Reducing Workers Compensation Costs Archives

The RED FLAGS of Workers Comp Fraud

June 19, 2019 by Michael B. Stack Leave a Comment

A critical part of controlling workers’ compensation costs is to put into place solid investigation techniques. No matter how severe or minor a workplace injury, each case needs to be reviewed to identify any fraudulent claims and take appropriate action.

When communicating with employees, make it clear that the company will:

Immediately investigate each accident when it occurs to determine the root cause

Identify corrective measures

Watch for minor extensions of days out of work and outright fraudulent claims.

Review these Red Flags of Fraud and request an investigation if you suspect a claim is illegitimate or exaggerated.

Injured Worker Red Flags:

Injury reported late, to an attorney or to the state commission before reporting it to the employer.

Fails to attend weekly meetings.

Is uncooperative, e.g., refuses to try a transitional duty job.

Is never home when you phone, especially during regular workday hours.

Has only a postal box rather than a home address.

Misses doctor appointments.

Is known to perform seasonal activities, hobbies, or work.

Has moved out of town or out of state.

Disputes average weekly wage due to additional income.

Files for benefits in a state other than the main location.

Disputes information supplied by the employer on “First Report of Injury” notice.

Refuses to cooperate in claim investigation.

Has an unstable work history.

Has recently been terminated, demoted, or passed over for promotion.

Has a prior history of injury management or liability claims.

Makes excessive demands or is pressing for a quick settlement.

Carries little or no health insurance.

Medical Flags:

Medical reports are repetitive, indicating continuing, constant pain with conservative medical treatment

The word “disproportionate” is used in medical reports

The doctor mentions there is “facial grimacing”

Positive “Waddell Tests” (test for low back pain) are mentioned

Workplace Flags:

Employer experiencing labor difficulties (i.e., layoffs, strikes, walkouts).

Tips from fellow workers, friends, or relatives.

The insurance company wants to settle the claim for a considerable amount of money.

“Things” just don’t ADD UP! Trust your gut, and if something seems off, be sure to check it out.

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 the founder & lead trainer of Amaxx Workers’ Comp Training Center.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://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.

Get the Most from the 33rd Annual SEAK, Inc. National Workers’ Compensation and Occupational Medicine Conference

February 14, 2013 by Michael B. Stack Leave a Comment

SEAK, Inc. National Workers' Compensation and Occupational Medicine Conference

The 2013 National Workers' Compensation and Occupational Medicine Conference and Expo is

July 16-18 in Hyannis, MA

It promises to again be monumental for our industry.

The 33^rd annual conference promises to bring together the nation’s leading workers’ compensation professionals, occupational physicians, occupational nurses, and attorneys to discuss cutting edge issues. Frank discussions and lively question and answer sessions will complement each presentation.

Among the highlights will be:

Exhibits and Networking Opportunities.

Sessions on cutting-edge topics such as

Worksite Wellness: Creating Health and Wellness Programs for Your Worksite where Dr. Raymond Fabius, MD will explain the relationship between health and productivity and how you can measure this in your company

Critical Mass in Reducing Workers’ Compensation Costs-Occupational Health Care Professionals where Attorney Douglas Jones will go beyond the traditional defenses and provide advanced strategies to demonstrate the critical role occupational health professionals play.

Psychological Risk Factors for Delayed Recovery: Assessment and Intervention where Dr. Michael Sullivan, PhD will discuss modifiable risk factors including catastrophic thinking, fear of pain, disability beliefs, and perceived injustice.

Psychological and Behavioral Factors in Chronic Pain Syndromes: What Occupational Health Professionals Can Do. Dr. Leon Ensalada, MD will explain how to devise and execute a strategy to mitigate the adverse effects of psychological and behavioral factors in chronic pain syndromes. He will discuss the factors that drive the syndromes and will differentiate between appropriate and inappropriate illness behavior.

The Aging Worker: Proactive Cost-Effective Ergonomics. Ronald Porter, PT, CEAS III will present simple cost-effective solutions to reduce or control risk factors for aging workers. He will explain the “persistent” injury, aging workforce, and prevention issues, power zone, and workplace athlete programs.

