5 Ways to Ensure a Workers’ Comp Claim Investigation Is Off to a Good Start

March 19, 2019 by

Effective Workers’ Comp Claim Investigation TechniquesIf you’ve ever been intrigued by police investigations in TV shows or detective novels, you might want to use that enthusiasm to investigate workplace injuries. Approaching a workers’ comp claim investigation claim in ‘detective’ mode will lead to better results; meaning, reduced costs and superior outcomes for injured workers.

 

 

The Workers’ Comp Claim Investigation

 

The ultimate goal of managing a workers’ compensation claim is to help the injured worker recover and get back to work as soon as possible, without the payer spending unnecessary costs. But often there are many gray areas to a claim. Determining exactly what happened and, therefore, what should be covered by workers’ compensation can be difficult.

 

Investigating a claim should uncover as many details as possible. Employers/payers can get all the information they need by implementing a precise system that kicks in immediately after an injury occurs. At the very least it should include:

 

 

  1. The Basics

 

The workers’ comp claim investigation process should begin with statements from the employee, employer, and any witnesses. There should be separate forms for each which should have open-ended questions, rather than boxes to check.

 

Additionally, there should be a separate attachment for details on each form. A form from a witness that says, ‘Joe slipped and hurt his back,’ really doesn’t reveal anything and won’t help determine whether and to what extent the claim is compensable.

 

The essential pieces of information that should be included about the injured worker and the incident include:

 

  • Date of birth
  • Name of the employee
  • Social security number
  • Average weekly wage
  • Date of injury
  • Date of hire

 

Too often such information is either not included or is inaccurate.

 

Another ‘basic’ procedure that makes a tremendous difference in a claim is the way the injured worker is treated. Anyone involved with managing the claim at any point should treat the person as if it is a friend or spouse and approach the employee in the same way as they would want that person treated.

 

 

  1. Preserve the Scene

 

Preserving the scene is where reading and watching cases in which detectives try to understand what has happened comes into play. Just as a detective on a case is trying to get to the truth, so too is the employer/payer.

 

Once an accident occurs, the area should be roped off to whatever extent is possible. If it is an area in which many people are working and is crucial to business operations, this might take some creativity. But the idea is to ‘protect’ any evidence that could indicate what and how the injury occurred.

 

Looking at the scene might reveal a cause. For example, water on the floor could indicate the worker slipped and fell. Or, there might be evidence that a piece of equipment was faulty, which could result in subrogation from a third party.

 

A thorough examination of the accident scene may help reveal the mechanism and extent of an injury. That could be advantageous if, say several months later the injured worker claims additional injury from the initial accident.

 

 

  1. Talk to Others

 

Witnesses play an important role in a workers’ comp claim investigation. While the injured worker experienced the accident, he may not know exactly how it happened. Someone who saw it might be able to fill in some of the blanks; for example, that a heavy box on an upper shelf fell, triggering the worker’s fall.

 

Also, identifying all witnesses as soon as an injury occurs prevents ‘new’ witnesses the injured worker may try to bring in later on.

 

 

  1. Record

 

While witness accounts of a situation are important, they may not always be reliable. Sometimes what people think they saw or remember may vary greatly from one witness to another. That’s why it’s also important to record the scene in as many ways as possible.

 

Just as a detective investigating a crime scene might seek out video footage of the area, getting recorded descriptions of the scene can help determine how the injury occurred and can be extremely valuable later on, if the case is litigated.

 

Video cameras may be present in or near the work area. There may also be video cameras around the building, or even on nearby buildings. The footage may reveal more information about the incident.

 

If no videos were present in or near the accident scene when it happened, taking a video of the accident area via a smartphone can also help provide information about what may have contributed to the injury. The person filming should also include narration to describe various objects, direction, location, etc.

 

Photos can also provide details. These can be taken from a distance as well as close up, to get different perspectives and angles.

 

 

  1. Document, Document, Document.

 

Every step taken during the workers’ comp claim investigation should be written down; from interviews with witnesses and others, to bits of information observed at the scene, and any other potentially relevant information.

