5 More Things The New Workers Comp Manager Needs to Know

Being new to workers’ compensation can often seem like you are trying to navigate a foreign land. It helps to know what to expect getting started.  Here are five additional items it helps to know about the job.

 

  1. Sometimes it is time to babysit.

Injuries do happen. The employee needs to know the company still cares after the worker is no longer able to work. If there is a workers compensation coordinator, you can delegate to her the job of keeping in touch with all the injured workers until they are back to work doing transitional duty. The best policy is to contact the injured employee after each medical appointment to learn of any issues with their medical treatment, their return to work status and any concerns they have about their job or their work comp claim. By showing the injured employees the employer cares, it will have an overall effect of lowering cost of workers compensation.

 

 

  1. Know the adjuster(s).

The adjuster is now a new best friend. A competent adjuster who does the job well will make the WC manager’s job easier. The better the working relationship with the adjuster, the fewer snags encountered on workers compensation claims. (The fewer adjusters to work with, the easier it is to learn their strong points and weak points. If the claims are not already consolidated with the minimum number of adjusters possible to cover the claims, work toward consolidating claims with the best adjusters available.

 

 

  1. Know your insurance broker.

The broker is now a second new best friend. A mistake a lot of new workers comp managers make is thinking the broker works for or is an employee of the insurance company. The broker is a knowledgeable business person who works for the employer as an advisor. The broker’s main job is to keep the employer (insured) happy.  Discuss with the broker what benefits are provided. Hold the broker to this, and the new job will get easier. Expect more than simply an annual stewardship report. Ask the broker to be proactive and make suggestions about your workers compensation program. 

 

  1. Know the return to work program.

The better the company’s transitional duty program, also known as modified duty or light duty, the quicker and faster the workers compensation claims will come to an end. The company is going to be paying the cost of the indemnity benefits through higher workers comp premiums. To reduce the cost of those benefits, return the employee to modified duty. While the injured employee may not be as productive as an uninjured employee, all the productivity of the injured employee on light duty is benefiting the company to some extent while reducing the cost of the claim.

 

  1. Review the claim files.

If asked, most third party administrators or insurance companies will arrange online access to the claim file notes where the adjuster records the activities and events of the claim. While the file notes are helpful, they do not tell the whole story. Go to the claims office and read everything in the claim files. The claims office will probably try to talk you into doing an on-line review, but an in-person review with the adjuster(s) about the claims will provide the most information. There are also claim consultants who do claim file audits, if that is preferable.

 

Good luck in the new role as the work comp manager. Use the ideas and consult our website often for advice on workers compensation.  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.

 

 

©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.

 

5 Things the New Workers Comp Manager Needs to Know

While more colleges are now offering majors in risk management and insurance than there were available just ten or twenty years ago, many of the people who come in to the field of risk management and the even more specialized field of Workers Compensation Manager, do not have previous experience or backgrounds in workers compensation. It is nothing unusual in this day of tight hiring practices and double duty jobs for the new workers comp manager to also be working in another department such as finance or human resources. It becomes a learn-as-you-go-experience.

 

 

The new workers comp manager, even the one who has been a workers comp adjuster, often needs a guide on what to anticipate in the new role. Therefore, we have put together a list of 5 things it helps to know about the job. Here is our list of five things the new workers compensation manager knows, but no one will tell.

 

 

  1. The Safety Manager is your new best friend. 

The better the safety manager does the job, the easier the new WC manager’s job will be, as fewer accidents means fewer workers compensation claims to be made.  Ask the safety manager what can be done to eliminate accidents and injuries.

 

 

  1. Learn how to read the loss run. 

The loss run provides tons of useful information on the nature and the extent of the injuries. Learn about the types of injuries that occur most often and discuss with the Safety Manager what can be done to eliminate the frequent reoccurrences. Review the loss run to see how much money is being spent on medical and how much money is paid out in indemnity benefits. Look for areas where costs can be reduced. Customize the loss run; ask friends about the most helpful stats they have on their loss run, and include those on yours.

