Get The Workers Compensation Claim Process Off On The Right Track

In past blogs I have discussed various strategies for preparing your temporary duty, return-to-work program. In this blog I will now direct your attention to its successful implementation.

After years of working with organizations to implement a successful program there is one thing I have learned – the successful implementation of your workers compensation disability management program actually begins the day of injury. How you respond to and communicate with the injured employee will in a large measure dictate how cooperative the injured employee will be. As a general rule, the more compassionate and prompt your response to the injury is the more likely the injured employee will be to come back to work with medical approval and the less likely the injured employee is to retain an attorney.

There was a study commissioned by the California Commission on Health and Safety and Workers’ Compensation to evaluate the information and assistance services for injured workers. The study obtained information from focus groups of injured workers. The focus groups consisted of employees from several different areas of the state who had filed with the Workers’ Compensation Appeals Board, and who had already resolved their claims. The purpose of the focus groups was to obtain qualitative data on the perceptions, feelings and manner of thinking of users of the workers’ compensation services.

The focus group participants provided many recommendations for improving information flow and providing help for injured workers. Most recommendations involve simple improvement in the content, form and delivery of information. While they may seem simple in many ways, they provide important insight into what you should do to get your workers compensation disability management program off on the right track.

First, improve understandability and content. Many of the participants believe that the information given to them regarding their claim and the workers’ compensation process was too general or not readily understandable. The most common recommendation was for information to be developed that more clearly guides the injured workers through each specific step of filing a claim. Such information should tell the injured worker “where to go,” “what to do,” and the anticipated time involved for each stage of the claim.

Second, provide a mix of oral and written information. Because not all employees comprehend written information well, it was recommended that information also be given orally. Recommendations included the conducting of individual or group sessions or even showing instructional videos similar to those used for safety or sexual harassment prevention training.

Third, ensure appropriate timing of information. Participants emphasized that more information regarding workers’ compensation law, claims procedures and dispute resolution should be provided at the time of employment. Participants also indicated a need for more complete information and guidance immediately following injury.

Fourth, take information easy to obtain. Many participants reported being unable to obtain needed information or reported obtaining needed information only after expending considerable time and resources. Recommendations included making a wide range of workers’ compensation information available to employees. Some recommended methods for distributing the information were through posting at work, the mail or via the Internet or company intranet.

Fifth, provide sufficient follow-up. Many of the participants felt that injured workers should be provided individual help in filling out forms. Also, participants were of the opinion that workers should have individual support and/or representation made available to them, such as a counselor, social worker, paralegal or legal-aid attorney.

Sixth, treat injured workers with respect. Many of the focus group participants felt that the employer, insurance company, claims personnel, doctors, counselors and others were rude, insensitive, cold, bureaucratic and even threatening. Participants recommended that they be treated with more respect and not assumed to be filing fraudulent claims.

Finally, clarify and even enforce obligations of employer and insurer. Many of the group participants said that employers should inform injured workers about their rights. In addition, participants believed that the employer representatives needed to become more knowledgeable about the workers’ compensation system.

Successful companies are proactively communicating with their injured workers while they are off on disability. This starts the very first day the employee is injured and includes an explanation of what they can expect from the claim process, how their medical bills are going to be paid, and who they can contact for questions.

At the same time many successful employers are requiring the injured employee to bring a “Physician Packet” along with them to all medical providers. This packet explains the company’s temporary duty process to the medical provider and asks them for information on the employee’s physical capabilities. The company then takes very proactive steps to obtain additional medical information and match up available temporary tasks when they are medically appropriate.

CompEraser comes with on-line, on-demand resources needed to CONTROL the temporary duty program, including this important step in the process. Resources also include the formalization of your safety team, injury prevention, OSHA compliance, safety training, prompt injury response, workers compensation disability management, plus more. These resources are available 24/7 and used irrespective of which workers compensation carrier you select. Its patent-pending technology also provides unique financial reports for monitoring the effectiveness of your safety and health program on an on-going basis. For more information visit our website at www.CompEraser.com.