 

Documentation pertaining to maintenance and training schedules and previous corrective actions involving the injured worker should also be included in the investigation materials. Information about prior medical treatment to the injured body part can also be relevant and should be included in the documentation

 

 

Conclusion

 

Conducting a thorough workers’ comp claim investigation provides the best opportunity to ensure the payer covers all of what should be funded and nothing more. It also signals the entire workforce that this is a normal process; meaning a worker will think twice before trying to fake an injury.

 

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

Filed Under: Work Injury Response

Overcoming Telemed Challenges for Occupational Health

January 29, 2019 by

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

 

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

 

 

Reality of Telemedicine Today

 

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

 

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

 

 

Challenges for Occupational Health and Telemedicine

 

Recognizing the challenges is key to overcoming them.

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

 

Solutions Moving Forward

 

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

 

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

 

 

 

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

Filed Under: Work Injury Response Tagged With:

6 Things Employers Can Do to Reduce Lag Time

January 24, 2019 by

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

 

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

 

 

Lag Time Is The Enemy 

 

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

  1. Have a system in place

 

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

 

 

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

 

 

 

  1. Get claims called in to the carrier/TPA

 

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

  1. Call claims in with correct and complete information

 

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

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

 

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

  1. Keep eyes and ears open on your work floor

 

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

 

 

  1. Be involved with the process

 

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

 

 

Summary

 

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

 

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

Filed Under: Workers Comp Cost Containment Fundamentals

Fix and Flip Your Work Comp Management Program

November 28, 2018 by

Fix and Flip Your Work Comp Management ProgramIn the popular TV show Property Ladder, real estate junkies seek to find homes in need of repair, fix them and then flip it for a profit.  Like the show, members of the claims management team should be on the constant look-out for parts of their program that need to be improved to increase client satisfaction and ensure it is being run ethically and honestly for the ultimate stakeholder – the employee!  This takes a lot of hard work, but the ultimate result can improve the satisfaction of clients and improve the experience for persons who have sustained a work injury.

 

 

Finding a Home to Renovate – Effective Injury Response

 

Like a broken home, the employee who suffers a work injury is in need of help and tender loving care. A fast and effective response to every work injury, no matter how minor, can pay dividends in the future.

 

All workplaces need to have a plan in place to deal with work injuries.  This includes the accessibility of first aid kits and other medical equipment.  Factors to consider include having a plan for all types of injuries and emergencies, making employees aware of the plan and proper implementation.  Do not forget that even if your company is not required to have one, the inclusion of a safety chair and emergency response team can assist in a program renovation.  This team can be used for the following tasks:

 

  • Maintenance and use of various fire extinguishers;

 

  • Knowledge and ability to perform cardiopulmonary resuscitation (CPR);

 

  • Understanding on how to contain and dispose of bloodborne pathogens;

 

  • Proper chemical handling, storage and containment procedures; and

 

  • Dealing with and responding to incidents involving hazardous materials and workplace fumes.

 

Other items to consider should include teaching employees basic first aid and other features such as lifesaving equipment that can include a portable defibrillator.

 

 

Fixing Up the Property – Workplace Ergonomics and Safety

 

A great way to ensure a safe workplace should include a review of workplace ergonomics.  This can include features such as assessing risks in the workplace on an ongoing basis, correcting the problems and encourage physical health.  Suggestions can include:

 

  • Onsight or easily accessible health clinics that include vaccinations, immunizations, and wellness information;

 

  • Encouragement to use a gym or health club – be sure to include discounts on medical insurance for frequent users. Onsite stretching activities, yoga, and mindfulness can also promote a safe work environment; and

 

  • Training on preventing and dealing with workplace violence and “active shooter” situations.