Fighting Workers’ Compensation Fraud: The Role Workers’ Compensation and Occupational Health Professionals Can Play. Attorney Stephen Fannon will discuss the many types of workers’ compensation fraud. He will explain the multiple types of red flags at work during medical treatment and how to use social media, investigation, and surveillance to root out and prevent fraud.

A Novel and Comprehensive Approach to Delayed Recovery and Disability Prevention. Dr. Jonathan Torres, MD, MPH will discuss an innovative and effective approach to delayed recovery delivered within the primary occupational health medical office. This program includes disability prevention initiatives within the routine office visits and offers a comprehensive assessment of possible factors causing or contributing to delayed recovery at the appropriate timeframe.

Motivating Employees to Embrace Optimal Health

Dr. Nicholas R.S. Hall, Ph.D. will explain why despite knowing what to do, employees seldom take the steps necessary to improve their health. He will present solutions to help you motivate your employees to change their image-shaping beliefs and embrace optimal health.

Defending Chronic and Pre-Existing Conditions: What Works

Attorney Warren K. Sponsler will discuss how good investigation and record keeping can help identify chronic and pre-existing conditions of the claimant. He will discuss symptoms vs. disease, arthritic and other degenerative conditions, the worsening of these conditions, and the mechanism of injury. He will offer practical suggestions for the evaluation settlements trial of claims involving chronic or pre-existing conditions of the claimant.

Abnormal Findings in Normal People: Significance for Claimants and Their Claims

Dr. Russell L. Travis, MD, FACS, FAADEP will discuss the thoracic and lumbar disc; normal and abnormal findings, including: disc herniations, annular tears, disc bulges, and degenerative disc disease. He will review the research of such findings in asymptomatic people. Dr. Travis will discuss the impact of the aging process in normal people and how these are frequently misinterpreted as abnormal findings and explain why many such findings are of little or no medical significance.

Psychological Testing: Objective Analysis of Subjective Claims of Pain, Brain Injury, or Mental Illness

Dr. Robert J. Barth, Ph.D. will explain how psychological testing provides a mechanism for objectively evaluating claims that are otherwise completely subjective (e.g. pain claims, claims of brain injury, and claims of mental illness). He will discuss the use of testing to: enhance diagnostic accuracy, objectively address whether a case is consistent with a legitimate presentation, and contribute objectivity to determinations of work-relatedness.

Why Attend this Conference

The workers’ compensation industry is always evolving – new players, new laws and new equipment. Everyone new to this industry should attend the conference and learn new techniques, meet new vendors, and discover the latest service enhancements. Even old hats need to learn about the cutting-edge issues and practical considerations to decrease their workers’ compensation costs.

A conference of this scale can help you expand your professional network while increasing your knowledge and gaining new solutions directly related to:

– Workers’ compensation

– Disability management

– Return-to-work programs.

Tips to Get the Most Out of the National Workers' Compensation and Occupational Medicine Conference:

Read the brochures when you return home to learn about service providers.

Pass out your business card and network, network, network. Meeting knowledgeable people gives you a resource when you encounter a problem. The conference offers ample opportunities for networking including a networking Reception and Social as well as numerous meals and refreshment breaks.

Learn what you don’t know. Being exposed to new ideas presents an opportunity to learn things you don’t even know you are missing!

Chat with people who do the same things that you do and see where you differ.

Ask about key cost drivers. Attendees come from organizations of varying industries. Find people who work in workers’ compensation departments you know next to nothing about and ask them whether they are satisfied with their workers’ comp vendors. Ask them what drives their costs.

Roam through the exhibit hall speaking to vendors and learning about the types of services that are available to reduce workers’ comp costs.THIS will be the best education you will ever get!

Wear comfortable attire. Bring comfortable shoes. The first day, people are a bit more dressed up than the following days. The last day is more casual because people are traveling back home. Definitely dress professionally because some of the people you meet with become lifelong contacts, so making a good impression is important, but you can be comfortable, too. For an ounce of prevention, bring moleskin to protect the areas of your feet most likely to get blisters.

Attend both the exhibit hall and the educational sessions.

Start early, leave late, and remember … although your feet may hurt, this is a once-a-year event!

Before the exhibit hall opens, join the group breakfast to network with new friends. You will find people are very friendly and helpful.

Author Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: mstack@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 about workers comp issues.