Develop An Inventory Of ADA - Compliant Job Descriptions of Temporary Duty Tasks

If I had a quarter for every time I was told by a consulting client that they did not have an inventory of temporary duty tasks I could buy my wife and I a great steak dinner. More often than not I am told that the organization will find the tasks on an ad hoc basis as the need arises.

But here is the problem with this approach. Recall that, on average, you have a three day waiting period under state works compensation law (state laws vary so be sure to find out what the waiting period is in your state). Because it takes, best case, at least two days to get the injury reported by the employee, take them to the occupational clinic or hospital, and get the medical evaluation back from the treating physician you have only one day to locate a job that will fit the injured employee’s work restrictions. Then you have to make the offer to the employee and get them back to work promptly. Having an inventory of temporary duty tasks at the ready not only saves time. It saves money.

It is recommended that Temporary Duty Tasks by developed by your organization’s Accident Coordinator, in conjunction with the departmental supervisor, for each job in the company that has the following characteristics:

·         Any job that was analyzed during the JSA process ;

·         Is a other job function that you seeking to fill either by a new employee or transferee ;

·         Any other “restricted duty” job function that can be occupied by an employee coming back to work under your return to work program.

This analysis should be up-dated and reviewed at least annually or whenever there are changes in operations

CompEraser comes with on-line, on-demand resources needed to CONTROL the temporary duty program, including this important step in the process. Resources also include the formalization of your safety team, injury prevention, OSHA compliance, safety training, prompt injury response, workers compensation disability management, plus more. These resources are available 24/7 and used irrespective of which workers compensation carrier you select. Its patent-pending technology also provides unique financial reports for monitoring the effectiveness of your safety and health program on an on-going basis. For more information visit our website at www.CompEraser.com.

How To Determine Which Jobs Require A Job Safety Analysis

In my last blog I discussed to how begin identifying potential temporary duty tasks within your facility. By carefully evaluating those areas of your operation that have historically generated the most worker injury claims you not only are better understanding how to prevent future losses but also identifying many temporary duty tasks. The good news is that this same process also provides a road map to prioritizing which jobs require a Job Safety Analysis (JSA).

OSHA says that Job Safety Analysis means:

“…carefully studying and recording each step of a job, identifying existing or potential job hazards (both safety and health), and determining the best way to perform the job to reduce or eliminate these hazards. Improved job methods can reduce costs result from employee absenteeism and workers compensation, and can often lead to increased productivity.”

A Job Safety Analysis (JSA) is designed to be a simple, cost effective method of preparing a detailed work description which establishes a standard procedure for accomplishing a single task. It is a valuable tool for reducing the possibility of an operational error that could result in injury, property damage, or lost production.

Through this technique a step-by-step training guide can be developed which, when properly used, assures that all needed job skills are taught by a trainer-including safe operational procedures. In addition, Job Safety Analysis can be used to identify and correct work hazards which may have been inadvertently introduced by employees in an effort to simplify or speed up a job. Also, Job Safety Analysis can assist supervisors in making decisions relating to line balancing, time standards, and job simplification.

A common misperception of Job Safety Analysis is that it must be performed for each and every job in the facility. As a result, many companies view this as an unrealistic strategy and take little or nor advantage of it. In fact, OSHA has suggested that you follow the following priority when determining which jobs you should analysis first:

1. Jobs with the highest rates of accidents and lost - workday injuries;
2. Jobs where “close calls” have occurred;
3. New job tasks as they are created;
4. Jobs where changes have been made in processes and procedures;
5. All other jobs.
6. Eventually a Job Safety Analysis should be conducted and made available to employees for all jobs in the workplace.

What this means is that you can perform Job Safety Analysis on a step-by-step, planned basis. You are not required to drop what you are doing and perform a Job Safety Analysis on each and every job task in your facility. Eventually this should be your goal. However, realistically you should perform a Job Safety Analysis on those critical tasks or processes that have the highest potential or actual accident rate.