 

 

 

  1. Know your insurer.

The insurance company that writes the workers compensation insurance is the insurer. The term “insurance carrier” will also be used. This does not mean they carry premiums to the bank. It is an old fashion term for carrying the burden of insurance loss. (Not to be confused with “insured” which is the employer). Learn about the insurer. Are they a mammoth insurance company who writes workers compensation as one of many types of insurance, or are they a smaller regional or local company that specializes in workers compensation. What services do they offer as part of you program or at low cost. Ask them to explain ALL of their services, not just those they pre-select.

 

 

 

  1. Know the cost of workers compensation.

Learn what is paid for workers compensation insurance each year, and if the premium is paid monthly, quarterly, or annually. Learn policy dates and which way the premium has been trending in recent years. (Declining premiums are a good sign the safety manager is doing his job well, while increasing premiums indicates a need to team with the Safety Manager to reduce the number of claims and the severity of the claims that do occur. Know how to translate this into total dollars spent on workers compensation.

 

 

  1. Timing is everything.

The most successful workers compensation managers are the ones that learn time is of the essence in almost everything done as a work comp manager. New injury? Report it immediately to the claims office and immediately advise the medical provider’s office of the transitional duty program. New disability slip? Coordinate with the injured employee’s supervisor on how to accommodate the light duty work slip. New information on an older claim? Call the adjuster and share it with her so she can act on the information while it is still beneficial.

 

Good luck in the new role as the work comp manager. Use the ideas and consult our website often for advice on workers compensation.  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.

 

 

©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.

 

Who’s In Control Of Your Workers Compensation Program?

 

We all like to be in control, right? Or at least feel like we’re in control anyway, but we know that there are times, and there are situations when the chickens are actually ruling the roost.

 

 

The Chickens Are Ruling The Roost

 

I’m going to show you a little clip. This is a YouTube clip from the show Super Nanny to really show and explain my point a little bit further. Let’s take a look at this together.

 

Donuts! Donut, donut. Please mommy! Please mommy! I’ll be extra good if you give me a donut!

 

Now anyone who has children probably knows that scene maybe all too well. My wife and I have four kids ourselves, so it’s something that we’re working on regularly.

 

If that parent gives in to the child and gives her the donut, who’s in control of that situation? If you get a note like this from Joe Martin, that says no work until seen by this office again, and you accept that note, who’s in control of that situation?

 

It’s going to create a worse outcome for that child long term if you give her that short term fix instead of working on the attitude and the behavioral challenges to create a better human being in the long term. The same is true for your work comp management program. If you accept a note like this from Joe without getting the needed information and plug him into your system, you’re creating long-term challenges and you’re creating a very expensive work comp system for your organization.

 

 

Information Needed At Time Of Injury To Take Control

 

Here’s the information that you need in order to take control of an injury at the start of that claim. You need to know the information about the injury itself, the diagnosis, the prognosis, the treatment plan. You also need to know some important information with regards to return to work. You need to know the estimated return to work date, as well as the medical restrictions from that treating physician for what that individual can and cannot do.

 

Finally you need to know some pertinent scheduling type information. Things like the next appointment date as well as that doctor’s contact phone number. If you get that information that puts you in control. If you deny that child the donut at that time, you start to get in control of that situation, creating a better long term outcome in both scenarios.

 

I’m Michael Stack with AMAXX, and remember your success in worker’s compensation is defined by your integrity, so be great.

 

 

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.

 

 

©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.

 

Make Your Work Comp Message Stick Like Gorilla Glue

This Is Part 2 in a 3 Part Mini Series.

 

The Tipping Point in Workers Compensation

  1. Paul Revere, Workers Compensation, and the Tipping Point
  2. Make Your Work Comp Message Stick Like Gorilla Glue
  3. How Work Comp Can Be Just Like Prison

 

I’m Michael Stack with Amaxx and welcome back to The Tipping Point mini series where we’re reviewing the elements discussed by Malcolm Gladwell in the book The Tipping Point: How Little Things Can Make a Big Difference. When you’re trying to implement change, when you’re starting to try to implement an epidemic of proper work comp management to reduce your work comp costs and really create a better outcome for your injured workers.

 

In the first series, I talked about the law of the few and really that’s very relevant when you’re trying to get buy in to your program. The CEO and senior management are onboard, but don’t forget about those employees that have an influence over others. They have those innate skills that connectors, the mavens, and the sales people.