Filed Under: Medical Cost Containment, Seminars and Courses Tagged With: Federal Workers Compensation, Occupational Medicine, Reducing Workers Compensation Costs, SEAK Conference, workers comp, Workers Compensation

Employee Hand Crushed On Conveyor Belt Costs Employer $57,750

January 24, 2013 by Michael B. Stack Leave a Comment

Fined $47,250, Plus $10,500 in Reparation

An Oamaru, New Zealand meat processor has been fined $47,250 and ordered to pay $10,500 in reparation after an employee’s hand was crushed between unguarded fixed rollers on a conveyor belt, according to the Ministry of Business, Innovation and Employment.

The Oamaru District Court heard recently that in January this year at the Lean Meats Oamaru Limited premises on Redcastle Road, Oamaru the worker was packing cuts of meat after they had been vacuum packed. As she tried to mop up excess water from the conveyor her hand became trapped in the fixed rollers leading to crush injuries needing hospital treatment.

Simple Safety Steps Would Have Avoided Injury

Acting MBIE Labor Group General Manager Southern, Francois Barton, noted “Unguarded machinery is extremely dangerous and an accident waiting to happen. There were several simple steps available to the employer that would have safeguarded against this sort of incident happening that were not taken – such as replacing fixed rollers with pop-out ones or putting in tunnel guards.

“This case illustrates the importance of effective safety auditing that identifies all possible trapping points and either removes them completely or guards them effectively.

MBIE Labor has a three-year project under way with the aim of reducing the number of workplace accidents involving unguarded and inadequately guarded machinery,” Barton commented.

Conveyors are a well-known hazard across a range of industries and have been involved in incidents and accidents for many years, according to officials.

Contact: mstack@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 about workers comp issues.

Filed Under: Workers Comp News Tagged With: Employee Safety, Health and Safety, lower your workers comp, reduce your workers comp, Reducing Workers Compensation Costs, Safety and Loss Control, Safety Issues, workers comp, Workers Compensation

Washington State Man May Get Decade Behind Bars

January 16, 2013 by Michael B. Stack Leave a Comment

Washington State Man May Get Decade Behind Bars

A Washington State man certainly wasn’t the apple of a superior court’s eyes recently, charged with first degree felony theft for illegally collecting workers compensation benefits.

As the Department of Labor & Industries (L&I) points out, Doyle Ronald Wheeler, 36, of Spokane, reportedly obtained benefits during the period of 2008 to 2011 on a workplace-injury claim for a neck and back injury.

Wheeler’s benefits ceased once an investigation deemed he was behind the operation of his own business -The Pensmith, Ammo Head Design and Ammo Head Hydrographics – this while collecting workers comp.

Claimant Said He Was Unable to Work

According to Wheeler, he was unable to work once a slow-moving pickup truck backed into him at his workplace, Toby’s Body and Fender.

According to a videotape of the accident, Wheeler displayed no signs of injury after contact with the vehicle. Videotapes taken following the accident by L&I investigators demonstrate Wheeler coming to his physical therapy appointments, where his shoulder seems to sag and his movements stiffen as he nears the office. Not long after his physical therapy appointments, Wheeler goes back to moving around with ease. Wheeler was arraigned recently in Spokane County Superior Court.

Jail, Fine Could Be Severe

As he awaits his fate, Wheeler could receive a maximum sentence of up to a decade in prison and a fine of up to $20,000.

The court could also order Wheeler to repay the more than $113,000 in benefits gathered via fraud. Given both the potential jail time and fine, Wheeler could really see something to cause him pain.

Contact: mstack@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 about workers comp issues.

Filed Under: Workers Comp News Tagged With: Fraud & Abuse, Lowering Work Comp Costs, Reduce/Lower WC Costs, Reducing Workers Compensation Costs, WC Fraud, workers comp, Workers Comp Fraud, Workers Compensation

Developing Cost Containment Strategies for Satisfied Employees

January 15, 2013 by Michael B. Stack Leave a Comment

When Returning Employee to Work Remember: It’s All Attitude

There is more than one way to return an injured employee to work. The difficult part is matching the right return-to-work strategy to the particular worker. Considering the personality and attitude of the worker is as important as considering the specific injury when implementing a return-to-work solution.