CompEraser comes with on-line, on-demand resources needed to CONTROL the temporary duty program, including this important step in the process. Resources also include the formalization of your safety team, injury prevention, OSHA compliance, safety training, prompt injury response, workers compensation disability management, plus more. These resources are available 24/7 and used irrespective of which workers compensation carrier you select. Its patent-pending technology also provides unique financial reports for monitoring the effectiveness of your safety and health program on an on-going basis. For more information visit our website at www.CompEraser.com.

How To Quickly Identify High Impact Temporary Duty Jobs

Once you have established and communicated your workers compensation disability management policy, assembled your disability management team, and gotten intimately acquainted with the legal parameters related to your workers compensation laws, the next step is to begin identifying potential temporary duty tasks within your facility.

For many companies this may seem at first blush to be a daunting job. After all there may be hundreds of tasks throughout your facility and an impossibility to evaluate all of them.  Well, there is a little bit of good news. By carefully evaluating those areas of your operation that have historically generated the most worker injury claims you not only are better understanding how to prevent future losses but also identifying many temporary duty tasks. You should carefully analyze your losses over a given timeframe from the standpoint:

• Nature of injury;
• Cause of loss;
• Body part injured;
• By department;
• By time of day;
• By day of the week;
• By month of the year.

When completed, this analysis will provide you with valuable insight into the types and number of claims that are occurring in your operation, the financial impact of the injuries, where the injuries are occurring, and when they are occurring. It is strongly recommended that you perform this analysis at least annually as there are often surprising lessons and insights that can be learned.

The best source of information for this analysis is from your insurance carrier (workers compensation loss runs) and your OSHA log. In addition, the impact on your experience modification can be provided by either your insurance carrier or your insurance agent via readily available claim analysis software. All factors highlighted in this analysis are critical to a complete understanding or your historical loss trends.

CompEraser comes with on-line, on-demand resources needed to CONTROL the temporary duty program, including this important step in the process. Resources also include the formalization of your safety team, injury prevention, OSHA compliance, safety training, prompt injury response, workers compensation disability management, plus more. These resources are available 24/7 and used irrespective of which workers compensation carrier you select. Its patent-pending technology also provides unique financial reports for monitoring the effectiveness of your safety and health program on an on-going basis. For more information visit our website at www.CompEraser.com.

Six (6) Things You Absolutely Must Know About Your Workers Compensation Statute To Control Worker Injury Claims

The third critical strategy in implementing an effective workers compensation disability management program is to understand the workers compensation laws that apply to your organization. It goes without saying that you must be up-to-date on the lost time benefits that are available to your injured workers. But here is a list of often overlooked items that can bite your bottom line.

What Are The Claim Reporting Requirements?

Each state varies as to the reporting requirements by both the employer and the employee, and as to any penalties or consequences of such late reporting. The employee should be required to report the injury promptly to the employer’s Claim Coordinator and this requirement should be made a part of the organization’s claim management. Always remember that the employee’s late reporting of a claim is a “red flag” for possible fraud.

How Much Control Do You Have Over The Treating Physicians?

The organization’s ability to direct the employee to the physician of the employer’s choice is a very important cost containment strategy. It may save medical costs and improve the quality of medical care to the injured employee. It also allows the employer to control the claim process to a greater extent. The question is: Will the state permit this strategy? Unfortunately, state workers compensation laws vary in this regard. You should know: (1) Who chooses the treating physician? (2) What happens if the employee is dissatisfied with the treating physician? (3) May an employer require an exam by its physician? (4) How many additional medical opinions may the employer get? (5) How many additional medical opinions may the employee get? (6) What if the employee refuses to be examined during the claim process?

What Are The Waiting Periods?

Waiting period provisions deal with the length of time permitted under the state workers compensation statute before an injury is recognized as a disability claim. In essence the waiting period acts as a potential deductible and minimizes the regulatory administrative work for small disability claims. Until the waiting period is reached the state law will not obligate the employer to pay workers compensation disability benefits mandated under the law. They still may be obligated to pay medical expenses per state workers compensation law, wages and other benefits per their company policy. Always keep in mind that the waiting period applies only to disability injuries. Medical benefits must always be paid.

Is Temporary Duty, Return-To-Work, Sponsored Under Workers Compensation Law?