 

 

Stickiness Is Message Into Memory

 

In this session, I want to talk about the stickiness factor and how memorable your message is. Maybe you’ve created a brochure, maybe you’ve done some training, maybe you’ve had safety meetings in regards to your work comp management, but you’re not getting your claims reported timely, which is really where this is very, very important in how memorable your message is, particularly at the time of injury to get that claim reported immediately. You have a very low cooperation or a very low implementation rate in getting those claims reported. Here’s the study, Yale University 1960s, what they were trying to do is get the students to get their tetanus shot.

 

It was a free tetanus shot at the health clinic. They did two different types of brochures, a high fear and a low fear, and they wanted to see if it made a difference and really gory photos of what happens if you get tetanus and why you should get the shot. Then, a very less intrusive or less fearful brochure. Here’s what was interesting that a month later, only 3% of students ended up getting the shot, very, very low cooperation with what they were trying to do and it didn’t matter whether they were in the high fear or the low fear group to get those outcomes.

 

 

Not The Message, But The Package

 

Often times, it’s not the quality of the message and you’re beating your head against the wall with why aren’t my employees reporting their claims when I’ve told them 100 times maybe it’s the way that you’re telling them that’s going to make a difference. In this study, all they did is they put a map of the campus of where the health center is as well as the times that it was open and they saw those rates increase to 28% of their students cooperating and going to get the shot. It didn’t matter what the message was from these groups. It was both relatively equal. When you’re trying to get by them, when you’re trying to get cooperation, particularly with your claims reporting for your program, don’t forget or discount the stickiness factor of how you’re packaging the message.

 

Maybe you have an injury triage hotline and you need to give them a wallet card, you need to put it on your lanyard, you need to create a new sign. You need to make some changes and do some testing in how you’re displaying or packaging that message. Remember the stickiness factor in getting your claims reported.

 

I’m Michael Stack with Amaxx. This is the Tipping Point In Worker’s Compensation mini series. Remember, your success in worker’s compensation is defined by your integrity, so be great!

 

 

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.

 

 

©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.

 

Excess Workers’ Compensation Insurance 101

Excess Workers Compensation Insurance 101

Self-insured employers purchase excess insurance coverage to limit the risk of exposure to catastrophic injuries. This is often accomplished by having a workers compensation policy with a high deductible. Common deductibles for excess insurance are $250,000, $500,000 and $1,000,000.  The self-insured employer needs to carefully analyze the amount of risk that is financially feasible before deciding on the deductible for the excess insurance.

 

 

The excess insurer has a strong interest in knowing about the workers compensation claims that have the potential to exceed the self-insured employer’s deductible. The insurance contract will normally state the self-insured employer must report to the excess insurer any time the reserve amount on a self-insured employer’s workers comp claim equals half of the deductible amount.

 

 

Any Injury With Potential To Exceed Deductible Should Be Reported

 

The excess insurance contract will call for the self-insured employer to report all “catastrophic” claims, regardless of the dollar amount of the claim.  This could include

 

  • Fatalities
  • Amputation of a major extremity
  • Spinal cord – quadriplegic, hemiplegic and paraplegic injuries
  • Brain and brain stem injuries
  • Comas
  • Burns over more than 25% of the body
  • Severe disfigurement and scarring, where applicable
  • Loss of eyesight
  • Loss of hearing
  • Heart attacks
  • Strokes
  • Multiple surgical interventions
  • Rape and sexual assault
  • Post-Traumatic Stress Disorder
  • Occupational disease claims
  • Non-union of bone fractures
  • Damage to organs – lungs, liver, heart, stomach, etc.

 

 

This list is not all inclusive.  Any injury that has the potential to exceed the self-insured employer’s deductible should be reported to the excess insurer. The report to the excess insurer should be completed by the third party claims administrator adjuster or the self-insured employer’s internal claims adjuster as soon as the information becomes available that there is the potential for the claim to exceed the self-insured employer’s deductible.  The failure to report the claim timely (within the requirements of the excess insurance policy) could create a situation where the excess insurer denies coverage, or accepts the claim under a reservation of rights which allows them to deny coverage after thoroughly investigating the matter.

