company procedures, employee brochures. Be sure that everything used as a teaching tool for employees is up to date and completely pertains to each area of the business.

• Conduct focus groups to find out how employees feel about not only loss procedures, but about working for the company in general. You may find that unhappy employees sometimes use workers comp claims as a way to indirectly express frustration with the job.  Simple changes in employees’ work environments can have a dramatic effect on workers comp costs.  Example: allowing music or having morale boosting events can not only reduce workers comp costs, but could also increase production.

• Utilize your insurance carrier’s loss control department. Your insurance carrier’s loss control department is always available to help.  It is in their best interest as much as yours to keep claims down.  A loss control rep can help assess hazards and offer suggestions to reduce claims and make the workplace much safer.

• Consider an independent consultant. In some cases, it is wise to have an impartial outside source completing evaluations.  However, having an internal source who knows the company inside and out may also be more effective.  Discuss the options with the business’s owners to decide.

Once you have all your data including self-evaluations, loss data, current policy review, employee focus group results, etc. you can begin to develop your program so it fits your specific company profile.  Before implementing any program, have it reviewed by your company’s legal counsel.  After the program is developed, be sure to reevaluate periodically to stay up to date on workers comp laws, procedures, and your company’s budget.

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is 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 of COMPClub, an exclusive member training program on workers compensation cost containment best practices.

Contact: mstack@reduceyourworkerscomp.com.

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

©2016 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.

An assessment of your workers’ compensation program is the first phase of developing a program meeting your company’s need to reduce insurance costs so the company can remain competitive in its industry.

Solutions and recommendations for changes, upgrades, revisions and current practices must be based on a complete understanding of key cost drivers: those factors which are the root cause of your company’s high costs. Many times, recommendations for change are based on assumption, not facts and therefore may be incorrect.

Analyze Effectiveness & Integration of Work Comp Components

Companies need to review their internal workers’ compensation management systems, their data, their file handling system and as well as vendors like outside medical service providers, investigators and insurance companies. Rather than simply taking an inventory of these items, companies should analyze the effectiveness and integration of these components in their workers’ compensation. program. A company should target its “unique identifiers,” those factors which differentiate its problems from other companies.

A thorough review of the level of understanding and awareness of the company management and the perception and attitude of employees is also critical to an effective assessment. In regard to internal control procedures, consider the consistency with which they are applied and look for procedures which are implemented in a timely manner. For example, delays in referring claims to the insurance company and delays in an employee’s return to work may be causes of higher than normal indemnity costs. Delays in referral of cases to a physician reviewer may result in higher medical costs due to unnecessary requests for medical examinations such as IMEs. Good procedures are only good if they are consistently and timely applied.

Consider Intangible Issues

Information should also be considered about more intangible issues such as internal company reporting relationships and duties of personnel having responsibility for workers’ compensation. Basic information about the company, its industry, number and location of employees, makeup of the work force and type of work is essential to a proper assessment. For example, problems associated with off-site employees are different than those associated with employees who are located on-site. Off-site employees such as delivery people, outside sales forces or seasonal construction crews may have little or no supervision, use different transportation modes or be required to carry more tools or materials than employees working in a manufacturing facility.    This impacts the types of workers’ compensation cases and expenses to the company from these employees.

12 Practices Should Be Reviewed:

• data analysis
• safety
• communication
• training
• return to work
• coordination of medical care
• medical cost containment
• investigation
• file reviews
• hiring
• account instructions
• claim handling standards

Rather than simply taking an “inventory” of these items, companies should analyze the effectiveness and integration of these components in their workers’ compensation program.

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is 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 of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment.

Contact: mstack@reduceyourworkerscomp.com.

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

©2016 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.

HIPAA Mandate

Congress initiated health care reform during the Obama Administration to provide people with health insurance throughout their employment (i.e., job after job) and to safeguard their medical data through a uniform management of electronically stored data. Rules imposed standards that were promulgated by the Department of Health and Human services, including specifics for managing and protecting health information. The specifics appear as the Health Insurance Portability and Accountability Act (HIPAA). Its Security Rule mandates that those covered by the Act evaluate their health care operation for potential security risk. Healthcare organizations are required to be compliant with HIPAA’s technical, administrative, and physical safeguards. The Office for Civil Rights has provided compliance information.

Methodology for Conducting an Effective Security Risk Assessment

Competing stakeholders utilize a variety of systems to manage data, store the information, and convey the information to users. Classically, these responsibilities have been “delegated” to data managers, but HIPAA stakeholders comprise a much larger concerned group than those who enter or maintain computers and IT data. Security risk can be assigned to multiple stakeholders, but the IT framework must address their access, hardware, software, employee training, and multiple interfacing business models with their internal processes. Risk assessment commences when the value of data is recognized on each level and the vulnerability of storage of information is defined. Managing risks identified will impact costs, productivity of employees, inter-system confidentiality barriers, communication, and decisions about delegating responsibility for continuing risk assessments in the future.

Goals Beyond HIPAA Requirements

Risk assessment may be impacted by issues beyond just risk. Those issues may foster additional goals for any assessment. For example, a further goal may be to identify points of noncompliance with existing mandates relating to office administrative protocols, technician and user training in data access, storage, actual technical training of technicians, etc. Another goal may relate to compatibility of data management with licensing requirements, limits based on the cultural folkways of the local region precluding effective risk assessment, legal mandates resulting from lawsuit, incident, complaint, etc. The additional goals will help determine whether resources for risk assessment are exclusively in-house or whether external consultants will be required for the risk assessment.