Just as there are many kinds of successful return-to-work programs, there also are a full range of employee attitudes accompanying each case.

The Employee Attitude Axis

Employers must individualize their return-to-work approach to meet the demands of the specific employee’s personality because the most important factor in returning the employee to work is the attitude of the employee. A successful method of training employers to respond properly to varied employee attitudes to ensure efficient and reasonable work returns is the Employee Attitude Axis.

The Employee Attitude Axis separates workers into four quadrants: active-satisfied; active-dissatisfied; passive-satisfied; and passive-dissatisfied. Most employees fit neatly into one of these quadrants and require and respond to different return-to-work strategies.

Handling Satisfied Employees

Satisfied employees are ones who have maintained a positive relationship with the company throughout their employment. The employee trusts that the employer will continue to look out for the employee post-injury and wants the employee back.

The active-satisfied employee needs no coercion or prodding to return to work. This worker is one who has been with the company 20 years and hasn’t missed a day. In this case, a simple get-well card may convince the worker that the company truly cares about the employee’s well-being.

The passive-satisfied employee while usually happy at work is a little more complacent. This employee needs some gentle intervention to ensure a timely return to work. Phone calls, weekly meetings and early intervention make sure the worker maintains a positive attitude about the employer and returns to work when ready.

Handling Dissatisfied Employees

Dissatisfied employees typically have some sort of misgivings about the employer prior to the injury. They may use miscommunication with the worker’s comp process to reinforce their negative beliefs about the company.

The active-dissatisfied employee may be quick to hire an attorney to answer the questions about the worker’s comp claim that the employer could have easily handled.

The passive-dissatisfied employee may be unhappy with the employer but express it in more subtle ways such as by not returning phone calls, completing paperwork, signing releases or withholding information.

The best way an employer can turn a dissatisfied injured worker into a satisfied returning- to-work employee is to maintain contact with the employee after the accident. Not only is contact immediately after the accident needed, contact with the employee following each medical visit will work wonders in maintaining rapport and trust with the employee. By maintaining an active interest in the claim and the employee’s wellbeing, the claim will move forward in a positive manner.

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

Filed Under: Implementation and Rolling Out Your Program, Return to Work and Transitional Duty Tagged With: lower your workers comp, reduce your workers comp, Reduce/Lower WC Costs, Reducing Workers Compensation Costs, workers comp, Workers Comp Cost Containment, Workers Compensation

How to Measure Your Return to Work Program Success

January 9, 2013 by Rebecca Shafer, J.D. Leave a Comment

For every day an injured employee is out of work, the cost of the workers’ compensation claim increases. Therefore, it is of critical importance to actively manage your claims using techniques designed to return injured workers to active work status as quickly as medically possible. This is true whether they return to active or modified duty. At the same time, you must be able to track and know exactly how well the return to work process is proceeding.

Return to Work (RTW) Ratio

How do you calculate whether injured employees are returning to work within an appropriate time frame or if they are out on comp for weeks at a time? The Return to Work Ratio (RTW) measures the effectiveness of your transitional duty program. The ratio calculates how long it takes employees suffering a lost time injury to return to work in either a transitional duty assignment or full duty. The RTW Ratio calculates total lost days and total claims to show the percentage of employees that have returned to work within the first few days after the injury. The RTW Ratio helps you categorize lost work days to ensure that employees aren’t off work too long.

The RTW Ratio accurately assesses how well your company manages the return to work process. The RTW Ratio allows you to calculate lost days quickly and see at a glance how well you are doing. The graphic visualization is helpful and motivational. Add new injuries to constantly update the ratio calculation to see how well you meet the goal of having 95% of employees returning to work within the first four days after an injury. Then you can take appropriate action as needed to improve your company’s rate of returning workers. You should also tell your broker when your RTW Ratio improves, as insurance carriers will want to know that you have made operational changes that will result in reduced workers’ comp losses.

For more about bringing employees back to work sooner see: http://reduceyourworkerscomp.com//employees-back-to-work-sooner.php

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 author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact:RShafer@ReduceYourWorkersComp.com.

Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: mstack@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 about workers comp issues.

