It is Deer Hunting Season, Be Aware of a Spike in Work Comp Claims

Deer Season Can Equal Spike in Work Comp Claims

 
Fall has arrived.  Time is say goodbye to days at the beach and trade in your golf clubs for shotguns or bows and arrows.  In the early Fall, whitetail deer season is a tradition among many families.  These hunters dress up in their camouflage fatigues and paint their faces in order to try and bag their trophy buck.   It is a time to become one with nature and to spend time with family and friends at the deer cabin or the family cottage.
 
What does this mean for employers?  The answer is simple: a spike in work comp claims.  Although I have not seen many formal statistical studies, I know from years of experience that this time of year creates spikes in lost work production time due to worker absences. I know of many people, hurt or not, that would drag themselves out to their deer blinds no matter what type of pain they are experiencing.  Many people hold deer season in very high regard due to the tradition of families spending time together away from home roughing it in rural areas around the country.  So what can you do to protect yourself from questionable comp claims around this time of year?
 
 
 
Do a Thorough Investigation
 
Be it this time of year or not, the best defense you can have in any comp claim is a thorough investigation.  Some workers may plot to have a “work injury” around this time of year so they can get the allotted time off to go hunting.  It may start off simply enough in the form of casual conversation around the water cooler talking about an injury that may or may not have occurred. Bill may say to you “Boy my back sure is sore today, I think I may have overdid it the other day unloading inventory off the truck.”  You ask them if they are ok and if they need treatment.  Oftentimes they will say they do not, and they do not want to file a claim or anything, since this “injury” should get better on its own. But they will let you know if they need treatment or need to file an actual comp claim for the “injury.”   
 
Then a month later when deer season comes around, Bill heads up to your office and says he has been receiving treatment and his doctor says he needs to take some time off of work. In addition, he should file a comp claim so his bills can be paid.  Be this a work injury or not, you still need to complete your investigation by sitting Bill down and asking him the normal questions about the injury, getting his medical information from his doctor, and asking about witnesses and other pertinent information.  Be sure to follow up and be as thorough as possible.  Just because Bill said he was injured at work a month ago doesn’t make that entirely true.
 
 
 
Gather the Facts
 
Be honest when Bill comes to your office asking you if you remember him mentioning an injury to you a month ago.  Sometimes employers are afraid to say no, fearing that they could get in trouble for not documenting something.  Chances are you may not remember, and that is OK.  But if you want to be more proactive, when an employee comes to you and mentions an injury, no matter how insignificant it may be or however casual the conversation, you should always jot a note down and put it in his personnel file for future reference.  You do not have to do a full blown investigation at that time, but it is a good idea to get some general details and get some potential witness names, then go talk to those witnesses and see if Bill’s story checks out.  If you have that feeling that something isn’t right, file the claim and send him to your occupational clinic and have the doctor do an evaluation.  Chances are if this injury isn’t entirely legit, the doctor will release Bill from care without any work restrictions.  When this happens, it automatically derails Bill’s idea that he can bring this injury back up at a future date. 
 
 
 
Be a Proactive Listener
 
No matter what time of year, you should always be a good listener.  You spend a lot of time with your workers day after day, year after year.  You may already know the people that are avid in outdoor activities such as hunting, fishing, snowmobiling, etc.  You may know that Chuck has a cottage up north where his family goes a few times a year to hunt or vacation.  In addition, other workers may unintentionally spill the beans on their coworkers.  If you are in the lunchroom and hear a conversation between some coworkers about another worker “planning some extra time off around the holidays by saying they got hurt at work” then it is probably a good idea to make a note of that. 
 
Now this is not to say that you can deny a claim based on some hearsay you obtained one day a few months ago.  But, it may remind you that someone knew this was coming, and it certainly won’t help them try and pull the wool over the eyes of their adjuster that is handling the claim.  Little tidbits of info like that are priceless to an adjuster.  That information alone can be what it takes to get the adjuster to take an extra close look at the claim, and sometimes that is what you need in good overall aggressive claims handling.  Perhaps Bill really did get hurt, and if that is the case and all of his details check out, then fine.  But if not, and the claim is questionable, then you may have prevented financial leakage by paying for a work injury claim that was never work related to begin with.
 