 

 

 

Review Specific Reporting Requirements of Excess Insurer

 

The report to the excess insurer should include the basic information about the workers compensation claim. This includes:

 

  • The facts surrounding the injury
  • Compensability
  • The nature and extent of the injury
  • The medical management of the claim
  • The amount already spent on the claim
  • The reserves for the future cost of the claim
  • Subrogation potential
  • Any other offsets of cost
  • Any Medicare or Medicaid issues
  • The action plan to bring the claim to a conclusion
  • The litigation management plan, if applicable

 

 

The self-insured employer at the start of the excess insurance policy should review with the excess insurer the specific reporting requirements of the excess insurer. A diligent effort by the self-insured employer to comply with the requirements of the excess insurer must be made.

 

 

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.

 

 

©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.

Ingress/Egress: Issues of Compensability Outside The Normal Workday

Questions concerning compensability under any workers’ compensation act starts with a simple question.  Did the personal injury arise out of and occur in the course and scope of employment?

 

While it may seem very basic, the reality is there are many gray areas that lurk beneath the surface.  One such issue involves the “ingress and egress” of employees as they enter and leave the workplace.  This is a challenge the claims management team must master in order to be effective.

 

 

The Origins of Ingress/Egress Compensability

 

When dealing with these questions of whether a personal injury is “work-related” courts early on recognized that employees need to first enter the workplace on time in order to perform the necessary functions of their work duties.  The result of this was an acknowledgement that employer’s obligations under a workers’ compensation act sometimes start even before the workday begins.

 

It is important to remember that claims involving these matters are fact specific.  The result is members of the claims team need to investigate these issues on their own merits and sometimes consult with an attorney before they accept or deny primary liability.

 

 

Understanding Unique Scenarios

 

There are an infinite number of possibilities when it comes to the ingress and egress of an employee.  Here are some of the common situations that take place:

 

  • Beginning/Completion of a Work-Shift: Generally, employees are covered under a workers’ compensation act from the time they arrive on company property until the time they leave.  Injuries that occur during these times are generally compensable when they take place within a reasonable time before or after work in entryways/cloakrooms, bathrooms, parking lots and sidewalks on or near the company premises.

 

  • Unpaid Work/Rest Breaks: Just because an employee is not being paid, does not mean they are not covered under a workers’ compensation act.  Examples of compensable injuries include taking breaks on company premise and even when the employee is walking to a nearby restaurant or convenience store.  Most jurisdictions also recognize injuries that take place when employees are smoking cigarettes.

 

  • Traveling Employees: This type of employee should send fear down any claim handlers spine.  They typically receive “portal-to-portal” coverage, which means they are covered from the minute they leave until they return.  The possibilities for mischief are endless as they go out to eat, engage in the entertainment of clients and countless other activities not directly related to their work.

 

When determining issues of compensability for these types of injuries, courts will look at a number of factors.  The circumstances that generally lead to an injury being compensable are as follows:

 

  • If the injury occurs at a location that could be constructed as the employer’s workplace, or an area under their control; or

 

  • When the employee is furthering the interests of the employer or engaging in activities necessary for the human condition. Common examples are eating food, drinking a non-alcoholic refreshment or situations involving necessary bodily functions.

 

 

Other Factors to Consider

 

The doctrine of “special hazards” can sometimes serve as the lynchpin for whether a claim is compensable.  Examples of these hazards people encounter inside and outside the workplace are numerous.  A review of case law has noted many examples where people are struck by a batted baseball, stray bullets or assisting in the rescue of unknown third parties become compensable injuries.  In these instances, the courts will generally use a balancing test to determine compensability.  Issues examined under this test will often include whether the hazard is unique to the workplace itself or if its origins rest in risk the employee would encounter in everyday life.

 

 

 

Conclusions

 

All work-related injuries require members of the claims management team to conduct a diligent investigation.  In circumstances involving ingress/egress or other hazards they must redouble their efforts.  This includes knowing the law and in other cases, coordinating their efforts with appropriate legal counsel.

 

 

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.

 

 

©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.

 

How The Heck Did You End Up In Workers Comp?

So, how the heck did you land in workers’ comp? I’m just going to guess and say it probably isn’t something you dreamed about as a kid.

