Work Comp Roundup - Page 2 of 486 -

How To Make Unions An Asset To Workers Comp Cost Savings

April 29, 2019 by Rebecca Shafer, J.D.

Many employers may be suspicious of working with unions, thinking that they support the filing of questionable workers’ comp claims. However, in some cases working with labor unions may lead to decreases in workers’ comp costs. Unions are usually strong supporters of improved safety policies, like following OSHA guidelines, use of safety gear like hard hats and protected eyewear and improved ergonomics. Unions can track workplace accidents and make suggestions over ways to improve safety.

Workers’ Compensation Policy Planning

Bring labor unions into your workers’ compensation policy planning. After all, a good company cares for its employees and wants them to be treated fairly. Leaving unions out of the process creates an “us vs. them” mentality that can drive up long-term costs. Including union input builds buy-in to the company’s workers’ comp process.

Here are some suggestions for working with labor unions:

Talk to union representatives early in the planning process.
Ask for the union’s perspective on issues such as how seniority affects injury management and their policies on things such as supplemental pay for the injured worker. Does the union have “collateral source benefits” that are a disincentive to returning to work?
Listen to the union’s input on issues such as safety planning and how to return employees to work post-injury.

Drug Testing

One area where unions and employers have disagreed is over the use of drug testing. Unions may object to drug testing as infringing on its members’ privacy rights or question the science behind drug testing. If employers work with the unions to explain how drug testing protects the safety of members, everybody wins. Unions may respond to the employer’s rationale of keeping intoxicated, unsafe workers from endangering the safety of the workforce, provided that the drug testing policy promotes employee treatment rather than termination. Having a written drug testing policy that is fair and equitable can go a long way towards convincing a union that your concern is for safety, not punishment.

Union Representatives Can Guide Injured Workers through the Workers’ Compensation Process

Union stewards or representatives can help guide injured employees through the workers’ compensation process, starting with arranging immediate medical care. This can help reduce costs as the sooner the injured employee is treated, the higher the probability of a quicker recovery. Make sure that communication with the union remains positive and proactive so that a disgruntled union representative does not urge the employee to stay off work longer because the union has some non-related dispute with management. Also, keeping communication positive and flowing can keep the employee from hiring a lawyer out of frustration over miscommunication or unreturned phone calls.

Complying with Labor Relations’ Laws

Make sure that your company complies with all required federal and state labor laws. Employees have the right to join together with co-workers to address issues at work, with or without a union. Most employers are required to post notices advising employees of their rights under the National Labor Relations Act (NLRA). You do not want to give unions ammunition to attack your company by forgetting to do a simple thing such as hanging a poster in the workplace. You can find out more about employers’ obligations under the NLRA at http://www.nlrb.gov/rights-we-protect/whats-law/employers.

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the co-author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact:.

Contact: RShafer@ReduceYourWorkersComp.com.

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

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

Filed Under: Return to Work and Transitional Duty

The 411 on Functional Capacity Evaluations

April 24, 2019 by Michael B. Stack

A functional capacity evaluation (FCE) is a comprehensive series of test administered by an occupational therapist or a physical therapist who has had specialized training in performing a FCE. The tests are specifically designed to measure:

stamina
dynamic strength
mobility
flexibility
body mechanics
cardiovascular condition
balance
coordination
dexterity
ability to tolerate functional activities

Used to Determine Employee’s Readiness to Return to Work

In workers’ compensation claims, a functional capacity evaluation is often utilized to determine the injured employee’s physical readiness to return to work and to measure any physical limitations the employee will have as a result of the work comp injury. A FCE can also be utilized to determine the injured employee’s physical capabilities for vocational retraining when the injured employee will be permanently unable to return to his/her prior vocation.

A functional capacity evaluation can be one of two types, either a job-specific FCE or a general purpose FCE. In a job-specific FCE, the therapist is provided a detailed job description prior to the testing in order to tailor the FCE to the specific job of the employee. To have a very accurate FCE, the therapist should visit the job site to have a detailed understanding of the functions of the job. In a general-purpose functional capacity evaluation, the testing measures the employee’s strength and tolerance in completing standardized or common work task.

Test Can Last Several Hours to Two Days

After a determination of the type of FCE, the appointment date is scheduled for the injured employee. An FCE can last from several hours to two days, depending on the nature and extent of testing.

At the start of the functional capacity evaluation, the therapist will perform a comprehensive interview of the injured employee. The interview is designed to identify any factors that could impact the employee’s ability to participate in the FCE. The therapist will want to know if the employee has any issues with asthma, COPD or other lung/breathing problems, high blood pressure, physical limitations besides the work comp injury, and obtain the employee’s own assessment of their physical condition including the employee’s perception of his/her pain level.