Temporary duty programs help the injured employee return to their work activities by providing them with temporary, alternate job tasks that take into consideration the demands of the job, the restrictions outlined by the treating physician, and the employee’s physical capabilities. The goal is to gradually increase the activity level until an optimal level of functioning is obtained (MMI), eventually returning the employee to his or her former job. Here are the critical questions you should answer: (1) Is the implementation of a temporary duty program expressly permitted under workers compensation law? (2) Are there any limitations on the use of temporary duty? (3) What are the potential consequences if the employee refuses an ADA-compliant and medically approved temporary duty position?

What Are The Fraud Provisions?

Detecting and managing fraudulent workers compensation claims is an important cost containment technique. Detection and management of these fraudulent claims can reduce an employer’s workers compensation claim costs. Virtually every state has stringent fraud statutes. While much focus has been given to employee fraud, in fact many states have fraud provisions built into their workers compensation statutes dealing also with employer fraud, attorney fraud, healthcare fraud, and insurance company fraud. Many state websites provide a tremendous amount of information on proper reporting, posters, and other information to help in the administration and application of the statute.

How Can I Use Post-Injury Drug Testing As A Containment Strategy?

State workers compensation laws vary considerably. 14 have workers compensation laws that are decidedly pro-employer. In these states the law generally holds that an employee injured while under the influence of illegal drugs in not entitled to workers compensation benefits. 7 states have workers compensation laws that are anti-employer. In these states injured employees under the influence can still recover workers compensation benefits under certain circumstances. The remaining 29 states are either neutral or silent on the issue, which generally means that the eligibility of workers compensation benefits is entirely dependent on case law and the circumstances surrounding the injury. In all states there is a rapidly growing body of case law on this subject, making the application of risk management techniques extremely difficult and challenging. Also, states vary all over the lot as to whether or not an employer can perform a drug test for reasonable cause during a post-accident investigation. Most are silent on the issue. The same holds true for safety related drug testing programs designed to identify drug users in the workplace and prevent resulting injuries. What this means is that, from the employer perspective, the design and implementation of a drug testing program is a virtual minefield. It is strongly recommended that you understand the worker compensation laws in each state of operation and stay current on any changes that may occur. It is also strongly recommended that you become and stay fully informed of your requirements and obligations under the Family Medical Leave Act (FMLA), the American with Disabilities Act (ADA), and similar federal and state laws. Each has a component that further complicates your disability management process.

CompEraser comes with on-line, on-demand resources needed to CONTROL the temporary duty program, including this important step in the process. Resources also include the formalization of your safety team, injury prevention, OSHA compliance, safety training, prompt injury response, workers compensation disability management, plus more. These resources are available 24/7 and used irrespective of which workers compensation carrier you select. Its patent-pending technology also provides unique financial reports for monitoring the effectiveness of your safety and health program on an on-going basis. For more information visit our website at www.CompEraser.com.

Effective Workers Compensation Disability Management – Assembling The Response Team

Once a formal temporary duty statement has been developed and communicated the next step is to assemble your disability management team. At a bare minimum the following individuals should make up your disability management team:

1.            An Accident Coordinator

2.            Medical provider(s)

3.            Supervisors

4.            Insurance company adjuster(s)

5.            Last but not least, the injured employee

Each has important roles to play in this process and all must be on the same page for the temporary duty program to work effectively.

To effectively manage your workers compensation disability management program it is important to have a single point of contact within your organization. The Accident Coordinator should be this single point of contact. This is a tough and demanding job. Therefore, the Accident Coordinator should be an individual who has a good understanding of the workers compensation system, your organization, and has the skills and authority to act as a liaison between the various members of your disability management team. Typically this individual is someone in an administrative role at the operating level, such as the human resource director, director of personnel, or plant nurse. It is absolutely essential that the Accident Coordinator have the visible support of top management and have access to plant management and senior management whenever it is necessary. Not only do decisions made by the Accident Coordinator have a substantial financial impact upon the organization, production efficiency and employee morale are at stake as well.

