We all make mistakes. Human error is a part of life. In many everyday situations, each of us makes errors, and most of the time, these errors bear no significant consequences for our lives or the lives of others. You mistake your brown shoes for the black ones and end up looking mismatched for the rest of the day. Likely, you’ll recover from your inadvertent fashion faux pas. But if you’re a healthcare provider, and you mistake one medication for another, the consequences could be much more serious.

Historically, the healthcare field has been marked by a punitive mindset, such that all mistakes, even those that bore no ill consequences, were reprimanded. This punitive attitude, which initially developed from the desire of healthcare organization to safeguard themselves against all potential damages, eventually grew into an atmosphere that deterred even minor mistakes from being reported out of fear of punishment.  This kind of atmosphere stifles constructive learning and tends to make providers feel unsupported by the healthcare systems in which then work.

Mistakes Can Grow Knowledge In Learning Culture

A healthcare learning culture is the opposite. A healthcare learning culture takes everyday occurrences, even mistakes, and uses them so that both organizations and providers can grow in knowledge, performance, and competence.  A learning culture engenders a just culture, and a just culture fortifies a learning culture.  Just culture seeks to create and reinforce a learning culture by providing a framework for managing mistakes and actions.  Just culture acknowledges that all people, including system designers, make mistakes.

So, for the healthcare provider who mistook one medication for another, a just culture promotes an environment where the provider who made the error should not fear to come forward.  A just culture investigates to see if the error was part of a system failure such that any provider in a similar situation would have made the same mistake.

A just culture, then, differentiates among unintentional human errors, system errors, mistakes made because of poor decision making, mistakes made because of disregard for procedures, and deliberate actions intended to be harmful. This differentiation helps determine the level of accountability and allows for a response on the part of the organization that is fitting and fair for the mistake maker.

Shift Focus to Management of Behavioral Choices

Just culture is founded in the belief that all stakeholders -from healthcare providers to business leaders- are responsible for the quality and safety of services. It demands that providers adhere thoughtfully and safely to clinical standards; furthermore, it expects that even minor errors are reported so that broader learning needs and system failures can be identified. In a just culture, errors become opportunities for the organization and all its providers, not just those who make mistakes, to learn and improve, which greatly reduces the chance that an error will be repeated.

Just culture shifts the focus of quality improvement from punishment and faultfinding to the management of behavioral choices in the context of the systems in which providers work.  Medcor has found that embracing a learning culture and a just culture increases providers job satisfaction and adds significant value to our quality improvement processes.  Just culture treats our advocates with fairness and respect and makes our leadership consider how we can improve our systems to promote the best outcomes for our employees, patients, and clients.

Author Dr. Sharon Moise, Chief Medical Officer, Medcor. Dr. Moise joined Medcor in 2015. Sharon is board-certified in emergency medicine and has extensive experience in occupational health, urgent care, clinical education, and clinical quality. Sharon provides broad clinical oversight for Medcor’s Worksite Clinics, Injury Triage Service, and supports all Medcor’s lines of business. In addition to involvement in many of Medcor’s projects and initiatives, Sharon is passionate about clinical quality and chairs Medcor’s Clinical Quality committee.

If 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.

2. 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.

3. 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.

4. 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.

5. 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.

In 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.

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.

If 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

Hey there, Michael Stack here, CEO of Amaxx. So this past weekend my wife was gone for the weekend. She was visiting one of her good friends from college, from Lehigh University, who’s actually was the maid of honor in our wedding up in Saratoga, New York. So whenever she’s gone, I like to take the opportunity to watch some movies that maybe she wouldn’t really like quite so much. So I was able to watch The Godfather and then I also watched Star Wars The Last Jedi, the latest Star Wars movie that I hadn’t seen yet.

“Don’t Worry, We’re With The Resistance”

In that movie, in The Last Jedi, there’s one scene which encapsulates and demonstrates so well a critical, critical, element of worker’s compensation management. Actually when I work with a company, one of the first things that I often recommend that they do. So here was the scene, there’s two characters Finn and Rose, and they go on an adventure of course to save the galaxy. On their adventure, they encounter a little boy, and they need his help. The little boy of course is scared. One thing they say to him, is they say, “Don’t worry, we’re with The Resistance.” And they show the little badge and they show The Resistance icon. In that little statement, in that little exchange, they demonstrated a number of very important things.

Identify, Branding, Meaning

One was identity. They demonstrated their identity. Number two, was the branding. They had the logo in order to identify themselves and demonstrate that visually. Number three, most importantly, was the meaning behind it. Identity, branding, and meaning. In one little exchange they were able to get the trust and understanding of that little boy and demonstrate what it is that they’re there to do. In an instant.