The Initial Assessment

“In broad strokes,” an initial assessment plan will define the present threat status for an organization, provide a framework for development of a continuing risk assessment program, and will typically entail these and additional parameters:

1. Determine specifics of analysis,e.g., HIPAA requirements, objectives, etc.

2. List organizational assets,e.g., system components, networking diagrams, physical hardware and equipment, data storage, types of data, software, existing operational protocols, operating security systems, access and authentication procedures, etc.

3. Determine potential threats to those assets

4. Itemize system vulnerabilities,e.g., people, equipment such as tyvek suits, communications and interfaces, etc.

5. Determine effectiveness of current security.

6. Identify specific levels of risk for problems delineated.

7. Identify interaction effects of organizational assets.

8. Review and modify organizational operations to eliminate potential internal threats.

9. Develop a strategy to ameliorate all potential external threats.

10. Establish a monitoring systemand a risk reassessment schedule.

Help in the Process

It is apparent that doing a risk assessment involves collection of a variety of information, in some cases, “voluminous” data. A number of resources (e.g., a “governmental consultant,” a “systems academic,” an “IT specialist,” a “safety consultant,” etc.) may assist the completion of the risk assessment task. Continuing education for a variety of health and safety professional groups continue to offer coursework on performing risk analysis. Businesses focusing on risk assessment vary from engineering groups, to IT groups, to medical schools, to software companies, etc.

Author Kenneth Overton is a risk management consultant and a former construction supervisor with over 10 years of experience in the industry. He specializes in risk analysis and disaster management.  Contact: kenneth.p.overton@gmail.com

Even when I type those words in the title, I cringe a little bit. But before I start to discuss this topic and what adjusters should do at the first mention of this diagnosis, let me give you my normal disclaimer:

I am not a doctor, nor do I claim to be one. I have no formal medical school credits. Please do not consider this medical literature in any way, shape, or form.

The Mayo clinic describes Complex Regional Pain Syndrome as:

Complex regional pain syndrome is an uncommon form of chronic pain that usually affects an arm or a leg. Complex regional pain syndrome typically develops after an injury, surgery, stroke or heart attack, but the pain is out of proportion to the severity of the initial injury.

The cause of complex regional pain syndrome isn’t clearly understood.

Signs and symptoms of complex regional pain syndrome include:

• Continuous burning or throbbing pain, usually in your arm, leg, hand or foot
• Sensitivity to touch or cold
• Swelling of the painful area
• Changes in skin temperature — at times your skin may be sweaty; at other times it may be cold
• Changes in skin color, which can range from white and mottled to red or blue
• Changes in skin texture, which may become tender, thin or shiny in the affected area
• Changes in hair and nail growth
• Joint stiffness, swelling and damage
• Muscle spasms, weakness and loss (atrophy)
• Decreased ability to move the affected body part

Symptoms may change over time and vary from person to person. Most commonly, pain, swelling, redness, noticeable changes in temperature and hypersensitivity (particularly to cold and touch) occur first.

For those who may not know, CRPS used to be known as RSD, or Reflex Sympathetic Dystrophy.

A Real World Example of Complex Regional Pain Syndrome

I can also give you a real world example. A friend of mine, who is an insurance attorney, has had to live through this nightmare. But she was not the one diagnosed with it, it was her husband.

He stepped on a nail at a construction site. What happened next was 3 years of torture, and his work comp claim spiraled into a disaster. It took a normal, active, hardworking, fun loving husband and reduced him to a secluded and depressed shell of a man. They have now finally settled his work comp claim, but the condition lives on.

This did not happen because of adjuster error, or a lack of getting proper treatment. They tried everything. He saw countless doctors and specialists. He tried tons of different medication, most of them leaving him in a drug-induced haze that was so bad he stopped taking them.

Early Diagnosis of Complex Regional Pain Syndrome Yields Better Results

As insurance professionals, we have to be aware of the fact that even the most normal of claims can turn in to a real big claim real fast. In addition to that, we have to fight the fact that some doctors can use this diagnosis to describe pain that they cannot locate or control, be it objective or subjective in nature. This is where adjusters we can utilize their resources.

As the Mayo Clinic notes, early diagnosis and treatment of CRPS will yield better success in treating and controlling the symptoms. Most of the time when a claimant starts to have odd pain complaints, the adjuster will consider malingering or secondary gain rather than potential early CRPS symptoms.

Some of these symptoms include pain in the opposite limb, uncontrollable pain complaints, and other subjective pain complaints that on the surface seem crazy. If you have a person that had trauma in the left leg, and all of the sudden they have right leg pain complaints, 95% of adjusters will be quick to disregard it as CRPS. Instead they will label the claimant as a malingerer and one that is only interested in trying to extend the life of their work comp claim for whatever reason.

But what adjusters should do is set an IME right away, with a doctor that is certified to diagnose this condition. If you are lucky, and CRPS is there, you can catch and treat it right away. If it is not there, then you have at least ruled it out and can address your next step of case defense at that point.

Adjusters Job is Use Your Resources to Solve the Medical Mystery

Not all of your cases with wild pain complaints are going to be diagnosed and certified CRPS claims. In fact, it will probably be a small percentage of them. But the chance is there, and as adjusters you have to step outside of the box and take an outside look at chronic pain complaint cases and consider a potential CRPS diagnosis as the culprit.

If CRPS is there and you catch it early, then you have solved the mystery and can start treating it and moving the claim towards a hopeful resolution. If you just ignore it, then you have failed not only the claimant, but your employer as well because you did not do your job.

Your job as adjusters is to use your resources to solve the medical mystery and to put the pieces of the puzzle back together to correlate pain complaints back to a work injury. Use the doctors and resources you trust, because either way it is your job to investigate and handle claims accordingly, no matter how crazy the pain complaints may be.

Author Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com.  Contact: mstack@reduceyourworkerscomp.com.

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