 

One of the challenges we are facing as an industry is how to attract the millennial generation. If none of us dreamed of being here, how did we all end up here? If we can understand where we’ve been it may help us understand where we are going.

 

Answer this short survey to share your experience https://www.surveymonkey.com/r/5WLRGKG. I’ll publish the results next week.

 

For me, I studied accounting and computer information systems at Indiana University. I’m not sure I even knew that workers’ compensation existed. When I first got started working with Becki Shafer (she is my wife’s Aunt – http://tinyurl.com/hfjxtle) doing research and small projects, my thought was “sure, I’ll help you out with some projects to make a couple extra bucks, but I’ve already got things figured out with my career path”.

 

 

We Never Know What Journey Our Career Will Take

 

Of course, we never know what journey our careers are going to take. The more I worked with Becki the more I liked it and found it made a lot of sense to me. Working with Becki, the projects and responsibility of working with employers on cost containment best practices continued to grow and it wasn’t too long until I decided that workers’ compensation was the perfect career for me.

 

 

To the outside world it’s an industry that seems completely foreign with a different language and an interesting dynamic of stakeholders. Once you start working in this industry it takes a while to figure things out. Becki was, and continues to be, a tremendous mentor for me. Without her help, teaching, and guidance, my career and interest in workers’ compensation would have started and stopped quickly.

 

 

What we do in this industry is incredibly important. We make an impact on the lives of individuals at a time when they are feeling the most vulnerable. And the reason it was so easy for me to decide that workers’ compensation was the right career is I learned that doing the RIGHT THING actually costs the employer the LEAST amount of money. Act with HIGH INTEGRITY, and you will get the BEST RESULTS. It’s just too good of a concept to pass up.

 

 

However, after being in this industry for many years now, what I’ve realized is that not everyone has the luxury of having someone like Becki as a mentor. So many get thrown into it and are expected to produce results with little to no training and guidance.

 

 

Workers’ Comp Newcomers

 

Because of this fact I am inspired to share the lessons I learned working with Becki, so I have spent the last 10 months in the creation of the Workers’ Comp Newcomers Course. I’ve designed it as a comprehensive introduction to workers’ comp cost reduction and injury management systems for employers. It is designed specifically for employers and insurance brokers working with clients that have the goal of reducing workers’ compensation costs.

 

 

I took everything that I needed to learn entering this industry and broke it down into bite-sized lessons that average about 10 minutes each. In our fast paced, demanding world, flexibility and accountability are critical components to learning. The course is mobile-enabled and spread out over 8 weeks, with 2 weeks to complete each of the 4 modules. Each lesson has a short quiz to self-test comprehension and a final exam that requires 75% to achieve the certificate of completion.

 

 

I hate to even count up how many hours are invested in the creation of this course, so I’m very excited to finally release it. The first class starts Monday, August 22nd. Find out more here: https://workerscompclub.com/wcnew/

 

 

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.

 

 

©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.

 

The Secret To Success In Workers’ Compensation

Hello Michael Stack here. Principle of Amaxx, founder of Comp Club and co-author of Your Ultimate Guide to Mastering Worker’s Comp Costs.

 

This past weekend was the start of the 2016 Rio Olympic Games. It is an impressive display by the world’s most elite athletes. It is something that I always look forward to and really enjoy watching. One of the elements in addition to the events that I really like to see is those personal stories, the back stories about the Olympians. Katie Ledecky is one of the US’s most decorated female swimmers. Just yesterday, she set the world record by almost two seconds in the 400 meter freestyle. It was an incredible event.

 

Before that event aired, before that race aired, they showed an interview between her and Matt Lauer from the Today Show. Matt asked Katie, he said, “What’s the secret to your success?” I thought the answer was just fantastic. She said, “The secret to my success is that there is no secret.” The secret to my success is that there is no secret. That’s years and years of practice, dedication and preparation in order to be able to dive into that pool at the sound of the gun and deliver an extraordinary outcome.

 

In Worker’s Compensation, often times we expect that extraordinary outcome that the claim is handled really well, that the employee gets back to work really quickly, and that costs are extremely low. We expect that extraordinary outcome without putting in the preparation, dedication and practice for what is going to happen at the time of the injury. If you watch the gymnasts in particular, you can really see this on display. Before their event, particularly, if one the gymnast is getting ready for a vault, you can see them really going through those movements.

