Workers Compensation Cost Containment Archives

Fine For Employee Deaths Amounts To Slap On The Wrist

March 1, 2013 by Michael B. Stack Leave a Comment

As the Alberta (Canada) Federation of Labor (AFL) sees it, the recent fine given to oil company Sinopec amounts to nothing more than a slap on the wrist.

According to the AFL, the $1.5 million fine will have little or no impact on halting the company from continuing to have in place reported practices that endanger their employees.

During a recent court hearing, the Canadian subsidiary of Chinese oil corporation Sinopec was fined $1.5 million for an incident that led to the deaths of a pair of their employees their lives.

As AFL President Gil McGowan put it, “One and a half million dollars doesn’t even amount to a rounding error in the annual budget of a monstrous global corporation like Sinopec. This fine does nothing to dissuade them from playing fast and loose with the safety of their workforce.”

Imported Third World Health and Safety Standards

The story unfolded when Sinopec and a pair of other companies were charged after a 2007 container collapse resulted in the deaths of two temporary foreign workers at an oil sands project near Fort McKay, Alberta. In all, 53 charges were handed down against the companies, of which Sinopec pled guilty to three charges of failing to oversee the health and safety of its employees.

McGowan noted that “Sinopec didn’t just import workers from the third world, they also imported third-world health and safety standards. Alberta missed its chance to send a message that Chinese companies working in the oil sands need to play by Canadian rules.”

While McGowan added that it might be the largest safety fine in Alberta history, it further demonstrates that Alberta has a long history in failing to aggressively enforce its own workplace safety rules.

The two victims, Ge Genbao, 28, and Lui Hongliang, 33, were just two of the more than 130 Cantonese-speaking workers who were transported from China for the Sinopec oil sands project.

Complete Abdication of Safety Responsibility

“We shouldn’t forget the circumstances that led to the deaths of Genbao and Hongliang,” McGowan went on to say. “The company did not get the construction plans certified by an engineer. The wires weren’t strong enough to hold up against the wind. It was a complete abdication of responsibility on the part of the employer.”

China Petrochemical Corporation (Sinopec Group) is a super-large petroleum and petrochemical enterprise group established in July 1998 on the basis of the former China Petrochemical Corp.

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.

Medical and Risk Trends for 2013

February 27, 2013 by Rebecca Shafer, J.D. Leave a Comment

Each new year brings talk and speculation about what will be the “next big thing” during that year — a new medical procedure; a new change in laws; or increases in disability and reserving. Some common themes popping up on blogs and in discussion threads are about medical procedures and distracted driving hazard effecting risk management.

1. Aggressive Total/Partial Joint Replacement Surgeries

Hip and knee joint replacements are among the most commonly performed surgical procedures in the United States, according the Center for Disease Control and Prevention. Between 1996 and 2006, total hip replacements increased by one third and total knee replacements by 70%.

Part of this new trend means doctors are finally realizing that months and months of physical therapy and other treatments are not resulting in outcomes patients’ desire. Injured people want to regain as nearly as possible most of their mobility and activity levels they enjoyed prior to an injury. This is particularly true of injuries taking years to develop before the joint finally gives out.

In addition, technology has changed, implants are better, more functional, and last longer and, depending on the comorbidities of the patient, recovery times have lessened. Therefore, physicians are going directly to joint replacement surgery, rather than waste a year on therapy.

Employers need to be aware of the actual causal relationship of joint failure to the issue of a workers compensation injury, keeping in mind most joint replacements are due to degenerative changes, not necessarily an occupational injury. The decision of whether or not an employer is liable for a workers comp claim can vary by state statute, meaning be very aware of all state statutes in every state where your company operates.

Rarely will a carrier opt to pick up a case with a joint replacement recommendation, since the costs are high, and the outcomes for total success can be limited. Be prepared to argue any case where a physician leans toward joint replacement following a workplace injury. Look for possible pre-existing conditions and be sure to have an independent medical examination (IME) done by a qualified and reputable physician.

2. Increasingly Sophisticated Bionic Implants/Prosthetics

Great outcomes are rare for severe occupational injuries that include the loss of a limb since these cases are catastrophic in nature and carry a massive dollar reserve. The days of peg legs and hooks for hands are gone. Current prosthetics are capable of grasping objects with a mind/body connection doing the work, rather than plain mechanics.