Filed Under: Return to Work and Transitional Duty Tagged With: lower your workers comp, Lowering Work Comp Costs, reduce workers comp, reduce your workers comp, Reduce/Lower WC Costs, Reducing Workers Compensation Costs, Return to Work & Transitional Duty, Return to Work and Transitional Duty, Return to Work Programs, Return to Work Ratio, Return to Work-RTW, workers comp, Workers Compensation

Employer Silence is Root of Many Workers Comp Problems

January 4, 2013 by Attorney Theodore Ronca Leave a Comment

46% of Workers Incorrectly Think Claims Being Contested

Workers Compensation Research Institute (WCRI) has published a most welcome study into the reasons that workers get compensation lawyers. The most disturbing reason, cited by 46% of workers surveyed, was that they thought their claims had been contested, even though the paperwork had just begun and no decisions had yet been made.

People working with claims, any kind of claims, understand that there is an initial lag, ranging from days to months, before an administrative agency becomes active on a claim. An insurance company usually, but certainly not always, is quicker to respond, but “quick” might mean weeks, and a family suddenly without a weekly check and little or no savings will be on the verge of panic.

Lawyer Should Not Be One Communicating with Worker

If they consult a lawyer, they will quickly learn that the resolution is inevitably going to take time. But why must they hear that from a lawyer? Every risk manager or human resources chief could tell them that a lot faster (and cheaper!)

But there is something else your personnel can tell a worker who has just filed a comp claim – how to receive information and, if necessary, some form of income continuation. (A lawyer could tell them the same, but many don’t and it isn’t nearly as comforting as hearing it from the employer.)

The study mentioned another fact. When an employer is small enough to know everyone in the workplace (say 200 employees or so) comp problems grow more slowly than when the employee has no one in charge who knows them. (Julius Caesar was famed as a military leader because he could address all centurions in his army by their names- over 500. If he could do it, with a bit of effort you can do it with 200.)

It is Your Responsibility

Finally, there is the old problem of “falling between two stools”, meaning that there is always help at hand, but everyone assumes that someone else will provide it. Rather than rely on a disastrous assumption, just reach out and communicate. An employer that stays in continuous touch during the month or two following a reported injury will be the first to learn of a problem, and the first to propose a solution. And somewhere, a lawyer won’t get that first phone call.

If a worker (and the spouse!) is aware that the employer will nudge a silent bureaucracy with a call, the comp problems will start small and grow smaller.

Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100. medsearch7@optonline.net

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

Filed Under: Communication with Employees Tagged With: Communication, Employee Communications, Lowering Work Comp Costs, reduce your workers comp, Reduce/Lower WC Costs, Reducing Workers Compensation Costs, workers comp, Workers Comp Communication, Workers Compensation, Workers Compensation and Communication

The Role of the Risk Manager in Workers Compensation Cost Containment

January 3, 2013 by Rebecca Shafer, J.D. Leave a Comment

What is the Role of a Risk Manager?

A risk manager is responsible for a broad array of duties as the company sets up a workers’ compensation management program. To reduce costs, the risk manager should closely monitor the implementation of the program. Naturally, the responsibilities depend on the size of the department and amount of assistance that is provided.

Tips on What a Risk Manager Should Do:

Determine the type of claims administrationarrangement. The risk manager needs to determine whether the type of claims administration you have is the right fit for your company and not take a one-size-fits all approach. The risk manager should perform an individualized assessment of your company’s strengths and needs to determine what arrangement works best for you.

Ensure the adjuster-to-claim ratio is appropriatefor adjusters responding to your claims to get your workers back to productive employment faster. The risk manager needs to determine whether the adjuster has too many claims to process yours fast enough to keep your costs down.

Consider whether your claims volume requires dedicated staff. The risk manager should assess whether the amount of workers’ compensation claims the company has requires one or more employees whose primary job function is to handle the workers’ compensation claims process.

Follow claims administration’s best practicesto better comprehend the adjuster’s role. The risk manager should be up-to-date on the insurance industry’s standards and recommendations in claims handling to assess whether your procedures need to be updated.

Make sure claims handling personnel are trained in injury managementconcepts so they can grasp the issues affecting your claims. The risk manager should make sure that personnel are familiar with the expected claims process, forms, medical terms, action plan, and potential issues. As your first-line defense, you want your claims handling personnel informed enough to spot issues that may arise.

