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.

It goes without saying that in workers’ compensation risk management proactive response to a workplace injury or incident is important.  However, what is often lost in the discussion of this topic is what takes place following the critical minutes following an injury and after the employee receives initial medical care and treatment.  Taking time to think about your long-term response can save your program dollars and can increase productivity in the workplace.

Lack of Communication and the Post-Injury Dilemma

Take a moment to think about a work-injury from the perspective of an injured employee.  The employee is frustrated with a number of issues.  These can include:

• Not understanding the workers’ compensation benefit process and payment structure. They do not want to get an attorney because everything seems right or they do not want to be viewed as a troublemaker.  They are receiving all the benefits they are entitled to, right?

• Time spent filling out forms and seeing a number of medical doctors and vocational rehabilitation counselors. When they do see their doctor, it is a rushed appointment and sometimes not all of their questions are answered.

• The major disruption in their life caused by physical disability. Their routine is in utter chaos.  Instead of spending time with friends at work, they sit at home and recover.

• There is a reduction in income, but not everyday living expenses. Hopelessness and despair set in.

Missing from most post-injury response plans is an effective and consistent line of communication between the employer and injured parties.  Workers’ compensation stakeholders serious about their bottom line need to consider the implementation of pro-injury communication with their disabled workforce.  Lack of information breeds contempt.

Implementing an Effective Plan

It is important to plan and implement an effective post-injury response immediately after a work injury occurs.  Suggestions to improve these lines of communication and avoid distrust of the injured employee can include:

• Assisting the injured worker in contacting immediate family about the injury and advising these parties about the status of the employee. In some instances, written authorization may be required given state and federal privacy laws.

• Contacting the injured worker immediately after they are out of danger and in a stable condition. Sending a get well card or making a telephone call are a good, visiting the employee at their home or in the hospital is even better. Proactive employers can also offer to take someone home from a hospital or clinic after their release.  Random acts of kindness build trust.

• Empathizing with the employee and explaining to them the workers’ compensation process can also be helpful. Developing literature about the workers’ compensation system can also be helpful if done right.

The open lines of communication should not stop there.  Additional follow-up steps can also be taken to build trust and confidence in the employee with the eventual goal of full recovery and return to work.  Other measures should include:

• Weekly conferences with the injured worker to check on their physical and emotional status. These meetings can be in-person at a location convenient to the employee or via telephone.

• Allowing the injured party to visit with friends and co-workers on the employer’s premises can develop a sense of worth.

• Offering a broad selection of return-to-work opportunities.

Conclusions

Effective injury response goes beyond having a First Aid kit on hand and calling 9-1-1.  For proactive stakeholders, it requires exceeding the minimum expectations to build a bridge of trust and promote a positive relationship with the injured worker.  While this takes effort, it can reduce costs in your program and pay dividends via cost savings.

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.

A big mistake made by employers is leaving the injured employee to fend for himself / herself in the world of workers’ compensation.  For most injured employees, the injury is their first workers’ compensation claim and they do not know what to do or what to expect.  Fear of the unknown and not knowing what to expect creates a lot of angst in the employee.

Fear of Unknown Creates Angst in Injured Employee

The smart adjuster during the initial contact with the injured employee will take all the time necessary to answer the employee’s questions about medical treatment, lost wages, light duty return to work, and any other questions the employee might have.  The smart employer will also contact the injured employee and answer all the questions the employee might have about their work comp claim.  When neither the adjuster nor the employer answers the employee’s questions and concerns, the employee will usually find someone who will – an attorney.

We always recommend for the employer to call the injured employee immediately after the initial medical treatment.  They will want to ask what the doctor’s diagnosis and prognosis are, when the employee will be returning to work, and if the return to work date is not known, what the work restrictions are.