If you have not already done so, a panel of medical providers should be established to ensure prompt, quality medical care for your injured employees and to cooperate fully in your temporary duty program. You should develop and use a checklist to evaluate medical providers situated in your local area. It is a good idea to tour their facilities after you have completed each survey. Once you have selected your preferred medical provider(s) it is also strongly recommended that they visit your facilities and so that they can understand the nature of your operation and anticipate the types of injuries that can arise in the normal course of business.

Your supervisors are the backbone of an effective workers compensation disability management program. They can literally make or break the program. For that reason sufficient time must be spend informing and training your supervisors on their role in the process. Each supervisor needs to take responsibility for easing the injured employee back to work. This responsibility includes understanding that the employee is not able to work at full speed and may need to return to temporary duty to build up strength and endurance. The supervisor also needs to be ready to deal with problems when they arise and be willing to reevaluate and modify work assignments in concert with the Accident Coordinator.

It is critical that you have a formal and detailed meeting with the claim adjusters who handle your workers compensation claims. There is not an insurance company around who will not be impressed with a well planned workers compensation disability management program and your commitment to containing costs. You should make this program an integral part of your underwriting submission each year. Depending upon the state of operation and market conditions this could translate into scheduled premium credits and other premium discounts. At the same time you need to review communication procedures with the adjuster(s) so that you are on the same page with them, and vice versa. The fact is that the average workers compensation adjuster today handles twice the case load of their predecessors and is much less experienced. Too often they simply cannot oversee each claim as closely as you can – and this can cost you money in the long run. For this reason, review the entire workers compensation disability management process that you have established and discuss with them how you expect them to communicate with you as they adjudicate each disability claim.

Employee responsibilities should be clearly spelled out in your workers compensation disability management policy. It is each employee’s responsibility to comply with this policy when out on work-related disability. The employee essentially has three areas of responsibility. First, all on-the-job injuries and accidents should be reported to their supervisor immediately, no later than the end of the work shift. They need to understand that this delay may make it difficult to understand the cause of the accident and prevent it reoccurrence. It may also delay the processing of the claim as well. Second, they have very specific instructions in the event they are injured. Third, they are expected to help in trying to prevent the accident from happening again. This will entail filling out the appropriate Accident Investigation form and answering any questions asked of them by their supervisor or the Accident Coordinator.

CompEraser comes with on-line, on-demand resources needed to CONTROL the temporary duty program, including this important step in the process. Resources also include the formalization of your safety team, injury prevention, OSHA compliance, safety training, prompt injury response, workers compensation disability management, plus more. These resources are available 24/7 and used irrespective of which workers compensation carrier you select. Its patent-pending technology also provides unique financial reports for monitoring the effectiveness of your safety and health program on an on-going basis. For more information visit our website at www.CompEraser.com.

How To Implement An Effective Workers Compensation Disability Management Program – Strategy 1 Of 10

In past blogs I had addressed the importance of implementing an effective workers compensation disability management program. These programs are also called temporary duty or return to work programs. Many employers with these programs are reducing lost work-days while helping the injured employee recover both physically and emotionally from a work related injury. Studies have shown that the longer an employee is off work, the more difficult it will be to assist that employee to return to work. These studies also indicate that after an employee has been out of work for one year there is only 25% chance that the injured worker will return to work at all. As a matter of fact, the probably that the employee will return to work begins to drop dramatically after thirty (30) days of disability. Therefore, time is critical, and it is essential to expedite the return to work process in any way possible. Temporary duty, return to work programs are also an excellent way to provide a smooth and gradual return to work while the injured employee progresses into his or her previous job tasks. The programs allow your organization to monitor the injured employee as he or she is recovering from their disability. By establishing a temporary duty program, your organization can be instrumental in motivating injured employees to use the abilities they currently have to perform certain portions of their job descriptions. This provides tremendous benefits to your organization and the injured employee. This blog will be the outline the first of ten in a series of steps your organization can take to implement an effective workers compensation disability management program.

Strategy #1 – Formalize And Communicate Your Workers Compensation Disability Program

The success of your temporary duty program depends on the support and direction from senior management, how well this policy is complies with federal and state employment laws (FMLA, ADA, etc.), and how well it is communicated. A policy statement written and publicized throughout your organization is an effective means of providing guidance and demonstrating this support.