 

 

Consistent Post Injury Response Procedure  

 

What are the movements in your Injury Management Program after an injury occurs? This is what we call the Post Injury Response Procedure. I’m going to go through some five summary steps of what that should look like, so hen that injury occurs at your organization, you know exactly what is going to happen, you know the steps that are going to occur.

 

 

Step 1: Report the Claim

The first step in this then, is to report the claim. The first step is to report the claim. Your lag-time summary, how quickly you’re reporting claims is a leading indicator to your program’s success. If you’re not getting claims reported timely, you’re not going to have positive outcomes, it’s just as simple as that. My recommendation is working with a 24-hour injury triage provider in order to help improve the outcomes of this claims reporting. Getting the proper level of medical treatment, advice to that employee, demonstrating that care right away and getting on top of that claim right away.

 

 

Step 2: Get Medical Care

Number two, get medical care. If you’re working with that triage provider, they’re going to be directed to the right level of care, often times reporting that individual to home treatment. You should also have relationship set up with medical providers, pre-existing relationships with these medical providers, so they know the protocol of your organization, they know the job descriptions at our organization, they know the type of work your employees are doing. When they’re treating that individual, they are a highly respected doctor that can also give you the medical restrictions for that individual employee. Can they lift 5 lbs., 10 lbs, 50 lbs., they can’t stand for a certain period of time. Get that medical care as part of your Injury Response Procedure.

 

 

Step 3: Return to Work

Step number 3, then, if you’ve gotten those work restrictions, is to return that individual to work. You should be shooting for 90% of your employees back to work or staying at work within zero to four days. 90% of employees back to work or staying at work zero to four days is your goal. Once you’ve gotten those medical restrictions, you plug them into your Return to Work Transitional Duty Job Bank descriptions that you’ve advised for how to now accommodate these restrictions that you’ve received from the doctors.

 

 

Step 4: Communication

Step number 4, communicate. This should be done from the direct supervisor: a first-day phone call, a visit to the hospital, a get well card. You’re demonstrating that care immediately. You’re also having weekly meetings with that injured employee. How’s the transactional duty job going? How’s your medical care going? You’re demonstrating care and you’re getting extremely valuable claims management information.

 

Step 5: Identify Fraud

The more you communicate with this individual, the more you’re going to be to identify fraud and malingering. You’re going to be able to sense if they’re not progressing in their return to work or transitional duty job program. Maybe that’s because the medical treatment is not going right, and you need to bring in some additional medical resources. Maybe there is some malingering going on, and you need to bring in some surveillance or additional resources to help that claim on track.

 

 

Know Exactly What Is Going to Occur After Injury

 

This is a very short summary version of what a Post Injury Response Procedure is, but the point is you need to know exactly what’s going to happen at the time of an injury in order to deliver that extraordinary outcome, just like the Olympians in the 2016 Rio Games. You won’t be awarded a gold medal, but what you will be awarded with is a great experience for the injured worker getting them back to work timely, and also extremely low Worker’s Compensation Claims cost. Remember your success in Worker’s Compensation is defined by your integrity, be great!

 

 

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.

 

 

©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.

 

3 Levers To Develop TRUST In Workers’ Compensation

Hello, Michael Stack here. Principal of Amaxx, founder of COMPClub and coauthor of your ultimate guide to Mastering Worker’s Comp Cost. Today I want to do something a little bit different. I’m going to tell you a personal story about myself and my family and then relate that to an extraordinarily important concept in worker’s compensation management.

 

My wife and I lived in a town just outside of Boston called Hingham, Massachusetts. We decided to move up to Kennebunkport, Maine. The way that the housing worked out, it didn’t exactly work out the way that we wanted it to, so we had to move our stuff into storage. We didn’t really have a place to live in Maine until September 1st. Running an online company affords us some flexibility as far as location is concerned. We decided to take the summer and go on an adventure; have us some new experiences for myself, my wife, Kori, and our 4 children who are ages 2 to 6 years old.