Prosthetic limb advancements have grown exponentially over the years, but are very expensive. Prosthetic hands and arms are now like mini computers, with sophisticated wiring and performance. This leads to increased hazards and damage, wear and tear, and replacement/maintenance costs.

Some state statues only require replacement of a lost limb with a “suitable” prosthetic. But suitable to whom? Is it suitable to the claims adjuster, or suitable to the person affected by this life-changing injury? Unfortunately in many insurance claims, the best is not always something the carrier is prepared to pay for. The carrier’s opinion is to replace with a suitable device, a Ford Focus, not a Cadillac Escalade or Ferrari. So a lost limb can be replaced by the Ford Focus of limbs, not the Cadillac of prosthetic devices, or the latest/greatest thing out there.

Prosthetic eyes have also come a long way from the days when eye implants were riddled with infection potential and replacement eyes had little reality to what a natural eye looked like. Today’s eye prosthetics are incredibly life-like, although they do not replace vision. However, a good-looking prosthetic eye is a confidence builder and beneficial to a good appearance.

Be prepared to litigate over the issue of “type of replacement” and do not be surprised when it arrives after coverage for the Cadillac version of a prosthetic is disputed. Avoid legal problems by doing due diligence and get multiple opinions and recommendations for treatment as well as estimates on maintenance costs/repairs.

Changing Demographics of the Workforce

Today businesses are doing more with less, leading to employees who are prone to more severe injuries with longer recovery times. Both the increase in obesity and aging adds to this statistic. It is not uncommon for workers compensation claims to increase when layoffs are rumored or forthcoming. Fear of losing a job may cause an employee to file a workers compensation claim over a minor injury and this spells disaster for the employer.

Employers must be aware of the risk. Every employer wants to run an efficient business, but employees can be over loaded by being asked to do more with less. What is the general consensus on the work floor? Are workers hearing about pending layoffs and not telling their managers about a potential injury for fear of repercussion or termination? Are workers asked to do more than one job when coworkers are laid off and not replaced? Failure to address these important questions can be dangerous and costly in the end and counter-productive to efficient management.

Better Recovery that Limits Risk of Permanent Partial Impairment

Injuries reported and treated before they morph into major injuries result in reduced recovery time. Reduced recovery time lessens the risk of a permanent injury. In states where an impairment rating is used to pay the claimant additional monies, just opening the lines of communication can save a business/carrier a large sum of money over time.

Let us look at carpal tunnel as an example of early treatment as opposed to late treatment.

When a worker is treated at the onset of symptoms, treatment consists of splinting and medication. The problem can resolve on its own with little loss of work time and minimal medical cost. On the other hand, the longer a worker waits to get treatment, the worse the nerves become damaged, sometimes to the point where surgery will be of little benefit to resolve pain and restore function.

Some states have an almost automatic impairment rating once surgery is performed and costs can be very large not only in additional wage loss, but also in increased medical coverage. Some states cover reasonable, related, and necessary medical costs over a 10-year period, meaning it is hard to wipe an existing claim of this nature off the financial books. Promote early involvement/medical intervention when an injury happens in the workplace.

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.

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: Aging Workforce, lower your workers comp, Medical Cost Containment & Managed Care, Medical Director Role in Workers Comp, Medical Issues, Medical Trends, Permanent Partial Disability, prosthetic devices, reduce your workers comp, Risk Trends, workers comp, Workers Comp Cost Containment, Workers Compensation, Workers Compensation Cost Containment

Mining Inspectors Zero In On Workplace Safety

February 27, 2013 by Michael B. Stack Leave a Comment

Mining inspectors in Ontario are focusing in on diesel emissions and other hazards that could affect air quality during a blitz in underground mines.

As part of the province’s Safe at Work Ontario strategy, which was unveiled four and a half years ago, Ministry of Labor inspectors are making sure that employers are complying with recent changes to emission requirements for diesel-powered equipment under the Regulations for Mines and Mining Plants.

Officials believe the changes improve protection for workers from the potentially harmful effects of diesel emissions by:

● Setting a lower allowed limit of carbon exposure for workers and

● Requiring equipment be tested under consistent conditions

The changes went into effect on Jan. 1, 2012.