Measure Various Physical Tests

In conjunction with the interview, the therapist will complete a clinical assessment of the employee to establish a baseline for the FCE. The therapist will measure the employee’s range of motion, balance, grip strength and coordination to establish the testing plan.

In a job-specific FCE the therapist will measure the employee’s ability to lift, carry and perform other tasks in comparison to the performance levels identified in the employee’s job description guidelines. In the general purpose FCE, the therapist will measure the employee’s maximum ability to lift, carry and perform routine work-related task.

5 Categories of Physical Demands

The U.S. Department of Labor characterizes jobs in 5 categories depending on the physical demands of the job. For instance, an over-the-road, or long-haul truck driver is classified as a “heavy” physical demanding job. The 5 categories are defined as:

Sedentary: exerting up to 10 pounds of force occasionally

Light: exerting up to 20 pounds of force occasionally or up to 10 pounds of force frequently

Medium: exerting 20 to 50 pounds of force occasionally or 10 to 25 pounds of force frequently

Heavy: exerting 50 to 100 pounds of force occasionally or 25 to 50 pounds of force frequently

Very Heavy: exerting in excess of 100 pounds of force occasionally or in excess of 50 pounds of force frequently or in excess of 20 pounds of force constantly

If the therapist is performing a general purpose functional capacity evaluation on a truck driver, the therapist would determine the truck driver’s job is a “heavy” physically demanding job. The general purpose FCE testing would measure the employee’s ability to meet the requirements of the “heavy” job classification. However, some truck drivers are “drive and drop” drivers where they never touch the cargo. The hardest part of their job is cranking the landing gear of the trailer up and down and disconnecting the fifth-wheel. Their job requirements would fall in the “medium” job classification for physically demanding. Therefore, when there can be different levels of physical effort needed for a job title, it is to both the employer’s and the employee’s benefit to provide a detailed job description to the therapist and to request a job-specific FCE.

Biggest Issue is Validity of Effort by Injured Employee

The biggest issue with FCE is the validity of the effort put forth by the injured employee. If the injured employee has been advised by his/her attorney that the better they do on the FCE, the lower their permanent partial disability settlement will be, the employee is given a financial incentive to put forth less than their best effort. If there is any concern the employee may not make a sincere effort in the FCE, the therapist should be advised prior to the FCE. The therapist can give the employee several different tasks or activities that measure the same physical ability. If the test results reflect a variation in the employee’s ability within a specific category when measured by two or more different methods, the therapist will be able to identify the employee who is trying to game the testing and include in their post testing report the fact that the effort put forth by the employee was inconsistent.

Results Compared Against Specific Job Description

When the FCE testing is completed, the therapist will compile the employee’s test results. The test results will be compared against the specific job description requirements or the general physical level classification of a job to see if the employee can return to performing the job. The results of the FCE are then reported to the treating doctor and workers’ compensation adjuster and/or nurse case manager.

Michael Stack - Amaxx 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/

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

Filed Under: Return to Work and Transitional Duty

6 Ways Insurance Companies Control Workers’ Comp Claim Leakage

April 23, 2019 by Rebecca Shafer, J.D.

When you review your broker’s or insurer’s website, there is one subject in workers compensation that most brokers and insurers never mention – leakage. Leakage in an insurance claim is any payment that is more than the payment should be. Leakage is defined as the difference between what the claims office spent and what they should have spent. Leakage is also been defined as lost opportunities to save money.

Workers’ Comp Claim Leakage Becomes Employer Expense

As workers compensation premiums are directly tied to the frequency and severity of employers’ claims, you will never hear the workers comp insurer say, “We did a poor job controlling the cost of your claims.” Their leakage becomes the employer’s expense through higher insurance premiums.

5 main causes of workers comp claim leakage:

Inadequate claims handling.
Judgmental mistakes.
Poor claim processes.
Overpayments.
Bad customer service.

While leakage can be caused by any one of these areas, it is often a combination of them that results in leakage.

There are about as many forms of leakage in workers compensation as there are workers comp subjects to be discussed.

10 examples of workers’ comp claim leakage:

Payment of medical bills without adjustment to the fee schedule.
The failure to properly investigate compensability and payment of claims that are not covered.
The failure to pursue subrogation.
The failure to utilize the early return-to-work program of the employer.
The failure to properly manage utilization review opportunities.
The failure to control the selection of the medical provider in those states where the employer controls the medical provider selection.
The selection of inadequate defense counsel.
The failure to pay medical benefits or indemnity benefits timely resulting in fines and/or penalties.
The lack of automation and/or technology in the process where it could be utilized.
The additional management and administration time due to any mistake in the claims handling.

The list could go on and on. Any failure to control the insurance claim can result in leakage.

Leverage Technology to Identify Leakage?