14 Points to Discuss With Your Injured Worker

1. The injured employee should be asked to submit a detailed report of how the claim happen, preferably written
2. Ask the injured employee who were the witnesses to the accident
3. Verify the injured employee is treating at an employer selected medical provider, if your state allows the employer to select the medical provider
4. Ask the injured employee if he has ever injured the same body part before, and if so, when
5. Tell the injured employee you will send him/her a copy of the First Report of Injury being submitted to the insurance company, and ask them to review the Report and advise you if anything is inaccurate
6. Ask the injured employee if he has discussed all pre-existing medical issues with the doctor (some medical issues like obesity will be obvious, others like hypertension or diabetes need to be disclosed to the medical provider)
7. Explain to the injured employee how mileage to medical appointments is reimbursed in your state, and the mileage rate
8. Explain to the injured employee the importance of attending every doctor’s appointment, diagnostic test and physical therapy session (if needed)
9. If the injured employee is going to be off work, explain to him what the state’s waiting period is for indemnity benefits
10. Explain to the injured employee how the indemnity benefits will be calculated by the insurance adjuster
11. Ask the employee to call you after each medical appointment to let you know the doctor’s current plan of treatment
12. Advise the injured employee to obtain an off-work slip at each doctor’s appointment
13. Ask the injured employee if he has any questions in regards to how the transitional duty program works
14. Ask the injured employee if he has any questions about any other aspect of how their workers’ compensation claim will be handled

Yes, this is a lot of information to review, and it will take you an extra five minutes.  However, the extra five minutes spent making sure the employee understands how everything will work in their workers’ compensation claim can be the most productive five minutes of your day.  By taking the concerned and caring approach, you will eliminate most of the hassles and headaches that occur when a work comp claim goes bad and save a lot more time later in the claim process.

On-Going Contact Will Avoid Many Problems

Managing and assisting the injured employee does not end with the initial follow up phone call to the employee.  The employee should be encouraged to call you after each medical appointment, and he does not do so, you should call the employee.  Any questions the employee has during the recovery period can be addressed timely in this manner.  By maintaining on-going contact throughout the time the employee is off work, you will avoid most of the problems that can occur with a work comp claim.  You will also be assisting the employee in returning to work the minimal amount of time.

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

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices.

Contact: mstack@reduceyourworkerscomp.com.

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

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.

A near miss may be the best thing that ever happens at your company. Depending on what you do afterward, it can be a huge opportunity to save money and headaches.

After the initial ‘phew!’ reaction, it’s time to get down to business and find out what happened and why and, most importantly, what you can do to prevent a recurrence that could result in an injury and comp claim the next time.

Fact is, most (probably all) workplace accidents have multiple causes. Even the seemingly simple-to-explain incident likely has several underlying factors going on. By getting to the real root of the problem you can avoid potentially costly and preventable claims.

Root Cause Analysis

Delving into the true causes of workplace injuries requires a team effort, though it doesn’t need to be all that complicated. There are a variety of frameworks for ‘root cause analyses.’  There are templates to make it easier to organize the information. Some organizations use a fishbone diagram to group causes into major categories to identify variation sources. Whatever system is used, there are several keys to successful root cause analysis.

1. Do NOT assign blame! This is the most important aspect in getting to the real root of a problem. It’s tempting to blame someone, punish him, and move on, but that doesn’t fix the underlying problems. Root cause analysis must be done without any finger pointing. Remember, most workplace accidents are the result of a confluence of contributing factors. The job of RCA is to identify and correct them.

2. Ask questions. Then ask more. And a few more after that. The main questions to ask: WHY? You may feel like a 2-year-old asking ‘why, why, why’ – but this is key to getting to the crux of the analysis. As an example, let’s say “Fred” fell off a ladder and, luckily, was not seriously injured. It might be easy to say, ‘well, Fred was being careless, he was in too much of a hurry, so it’s his fault.’ But asking ‘why’ will uncover important details that would prevent future such incidents. The answer to the first ‘why’ could be that one of the rungs on the ladder broke. ‘Why,’ you ask again, and find out it could not hold Fred’s weight. If the rungs were designed to hold 350 lbs. and Fred weighs only 170, what was the extra weight? You discover Fred was carrying materials up the ladder and the combined weight exceeded 350 lbs. But the company has a hoist truck for such jobs, so why was Fred not using it instead of carrying the materials himself? Turns out the hoist truck was being used elsewhere. So why didn’t Fred wait until the hoist truck was available? Because he was under the gun to get the job finished on time and would have missed the deadline otherwise.

From the example, several problems come to light. There were not enough hoist trucks available, the ladder’s weight restrictions were ignored, and the deadline did not allow for the job to be done properly. Those are only some of the issues. With continued delving, there would likely be additional factors that contributed to the accident.