 

We spent some time in Bend, Oregon. Had a nice time there and now we’ve landed in Steamboat Springs, Colorado and will be here for a month. Anyone that’s raised children, particularly children that are close together, know the joys that comes with that but also the stress and the challenges and the frustration that comes with that. My wife Kori and I committed to this concept of going on date nights because we felt it was important to have a united front and really raise those children as successfully as possible for our marriage as well as for our family.

 

 

Trust Is The #1 Determining Factor If Employees Hire An Attorney

 

Being here in Colorado, we wanted to continue that tradition but we were looking for a babysitter. I was looking for a babysitter which really lead me to really think about this concept of trust and how important this concept is. WCRI did a study a couple of years ago and said, “Trust was the number 1 factor in why an employee is going to hire an attorney.” Number 1 factor in the outcome in that claim, if it’s going to go south or potentially go in the right direction. It led me to start to think about this concept. I’m going to tell you a little bit more about this story of looking for a sitter and how it relates to developing this trust in worker’s compensation management.

 

In order to have someone watch your kids, particularly young kids, you need to have a high level of comfort with that person and a high level of trust. Being here in Colorado, we don’t have those babysitter relationships. I went on this website called Care.com. It has a lot of different caregivers and providers, etc. Reading the reviews about different local sitters here in Steamboat Springs. Reading through 5-6 reviews about certain sitters. They did a nice job for their kids and they’ll probably do a nice job for my kids so it gives me a certain level of comfort to have them hired even though I’ve never met them, but only so much.

 

One of the nice things this website does is it connects you through Facebook of who your shared friends are. My sister-in-law happened to have a relationship with one of the sitters. She was good friends with her. I called her up. She gave me the endorsement. “She’s a trustworthy individual.” Boom, immediately I felt comfortable with that individual that I’ve never met before and she is now signed up to babysit us to go to dinner on Friday night, which will be great.

 

 

3 Levers To Develop Trust

 

How do you now develop this trust and how does this relate to your organization, to your worker’s compensation management program? Trust is developed really through 3 different levers. 1 is through relationships. Number 2 is through communication and number 3 is through time. Relationships, communication and time. 3 different levers in order to develop a trusted relationship, particularly in a new experience.

 

 

Leverage The Supervisor Relationship

 

Here’s the important concept here. I read the reviews and had a certain level of comfort with individuals. It wasn’t until the trust of my sister-in-law got transferred. Immediately, my comfort level went up with that individual to contact her and have her come over. How does that relate here? The most trusted relationship of an employee, of an injured worker is their supervisor. That relationship needs to be leveraged, when that injured worker gets injured, of what this is going to happen. What experience is going to happen. They don’t know what’s going to happen. They’ve never been through this before. They need to leverage that supervisor relationship. Have them be involved in the process. That’s the concept, here are the tactics. That’s done through communication and that’s done over time.

 

 

Build Trust Through Active Communication

 

In communication, 3 different concepts here. A first day phone call and even better, a first day visit to the hospital. Having that supervisor contact that employee immediately. Talk about: we’re sorry you got hurt, we can’t wait for you to come back to work, how’s everything going for you so far? A lot of times companies will have someone from HR do this. They’ll reach out. It’s someone from the corporate office but there’s no relationship with that individual. Very similar to me reading those reviews on care.com. I have no relationship with these people that are writing the reviews.

 

If your organization is doing this, someone from HR’s doing it, it’s better than nothing. Reading those reviews is better than nothing but it’s nothing in comparison to leveraging a trusted relationship. That can immediately increase the comfort level just as my experience in looking with the babysitters. First a phone call or even better, going to visit the hospital. Follow this up then with a get well card that’s signed by the department and by the supervisor. “We can’t wait for you to get back to work. We’re sorry you got injured.” That’s the communication tactic, leveraging that relationship.

 

 

Solidify Trust Over Time

 

Next piece in this, this is also done immediately transferring that level of trust from that trusted relationship with the supervisor and then this is also done over time. This is done with a weekly meeting with the injured worker. In both of these incidences, it’s not just about giving care and it’s not just about understanding that you want them back to work. It’s about also understanding valuable claims management information: assessing the attitude of that injured employee, assessing how their medical treatment is going, assessing how their transitional duty job is going, if they’re in one, insuring that’s progressing and if they’re not in one yet, how can you work together to get them back to work. We know the benefits that come from that.