Some consultants and insurance brokers who attempt to identify leakage by the use of computer outcome modeling or algorithms. These provide a detailed report reflecting payment areas in which the employer’s claim cost exceed the average for their industry or the employer’s prior lost history. When the employer has thousands of claims, automated methods can identify some possible areas where there is leakage, but will miss many others. When the employer does not have thousands of claims, the cost averages can be influenced by a few outlier claims making the identification of leakage by computer averages less reliable.

An example of how computers and algorithms fail to identify leakage: A computer average for indemnity paid will not show the failure to contest small claims that should been investigated and denied. Because it is easier for the adjusters to pay numerous small claims rather than contesting them, the behavior looks like superior performance on a computer average, though, in fact, every small claim that was paid but should not have been, is leakage.

A better way to control leakage is the utilization of these 6 time-proven methods:

Having an established set of best practices for workers compensation claims.
Proper education and training of the workers’ comp adjuster including state statutes, customer service, and claims-handling practices.
Excellent education and training of all support staff.
Linking salaries and pay raises to compliance with best practices.
Having an established work-flow process.
Incorporating automation and technology into the claims process.

An integrated approach incorporating all of the methods will eliminate most leakage.

If you feel like there is leakage in handling your workers compensation claims, there probably is. Identification of various forms of leakage on your claims can be done through a claims audit. An experienced quality assurance auditor will be able to point out where leakage has already occurred and identify situations where mistakes have already been made, but can be corrected before additional money is paid. If you would like to discuss a leakage audit of your insurance claims, please contact us.

Contact: RShafer@ReduceYourWorkersComp.com.

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

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

Filed Under: Claim Management

Confusion and Workers’ Comp Abbreviations Can Add to Costs

April 22, 2019 by Michael B. Stack

Creating confusion costs you money. Creating confusion costs you and your organization or your clients organization money. Hello, my name is Michael Stack, I’m the CEO of Amaxx. And today I want to talk with you about the language we’re using to communicate with our injured workers. The language we’re using to communicate with our injured workers. Are you causing confusion? Are you causing them to be fearful of the words you’re using?

Workers’ Comp Abbreviations and Confusion

So let’s go over an example. Say an injured worker gets hurt and you tell them, “We’re going to pay you TTD until the time at which point you’re able to return to work. And then we’re going to work on your medical until you reach MMI. And then at that point, you may need to go see an IME in order to help us establish a permanency rating to settle your case. And depending on the severity of your injury, you may need to then apply for SSDI.” Excuse me? I’m sorry, what was that that you said? We tend to forget that the terminology and the abbreviations and the words that we’re using that are specific to our industry, just like any other industry, are not commonplace among everyone else outside of our industry.

Clear and Simple Communication

So I want you to establish this idea of clear and simple communication. First off, are you calling your injured workers or injured employees claimants? Does that sound very nice? Does that present a very welcoming picture that you’re going to take care of them, that there’s going to be an established level of trust? I think not. So let me challenge your communication and that verbiage that you’re using.

Next piece, I want to outline very simply for you this employee brochure. So when an employee gets injured, you want to establish that trust, that communication right out of the gates. I want to give you a little bit of framework, three-part framework here, or simplified three-part framework for this employee brochure. And you can download this value piece below here, The Nine Elements to Employee Brochure, that I’m going to dive into this a little bit deeper. I want to outline this very quickly.

Set Expectations with Employee Brochure

So first off, first piece, you want to establish when an employee gets injured, even before they’re injured, the time prior you’re going through this with them and then at the time of injury you’re running through it. Work comp 101, what it is, what they can expect from you as far as their benefits. This includes, their wages, how are they going to get paid and are you calling this an indemnity, are you calling it wages? A lot of people don’t know what the heck indemnity means. So are you calling it your wages or wage loss? Your medical and their pharmacy, how are they going to get medical treatment? How are they going to get their prescription drugs et cetera. Establish these expectations. What does it look like as far as return to work? And don’t call it RTW, call it returning to work, getting back it the workforce. Use language that makes sense to people that are not in the work comp industry.

And then lastly, what you expect of them. We expect you to report to work, this is an established part of our organization, we expect you to communicate with us, we expect you not to commit fraudulent acts, et cetera, et cetera. You establish this expectation right out of the front using simple words that everyone can understand and it’s going to get you off to the races as far as getting that claim going in the right direction.

Again, my name is Michael Stack, I’m the CEO of Amaxx. And remember, your work today in workers compensation can have a dramatic impact on your companies’ bottom line. But it will have a dramatic impact on someone’s’ life. So be great.

Contact: mstack@reduceyourworkerscomp.com.

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

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

Filed Under: Communication with Employees

RIMS 2019 – Workers’ Comp Related Sessions That Stand Out

April 18, 2019 by Michael B. Stack

RIMS 2019 is the largest risk event of the year. With 300+ speakers on the schedule, this post contains Workers’ Compensation related sessions that stood out for me.