Illness and Death Result from Poor Air Quality

Poor air quality in underground mines can lead to occupational illness and death of workers. In particular, workers are at risk in the event they are exposed to carbon monoxide in diesel exhaust.

Underground mines can have poor air quality when:

● There are too many "particulate particles" (a mixture of various chemical solids and gasses including carbon and nitrous oxide) and other airborne substances such as dust in the air and/or when

● Fumes emitted by diesel-powered equipment are over the prescribed limits

To protect workers, the new amendments require employers to:

● Perform routine testing to determine the carbon monoxide content of exhaust from diesel-powered equipment under consistent conditions

● Develop and implement testing measures and procedures for diesel-powered equipment, in consultation with the mine's Joint Health and Safety Committee (JHSC) or health and safety representative

● Provide test results, as required, to the JHSC or health and safety representative

● Investigate overexposure by workers to diesel emissions and take remedial action, if possible, to prevent future incidents

The mining regulations are part of Ontario's Occupational Health and Safety Act (OHSA).

Inspectors Focus in on Diesel Equipment

Inspectors will target underground mines that use diesel equipment, including:

● Mines with large fleets of diesel equipment operating in the underground environment

● Recently reopened or new mines operating diesel equipment

● Mines where previous ventilation concerns were observed, and

● Mines with a poor health and safety compliance history

Inspectors will check on two types of equipment:

● Diesel equipment used for underground transportation of workers and materials and blasting of rock and

● Ventilation systems used to deliver fresh air to underground mines

Lastly, mining inspectors will zero in on the top priorities:

Committee Consultation: Inspectors will check that employers have developed and implemented testing measures and procedures for each piece of diesel equipment, in consultation with the JHSC or health and safety representative.

Diesel Equipment: Inspectors will check that equipment used for underground transportation of workers and materials is being regularly tested, as required.

Workplace Air Sampling: Inspectors will check that employers are regularly testing the air in underground mines to ensure exposure to toxic airborne substances do not exceed the prescribed limits.

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: Coal Mine Safety, Coal Mining, lower your workers comp, Mine Safety & Hazard Control, Miner Health and Safety, reduce your workers comp, Safety and Loss Control, Safety Investigation, Safety Issues, workers comp, Workers Comp Cost Containment, Workers Compensation, Workers Compensation Cost Containment

What to Look For in a Structured Settlement Company

February 26, 2013 by Rebecca Shafer, J.D. Leave a Comment

The use of structured settlements in large and catastrophic workers’ compensation claims is well recognized as a way to reduce the overall settlement cost while at the same time providing the injured employee with a fair claim settlement. However, a factor often overlooked in structured settlements is the identification and selection of the best structured settlement company.

There are several characteristics and qualities that should be considered in the selection of the structured settlement company. They are:

Experience.

You want a structured settlement company that has a track record. A structured settlement company that has been around for decades has more resources to draw from then a structured settlement company that has been in business for a few months. The more structured settlements the company has completed in the past, the greater likelihood that they know how to deal with every possible scenario that could interrupt or prevent a structured settlement from occurring.

Ability to Design Settlements.

The structured settlement company must have the ability to taken into consideration the needs of everyone including the injured employee and employee’s family, the attorney for the employee, the employer and the employer’s workers’ compensation insurer. The structured settlement has to be designed to be flexible to address the needs of the employee while maintaining control of the settlement cost for the insurer.

The structured settlement company consultant must have an in-depth knowledge of sophisticated damage analysis and life care plans, along with the different types of trusts that can be included in a structured settlement. By understanding the injured employee’s future financial needs and future medical care, the structured settlement consultant can design a creative solution that benefits all parties involved in the workers’ compensation claim.

Resources.

A structured settlement is basically an annuity (or annuities) purchased from a life insurance company. It is therefore essential for the structured settlement company to have several top rated life insurance companies available to provide the annuity/annuities. By having several highly rated insurance companies available, the consultant can shop the settlement package with the different insurers to obtain the lowest overall cost for the structured settlement.

Reputation.

There are structured settlement companies that work only with the plaintiff attorneys and there are structured settlement companies that specialize in working only with the defense attorneys. These companies are well known to both the sides of the legal aisle, and are often mistrusted by the other side. A structured settlement company that works with both plaintiff attorneys and defense attorneys must maintain a reputation of being unbiased and fair in all their dealings. By selecting a structured settlement company that has the trust and extensive experience working with both sides of the legal aisle, the mistrust that hampers and prevents some structured settlements from occurring is removed.