 

Having a weekly meeting, developing that relationship over time, leveraging that trust immediately from the supervisor, down through our first day phone call or personal visit and sending that get well card, your outcome of your claims will be significantly impacted. It will make a better outcome for your injured worker and significantly reduce your worker’s compensation claims cost.

 

Remember in worker’s compensation management, your success is defined by your integrity, so be great!

 

 

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.

 

 

©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.

 

When Your Workers Compensation Insurer Goes Bankrupt

When your workers' comp insurer goes bankruptWork injured employees of self-insured businesses, and workers compensation claimants being handled by insurance carriers, generally have little to fear should the employer or insurance carrier go bankrupt.  Every state and all levels of government have two safety nets, the State Guaranty Funds and Self-Insurers’ Security Funds.

 

Facts Regarding Guaranty & Security Funds:

 

  • These funds step in immediately to take over the handling, paying and settling of claims, and they maintain coverage to protect the corporation or insurance carrier.
  • Both are financed by assessment against self-insured employers and insurance companies. Assessments are based on multiple calculations established and regulated by the States and Governments.

 

 

Operational Practices When Carrier Goes Bankrupt:

 

The Funds are designed, by statute, to protect employee benefits much like the Federal Deposit Insurance Corporation protects the public deposits in banks.  This is extended to lifetime and death cases.

 

Sometimes Guaranty Funds transfer cases to solvent carriers.  However, in most instances they retain enough insurance company employees to maintain polices, coverages and claims.  This includes gathering in unpaid premium, and following for proper reinsurance.

 

As policies expire and claims are finalized, the attending staff is reduced.  Some employees go on to other jobs immediately while others go on unemployment benefits until they obtain replacement jobs. During this period the retained employees are actually state employees.  They receive all the employment benefits the state has in place.  As a result of this operation, the retained employees do not suffer economically.

 

Claims are investigated, documented, processed, and disposed of with all the same dispatch as though the claim unit was still solvent.  Subrogation cases are placed on lien for recovery. Non-compensability, fraud, and any illegal conversion are pursued.  Fraud recoveries are collected.  All controverted cases are pressed for judicial remedy.  Claimant attorney fees honored are maintained as usual.

 

Some Guaranty Funds maintain the legal defense attorneys the carrier used.  Others transfer the cases to State Employed Attorneys designated to handle legal workers’ compensation issues.

 

For the most part claimants seldom realize the carrier no longer handles or pays the claim.  The speed and dispatch for handling workers’ compensation cases is considered to be highly efficient.

 

 

Possible Problems:

 

While the system generally operates with efficiency, there are a few possible downsides. A notable downside is that most funds do not have a cash reserve and are funded on a pay as you go system.   In other words, assessments are not prepaid.  Therefore, payments to claimants or medical providers might fall behind until funds catch up to payments due.

 

Another strain could develop if the number of carrier or employer failures or bankruptcies suddenly surged.

 

According to online reviews, and reports, there is an average of two insurance companies a year.  If you go online and type in “Insurance Company Bankruptcy”, you will be directed to various sources for information.   There are related sites that address Obamacare impact, Annuities, Accident and Health Carriers, as well as many other lines that employers might be concerned with.

 

Some Reasons for Insurance Company failure are:

  • Poor Underwriting by insuring high risk entities
  • Underfunded premiums
  • Poor Investing
  • Excessive Premium Discounts
  • Failure to properly reserve for losses
  • Not perusing 3rd party recoveries
  • Poor investigations allowing claims that might otherwise be defendable
  • Shrinking markets
  • Poor Fraud Prosecution and Recovery
  • Under funded or not reinsured for catastrophic losses
  • Inept staffing
  • Economic impact or collapse

 

 

Summary:

 

The system has been pretty effective and serves its function well.  Most workers compensation claimants have had little, if any, loss of workers compensation benefits and service due to carrier or self-insurer bankruptcy.

 

AM Best is one of the industry watch dogs that tracks insurance carriers for solvency and performance.  Their rating system is a bench mark that should be reviewed periodically.

 

 

Michael Stack - AmaxxAuthor 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.

 

 

©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.

 

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