ACME IPAR Program

If you take this concept and you look at your work comp management program, your injured worker is scared, they don’t know what to expect, they don’t know what is coming next. If you can demonstrate to them and create some branding, create this name around it. An example I love to use, is the Acme, if the Acme is your company, the Acme IPAR, the Acme Injury Prevention and Recovery program. You create an identity and a branding campaign around that, so that you can know and demonstrate in an instant the meaning of what is going to happen next to that injured worker.

If you can put some thought into that, if can brainstorm around that, if you can create this identity, create this brand, and attach it to that meaning of what to expect next, you will win the worker’s compensation battle. Again, I’m Michael Stack, CEO of Amaxx. Remember your work today in worker’s compensation can have a dramatic impact in your company’s bottle line. But it will have a dramatic impact on someone’s life, so be great.

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

Contact: mstack@reduceyourworkerscomp.com.

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

©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.

Injury triage has become more common over the last several years. Although the market is still in the process of adopting the service as a best practice, there are fewer risk managers that start off a conversation regarding triage by asking: “What’s that?” Indeed, injury triage is no longer a service only utilized by early-adopting, forward-thinking risk professionals. The service has proven its value in enough settings and employer types that adoption of the service will continue on to virtually all employers who have exposure to work-related injuries.

Looking at Triage Simply to Reduce Claims Could Miss Bulk of Savings

So, what is the reason why more employers, insurers, and carriers are beginning to use the service? The easy answer is that injury triage reduces the number of claims that are produced. By reducing claim volume, one can easily assume that overall claim costs for an employer or insurer will also decrease. This seems logical, right? While that may be true, looking at triage simply as a means to reduce claim frequency might be missing the bulk of the savings and efficiencies gained from use of injury triage.

Rather, a strong argument can be made that the real value is delivered through the use of the service from what might be referred to as “second-tier savings.” These are ancillary savings that are often unique to an employer’s situation. Many times the real value of utilizing injury triage has much to do with the specific challenges faced by an employer. For example, an employer that operates on a 24-hour basis or during late-night hours might have a significant dilemma regarding Emergency Room visits. ER’s are typically the only place where medical treatment is available at night. This type of medical treatment is expensive and not conducive to the overall goals of a well-managed workers’ compensation program. The ability of injury triage to greatly reduce the frequency of ER visits would be far more significant to that employer than an employer who operates during normal business hours when there are other accessible healthcare options.

Evaluate Real Value by Examining All Savings

Another example of injury triage’s real value demonstrated through “second-tier savings” would be a contractor or similar business, that is highly sensitive to OSHA recordables. In many cases, these types of businesses must be able to prove that their OSHA recordable rate is below a certain level in order for them to be able to obtain new projects and earn new business. The ability of injury triage to reduce OSHA recordables by making sure that injured employees access the proper level of care can be more valuable than any other benefit. This would not necessarily be the case for employers who are not as sensitive to OSHA recordables; so the real value of injury triage for some contractors lies in ancillary benefits.

A strong Return on Investment can be shown simply by looking at injury triage as a means to reduce the number of claims that are produced in any given time period. However, evaluating the real value of injury triage should be done by examining all of the savings the service provides on an employer-specific basis.

Author Craig Deneau, Medcor, National Practice Leader-Triage Services. Medcor helps employers reduce the costs of workers’ compensation and general health care by providing injury triage services and operating worksite health and wellness clinics. Medcor’s services are available 24/7 nationwide for worksites of any size in any industry. Headquartered in McHenry, Illinois, the company operates 174 clinics and provides triage services to over 90,000 worksites across all 50 states and US territories. Medcor’s triage methods are covered by U.S. & foreign patents, including U.S. No. 7,668,733; 7,716,070; & 7,720,692; other patents pending. Medcor is privately held. Learn more at www.medcor.com.

Too many employers end their involvement in the workers compensation claim  when they send the employee to the doctor. A bad mistake – one resulting in a steady increase in the amount of your workers compensation insurance premium.

The employer needs to have an established post injury process to include:

1. Report the claim to the insurer, third party administrator or self-insured claims office immediately. Ideally the supervisor or your workers compensation claims coordinator reports the claim to the claims office while the employee is still en-route to the medical provider.  Or, you can start the process by calling nurse triage, a great way to make sure the employee gets the RIGHT kind of medical treatment. In some cases, the injury will not turn into a claim by using nurse triage.
2. Complete the Employer’s First Report of Injury and any other state required paperwork on the claim. If the injury is severe and the employee is unable to return to work within the waiting period, provide the claims office with necessary wage information for the calculation of indemnity benefits.
3. Advise the claims office of the claimant’s prior history of workers compensation claims. The adjuster’s approach to the claim varies significantly between the employee who never had a workers compensation claim and the employee who with 15 workers compensation claims in the last ten years.
4. Provide the adjuster with relevant information about the employee. In many situations this may include employee information such as employment application, job description, list of medical absences, list of disputes with employee/employer disputes.
5. Review your transitional duty program and find a job the employee can do within the treating physician’s restrictions. Have a job bank with tasks in multiple departments set up and ready to go, so there is no delay in placing every injured employee in a transitional duty task. In most states, it is best to  pay as close to their original pay as possible to reduce indemnity payments.
6. Be sure the employee’s supervisor (and co-workers if needed) is available to discuss the accident and injury with the claims adjuster and to assist the adjuster with the claims investigation.
7. Don’t alienate the employee – show empathy to the employee. When employees feel the company does not care about them and their injury and the company owes them, the claim gets ugly if employees feel it is time to stick it to the employer.
8. Maintain an open dialogue – call the employee at home to show your concern and to offer assistance on processing the workers compensation claim with the insurance company. Address any employee problems or issues right away. Also, call the employee on a regular basis until s/he is back at work. Make this contact procedure the same for all employees.
9. If an attorney representing the employee contacts you, notify the claims adjuster immediately.
10. Immediately dispute any invalid or fraudulent claim. Assume every employee who reports an injury is injured, but when you notice things don’t add up, let your adjuster know. Using nurse triage services greatly reduces fake injury reporting because a nurse specialized in triage will ask many questions about the medical condition, and most employees faking an injury will look for easier prey.
11. If the employee has a questionable claim, or a subjective claim for neck or back injuries, and immediately goes to the attorney advertising workers compensation on television, or a plaintiff’s attorney-oriented doctor known for excessive disability ratings, advise the employee immediately of your intention to fight the claim as the attorney and/or doctor has a history of inflated claims.
12. Monitor the state filings by the adjuster and any other claim related paperwork.
13. Monitor the Workers’ Compensation Board decisions – that means, reading them carefully, not just filing them away. Be ready to protest any finding or order you feel is unfair to you as the employer as all decisions have time limits for disputing the decision, with some time limits as short as 15 days.
14. Monitor the medical progress reports to be sure the treatment is appropriate – for example – no physical therapy for the low back when the injury is a cut finger.
15. Always advise the adjuster when the employee returns to work – the same day. Double-check to make sure the indemnity payments stop when the employee returns to work.

Stay involved with the adjuster, the employee and the medical providers. As long as it’s an open claim, it can affect your experience rating, so dropping the claim on the adjuster’s desk is the WORST thing an employer can do. Ask your broker’s claim VP and the adjusters to discuss the open claims during a round-table discussion often, either weekly, bi-weekly, or monthly.

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.

The best time to develop defense strategies is before a claim is even filed. Employers that implement proactive tactics toward injury response management will see reduced attorney involvement and lower overall claim costs.

Instead of leaving things to chance, employers need to take control of all facets of a post-injury situation. Employers who do so also exude competence, which helps set expectations for the injured worker and can reduce much of the animosity typically present in the workers’ compensation system.

The Problem

The less control an employer exerts following a workplace injury, the longer the time off work — leading to higher costs.

Consider the following example;

A worker gets a fairly deep cut in her arm rounding a corner at work as she’s carrying a heavy load of paper. Neither she nor her supervisor knows what to do, so the supervisor calls someone in HR who asks if the injury is ‘life-threatening.’ Since it is not, the HR person spends 20 minutes asking a series of questions before sending the employee to a physician’s office.

In the meantime, the injured worker and a coworker have covered her wound with paper towels from the restroom. The cut is deep and she loses enough blood to make her feel dizzy.  

Appalled at the presence of unsanitary paper towels on the employee’s cut, the physician prescribes antibiotics as well as stitches and suggests she take a few days off work because of her dizziness and to see if there is an infection.

She is not contacted for several days and becomes increasingly disgruntled. Ultimately, she files a workers’ compensation claim.

This scenario shows the disorganization and wasted time, energy and expense that occurs all too often following the injury. Having a formal, post-injury procedure in place can avoid much of that.

The Strategies

A post-injury response plan that is fully communicated to managers, supervisors and employees is a must to avoid the scenario described above. It should incorporate a series of action steps to be taken after any workplace injury.

1. Supervisor’s responsibilities. Immediately after the injury, the employee should contact her supervisor, as she did in the case above. However, the supervisor should understand and follow a specific protocol. She should know that the employee’s injury is the most immediate need. If the company employs a triage nurse, he should be contacted immediately to determine the severity of the injury and next steps. If the case is an emergency, the employee should be taken to the closest emergency room. In the absence of a triage nurse, the employee should be given the names and locations of the company’s workers’ compensation physicians. The supervisor should escort the worker to the physician’s office; if not possible, she should designate someone to drive her there.