 
 
Accommodate Work Restrictions
 
Nothing is better at stopping a mini-vacation from work like not being able to be off in the first place.  Your workers are not dumb.  They know by being around the work floor that anytime someone gets hurt, they are never back to work until they are fully released from their doctor.  This is ammo they can use against you down the road when it is their time to claim a work “injury.”  By being flexible and accommodating medical restrictions whenever possible, workers know that just because they may get injured it doesn’t mean that they will be off of work until the doctor releases them from care. 
 
One of the best deterrents against questionable soft tissue work injury claims is providing light duty work while they rehab from said “injury.”  Workers know that they cannot cash in easy time off of work just by claiming they are hurt, and the more examples they see of this the better.
 
 
 
Summary
 
The arrival of deer season will possibly create a spike in work comp claims around your workplace.  But by taking notes, gathering facts, being a good listener, and accommodating medical restrictions you can take a leg up on your potential workers planning an extended vacation to go bag their trophy buck.  In the end, these claims cost you money in the form of dollars spent and possible increased insurance premiums.  By following the guidelines above, you can keep these workers in check and focus on more important issues. 
 
 

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

 


WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com

VIEW SAMPLES PAGES

MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php

 

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

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

Are Idiopathic Injuries Real Workers Compensation Injuries

The recent Alabama Supreme Court case that held an idiopathic injury occurring in the workplace is not a compensable injury is another example of how the various states differ in what is and what is not workers compensation. A few states cover most idiopathic injuries in workers compensation, most states cover idiopathic injuries that meet narrow restrictions and some states deny workers compensation benefits for any idiopathic injury.
 
 
An idiopathic injury is an injury arising from an unexplained origin or cause. For the purposes of workers compensation, some states have broadened the definition of idiopathic injury to include an injury brought on by a purely personal condition. If you ask why all the fuss over the origin or cause of the injury, the answer is because of the wording of most workers compensation statutes. Most states have wording in the work comp laws qualifying when an injury is to be covered by work comp. The laws will read the injury must “arise out of and in the course of employment” Idiopathic injuries do not meet this definition as they do not “arise out of” the employment. (WCxKit)
 
 
Workers compensation statutes borrow from tort law the concept that you take an employee as you find him/her with all their bodily flaws. Simply put, if your employee already has a weak back and hurts his back while working, you are stuck with the work comp claim. With the employee who is prone to get hurt because of a bodily flaw like the weak back, the injury arises out of and in the course of the employment. This differs from the employee who has an idiopathic episode where the weak back starts hurting while at work, but the back pain has no relationship to the work.
 
 
Another example, if the employee has a heart attack (a purely personal condition) while setting at his desk working (in a non-stressful environment), it is not a work comp injury. If the heart attack employee falls out of his desk chair and hits his head on the floor, the injury to the head is still not a work comp claim in most states. However, if the employment premises increases the risk of injury or aggravates the injury, the injury will become compensable. For example, the employee has a heart attack while climbing a ladder to the top of a tower, and falls injuring other body parts. The other body parts injured in the fall will be covered in most states as the employment premises increased the risk of injury.
 
 
The first idiopathic injury case in Georgia is often used as an example of the narrow interpretation of idiopathic injuries in most states. In 1947, a Mr. Richardson worked in a department store selling men's apparel. The alteration and tailoring department of the store was on a different floor of the store, resulting in Mr. Richardson making numerous trips up and down the stairs each day. Mr. Richardson was an epileptic and had suffered epileptic attacks while working on previous occasions. There was no evidence that the epileptic condition was in anyway related to Mr. Richardson's employment. However, it was known that exertion brought on the epileptic attacks, but their was no evidence of exertion prior to the epileptic attack from the incident from which his work comp injury arose. In prior epileptic episodes, Mr. Richardson had fallen on the floor sometimes with minor injuries, sometimes with no injury. When Mr. Richardson fell during the epileptic attack in question, he struck the side of his head on the sharp corner of a table resulting in a skull fracture and a brain injury The Court ruled that the sharp corner of the table was a hazard of his workplace environment and the resulting head injuries were compensable. 
 