Geographical spread.

The structured settlement company should be somewhat local. If the structured settlement company has only one office or even several offices in another part of the country, it is difficult for the structured settlement consultant to meet with the various parties involved in the injury claim. An example – if the structured settlement company is located in Florida and the injured party is in California, the structured settlement company will be less effective. The structured settlement company that has a complete geographical spread and can provide a local consultant whether the injured employee is in Maine, Hawaii or somewhere in between will be able to provide the best service.

The proper selection of the structured settlement company can have a significant impact on the cost of the structured settlement. For assistance in identifying and locating the best possible structured settlement company, please contact us.

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: Structured Settlements Tagged With: claim settlement, Claims Resolution and Settlement, Large Dollar Claims Settlement, lower your workers comp, Lump Sum Settlements, reduce your workers comp, settlement value, Structured Settlements, workers comp, Workers Comp Cost Containment, Workers Compensation, Workers Compensation Cost Containment

Safety Efforts Pay Off For Record Safest Year in 2012

February 26, 2013 by Michael B. Stack Leave a Comment

It appears that the efforts to make Victoria (Australia) workplaces safer has paid off.

According to information from WorkCover, 2012 witnessed 18 people pass away while on the job in Victorian workplaces, that being seven less than the 25 who were killed in 2011. That figure for 2012 also equals the prior record low of 18 workplace fatalities in 2005.

7.77 People Injured for Every Million Hours Worked

The number of Victorians who were injured at work also dipped to a new low. Last year, 7.77 people were injured for every million hours worked, that in comparison to 7.9 people per million hours worked in 2011.

WorkCover Assistant Treasurer Gordon Rich-Phillips remarked that the improvement was a major achievement, maintaining the state’s track record of leading Australia in terms of workplace safety.

“In 2012 national data confirmed Victoria’s position as having the safest workplaces of any state or territory in Australia, and that’s a credit to employers, workers and the efforts of the WorkSafe team,” Rich-Phillips remarked. “Many things need to come together to achieve these sorts of outcomes – active engagement and support from employers and workers, practical assistance combined with inspection and enforcement activity by the VWA and a commitment to improved workplace safety.”

Victorian Workplace Deaths Nearly Halve in Last Decade

According to Rich-Phillips, fatalities in Victorian workplaces had almost halved over the past decade.

“However, it is clear that more can be done, as many of the fatalities and injuries resulted from known hazards, with known safety solutions,” Rich-Phillips said. “Eighteen families had a sad and distressing 2012 because a family member failed to return home safely. The impact of a workplace death is also enormous on colleagues and employers, which is why we ask everyone returning to work to make safety their number one priority this year.”

Of the 18 deaths in 2012, 12 were in Melbourne and six were in regional Victoria. Sixteen of the fatalities were turned out to be males, one was an elderly woman and one was a four-year-old. Half of the deaths involved men aged 50 and over.

“Employers can improve safety and reduce injuries by making sure people are trained and supervised, that they have the right equipment to safely carry out a job and that machines are properly guarded,” Rich-Phillips said. “Workers can also improve safety in the workplace by taking responsibility for their actions. A shortcut might seem like a good idea but it’s often a shortcut to a serious injury.”

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, lower your workers comp, reduce your workers comp, Safety and Loss Control, Safety in the Workplace, Safety Issues, Safety Management, Safety Programs, workers comp, Workers Comp Cost Containment, Workers Compensation, Workers Compensation Cost Containment

Ergonomic Concerns With An Aging Workforce

February 25, 2013 by Rebecca Shafer, J.D. Leave a Comment

There has been a lot of industry talk about the risk of an aging workforce and how this can affect your workers compensation program. A main risk is how ergonomics plays into injury prevention, not only for an aging worker but for all workers.

Here are several ergonomic issues, and ways to try to trim your exposure:

Why should employers be concerned about this issue?

I recently read in the paper where it is projected that 50% of workers expect to work into their 70s, some into their 80s, and some plan to never retire! The reasons for such a statement would vary per the individual needs of the person, so it is hard to say exactly why this phenomenon is occurring.