 

 

Flippin’ the House for Profit – Ongoing Employee Satisfaction

 

Like a completely remodeled home, a workers’ compensation program that is in pristine shape will add value and create its own demand.  This will improve company morale and improve return to work rates following an injury.  Interested stakeholders should look for opportunities to add value through a workers’ compensation program’s “curb appeal.”  This can be accomplished by promoting medical and behavioral health consultations to assist employees manage their lives in and outside the workplace – and enhance one’s work/life balance.

 

Addressing the needs of employees mental health needs is important in today’s fast-paced society.  This is especially the case when employees work during a clinic’s hours of operation.  By making these services available to employees on-site or at a convenient location, people are more willing to receive the care they may need.

 

Addressing the mental health needs of all employees are important both before and after a work injury.  Studies suggest that people who receive mental health counseling following a work injury have a lower chance of re-injury or malingering.  This translates into lower workers’ compensation insurance premiums.

 

 

Conclusions

 

Members of the claims management team should seek to climb the property ladder to add value and reduce costs to a workers’ compensation program.  This includes simple steps that can be taken to renovate a program, make it better and increase its value.  When a program is strong, it also adds value to the clients it serves.

 

 

 

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.

Filed Under: Work Injury Response

Orchestrate A Culture of Quickly Reporting Workplace Injuries

September 27, 2018 by

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: 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.

Filed Under: Report A Claim

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

September 20, 2018 by

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

 

 

 

 

Filed Under: Work Injury Response

3 Reasons and 5 Ways to Speed Up Workers’ Comp Claim Lag Time

August 9, 2018 by

3 Reasons and 5 Ways to Speed Up Workers’ Comp Claim Lag Time

Determining lag time is one of the easiest things to measure in workers’ compensation. Yet many organizations put little if any effort into it. More than likely they don’t see the value in tracking that particular metric.

 

But those that do report better outcomes for their injured workers and significant dollars saved for their bottom lines. There’s substantial research to back them up.

 

 

Why Workers’ Comp Claim Lag Time Matters

 

Lag time refers to the time period from the moment of injury until it is reported to the insurance carrier. For example, if an injury occurs on Oct. 1 and the insurer receives notice of the claim on Oct. 3, the claim will have a report lag of two days.

 

Tracking a company’s lag time is fairly simple, since every claims handler or adjuster has the information. The goal is to have shorter lag time, as several studies reveal tremendous cost differences.

 

Kemper Insurance Study

 

Kemper Insurance did a study and found that a claim reported within 30 days is 48 percent higher on average than a claim reported within 10 days of an injury.

 

 

The Hartford Insurance Study

 

The Hartford looked at 53,000 permanent partial and temporary claims and found the cost of a claim increases with each passing week before the incident is reported. Compared to an injury reported within week:

 

  • Within 2 weeks the claim was 18 percent more expensive
  • Within 3 weeks the claim cost 29 percent more
  • Within 4 weeks there was a 31 percent cost difference
  • Within 5 weeks, the claim was on average 45 percent more expensive

 

 

NCCI Study

 

NCCI’s study found “the closure ratio — the ratio of the number of claims closed within 18 months of the report date to the total number of claims — is inversely related to the median claim cost … the highest closure ratios are for claims reported in Weeks 1 and 2. Claims reported after Week 2 are less likely to be closed at 18 months…”

 

The study also found that median claims costs were lowest for claims reported after the day of the accident but within two weeks. It noted that claims reported on the actual day of the accident can be costly, as these are often the most serious injuries and require emergency care.

 

Additionally, longer lag times were associated with:

 

  • Greater attorney involvement —12.8 percent after more than 1 week, increasing to 148 percent more than 5 weeks after injury.
  • More use of lump-sum payments
  • Lower paid-to-incurred ratio at 18 months
  • Lower closure rate at 18 months.

 

The data indicates that claims with a lag time of more than two weeks are more complex, take longer to close, and have longer disability durations.