 
Most states that allow idiopathic injuries have follow Georgia in this regards by allowing injuries that result from idiopathic conditions (but not the idiopathic condition) to be considered workers compensation when there is a hazard connected to the employment. When employees faint, have a heart attack or stroke, or fall for no apparent reason and land on the floor without striking any object, the resulting injury from landing on the floor is not a work comp injury (in most states). However, if the employee strikes an object while falling, the injury will be covered as a work comp claim. In addition, if the employee is at an increase risk of injury when they fall, for instance from an unprotected height, or off a ladder, or down a flight of stairs, the resulting injuries are normally covered by work comp.
 
 
Another example of where an idiopathic injury can be covered is the long distance truck driver. In a Florida case, the employee was part of a truck driving team where each driver would drive the maximum of eleven hours with minimum breaks before the other truck driver took over. open-ended. The 60-year-old truck driver had a pulmonary embolism after he had been driving for about ten hours. (A pulmonary embolism is a blockage of the main artery of the lung or one branches of the artery by a blood clot that traveled through the bloodstream from the deep veins in the legs). The initial response from the work comp adjuster that this was not work related but resulting from the employee's personal medical condition. However, the treating medical provider stated the pulmonary embolism was a direct result of the extended time the employee was remained seated while driving the truck. This was a purely personal condition that was aggravated by the requirements of the job, and hence a compensable work comp claim. (WCxKit)
 
 
Idiopathic injuries and idiopathic conditions will continue to be an area of work comp law that will often be litigated, as they do not fall clearly within the definition of workers compensation. If you have an occurrence of where a person has a medical condition that results in an injury (as opposed to the activities of work resulting in an injury), your best course of action is to immediately discuss the matter with your workers compensation claims manager and/or your work comp defense attorney. The claims manager or defense attorney can provide you direction on how to proceed. The primary advice will be to clarify all the events surrounding the idiopathic injury so a correct determination of compensability can be made.
 

Author Rebecca Shafer
, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website 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. See www.LowerWC.com for more information. Contact:RShafer@ReduceYourWorkersComp.com or 860-553-6604.
 
 

 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

NCCI Publishes 2010 Workers Comp Prescription Drug Study Update

NCCI Holdings Inc. recently unveiled an updated study that shows that the volume of prescription drugs dispensed to workers compensation claimants has risen sharply—putting upward pressure on costs.
 
 
The volume of prescription drugs dispensed by physicians to workers comp (WC) claimants has risen sharply in recent years—putting upward pressure on WC costs. This updated NCCI study investigates the increase and other issues associated with WC prescription drug (Rx) costs. (WCxKit)
 
 
Key Findings
 
1.      WC costs due to physician-dispensed drugs rose dramatically in 2008.
2.      Three-fourths of WC repackaged drug costs originate from physicians
3.      Lower than expected emergence of Rx costs has prompted us to lower our projected ultimate Rx share of total medical from 19% to 18%.
4.      After two seemingly abnormal years in which price change was the dominant factor affecting per-claim WC Rx cost increases, utilization change has once again taken its historically dominant role.
5.      OXYCONTIN® has become the top prescribed (in terms of paid dollars) WC Rx. A successful patent defense, which resulted in the removal of the extended release generic version of OXYCONTIN® from the market, is likely the major contributing factor.
 
 
In addition to a new look at physician-dispensed drugs NCCI has updated prior analyses for:
 
6.      The prescription drug share of total medical costs by injury year
7.      Changes in price, utilization, and cost
8.      Prescribing patterns
9.      Drug rankings by overall cost
 
 
Prescription drugs have been a significant driver of WC medical costs for many years.
 