Truly there are a number of different factors all combined into why this is happening, I do not think it is solely due to financial needs, or solely due to people just liking to work and be out of the house, on so on. The reality is that it seems there are older workers out there who just are not removing themselves from the workforce. Whether or not this will change in the future is unknown, but the current trend is that workers are not in a hurry to retire.

What are the risk factors?

Ergonomics are intended to maximize worker productivity while minimizing fatigue and discomfort. When work stations are designed based on production demand and not on the human element, the result will be increased injury. Worker injury exposure should look at the overall ability of the worker performing the job. It could loosely be said that a 75 year old worker cannot perform as quick nor have the physical stamina of a 25 year old worker. But, you have to take into account worker experience, motivation to perform at a high capacity, overall occupational education, and so on. This would be the human factor of a particular job. Job station risks would include repetitive motion, awkward postures such as bending/stooping and overreaching for items are all ergonomic workstation factors.

When a worker is manually handling heavy objects, it forces the body to comply and this can cause injury. An aging workforce most likely cannot continue to meet strict production demands that stress the body at a high capacity without experiencing injury at some point.

How can I reduce the risk?

The best thing for employers to do is to contact ergonomists and/or risk control professionals for their expertise on how to control and reduce the risk of ergonomically related claims. Many insurance carriers have adequately trained risk professionals that can help, or they can refer you to an outside vendor for further expertise.

Employers can also start to look at work duties and tasks for all of their employees. They should bear in mind necessary accommodations for an aging worker in a high demand, fast-paced work station.

Employers can also use loss run data to look for injury trends in order to pinpoint a particular task that could be increasing injury risk. As well as accommodate the needs of older workers by providing increased breaks, job rotations, sitting options, etc.

Any other ideas that will help out?

Depending on the work demand, a key topic that is having proper footwear and using correct body mechanics when handling materials.

Workplace footwear should be slip-resistant and designed for standing on concrete or other hard surfaces for long periods of time within the work environment. Anti-fatigue mats used with the correct footwear reduces pain and fatigue to the back and lower extremities, thereby reducing some injury exposure.

Establishing proper body mechanics defined by job description help not only an aging workforce, but all employees, on how to properly handle materials with minimal impact to the vulnerable areas of the body.

Summary

The increased presence of an aging workforce presents new exposure to an employer that was not as prevalent in the past. It is important to be proactive, and to become involved in the injury exposure in order to reduce your risk. Talk with your vendors or your carrier about what options you have for reducing your exposure.

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: Risk Management Tagged With: Aging, Aging Workforce, Ergonomics, lower your workers comp, reduce your workers comp, Work Comp, workers comp, Workers Comp Cost Containment, Workers Compensation, Workers Compensation Cost Containment

Construction Sites Targeted That Put Workers At Risk

February 25, 2013 by Michael B. Stack Leave a Comment

Focusing on the importance of workplace safety for construction companies, officials in New Zealand are making a concerted effort to see to it that 2013 is a safer year in this industry.

According to information from the Ministry of Business, Innovation and Employment, its inspectors passed out more than 1,000 notices and written warnings to construction companies performing work at height unsafely nationwide a year ago.

In an effort to protect workers, inspectors a year ago assessed more than 1,600 construction sites tied to the Preventing Falls from Height project, which seeks to lessen injuries and fatalities caused by falls in the construction sector. The project is continuing over the next 12 months, with construction workers being urged to make safety a priority in the New Year.

Sites Targeted That Put Workers at Risk

“The Ministry will continue to target sites that carry out work at height unsafely and those companies that put their workers at risk,” stated Francois Barton, the Ministry’s Southern Division general manager. We want to see enforcement figures improving in 2013 – safe work at height should be standard practice in the industry.

“Despite the high number of notices and warnings issued last year, it has been very positive to see some construction companies using innovative solutions to ensure their staff are safe while working at height. Companies are using adaptive scaffolding systems, mobile stair systems instead of ladders, and soft landing systems to stop workers getting hurt from falling off the top plate.”

Barton added that a sizable number of these solutions are also increasing productivity by bettering access for builders and the tradespeople that work alongside them.

Hundreds of Construction Workers Injured Every Year

Builders, roofers, electrical workers, painters and decorators are most apt to fall from height and get seriously hurt while they are working, according to officials.

“Tradespeople are going back to work after a few weeks off, so now is the time for a renewed focus on safety issues,” Barton remarked.