I look forward to seeing you there!

Monday, April 29, 2019: 1:30 – 2:30 pm

Addressing PTSD at the Workplace

Post-traumatic stress syndrome (PTSD) is showing up more frequently at the workplace. The occurrence of school shootings, store robberies and job-related fatalities—as well as assault, domestic violence and accidents—underscore the need to address the issue on a broader basis than you may have in the past. Determine how you can assist employees suffering from PTSD and minimize and mitigate the impact on their safety and productivity and that of those around them.

Learning Objectives:

Define PTSD in terms of its causes and characteristics
Explain how an employee might manifest PTSD symptoms at the workplace
Identify the risks of leaving unmitigated PTSD at the workplace and strategies to help sufferers

Speakers:

Teresa Bartlett

Senior Vice President, Medical Quality

Sedgwick

Denise Algire

Director, Risk Initiatives | National Medical Director

Albertsons Companies

Steve Wiesner

Kaiser Permanente On-the-Job Medical Director-Workers’ Compensation Service

Kaiser Permanente

Monday, April 29, 2019: 1:30 – 2:30 pm

Using Data Analytics to Drive Performance

Transform existing information into action. Take a practical and pragmatic look at the workers’ compensation tools available for data-informed decision making. Identify key sources of data. Look at data analytics and predictive modeling to see how past data can explain what happened and predict the future. Use current data to determine the best action to take now. Address artificial intelligence, machine learning and automation. Improve your decision making and program performance.

Learning Objectives:

List key data sources and industry resources
Juxtapose the methods and outcomes of descriptive, predictive and prescriptive analytics
Choose from advanced technology tools for managing data and information to improve outcomes

Speakers:

George Furlong

Senior Vice President, Managed Care Program Outcomes Analysis

Sedgwick

Jeff Rycroft

Vice President

Express Services, Inc.

Zoe Zinn

Workers’ Compensation Manager

Packaging Corporation of America

Monday, April 29, 2019, 2:35 – 2:55 pm

Medical Marijuana Highs and Lows: Federal and State Challenges

Stay up-to-date on current trends in legislation and regulation of medical marijuana and cannabis programs. Examine the potential implications for workers’ compensation with a focus on how this issue has arisen in California.

Speaker:

Lisa Anne Bickford

Director, Work Comp Gov’t Relations

Coventry

Tuesday, April 30, 2019: 11:00 am – 12:00 pm

Telemedicine for Workers’ Compensation May Be the Last Frontier

When injured employees need immediate care, do they turn to an emergency room or local health clinic? Take a look at telemedicine as a promising alternative that ensures early treatment and possibly more positive overall outcomes. See how, using a mobile device, injured employees can reach a qualified occupational medicine clinician from home or the worksite. Consider how this technology can improve access to care as part of your efforts to manage injured employees’ health care experience.

Learning Objectives:

Demonstrate ways telemedicine can be integrated into your workers’ compensation program
Extrapolate on telemedicine’s ability to improve care and convenience and reduce lost time
Highlight the essential elements of an effective telemedicine solution

Speakers:

Ann Schnure

VP of Telemedicine

Concentra

Janine Kral

Vice President Risk Management

Nordstrom, Inc.

Tuesday, April 30, 2019: 11:15 am – 11:35 am

Highly Effective Workers’ Comp Communication Strategies: What to Say and How to Say It

Master tactics that set employee expectations for workers’ compensation through consistent, clear and prioritized communications. Know exactly what to say before and after an injury. Find ways to leverage your workers’ compensation team to create multiple touch points to improve claims outcomes.

Speaker:

Michael Stack

CEO

Amaxx LLC

Tuesday, April 30, 2019: 1:20 pm – 1:40 pm

The Opioid Crisis: How Are States Coping?

Join a cross-country examination of the changes to healthcare and workers’ compensation processes in response to the opioid crisis. Make sure you have the most up-to-date information on compliance rules and can make the necessary adjustments to your injured worker and return-to-work programs.

Speaker:

Joseph Pachman

VP and National Medical Director

Liberty Mutual Insurance

Tuesday, April 30, 2019: 2:10 pm – 2:30 pm

Virtual Reality and Wearables: Alternatives to Pain Medications

Familiarize yourself with the potential future of pain management—a digital pain-reduction kit. Consider the future use and benefits of virtual reality in workers’ compensation. Examine the technologies that could reduce medical costs and prevent injured worker exposure to addictive narcotics.

Speaker:

Richard Ives

Travelers

Tuesday, April 30, 2019: 2:45 pm – 4:00 pm

Public Entities Industry Session: Risk Management Tactics and Trends

Join members of the Public Risk Management Association (PRIMA) in a discussion of the biggest risk management issues that public entities face. Explore best practices and trending topics related to workers’ compensation, crisis management, disaster recovery, fleet management, reputational risk, educating elected officials on the importance of risk management and more. Learn to develop solutions for the unique risks and challenges that exist in the public sector.