3. Get all relevant information — and then some. In addition to the obvious details such as interviews with witnesses, examining any video footage of the incident, and speaking with the injured — or nearly injured — worker, other considerations include:

• The environment. Was the ladder properly placed on the floor? Was there anything surrounding it that might have contributed?
• Training and skill level. Did Fred have training on using the ladder? Did he understand the weight limit? Had he ever used the ladder before? Was he instructed to avoid carrying materials up the ladder (which, aside from the weight limit, could have caused him to fall)?
• Was there a specific procedure in place for using ladders? If so, was that procedure communicated to Fred and other employees? Was the procedure ever updated, and the updates communicated? Were workers known to circumvent the procedures?
• Was it properly maintained? Was there enough available? Had any relevant equipment been updated as needed?
• Human behavior. We found out Fred was in a rush due to deadline pressure. But why — what were the consequences of not meeting the deadline? Were there too few employees working on the particular job?

The Fix

Once you’ve ascertained all the causes (and potential causes) of the incident, it’s time to figure out corrective action. All the ‘why’ questions should end with something that indicates what and how something should be changed.

In our Fred scenario, several things could be changed to make the organization run more efficiently and with less chance for an injury. Training would be one area, for example. Fred clearly did not understand (or did not care) that carrying materials on the ladder could exceed the weight limit of the rungs. Procedures may need to be reviewed and changed to prevent people from carrying heavy or awkward items while climbing a ladder.

Equipment might need to be upgraded, perhaps with an investment in an additional hoist truck would be warranted. Communication might need to be ramped up to ensure that, while meeting a deadline is important, attention to safety is more important.

Conclusion

Workplace accidents, unfortunately, happen and may result in injuries and workers’ comp claims. However, the same incident should never be repeated within an organization.

By digging deep you can identify a variety of factors that could lead to an injury. Taking corrective action will help ensure workers stay safe, the job gets done, and you’re not wasting money on preventable problems.

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

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices.

Contact: mstack@reduceyourworkerscomp.com.

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

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.

High quality, and simple. High quality, and simple. High quality, and simple. Those two concepts are the cornerstones of the clothing brand Patagonia’s business philosophy.

High Quality & Simple

I’m Michael Stack with Amaxx, and I was recently up in Freeport, Maine with my wife celebrating our eighth year anniversary on a little getaway. Now, she needed a raincoat so we spent some time in the Patagonia outlet, and I picked up the book written by their founder Yvon Chouinard. As I was reading it that day and later following to finish it, these two concepts resonated throughout the 258-page book for their business success and the foundation of that company.

Employee’s Bombarded With Information

It got me really thinking as I was reading this book, is how these two concepts can really be applied to Workers’ Compensation, particularly in the communication and the messaging to our employees. Because the reality is that employees today are just bombarded with information on a day-to-day basis of things that they need to understand, and a lot of times need to put into action. The other reality is that Workers’ Compensation for employees that are not injured, it’s just not that high of a priority. When they become injured it does become a high priority, and then that information that you are giving them needs to be extraordinarily high quality and extraordinarily simple. My recommendation is to have you take a look at your messaging of what you want your employees to do at the time of injury, whether you’re giving them a wallet card, you have posters on the walls at your organization in the shop, or maybe it’s even signs within your trucks. How simple is that information? What information can be taken away to improve the quality of that messaging?

Injury Triage

My recommendation here is to work with an injury triage provider, that you can get an 800 number to call that they can talk to a medical professional 24 hours a day. Then the only message that they really need to remember in the midst of all this overwhelm of information is that any time you have an injury, no matter how minor, just go ahead and call that number and we’ll take care of you from there.

Again, I’m Michael Stack with Amaxx. If you’re watching this video somewhere other than reduceyourworkerscomp.com, go ahead and go to that website and sign up to receive a lot more free information about how to control your Workers’ Comp costs. To take it one step further, I’d love for you to join me on my next live stream training. Go ahead and go to workerscompclub.com/livestreamtraining. Remember, your success in Workers’ Compensation is defined by your integrity. This’ll be great.

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

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment.

Contact: mstack@reduceyourworkerscomp.com.

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

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

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