Hundreds of construction workers are injured on building sites every year – these accidents are preventable if precautions are in place. Workers must make safety a priority, especially during summer when there is an overall increase in workplace injury, according to Barton.

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: Construction and Building Workers, Construction Deaths, Construction Industry, Construction Injuries, lower your workers comp, reduce your workers comp, workers comp, Workers Comp Cost Containment, Workers Compensation, Workers Compensation Cost Containment

The Best Tidbits of News From The Workers Comp Community

February 22, 2013 by Michael B. Stack Leave a Comment

CMS to Resolve MSA Backlog by February 28, 2013

While there have been no formal updates to the CMS website, the WCRC recently provided an update to Gould & Lamb that it will have all remaining cases that were not part of the previous streamlined process resolved by February 28, 2013, or will provide the specific information that is necessary for the approval process to be completed. Read more…

Cavalcade of Risk #177: Health & Insurance Edition

From skiing injuries to sniffles, there’s no season like winter for thinking fond thoughts of the American health care system. And there’s no time like exactly one billing period later for screaming curses at the American health care system.

With the Affordable Care Act here to stay and its changes already in motion, we present this week’s Cavalcade of Risk: articles on health insurance and its impact on our lives and economy. Read more…

Lexis Nexis News:

The Ambiguous Statute

"Larson's May Help Interpret Law, But Can't Supplant Text of Statute, by Thomas A. Robinson. Larson's Workers' Compensation Law is often used by federal and state courts to explain and interpret a workers' compensation statute, particularly when that statute is ambiguous. In a recent decision, the Kansas Supreme Court indicated that although consulting the Larson treatise is in order when the statute is unclear, it may not serve to supplant or alter the actual text of a statute. Read more about this case and other cases on Credit for Pension Benefits, Intentional Tort, and Substantially Certain Rule."

New AMA Guides Study

"Strong Association Exists Between AMA Guides Impairment Ratings and Earnings Losses, But Losses Vary Significantly Across Body Regions, by Robert G. Rassp, Esq. & Robin E. Kobayashi, J.D. A new major study funded by CHSWC focuses on the AMA Guides Fifth Edition in California but has implications for the AMA Guides Fourth and Sixth Editions used in other states. The study purports to quell the main criticism that the AMA Guides can only measure severity of impairmentand not disability. The study examines whether there is a strong association between AMA-based impairment ratings and earnings losses for workers' comp claimants with permanent disabilities, thereby indicating that impairment ratings accurately reflect the effect of impairments on the ability to work. The study also examines…Read more"

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: CMS, lexis, Lexis Nexis, Lexis Nexis Work Comp Law, Lexis Nexis Workers Compensation Law Community, lower your workers comp, Medicare Set Asides, Medicare Set Asides (MSAs), reduce your workers comp, workers comp, Workers Comp Cost Containment, Workers Compensation, Workers Compensation Cost Containment

Ohio Bureau of Workers Compensation Convicted 125 Employers for Fraud in 2012

February 22, 2013 by Michael B. Stack Leave a Comment

Showing further evidence that crime does not pay, officials with the Ohio Bureau of Workers Compensation (BWC) recently reported 11 individuals were convicted of or pleaded guilty to charges related to defrauding the state’s compensation system in the month of December.

The court actions stem from investigations conducted by BWC’s special investigations department (SID). From illegally receiving workers comp payments to running a business without comp coverage or under reporting it, a number of individuals have been arrested and charged within the last year.

“Our investigators wrapped up 2012 with 125 convictions of employers, injured workers, providers, and others who committed fraud against the State Insurance Fund,” said BWC Administrator/CEO Steve Buehrer. “Their work helps keep employers from having to cover the cost of fraudulent claims, non-payment of premium, illegal billing, or any other illicit schemes designed to cheat the system.”

Among those who ran afoul of the law for a variety of offenses:

Eric Renzhofer, dba ARS Construction Inc., (Bowling Green, Wood County) was found guilty Dec. 3 of workers comp fraud for altering his coverage certificate. SID received an allegation from a premium auditor that Renzhofer may be altering a certificate of coverage. While conducting an audit on an unrelated case, the auditor noticed the policy number listed did not match ARS Construction, Inc. The Employer Fraud team investigation found that Renzhofer altered a certificate belonging to another business to make it appear that his business (ARS Construction) had active coverage. Renzhofer confessed to altering the certificate and cooperated by providing business records to determine the premiums he owed. Renzhofer was ordered to pay fines of $250 and restitution.