Visit an adjuster claims handling locationto see how your adjuster handles your files and view their claims operations first hand. There is no substitute for knowing exactly how your claim is being handled in the physical location where it is being processed.

Attend associate seminars and meet with other industriesto observe how other organizations address workers’ compensation issues in today’s labor market.

Maintain benchmarks for your professionshowing how potential savings generated by an effective injury management program far outweigh the initial costs of staffing.

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

Filed Under: Risk Management Tagged With: reduce workers comp, reduce your workers comp, Reduce/Lower WC Costs, Reducing Workers Compensation Costs, Risk Management, Risk Managers Role, workers comp, Workers Comp and the Risk Manager, Workers Compensation

Winter Workers Comp Surveillance Tips

January 2, 2013 by Michael B. Stack 1 Comment

Now that winter has arrived with a bang, it is always a ripe time for surveillance on those questionable claims. The hustle and bustle of the Holiday season is over, and people settle in to their normal winter routines, waiting out the cold weather for the arrival of spring.

For those problematic claims out there, this time of year is always a busy one for surveillance companies. Adjusters cannot wait to try and get some film of their injured claimant potentially violating their medical restrictions by shoveling out their driveways or partaking in a winter recreational sport.

Here are some tips to keep in mind for a successful hunt of trying to get that elusive film that can direct a claim from compensable to suspended:

Strike Not Only After the Big Storm, but During It

If you are like me and do not own a snowblower, the best way to make shoveling your driveway easier is to do it a few times while the storm is going on. This makes it a bit easier to heave all the snow off of your driveway. True, the snow you are pushing may not weigh 500lb, but that is the point. Anyone with a lingering back injury is going to have a hard time pushing a shovel, and I think any doctor will lighten the medical restrictions if they see their patient spending a lot of time outdoors with a shovel. When caught, most claimants will try to say they were only pushing the snow, and not lifting the shovel. However, any activity is showing that they are active, and it can be a way to get that person back to light duty work if they are currently on a no-work status.

Use Snow Blowing to Your Advantage

If your claimant does indeed have a snowblower, this can mean that they are not actually lifting anything. But they are on their feet, for long periods of time, pushing and pulling the blower around and being active in general. This may not mean that they are 100%, but they are certainly capable of doing light duty or sedentary work. Even if they claim that the snow blower is self-propelled, the claimant is still walking behind it, bending down, and doing this for a period of time. I would find it hard to believe that any doctor would keep this person from doing sedentary work if confronted with the video evidence. Use your tape to get them back to work, and doing something beneficial for your workplace.

Watch For Potential Aggravation of Injury

Snow and ice are slick, and people slip and slide while shoveling and snow blowing. They are also bent over while using the snowblower which could lead to an aggravation of your current back injury claim. I am not injured, but I am sore after shoveling. If I were to already have had a lingering back injury, this is only going to make it worse. The same could be said if you are watching the video and your claimant slips and tweaks their back, or even worse they fall hard, probably making their current injury worse. The best way to handle this is to wait to show the doctor the tape until after their next appointment. In the medical notes, the claimant may show worsening signs of injury, and they probably will not tell the doctor that their symptoms worsened due to falling on their rear end while shoveling. At this time you have good evidence to show that their injury wasmade worse by slipping and/or falling down. Make sure you have the doctor be objective. By showing the doctor the film, you have concrete evidence when paired with the worsened medical report that their injury is now exacerbated by their outside activity. This should allow you to be able to be aggressive in trying to end your comp claim and move it to a personal medical condition.

Know if they Have any Outdoor Hobbies.

Since you know these people for a period of months or years, you may already know that they love to ice fish, or to snowmobile. Snowmobiling is very arduous, since riding on the machine can lead to jarring of the back, resulting in a worsening of the injury. Even if they do not claim to be medically worsened, if you can show them active on a snowmobile, then it would seem that they are healthy enough to return to work. The best evidence you could get is if the snowmobile gets stuck and they have to get off and lift the back of the machine to get it working again. These machines weigh hundreds of pounds, and if you can do that, you should be good enough to be returning to work.