In preparation of the development of your temporary duty policy you should carefully review your employee handbook, disability policy, absentee policy, existing temporary duty policy, collective bargaining agreements (if applicable) and any other policies and procedures that may come into play.

Your temporary duty policy should contain the following components at a minimum:

• It should be in writing;
• It should clearly spell out the responsibilities of the employer and the employee;
• It should clearly indicate that the employee expected to comply with the temporary duty policy, including a requirement that they call the Accident Coordinator on a specified basis and what the disciplinary action will be for non-compliance with the policy;
• It should make it clear that the tasks assigned to the employee are, in fact, temporary. It is strongly recommended the policy state that the temporary work assignment can be terminated when the treating physician has determined that the employee will not be returning to work or when the employee has obtained from the treating physician a release to return to regular work;

Once completed this policy should be included in all of your human resource documents, including your employee handbook and other human resource policy and procedures. In the event this policy is developed during the benefit plan year you should prepare addendum to your handbooks and give each employee a copy. Since this is such an important policy you may also want to consider reviewing this at employee meetings, safety committee meetings, and any other formal employee meetings. Also, a formal announcement should be included in your company newsletter and similar internal publications. In short, use any and all means at your disposal to announce and communicate your temporary duty policy.

If you are bound by collective bargaining agreements you should present this policy to the union leadership as well. It is extremely important to get their buy-in and support of this policy up front.

Finally, management should also announce this policy statement to the employees so that they full understand that it is sponsored by senior management.

CompEraser comes with on-line, on-demand resources needed to CONTROL the temporary duty program, including this important step in the process. Resources also include the formalization of your safety team, injury prevention, OSHA compliance, safety training, prompt injury response, workers compensation disability management, plus more. These resources are available 24/7 and used irrespective of which workers compensation carrier you select. Its patent-pending technology also provides unique financial reports for monitoring the effectiveness of your safety and health program on an on-going basis. For more information visit our website at www.CompEraser.com.

Injury Prevention In Tough Economic Times

In talking to many companies in many industries across America over the last six months there is one message that is consistent: “In these difficult economic times we must find ways of cutting costs.” Unfortunately many organizations have taken this to mean that cutting back on injury prevention efforts, or even laying off safety personnel, is the way to go. While I concede this will save money in the short term, in reality this decision may actually drive up costs.

While I could give you a long list of “boiler plate” reasons why safety is important to your organization, I am quite certain you have read this before and, in all probability, embrace sound safety practices in your organization. But what I am going to give you is one reason that, in my opinion, underlines all others. It has to do with maintaining trust within your organization.

Like you, employees are extremely afraid and insecure right now. They read the newspapers and all the doom and gloom. So when they come into work probably the thought that is foremost on their minds is: “Is my job secure?” They are constantly looking at the “little signs” within your organization to determine if it is or not. Are there layoffs? How are people being treated? Are we keeping customers? Are we getting new orders?

Safety plays a key role in how your employees answer these questions. While most do not blame you for these difficult economic times, they will get concerned if they see your organization cutting back efforts to prevent injuries. This particularly hits home if your employees are asked to work harder with less.

Visibly reducing your injury prevention efforts directly underlines the trust you have earned with your employees. Once this “cancer” takes hold it will completely erase all the hard work and money you have invested. The frequency of injuries will rise and with this will be an increase in injury severity. This, in turn, impacts productivity, insurance premiums, and employee morale.

In these tough economic times your organization should completely re-evaluate its injury prevention program and identify cost effective ways of preventing injuries. Successful organizations find that by redeploying their scarce safety resources they can still maintain an effective safety program and maintain the trust that is so vitally needed today.

CompEraser’s resources also include the formalization of your safety team, injury prevention, safety training, workers compensation disability management, plus more. These resources are available 24/7 and used irrespective of which workers compensation carrier you select. Its patent-pending technology also provides unique financial reports for monitoring the effectiveness of your safety and health program on an on-going basis. For more information visit our website at www.CompEraser.com.