Learning Objectives:

Assemble crisis management program building blocks that address exposures and recovery
Detail ways you can work with community leaders to achieve your risk management goals
Demonstrate the value in your risk management program

Speakers:

David Demchak

Senior Vice President

Connecticut Interlocal Risk Mgmt. Agency

Raymond Sibley

Director of Risk Management

City and County of Denver

Gary Langsdale

University Risk Officer

Pennsylvania State University

Jane Waters

Insurance Program Administrator

DC Office of Risk Management

Mark Walls

Vice President Communications & Strategic Analysis

Safety National

Contact: mstack@reduceyourworkerscomp.com.

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

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

Filed Under: Workers Comp News

5 Key Terms That Define Professional Administration Contracts

April 17, 2019 by Porter Leslie

Setting up support with professional administration of medical funds after settlement is a clear choice. It helps the injured person save money on their healthcare expenses and provides support in navigating ongoing care. The service is especially helpful for Medicare Set Asides because the administrator helps ensure the injured person’s Medicare benefits remain intact while protecting the injured worker, their attorney, as well as the payor from any potential mishaps. In fact, Medicare “highly recommends” that injured individuals use a professional administrator after settlement. (What is professional administration? Learn more)

When it comes to administration, all involved should have a thorough understanding of the administrator’s role and how it benefits the injured person. What can sometimes be less obvious is how to set up the administered account with an agreement that adequately governs it and how administration fits into and facilitates settlements. The following concepts are essential to understand these agreements.

1. Who is involved? Parties to the Agreement

Ideally, the agreement is between the injured person (also known as the “member”) and the administrator. It’s useful to get to know the administrator involved and to see if it is independent and truly has the best interests of the injured individual at heart. Conducting some background research, contacting the administrator directly, and asking for references are good starting points.

Tip: Be aware of administrators that operate other lines of related business. This could create a conflict; for instance, if they work for the carrier/employer to provide low estimates of future medical allocation amounts, it does not make sense that they are also offering to work for the injured person to help them maximize their medical settlement funds.

The cleanest arrangement is a bilateral agreement between the administrator and the injured person where the administrator is focused on its duty to protect the injured person.

2. The Purpose of the Agreement / Responsibilities of the Administrator

The administration agreement should outline the benefits and services the administrator will provide. These often include:

Placing the settlement funds in a separate, interest-bearing bank account under the member’s name
Securing discounts on medical bills where possible and paying medical bills on the member’s behalf
Tracking and providing complete reporting on all expenses
Filing any required government reports, such as Medicare Set Aside reporting

The responsibilities of the administrator should be clearly outlined. If it is determined that the administrator is going to do something extra or different for the member, this should be included in the agreement.

3. The Bank Account

The administration agreement should provide detail on how the member account will be established. For utmost security, it should be a separate, individual bank account established in the name of the member. In unique situations where the settlement is funded into a special needs trust, then the account may be required to be setup in the name and Tax ID number of the trust to ensure government benefits are protected.

Often times, included in the administration agreement is the standard information the bank requires. With complete security, the administrator is the custodian of the account and must authorize any disbursement.

Tip: The safest account is a separate checking or savings account. Be careful of any pooling of the injured person’s funds with money from other clients. This can have significant consequences because it:

may result in their funds being invested in less liquid assets or that are at risk of losing value. (Investment losses are not an appropriate use of MSA funds)
may result in the loss of FDIC insurance of $250,000
means their money and will likely be tracked manually by the administrator instead of the bank which could potentially lead to mistakes

It’s important to know the member’s money is deposited at a reputable bank in a separate and secure account managed by a top-notch administrator. It is also important to choose an administrator that has multiple banking partners to ensure that large accounts that may be in excess of FDIC limits can be set up in the most protective way.

4. Beneficiary Designation

An important provision of the administration agreement is the beneficiary designation language. Similar to the setting up of a trust or estate plan, it’s important for the member and all parties involved to know where the administrator should send the remaining funds in the account when the member passes away.

Typically, the administration agreement follows the guidance provided in the master settlement documents. If there is no designation of a beneficiary in the settlement documents or if the account is established after settlement, the administrator will defer to the member for whom they wish to designate.

Tip: this provision, like many others, can be negotiated as part of the overall settlement discussion, separate from the administration service. The beneficiary of the administered account can be the member or their estate; it can also be a corporate entity like the carrier/employer/payor involved in the claim (frequently referred to as a “reversionary” party), or a non-profit or charity, etc. During settlement negotiations, the defense and plaintiff parties can negotiate the terms of this part of the agreement to determine who or what entities benefit from the remaining funds; sometimes the designation of the funds or a portion of them can be subject to certain terms and conditions, just as they can apply to other aspects of the settlement.