 

 

Why Workers’ Comp Claim Lag Time Is Important

 

There are many possible reasons that increased lag times result in increased costs. Experts speculate some include:

 

  1. An injured worker may visit a primary care physician rather than an occupational physician who understands return-to-work and other elements of the workers’ compensation system.
  2. The worker may feel he and his injury are being ignored, that the company doesn’t care about him. That could drive him to seek an attorney.
  3. Quicker reporting means faster medical treatment which results in faster RTW rates.

 

Tracking lag time helps you and others at your organization better understand how well your program is working. You can use it, along with the available research to show the cost savings you are achieving by having shorter lag times.

 

Organizations with multiple divisions can compare the lag times for each to show which are doing a better job of getting injuries reported quicker.

 

Improving Workers’ Comp Claim Lag Time

 

Getting injuries reported to the carrier as quickly as possible takes a concerted effort and should be embraced by everyone in the organization. The employee needs to report the injury immediately and the supervisor must complete the necessary paperwork to get the report to the carrier as soon as possible. Senior managers should consider the issue a priority as well.

 

Getting the buy-in of all involved takes some education, so everyone understands the value in shorter lag times and the process required. Injured workers should be made aware that reporting an injury sooner means they will get medical attention and care they need immediately. Supervisors and managers need also to understand the financial impact of shorter lag times.

 

There are several ways to ensure better lag times:

 

  1. An employee brochure. This should explain the workers’ compensation process and be provided to all personnel.
  2. One-pager. A short notice that explains the process for reporting an injury should be available to all employees. It can be posted in areas where workers congregate, placed in company vehicles, and even provided on the back of a lanyard.
  3. Employee training and retraining. In addition to providing written material, new hires should undergo training on proper incident reporting. This should be repeated as retraining annually.
  4. Supervisor education. All supervisors and managers should be well versed on the process required once an employee reports an injury. This can even be part of their performance reviews.
  5. Make it easy. A complicated reporting process is more likely to incur longer lag times. There should be a single contact within the organization to report injuries when a supervisor or manager is unavailable, such as a single phone number.

 

 

Summary

 

Improving and tracking lag time are fairly simple processes and can have a tremendous impact on the company’s bottom line. The sooner an injury is reported, the sooner the worker will receive medical care and return to work, and the better off the organization will be.

 

 

 

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.

Filed Under: Report A Claim

The Process to Workers’ Comp Reform Is Just Like Riding A Bike

July 30, 2018 by

Hey there, Michael Stack, CEO of Amaxx. It was a pretty exciting weekend for my family, a landmark weekend if you will. I was worked with, and taught our five year-old daughter, Emma, the third of our four children, to ride a bike. Now if you think about this process and this challenge of learning to ride a bike, it’s one of the first accomplishments in a child’s life that they have to do all on their own. They have to feel that balance. They have to figure it out. They have to work through that challenge to overcome what feels like a major obstacle.

 

 

Overcome Resistance to Workers’ Comp Reform

 

Kind of sounds a lot like the process organizations go through when they’re looking to reform their work comp program. You start at the bottom. Your work comp programs feels like it’s a total disaster. Things are off the track. Fraud is out of control. Litigation rates are extraordinarily high. To get to the end of the rainbow, well where it’s a well oiled machine working like clockwork, and you’re creating these great outcomes for your injured workers, and drastically reducing your work comp costs.

 

What I want to talk with you today is a two step process that works to teach a child to ride a bike and works in our work comp adult organizations looking to overcome this major obstacle. The first step that I want you to have as you’re approaching this very difficult and very challenging obstacle of reforming your work comp program is to have a can do attitude. Have a can do attitude. Very, very rarely will you get the 100% buy-in from your senior managers, because have you met Sue? Have you met Jim? Have you met John? Whoever it is that’s that senior manager that’s very difficult, that isn’t onboard with this idea of reforming your work comp program, they’re never going to give you that 100% buy-in unless they can see the proof.

 

 

Step #1: Can-Do Attitude

 

So while you can’t have that 100% buy-in, what can you get approval for? What small piece can you start to get that buy in to start to build that momentum? Have that can do attitude not for what’s not approved, but for what that small thing is that can be approved. Maybe it’s just getting an employee brochure started, and getting that deployed within your organization.