2. Information. A packet should be readily available for the supervisor to give to the injured worker. It should include instructions and phone numbers on whom to call, how to file a claim and what to expect in the days ahead. It should also contain a ‘workability form,’ for the physician to fill out.

3. Investigation. The supervisor should immediately begin an incident investigation, that includes statements from any witnesses to the incident. If immediate medical attention is unnecessary, the supervisor should speak with the injured worker about the incident.

4. WC designee. A workers’ compensation coordinator should be available to meet with or speak with the employee upon her return to the office. The coordinator should review the physician’s notes and restrictions — if any — and determine if transitional or modified duty is required.

5. Communication. If the employee cannot return to work immediately, she should be contacted by her supervisor, a manager or the workers’ compensation coordinator on day 1. The communication should continue on a regular basis.

6. Documentation. The designated workers’ compensation coordinator should fill out and send to the insurer or third-party administrator a first report of injury that includes statements from the worker and any witnesses, as well as photos of the incident site. A detailed job analysis should also be provided to the carrier/TPA.

7. Monitoring progress. The workers’ compensation coordinator should meet with and/or contact the employee at least weekly to discuss the employee’s progress, and when she might return to work in some capacity.

Establishing such a procedure requires up-front legwork to be effective. A workers’ compensation coordinator must be designated and properly trained in workers’ compensation issues, including alternative leave plans; the injury response plan should be formally written up and presented to all employees; treating physicians should be identified and working with the company to understand its culture and the focus on returning the employee to work as soon as possible; and transitional work assignments should be outlined.

Conclusion

Workers who are injured on the job do not typically start out being angry toward their employers. But the failure to have a formal, structured, well-understood post-injury response plan can lead to confusion and anxiety and, ultimately, an expensive claim.

Employers can cut disability durations, hostility, and costs with a well thought-out plan that addresses the employee’s needs as well as the company’s.

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.

Medical costs continue to be a significant driver in workers’ compensation claims across the United States.  This is due to a number of different factors, which include fraud, waste and abuse within the system.  In other instances, the increase in medical specialization is a driver of costs, which can lead to duplicative and unnecessary care.  When this takes place in the context of a workers’ compensation claim, the result is an unnecessary financial burden to the program.

Now is the time for members of the claims management team and other interested stakeholders to take control of their programs.  One important way to do this is by being proactive on the medical factors of claims and to direct effective medical care and treatment.

Responding to Injuries

All employers, regardless of size need to take a proactive and immediate approach to every workplace injury.  This includes personnel within the work environment who know how to provide medical care and being responsive to employees who suffer an injury.  Other key elements of an immediate and effective injury response include:

• Rapid response to injury and with 24/7 nurse triage hotline. Time is of the essence to triage the injury and direct the employee to the right level of medical care, whether home treatment or the appropriate medical provider. The ability to use a 24/7 nurse triage hotline is not affected by differences in state laws regarding directing medical care.

• Transportation to a medical facility is also an important component of responding to a work injury. This includes providing a means of transportation for a person who does not need an ambulance.  Instead of making that person drive himself or herself to the appropriate facility, an employer representative should make every effort to provide transportation.  This best practice demonstrates “good will”, and ensures the employee arrives at the medical provider to receive treatment.

Working with Treating Physicians

Having a designated medical facility for initial post-injury care does not preclude an injured worker from seeking future treatment at another location.  It is a general rule that employees suffering from the effects of a work injury have the right to choose their initial medical provider and seek care from a facility of their choosing.  It is important for members of the claim management team to communicate effectively with these treating physicians.

When working with the employee’s treating physician, claims handlers and other interested stakeholders should also keep the following factors in mind:

• Professionalism: As a claim hander, you are the “face” of the employer and insurer.  Claim handlers need to understand and respect the doctor-patient relationship.   It is important to be patient and professional at all times. While state and federal privacy laws are relaxed in the context of a workers’ compensation claim, disclosure of information may be delayed.

• Cooperation: This is an essential key when dealing with contentious matters such as workers’ compensation claims.  Building and maintaining cooperation is a two-way street.  Always seek to be a problem solver, not cause them.

• Relationships: People like to do with business with people they like.  This includes working with medical professionals and the injured party.  The expression, “You catch more flies with honey than you do with vinegar,” is something to consider.  An employee suffering from a work injury has a number of worries beyond recovering from the incident.  This includes financial, emotional and family pressures.  Always seek understanding and approach every employee as a person, not just another claimant.

Conclusions

There are no simple solutions to reducing the medical aspects of a workers’ compensation.  Interested stakeholders can take a significant step to addressing this issue through a proactive approach to directing medical care in all injury-related claims.

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

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/

Live Stream WC Training: http://workerscompclub.com/livestreamtraining

©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.