Upon death, the administrator will typically require a grace period to make sure all outstanding bills are gathered and payments are made; then, the administrator will close the account and cut the check to the designated party or parties.

5. Rights of the Injured Person

Finally, it’s important the member fully understands their rights when their account is being established. They should have a number of common rights and protections and should also be aware of any restrictions. Here are a few common items to consider:

Review of performance: the member should be able to review the work of the administrator and report any inaccuracy to have it addressed
Protection: The member should be held harmless for any mistakes made by the administrator due to negligence
Savings: the member should receive the benefit of discounts secured on their behalf by the administrator. If the administrator benefits in any way from discounts negotiated, they should be transparent to the member.
Open Network: the member should be able to seek treatment with any provider or pharmacy. While a network may be in place to help the member save money, administrators should not restrict the member’s access to care with any provider, pharmacy or facility.
Termination: it should be clearly stated whether termination of the agreement or a withdrawal of the funds is allowed. This can be negotiated as part of the overall settlement. Typically, if the member is the sole beneficiary, they can choose to terminate the administration agreement and receive all their reporting and a check for their funds. However, if there are other designated beneficiaries, language in the settlement agreement may restrict their ability in order to protect all beneficiaries’ interests.

Fitting It All Together

Along the way, if you or the injured person have any questions, the administrator will be a valued resource to clarify the terms of the agreement or explain how the service works. Not all settlements are alike, so sometimes it’s beneficial to request edits and tweak terms of the agreement to your liking.

Once all parties are confident in the terms of the administration agreement, most often, the administration agreement will be added as an addendum to the settlement documents. This way, it is part of the overall settlement package and can be approved at settlement; in workers compensation cases, the judge often wishes to sign off on all aspects of the settlement, including administration.

Author Porter Leslie, President Ametros. Porter directs the growth of Ametros and works with its many partners and clients. He built his career leading customer-focused businesses in the healthcare and financial services industries. Prior to Ametros, Porter worked in investment banking, private equity and corporate development.

Porter earned a B.A. in Economics from Columbia University, as well as an MBA from the Wharton School and an M.A. from the Lauder Institute at the University of Pennsylvania. Porter is fluent in Spanish and Portuguese and resides in Boston with his wife, Ruth, and son, Camilo.

Filed Under: Professional Administration

Responsibilities of a Workers’ Comp Claims Investigation Leader

April 16, 2019 by Michael B. Stack

Central to successful leadership is attention to detail, solid work ethic and commitment.

Members of the claim management team and fully-engaged employers must exhibit these same traits when it comes to workers’ compensation claims. All claims must be investigated promptly – by the book with no corners cut. This process also includes the development of best practices to manage risk and control workers’ compensation program costs.

Responsibilities of a Claims Leader

There are several goals a good leader must undertake when developing a program. This is something that can be done inside an insurance carrier or company. Items to consider should include:

Develop a program to sniff out fraud. This program includes being proactive to prevent it from taking place and detecting it early on to mitigate program costs;

Update upper management within the organization on issues concerning the overall workers’ compensation program. This position should be able to effectuate and promote change;

Understand how to conduct an effective investigation. This is especially important in more complex claims or those which involved special or unique circumstances; and

Coordinate all efforts between defense counsel and the clients. This should include all interested stakeholders to promote an effective program.

Special Investigation Unit: Dealing with the Tough Claims

Not all workers’ compensation claims are the same. Some claims are more difficult than others. This can include instances where the employee sustains a severe injury, the circumstances surrounding the claim are suspect, but difficult to prove it did not occur or fraud. Proactive claim management teams and employers can address these barriers by developing a “special investigation unit.”

Teamwork is key when working on special claims. It all starts with a dedicated leader who knows how to peel back the layers and get to the bottom of things. Important characteristics of this leader should include:

Someone with law enforcement or military background. These are people who faced difficult challenges in the past and are resourceful;

A person who has a reputation for being fair and honest. Remember, all injured employees need to be treated with dignity and respect. Integrity is paramount;

Knowledge of the law and other applicable tools to complete the goal. An attorney can be considered for this role, but not necessarily required; and

A leader who can effectuate change within an organization.

Leading from the Front – Taking the Lead

The leader of a special investigations unit needs a strong supporting crew. This can include assistance from the following departments:

Human Resources: This area brings an understanding of other applicable rules and regulations together to assist in claim investigation and help an organization avoid countless pitfalls;

Legal Department: An attorney can advise the unit on legal issues and provide advisory opinions, guidance and assist in the development of a legal strategy;

Medical: Having an on-call nurse or doctor who can assist in complex issues such as utilization review of medication or other procedures will drive down costs. They can also assist in injury response; and

Management: It is important to include a representative from senior management. This person can help clarify the mission of an organization and desired results.