 
NCCI first examined WC Rx issues in 2003 and found that utilization (as opposed to price) increases were the significant force behind Rx cost increases at that time. In 2007, NCCI found that state cost differences were driven mostly by the mix of drugs prescribed (as opposed to price or number of scripts). Several drugs, such as ACTIQ® and MOBIC® have shown significant changes in market share over the course of these prior studies. (WCxKit)
 
 
For further historical details, see the previous five studies—available for download at ncci.com

The moral of the story …. make sure you have a good PBM program. Ask your TPA to do a dog and pony show about their current service so you can learn more about it.

 

Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website 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.  See www.LowerWC.com for more information. RShafer@ReduceYourWorkersComp.com 

 
WORK COMP CALCULATOR:   http://www.LowerWC.com/calculator.php
 
WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/
SUBSCRIBE: 
Workers Comp Resource Center Newsletter

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

©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Info@ReduceYourWorkersComp.com.

CALIFORNIA Are Injuries Sustained 130 Miles From Home En Route to Medical Visit Workers Comp

How Would You Decide: 

Here’s what Tom Robinson, J.D., writer for Lexis Nexis Workers Comp Law Center reports:  Is Injury Sustained During Doctor Visit 130 Miles from Home Workers Comp? 

 

Here’s What Happened
Esquivel, a correctional officer,  resided in San Diego and at the time her case arose, was being treated for work-related industrial injuries by medical providers located within eight miles of her home. For reasons unrelated to her need for that treatment, Esquivel drove about 130 miles to her mother’s home in Hesperia, in San Bernardino County. Esquivel suffered serious new injuries when she drove through a stop sign in Hesperia while en route from her mother’s home to the San Diego offices of the medical providers.  The workers’ compensation judge (WCJ) found that Esquivel’s motor vehicle accident injuries were a compensable consequence of her existing industrial injuries and awarded her temporary disability indemnity and additional medical benefits.  Upon reconsideration, the Workers’ Compensation Appeals Board (the Board) reversed the WCJ’s findings and award, finding that the accident occurred too remotely from Esquivel’s home and her destination to reasonably assign the risk of injury en route to the employer.  Esquivel appealed.

 

Here’s What The Court Decided
In Esquivel v. Workers’ Comp. Appeals Bd. (Corrections Corp. of Am.),  2009 Cal. App. LEXIS 1664 (Oct. 13, 2009), the Court of Appeal of California (Fourth Appellate Dist., Div. 1) affirmed the Board’s decision.  The essential issue, said the appellate court, was whether there is a reasonable geographic limitation on an employer’s risk of incurring liability under the Act with respect to new injuries an employee suffers while en route to or from a medical appointment for examination or treatment of an existing industrial injury.  The court held that there was such a limitation and held that the employer bears this risk while the employee is traveling a reasonable distance, within a reasonable geographic area, to or from the medical appointment. As to what constitutes a “reasonable distance,” the court also held that such determinations must be made on a case-by-case basis considering all relevant circumstances.  The court indicated that the most serious problem with providing coverage in the case of the trip to the doctor’s office was that the employer lacked the opportunity to exercise any control over the trip.  (workersxzcompxzkit)  It was one thing to saddle the employer with the risk of additional injury when the injured worker traveled a reasonable distance to the medical provider and yet quite a different matter where, as here, Esquivel was driving some 130 miles.

 

See generally  Larson’s Workers’ Compensation Law, § 10.07.

 

Tom Robinson, J.D. is the primary upkeep writer for Larson’s Workers’ Compensation Law (LexisNexis) and Larson’s Workers’ Compensation, Desk Edition (LexisNexis). He is a contributing writer for California Compensation Cases (LexisNexis) and Benefits Review Board – Longshore Reporter(LexisNexis), and is a contributing author to New York Workers’ Compensation Handbook(LexisNexis). Robinson is an authority in the area of workers’ compensation and we are happy to have him as a Guest Contributor to Workers’ Comp Kit Blog. Tom can be reached at: compwriter@gmail.com.
http://law.lexisnexis.com/practiceareas/Workers-Compensation

 

Try Our FREE WC IQ Test: http://www.workerscompkit.com/intro/
WCBooks: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php

 

 

Follow Us On Twitter: www.twitter.com/WorkersCompKit
A NEW Article:
 Return to Work in Unionized Companies

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workman’s comp issues.