Eugene Vaughn (Spencer, Medina County) was found guilty Dec. 28 on five felony counts of deception to obtain a dangerous drug after he was discovered doctor shopping. A pharmacy contacted SID and advised that Vaughn was receiving prescriptions from multiple insurers, including BWC. SID worked with the Medina County Drug Task Force on the investigation, which found Vaughn obtained narcotics from different doctors during the same prescription cycle, including prescription drugs paid by BWC. Vaughn also used multiple pharmacies to fill these prescriptions. Vaughn was sentenced in the Medina County Common Pleas Court to three years general supervision by the Adult Parole Authority, drug screening, and continued drug treatment. Vaughn’s driver’s license was suspended for six months with work privileges upon request. He must have only one prescribing doctor with those prescriptions verified by Adult Parole Authority.

Victor Figueroa (Columbus, Franklin County) pleaded guilty Dec. 13 to one count of workers comp fraud for working while receiving benefits. SID’s Intelligence Unit detected that Figueroa was earning wages from multiple employers during periods he was collecting Temporary Total disability benefits from BWC. The investigation found Figueroa worked for Fairfield Insulation and Qualiteck, Inc. while collecting these benefits. Figueroa was ordered to pay restitution of $9,653.70 and he paid in full at the sentencing. He was also sentenced to one day in jail, suspended for time served.

Danny Albert (Columbus, Franklin County) pleaded guilty Dec. 17 to one misdemeanor count of workers comp fraud for working while receiving benefits. SID received an allegation that Albert was working for Southeast Mental Health as a Resident Specialist while he was receiving benefits and was prohibited from working. The investigation found Albert was in fact employed with Southeast, Inc, and Stevens Building Services while receiving Living Maintenance and Temporary Total benefits. Evidence obtained during the investigation also showed that Albert intentionally misrepresented and withheld employment activity in order to continue collecting these benefits. Albert was sentenced to 180 days in jail, suspended for 12 months of community control, and ordered to pay $7,051.75 in restitution.

Sheldon Greene (Middletown, Butler County) pleaded guilty Dec. 6 to one felony count of workers comp fraud for working while receiving benefits. SID received an allegation that Greene had returned to work at Michael’s Dining and Jazz restaurant in Dayton. The investigation found Greene was working at Michael’s Dining and Jazz restaurant as a chef and was operating his own catering company, Liberty City BBQ, in the Cincinnati and Dayton areas while receiving BWC disability benefits. Greene appeared in the Franklin County Court of Common Pleas and the judge terminated the case after he repaid BWC $9,992.28.

Jerry Adams, dba Quaker Pool & Spa, (Calcutta, Columbiana) was found guilty Dec. 13 of one felony count of fraud for allowing his workers comp insurance coverage to lapse. BWC’s Employer Compliance Department attempted to work with Adams, owner of Quaker Pool & Spa, after he allowed his coverage to lapse. After multiple attempts, Adams still failed to submit outstanding payroll reports and the case was turned over to SID for a fraud investigation. Employer fraud team agents met with Adams and his accountant on multiple occasions and facilitated the receipt of all but one of the outstanding payroll reports. Adams was given instructions on how to request a payment plan in order to get the policy reinstated. However, Adams again failed to follow through. Adams paid $4,226.34 as a down payment and signed a Payment Plan with the Attorney General’s Special Counsel agreeing to pay the remaining balance of $11,495.50 over the course of the next year. His sentencing is scheduled for February 21, 2013.