Conclusions

Workers’ compensation claims present challenges that call for special measures. To be successful, proactive employers and insurance carriers can develop special units to tackle these matters head-on. This includes engagement from a variety of areas within an organization to resolve claims and reduce workers’ compensation program costs.

Contact: mstack@reduceyourworkerscomp.com.

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

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

Filed Under: Fight Workers Comp Fraud & Abuse

Living Values, Drug Trend Simulcast, MSA Metrics, and More Top WC News Tidbits

April 15, 2019 by Senior Editor

Living Our Values — The President’s Award

Our claims professionals have critical interactions with clients, injured workers, insureds and business partners on a daily basis. Whether through an email, phone call or in person, every one of these conversations is an opportunity to restore the lives of those affected by losses. Since adjusters and other employees can often be the unsung heroes of the industry, leaders in claims organizations must make a special effort to highlight the contributions and successes, both large and small, of each employee.

Industry First: Drug Trend Report Simulcast: Thursday 4/18 @ 3:00 pm EST

The 2018 myMatrixx Drug Trend Report combines both legacy Express Scripts data and myMatrixx data providing a more comprehensive view of the industry than ever before. In this year’s report our readers will be able to see which drug categories are on the increase as opioid utilization declines. Our industry experts will guide you through the report and answer questions about, “What’s Next?” in the future of Workers’ Compensation.

Tower MSA Partners Presents A Premier Webinar: Leveraging Metrics And Msa Partner Relationship To Settle Claims

On April 24, Tower MSA Partners CEO Rita Wilson and Chief Compliance Officer Dan Anders will host a lively hour-long webinar that explains how to measure the performance of an MSA program and identifies the metrics needed. They also discuss ways to strengthen the payer/provider relationship in order to produce lower allocations on CMS-approved MSAs and quicker claims closures. Discussion points include:

How to measure your MSA program performance – what metrics should you use?
MSA drafting and review factors that impact MSA performance
Implement simple strategies to effectively work with your MSA partner and settle claims
Make your MSA provider part of your settlement team

What You Can Do to Prevent Atherosclerosis

Your good health has an enemy — atherosclerosis. Atherosclerosis is common. And its effects can be very serious. This condition can lead to strokes, heart attacks, and death. But, you can take steps to protect yourself from this disease.

What is atherosclerosis? The inside walls of healthy arteries are smooth and clean. This makes it easy to transport the blood your body needs. But arteries can become clogged. Fatty substances like cholesterol can stick to artery walls. These deposits are called plaque. Plaque can eventually slow or block the flow of blood. This blockage is atherosclerosis.

How to Adjust Your Workspace to Reduce the Risk of Injury

Small inexpensive adjustments you can make to your workspace to increase blood flow and reduce the risk of injury.

Contact: mstack@reduceyourworkerscomp.com.

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

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

Filed Under: Workers Comp News

Why Work Comp Claims Become Old Dog Claims

April 11, 2019 by Michael B. Stack

Every self-insured employer who has been managing their own workers’ compensation claims program for 3 years or more have “old dog” claims, or for the politically correct folks, legacy claims. These claims include the injured employees who take longer than normal to reach the level of maximum medical improvement (MMI), the injured employees who have reached MMI but need on-going medical maintenance medical care, and the employees who are permanently totally disabled.

Claims Can Stay Open For Many Reasons

If you ask the third party administrator (TPA) adjuster why any particular claim is still open, the adjuster will recite the employee’s medical condition and possibly the industrial commission ruling on the particular claim. While the medical condition and/or the industrial commission ruling are factors in why the claim is still open, there are often many other factors and reasons that the adjuster does not recite (and frequently does not recognize). Some of the reasons that a work comp claim becomes an old dog claim include:

Inadequate initial investigation into the nature and extent of the injury
Inadequate claims training of the work comp adjusters
Inadequate medical management throughout the claim
A change of adjusters during the life of the claim resulting in a loss of continuity in the claim handling
The original adjuster, prior adjuster(s) and/or the current adjuster have had inadequate training on how to deal with complicated claims
The adjuster handling the claim has too many other claims assigned, causing the adjuster to miss opportunities when they occur to settle the claim
The TPA puts too much focus on closing claims, so the adjusters give priority to the smaller, easier to resolve claims
Other priorities keeps the adjuster from focusing on the legacy old dog claim
The TPA does not have a ‘home office examiner’ reviewing and providing guidance to the adjuster on the large or older claims
The claim is still being handled by a prior TPA who no longer values your business as the prior TPA is not receiving any new assignments

Legacy “Old Dog” Claims Can Be a Financial Burden

When legacy (old dog) claims drag on, they become a financial burden to the self-insured employer. As time goes by, the claims become a bigger and bigger drain on the financial resources of the company. If nothing is done to resolve the claim, it becomes a permanent drain on the company.