©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com

 

 

Insurance Company Ordered to Pay 4.5 Million in EEOC Case

Note: Workers’ Compenstion Insurance is a type of “property and casualty” business insurance required in all states, except Texas where an employer may opt out. It is referred to as a “line” of insurance coverage and is purchased from an insurance agent or broker.

Major Insurance Company Ordered to Pay $4.5 Million in Age Bias Suit

The U.S. Equal  Employment Opportunity Commission (EEOC) announced a major settlement of an age discrimination class lawsuit against a major insurance company for $4,500,000 to be paid to approximately 90 older former employees, in addition to significant remedial relief.

“Discrimination against  older workers is counterproductive and wrong, and the EEOC has been taking a close look at ways to increase our law enforcement efforts in this area,” said EEOC Acting Chairman Stuart Ishimaru. “Corporate America must be more vigilant in guarding against job bias affecting older workers, or risk action by the EEOC. This settlement shows there is a high price to pay for discriminatory employment policies and practices that adversely impact older workers.”

In its lawsuit,  filed in October 2004 under the Age Discrimination in Employment Act (ADEA), the EEOC charged in 2000 the company adopted a hiring moratorium for a period of one year, or while severance benefits were being received, that applied to all its employee-sales agents who were part of Allstate’s reorganization from employee agents to what the company considered independent contractors.

The EEOC  alleged the policy had a disproportionate impact on the company’s employees over the age of 40 because more than 90% of the agents subjected to the hiring moratorium were 40 years of age or older. The employer denies its hiring moratorium violated the ADEA.

In 2005,  the U.S. Supreme Court held in Smith v. City of Jackson that a facially neutral policy, such as the one used by the insurance company’s hiring moratorium, which disproportionately affected those age 40 and over violated the ADEA unless the policy was based on a reasonable factor other than age.

As provided  in the Stipulated Order resolving the litigation, pending approval by U.S. District Judge E. Richard Webber in U.S. District Court for the Eastern District of Missouri (Civil Action No. 4:04CV01359 ERW), the employer will pay former employees who sought employment — or would have sought employment with the company in the absence of its policy — a total of $4.5 million to be divided among the class via a settlement fund.

The order, effective for three years, also provides for discrimination prevention training, posting of notices, reporting and monitoring, and other relief designed to educate all company managers in order to prevent future violations of the ADEA.  (workersxzcompxzkit)

In 2007,  the parties settled claims of disparate treatment which were asserted for two individuals. Those claims were settled for $250,000 and are not covered by the 2005 settlement.

In July, the Commission held a public hearing on age discrimination and barriers to the employment of older workers. Additional information about the hearing can be found on the EEOC’s Web site at http://www.eeoc.gov/abouteeoc/meetings/7-15-09/index.html

Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-786-8286.

We are accepting short articles* (300-600 words) on WC cost containment. Contact us at: Info@ReduceYourWorkersComp.com. *Non-compensable.

Reduce Your Workers Comp: www.ReduceYourWorkersComp.com/
Workers Comp Kit: www:workerscompkit.com/
Follow Us On Twitter: www.twitter.com/WorkersCompKit
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers’ comp issues.

©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com

Professional Development Resource

Learn How to Reduce Workers Comp Costs 20% to 50%"Workers Compensation Management Program: Reduce Costs 20% to 50%"
Lower your workers compensation expense by using the
guidebook from Advisen and the Workers Comp Resource Center.
Perfect for promotional distribution by brokers and agents!
Learn More

Please don't print this Website

Unnecessary printing not only means unnecessary cost of paper and inks, but also avoidable environmental impact on producing and shipping these supplies. Reducing printing can make a small but a significant impact.

Instead use the PDF download option, provided on the page you tried to print.

Powered by "Unprintable Blog" for Wordpress - www.greencp.de