Ice fishing is not as arduous, in fact it is pretty lazy, but it can still show a person hauling their gear out to their fishing shack and sitting for long periods of time. You want to show the doctor that this person is more active than they are leading on. Once you can show that, you have some great evidence to show that this person is healthy and ready for a return to work in some capacity.

If You Strike Out, Keep Trying

Getting some great surveillance film is luck of the draw. Sometimes there will be times that you send your vendor out and they return with nothing. That is OK, you won’t strike gold every time. But be persistent. Watch the weather reports, be aware of local fishing and skiing competitions, and send your vendor out again. If indeed you cannot gather any evidence then that is not necessarily a bad thing. This means your claimant is avoiding any activity that will make their pain worse or aggravate their injury. My friend calls surveillance “the art of verification.”

Summary

There are a lot of people out there that love the snow and the winter weather. I know people that have fishing shacks that are like a mini house, complete with TV and propane heaters. Some people snowmobile for miles in the bitter cold, and they actually enjoy doing it. This doesn’t mean that everyone out there is up to something bad, but it is a possibility. So take my pal’s advice, and verify that your claimant is doing exactly what they are supposed to be doing–which is laying low, resting, and giving their injury time to heal before returning to work.

Contact: mstack@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 about workers comp issues.

Filed Under: Fight Workers Comp Fraud & Abuse Tagged With: Lowering Work Comp Costs, Reduce/Lower WC Costs, Reducing Workers Compensation Costs, Surveillance, workers comp, Workers Compensation, Workers Compensation and Surveillance, Workplace Surviellance

5 More Workers Comp Cost Reduction Techniques

December 28, 2012 by Michael B. Stack Leave a Comment

Reducing your workers comp costs is a not just a one day fix. If done properly, managing your workers compensation program is a gift that will keep on giving. In the spirit of the season, here are 5 additional techniques to help you save in 2013.

1. Manage Vendor Relationships

There is nothing wrong with having a good vendor that has provided great service over the course of the past number of years. But competition is always good for keeping that vendor on their toes. So go ahead and shop around a bit, and see what other companies are out there. You may find a new vendor that can provide better service for a cheaper price. Nothing is written in stone, you can always switch back if the service the new vendor provides is not all that you dreamed it would be.

2. Measure Results in Order to Review Progress

If you have a program in place for light duty work and for getting employees back to work in general post injury, it really doesn’t do any good if you are not tracking the results, and seeing if there are ways you can improve the program. Start a log, and track your program’s results. Bring in some outside help if you have to in order to brainstorm new ideas on cutting down on wage loss exposure. Having a new set of eyes looking at your program may lead to some new ideas that you haven’t thought of.

3. Shop Some New Carriers to See if you can Decrease Your Premium

There are a lot of options out there for insurance coverage. But if you are not out in the marketplace shopping around, you don’t know what is out there. Deductible differences, state-based assigned risk pools, or group self-insurance may be a potential option for coverage, depending on the size of your business. You can look at several carriers, reviewing their staff, locations, claim management services, closing ratios, service expectations, and the list goes on to find a perfect fit for your exposure.

4. Get Involved in the Overall Comp Process

Employers play a key role in developing or updating workers compensation laws in the various states. All states are different, and some states have been very active lately in updating their dated comp statutes. States legislature boards will listen if employers come together and state their problems. The squeaky wheel will eventually get the grease, even though at times this will seem like a process that takes forever. If everyone chooses to let someone else do it, then nothing will change.

5. Solicit Feedback From Your Employees on Workfloor Issues

One of the most important assets is your staff. These are the guys and gals that work every day on your floor, doing the job tasks day in and day out, for months or years at a time. Since they are spending their time working, it’s a good bet that they have some ideas that could make job tasks easier, decreasing risk and therefore decreasing injuries and the associated costs. So hold a meeting and see what your employees have to say. You may stumble upon a fantastic idea that could revolutionize the way you do business.

The best way to implement major change is through a series of small steps. Bite off what you can chew and do not be afraid to ask for help.

Happy Holidays!

Contact: mstack@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 about workers comp issues.

Filed Under: WC 101 Tagged With: Reduce/Lower WC Costs, Reducing Workers Compensation Costs, workers comp, Workers Comp Cost Containment, Workers Compensation, Workers Compensation Cost Containment