 

 

Step #2: Feel Success

 

Because when you do that, now you can go on to step two which is to feel success. Feel what success feels like. Prove to your organization that you can be successful in this. The first very first, and most important, step in teaching a child to ride a bike is to have them feel that balance for themselves. The very first, and most important, step in teaching a child to ride is bike is to have them feel for themselves that they can balance, even if it’s just for a foot, or two or for three feet, because now they can start to build on that momentum and they believe in their ability in order to get it.

 

 

Build Momentum To Workers’ Comp Mastery

 

That same theory applies here. You need to build that momentum to feel for yourself, as an organization, that this system can work for you. Sure, it’s worked for hundreds or thousands or organizations, but can it work for you? You need to prove that to yourself and feel that success. So when you get that employee brochure deployed, you can now start to set those expectations for your employees. You can start to change some of the mindsets. You can start to have this system, the very first part of it, start to work, and feel the success of improving the outcome for the injured worker, and starting to lower your work comp cost. When you feel that first momentum, when you have that can do attitude, you take that first step. Now you’re ready to take the next step, and you continue to build on that momentum, and you continue to take those steps all the way down to get to the end of the rainbow. Get on Michael Stack CEO Amaxx, and remember your work today, in worker’s compensation, can have a dramatic impact on your company’s bottom line. But it will have a dramatic impact on someone’s life, so be great!

 

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: 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.

Filed Under: Workers Comp Cost Containment Fundamentals

4 More Ways to Spring Clean Your Workers’ Comp Program

May 17, 2018 by

Spring is here and it’s time to clean out the junk in your garage and trim the bushes. As we go through our annual spring cleaning ritual at home, it’s also time to take a look at tuning up your workers’ compensation practices.

 

See 5 Ways to Spring Clean Your Workers’ Comp Program

 

Here are 4 additional ways to spring clean your workers’ comp program:

 

 

Cooperate Fully with the Claims Adjusters

 

Stay in contact with all your injured employees who have not returned to work. In addition, make the commitment to stay in contact with the claims adjuster(s) handling your work comp claims.

  • You work comp claims coordinator should be exchanging information with the adjuster(s) on all claims on a regular basis. You may know important information that will assist the adjuster in bringing the claim to a speedy conclusion.
  • Or, the adjuster can coordinate with the nurse case manager on the information you provided about the employee’s medical concerns.

 

 

Update the Medical Treatment Panel

 

If you have not revisited your posting on required medical providers (or recommended medical providers in the states where the employee selects the medical provider), now is an excellent time to do so. Set up a conference call and consult with the work comp adjuster(s) and the nurse case manager(s) on your work comp claims.

 

  • Do any of the doctors on your medical treatment panel list seem to keep employees off work longer than others?
  • Do any of the doctors seem to have to operate on employees more than other doctors?
  • Do any of the doctors on your medical treatment panel fail to provide timely medical reports to the adjuster(s) or nurse case manager(s). .
  • Are there any doctors the adjuster(s) or nurse case manager(s) would recommend to be added to your medical treatment panel?

 

Use the Expert Panel if your TPA has one.  If your TPA doesn’t have one, consider changing your TPA.

 

 

Fight Fraud Religiously

 

An excellent spring renewal is to fight fraud. In addition to your anti-fraud posters, start a fraud hotline for other employees to report fraud anonymously to a tip-line.

 

  • Offer a reward for anyone who reports a work comp fraud that results in a criminal conviction.
  • Make sure all your employees know about your Return To Work Program that will prevent them from being off work any longer than is necessary.
  • Always report any suspicious claim to the Special Investigations Unit of the insurer.

 

 

Improve Your Medical Management Program

 

Make the commitment to maximize your medical management program. Review all your programs to control medical cost.

 

  • Consider ways you can improve your use of nurse case managers, utilization reviews, pharmacy benefit managers, medical fee bill reviews, durable medical equipment, independent medical examinations and peer reviews.
  • Seriously consider Injury Triage for all injuries. Employees love it and it will reduce your claims volume significantly.