Determining Initial Compensability Can Avoid Countless Workers Compensation Claim Problems

I have no idea where the idea that “the adjuster” determines compensability” came from…but it is dead wrong. The employer also has a vital rule in this process. Unfortunately many employers fail to properly evaluate the facts surrounding a worker injury from the perspective of compensability. Part of the reason is that the process itself often seems confusing. However, as you will see, the process is straightforward and is uniform in every state jurisdiction. I concede that the adjuster has the final say in most cases, but they rely completely upon information received. If all they rely upon is information from the injured employee and the treating physician, without vital input from your safety team, more often than not problems may ensue. And remember, in most state jurisdictions, one the adjuster pays $1 of compensation benefits your organization is on the claim 100%. Therefore, the Claim Coordinator, with the help of others on the claim management team, must not leave anything to chance.

While the claim adjuster will have a significant role in establishing compensability, from a CONTROL perspective the claim management team must take into account all the information it has gathered through its prompt injury response program to make its initial assessment. The Claim Coordinator should still report the incident to the claim adjuster for discussion and agreement. However, as part of the report the Claim Coordinator should submit all facts that support a denial of the injury under workers compensation law. As a brief overview, the diagram below depicts the systematic steps that should be used in determining initial workers compensation compensability.

Is the Injured Person A “Covered Employee”

Workers compensation law specifically identifies those employee groups that are covered under the act and those that are not. Always keep in mind that although these exempt employees may not be entitled to workers compensation benefits under the act, they still may sue for damages caused by the employer’s negligence. Also, there are individuals who may not be considered “covered employee’s” under certain circumstances. Chapter 8 will discuss these examples in more detail.

Did The Employee Suffer An Injury Or Illness?

This is a medical question. However, what many employers fail to realize is that just because an employee suffered an injury or illness does this not necessarily mean that it is compensable under workers compensation statute. In short, determining compensability is not the responsibility of the treating physician.

The treating physician’s job is to provide prompt, quality medical care and determine the extent of the injury or illness. During this process they naturally will interview the injured employee to determine, in the employee’s opinion, what happened to cause the injury. However, the treating physician should focus on treatment and diagnosis at this stage and communicate this information directly to the Claim Coordinator. Ideally the treating physician should be required to provide the employer with detailed information on his or her diagnosis. The employer then should initially determine the compensability of the injury based upon the facts determined by the incident investigation.

If the Claim Coordinator challenges the results of the physician’s diagnosis then he or she should provide the physician with specific information on the work being performed at the time of the injury, the facts surrounding the alleged incident, and any other reasons for questioning the claim. Because determining whether the injury is a medical question, rarely is it challenged on its face. However, as will be discussed shortly, whether the injury is work related is often contested. They also have the option of obtaining an independent medical examination.

Did The Injury Arise In The Course Of Employment?

Employees are presumed to be in the course of their employment from the time they arrive at work until they leave. As a general rule the employee’s injury is viewed as being sustained “in the course of employment” unless the employer has clear and substantial facts to the contrary. In short, this criterion is a timing issue to a large extent; i.e., was the employee at work or not. While the answer to this question may see very clear-cut, there is one area where this normally easy criterion can be quite difficult to determine.

This involves what is called a “significant deviation” from work. A “significant deviation” is one that takes the employee out of the course he or she would follow to further the employer’s business. Each state has a wealth of case law on this subject and it is recommended that it be studied before jumping to conclusions. If the employee is traveling they are presumed to be in the course of their employment from the time they leave home until they return. This presumption can often be refuted by showing that the employee made a “significant deviation” from employment. This will often entail careful investigation by the employer and could also involve the retention of a private investigator.

As a general rule, minor deviations such as a driver stopping in a coffee shop for lunch are not significant and would not take an employee out of the course of employment. However, stopping at a tavern might be a significant deviation. There have been many litigated cases involving employees who made a diversion from their business. Often, this leads to vehicle accidents or other injuries. Depending on the specific circumstances, these cases are often viewed as “significant deviation” from employment.

Did The Injury Arise Out Of Employment?