To move these claims forward, while mitigating the ultimate claim cost, an in-depth review (file quality audit) of each claim is needed. While the audit can be done internally, most self-insured employers do not have the resources needed to do the audit. Plus, a fresh set of eyes reviewing the claim will often pick up points previously missed. An outside, highly-experienced, independent claims auditor can review each legacy file and craft a detailed action plan with completion dates for each specific file.

Independent Claim File Audit Can Uncover Solutions

The independent auditor’s detailed action plan for each file should provide:

A review of the reserves to determine the adequacy of the current reserves and make reserve change recommendations to the ultimate value where appropriate
If the employee is not currently working, a recommended return to work process, whether it is with your company, or vocational training to work somewhere else
An analysis of the current medical situation and what future medical steps are necessary
A review of the litigation plan if the case is currently being litigated or appears headed into litigation
Confirmation or recommendations on compliance with state filing requirements
Recommendations on whether or not to attempt an all-inclusive settlement of the claim
Recommendations on whether or not to use a structured settlement of the claim
Recommendations on possible financial offsets (subrogation, social security disability, state disability, second injury fund or subsequent injury fund, recovery from the excess carrier, etc.)

While the independent, experienced claims auditor cannot undo the damage already done due to prior claim handling mistakes, the independent audit can assist you in mitigating future financial damage from the legacy old dog claims.

Contact: mstack@reduceyourworkerscomp.com.

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

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

Filed Under: Claim Management

Five Easy Steps To Foster Loyalty And Positive Culture

April 10, 2019 by Kelly Dieppa

Blog originally appeared at https://www.crawco.com/blog/five-easy-steps-to-foster-loyalty-and-positive-culture.

Developing a positive culture and inspiring loyalty requires a delicate and sometimes complicated balance between intentional interventions and behavioral modifications. In a day and time when the word loyalty has somewhat lost its meaning, maintaining a high retention rate and creating a positive work environment is critical and complicated.

Creation of a positive working culture, and the ever-elusive loyalty, requires leaders that are sincere, heartfelt and real. The best leaders are able to effectively communicate across the generational spectrum and inspire loyalty through their approachability, their communication style and their interaction at a guttural level.

The days of simply bringing in donuts once a month to foster and maintain an attractive work culture are long gone. Employees have higher expectations of their leaders, rightly so, in a landscape filled with alternative occupational options. Creation of a compelling family environment, with the right level of promise of career advancement, recognition, stability, growth, and development is critical.

How do we do this?

Unfortunately, there is no silver bullet. There is no single action or training program you can take and then step away. These traits, while innate in some people, can take work to uncover and, in some, may never emerge. However, that doesn’t mean the effort is not without its rewards. Your organizational culture and loyalty of employees are like a garden in many ways — it requires your constant, consistent and ongoing attention and dedication to grow, evolve, produce fruits and be sustainable. Take your eye off the goal for a week or month and your crops will wither and retract.

The advice I provide to anyone wishing to create, foster and grow a culture that inspires loyalty is to do so through intentional, purposeful acts. Just as we schedule meetings, client visits, and 1x1s, schedule time to attend to your organizational garden. Acknowledgment, remembrance, recognition, building up — big words that take very little time and reap great rewards. Reaching out on a human level, remembering and acknowledging service dates, anniversary dates, a great sales closure or finalization of a project — these things matter. They matter more than we realize — to all employees. From early career to mid-career and late career, no one is immune from needing recognition and praise for a job well done. Taking time, rather MAKING time, for these interactions is pivotal in establishing a working environment where employees feel valued, impactful, necessary and loyal to the vision and brand.

There are five steps that will set you out on the road to success. While these may seem easy and simple, consistency is key – doing it once a week or a month will not cut it. Making this a part of your DNA and who you are as a person in the work environment consistently will result in team members that are loyal and a far more positive and welcoming work culture:

Make eye contact as much as possible — with everyone
Say “thank you,” verbally and in writing, for specific things
Remember personal things shared with you and refer back to them
Be present in conversations — listen far more than you talk
Follow-through and follow-up — be reliable

Connect with people on a real level, treat everyone with respect and you will, in turn, gain their respect. This takes no money and no complicated reward programs — only your purposeful and consistent time.

Author Kelly Dieppa, Broadspire, Vice President of Disability & Leave Operations. Broadspire is Crawford’s Third-Party Administrator (TPA) specializing in servicing the claims needs of corporations, brokers and insurers who wish to take greater control over the claims process, indemnity spend, data capture, and to access meaningful management information. With industry-leading claims management, case management, medical bill review, pharmacy programs, physician review services and preferred provider networks, Broadspire can have a positive impact on employee productivity as well as costs.

Filed Under: Culture