Anil Nalluri, MD (Youngstown, Mahoning County) pleaded guilty Dec. 13 to one misdemeanor count of workers comp fraud for billing for services not rendered. SID began investigating Nalluri in 2003 after receiving a complaint from an injured worker that he was providing only 10 minutes of psychotherapy services during what was supposed to be a 45 minute session. The injured worker confronted Nalluri about the lack of care and Nalluri informed the patient that he would receive payment from BWC regardless of the treatment provided. Nalluri later removed the injured worker from treatment at the office and failed to provide the patient his medical records when requested. Agents conducted an undercover operation and observed several patients exiting the office very soon after arriving. An agent also posed as a patient, visiting Nalluri 12 times and capturing video supporting the allegation, including an appointment that lasted one minute. In another instance, BWC was billed for a 20 – 30 minute psychotherapy session that video showed lasted three and a half minutes and consisted primarily of discussions about the economy. After the undercover operation concluded, investigators conducted interviews with Nalluria’s employees and patients. A number of patients reported the services they received were less than adequate and often lasted just enough time for Nalluri to write a prescription. Nalluri was paid $71,669.62 in restitution and investigative costs. He was also voluntarily decertified as a BWC provider.

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: lower your workers comp, Ohio Bureau of Workers Compensation, Ohio BWC, Ohio WC, Ohio WC Law, reduce your workers comp, workers comp, Workers Comp Cost Containment, Workers Compensation, Workers Compensation Cost Containment

Properly Designing and Implementing Transitional Duty Program Ensures Success

February 21, 2013 by Michael B. Stack Leave a Comment

Big Mistake is Designing Program After Employee is Injured

The biggest mistake employers make with a transitional duty program is having a “sorta” light duty program. The employer recognizes a transitional duty program is an important way to reduce workers’ compensation cost and realize the importance of providing modified duty/light duty work for an injured employee, but does nothing about it until an injury employee is placed on light-duty work restrictions by the medical provider.

For a transitional duty program to be effective, it needs to be properly established. This does not mean identifying a light duty job for the employee once an employee has been injured. It means having a written policy on light duty work that is known to everyone in the company. When there is a written policy of providing transitional duty work, every employee will know that a light duty or modified duty job will be available and required of them, if they are ever injured on the job. The supervisors and managers within the company should be educated on the details of the transitional duty program so they can properly explain it to any employee who is injured.

A transitional duty position should be designed for every current job within the company. The transitional duty job does not have to be in the same department as the injured employee’s original job. It can be anywhere in the company. The placement of the employee in a transitional duty position outside of the employee’s regular department is beneficial to the employee by broadening the employee’s skill base and knowledge of the company. Any training the employee needs to accomplish the transitional duty job should be provided during the first days on the temporary job assignment.

Transitional Program Should be Understood Throughout Company

All employees should understand that transitional duty jobs are temporary and are not a new permanent assignment for the employee. If the transitional duty is going to last more than 30 days, the employee should be moved to a second transitional duty job that allows for increased physical assertion, but still within the work restrictions set by the medical provider. The employee should be clearly told that as soon as the medical provider clears them to return to their regular duty job, they will be required to do so.

The business partners who are involved in the handling of the workers’ compensation claim need to understand that transitional duty is required of all injured employees who are able to work in some capacity. The nurse case manager and the designated adjuster or dedicated adjuster(s) assigned to your work comp claims should understand that your company will return all injured employees to work as soon as the medical provider states what work restrictions are necessary.

The medical provider, whether employer selected or employee selected, should be advised there is a transitional duty job available to the injured employee. The medical provider should be given both a copy of the physical requirements of the employee’s regular job and a copy of the physical requirements of the transitional duty job that will be available to the employee. If it is a non-emergency situation, the physical requirements or the regular job and of the transitional duty job should be given to the medical provider prior to the first medical visit. When this is not possible due to the need for immediate medical care, the physical requirements of both the regular duty job and the transitional duty job should be provide to the medical provider prior to the employee’s second medical appointment.

The employer should never allow the transitional duty job to interfere with the employee’s medical appointments, physical therapy appointments or other medical treatment. The supervisor in charge of the transitional duty job position should be provided the date of the next medical appointment immediately following the most recently completed medical appointment to minimize the interruption in productivity of the department where the injured employee is working.

Properly Designed & Implemented Program Ensures Success

The work comp coordinator within your company should coordinate the transitional duty position with the employee, with the supervisor of the transitional duty position and with the medical provider to be sure everyone is on board. Any issue that arises with the employee working in the transitional duty position can be addressed timely by the work comp coordinator. The work comp coordinator should also verify that the transitional duty job meets the work restrictions set by the medical provider.

The establishment and implementation of the transitional duty program before it is needed is the key to a successful program. By designing your transitional duty program to accommodate the needs of the injured employees, you will ensure the success of your transitional duty program.

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.