 

 

 

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.

Filed Under: Workers Comp Cost Containment Fundamentals

5 Ways to Spring Clean Your Workers’ Comp Program

May 16, 2018 by

Spring is here and it’s time to clean out the junk in your garage and trim the bushes. As we go through our annual spring cleaning ritual at home, it’s also time to take a look at tuning up your workers’ compensation practices.

 

 

Improve Safety

 

A safe workplace is the best way to reduce workers compensation cost. Now is an excellent time to renew your commitment to safety.

  1. review your safety program for ways to improve your safety training,
  2. update the job hazard analysis of every job position within the company,
  3. review the qualifications of the members of your safety committee
  4. schedule the work-site evaluations and safety inspections for the year
  5. update the safety manual to cover new equipment, new machinery or new job positions
  6. review your safety posters, safety brochures and other employee safety communications

 

 

Report All Claims Timely

 

If a review of your loss run reflects that you have claims that were not reported the same day as the accident, a great spring cleaning task is to review your claim reporting procedures to be sure all claims are reported timely (the day of the accident). All department managers or location supervisors should be trained to report all injuries to the company’s claims coordinator or directly to the claims office immediately after they have arranged transportation to the medical provider. Timely reporting allows the work comp claims adjuster to investigate properly, establish compensability and better control the course of the workers’ compensation claim.

 

 

Keep in Touch with All Injured Employees

 

Make the commitment to show your injured employees that your company has a human side and does care about their well-being. For every injured employee who has not returned to work, mark on your calendar when you want to contact them. A contact schedule that you can modify as needed would be to:

 

  1. contact the injured employee the day of the accident (First Day Phone Call)
  2. contact the employee 2 days after the accident to make sure they understand the WC procedures and process, and answer any questions they have. Make yourself available. (Follow-up Phone Call)
  3. invite the employee to attend all workplace functions even if they are not working in the workplace temporarily.
  4. have the employee attend a Weekly Meeting until the employee is back to work. Use Weekly Meeting Guidelines to structure these meetings and make notes.

 

 

Stay Current on All Work Comp Claims

 

Closely related to staying in touch with the injured employee is staying current on ALL of your work comp claims. Make the commitment to do so.

 

  • During these contacts with the employee ask the employee the status of their medical treatment and when the doctor may be able to let them to return to work either full duty or on modified duty.
  • Stress to the employee that the work they do for your company is important and that you need them, not some new hire, doing their job. If you have employees you haven’t communicated with, now is the time to reconnect with them.
  • We worked with a large bread company and when the risk manager started his job there were 45 employees out of work. We directed him to invite each to lunch and ask them when they could come back to work. Twenty said they could come back to work “now” but that no one had asked them to return to work up until that lunch. A good lesson about why to stay on top of all of your claims.

 

Do not rely solely on the employees for information about their work comp claims, call the adjuster on a regular basis to discuss treatment status, return to work status and any permanent partial disability which will require modification of the employees job position. Hold bi-weekly or weekly roundtables with the adjuster to discuss a rotating selection of claims.

 

 

Improve Your Return To Work Program

 

If your idea of light duty return to work is to have the employee count paper clips, now is the time to commit to improve your Return To Work Program. A good place to start would be to review our website and all the information we provide to employers on managing your Return To Work Program.

 

 

Your commitment to RTW should include:

 

  • On every lost time claim to take the time to contact the medical provider and ask that the employee be allowed to return to work on light duty.
  • Make sure to provide the medical provider with a complete job description so the medical provider can place the appropriate restrictions on the employees workability.
  • You should have > 95% returning to work within 1-4 days after the injury.

 

 

Summary:

 

Spring is a time for renewal. If you follow through with your commitments, your workers’ compensation program will bloom and prosper.

 

 

 

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.

Filed Under: Workers Comp Cost Containment Fundamentals
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