“Out of employment” means the injury or illness occurred at work and was caused or aggravated by some risk or exposure peculiar to the employment. This criterion is routinely determined based upon the facts surrounding the injury as part of the accident investigation process. Always keep in mind that an injury cannot arise out of employment unless it occurs in the course of employment. However, injuries occurring in the course of employment do not automatically arise out of the course of employment. Determining if an injury arose out of employment requires looking at the nature of the risk that resulted in the injury.

In many cases the injured employee will allege that the injury was caused while at work and arising out of a hazard associated with his or her work. In short, they will attempt to force an otherwise non-compensable injury into the workers compensation system. That is why it is essential that the employer carefully investigate each claim to fully understand the cause of the injury and the hazards associated with it.

As an example, if a worker injury arises from an employment risk, such as an unguarded machine or a slipper floor, it clearly arises out of employment. An injury related to personal risk, such as hereditary heart diseases, normally does not arise out of employment, even if it first becomes symptomatic in the course of employment. That being said, many states now regard stress-related claims to be compensable in specific cases. Therefore, it is important that the Claim Coordinator carefully review the case law on this subject before jumping to conclusions.

CompEraser’s resources include the formalization of your safety team, injury prevention, safety training, workers compensation disability management, plus more. These resources are available 24/7 and used irrespective of which workers compensation carrier you select. Its patent-pending technology also provides unique financial reports for monitoring the effectiveness of your safety and health program on an on-going basis. For more information visit our website at www.CompEraser.com.

Beating The Waiting Period Time Clock Is A Key To Workers Compensation Cost Reduction

Waiting period provisions deal with the length of time permitted under the state workers compensation statute before an injury is recognized as a disability claim. In essence the waiting period acts as a potential deductible and minimizes the regulatory administrative work for small disability claims. Until the waiting period is reached the state law will not obligate the employer to pay workers compensation disability benefits mandated under the law. They still may be obligated to pay medical expenses per state workers compensation law, wages and other benefits per their company policy. A graphical description of the waiting period is shown below.

Always keep in mind that the waiting period applies only to disability injuries. Medical benefits must always be paid. Also, states vary as to whether the benefits are retroactive once the waiting period is exceeded. For example, let’s assume that Company A is in a state with no retrospective provision and Company B is in a state with a retrospective provision. Each company has experienced a worker injury with five days of disability. In this example, Company A will generally pay for the wages expenses out of payroll or file a claim under its short term disability insurance policy for the first three days and then file for workers compensation benefits for the remaining two days. In this case the waiting period provision acted like a deductible.

Company B had a different experience. Because it had a retroactive feature embedded in waiting period provision, and because the claim exceeded the three day waiting period, it would file the entire five day disability as a workers compensation claim. In short, where the waiting period is exceeded disability benefits start as of the first day after the injury. On the other hand, if the injury for Company B had been only 2 days it still would fall within the waiting period provision.

Now why is this important from a workers compensation cost reduction perspective? First, by getting the injured employee back to work prior to the expiration of the waiting period will avoid workers compensation disability payments. In short, the claim remains a medical only claim. Successfully implementing this strategy can reduce your workers compensation claim costs by 40% or more. Second, because the employee is back to work on some basis your organization has better control over the claim, can better monitor the injured employee’s status, and can gain some level of productivity otherwise lost. Third, because the claim is now a medical only claim your workers compensation experience modification is vastly improved. Only 30% of a medical only claim goes into the experience rating formula. On the other hand, 100% of a disability claim goes into the formula.

CompEraser’s resources also include the formalization of your safety team, injury prevention, safety training, workers compensation disability management, plus more. These resources are available 24/7 and used irrespective of which workers compensation carrier you select. Its patent-pending technology also provides unique financial reports for monitoring the effectiveness of your safety and health program on an on-going basis. For more information visit our website at www.CompEraser.com.

CompEraser Announces New Premium Overcharge Recovery Service That Will Dramatically Reduce Your Workers Compensation Premiums

Can this happen to you? Bob arrived at the office at his usual early time in the hopes of preparing for his 10:00 meeting with the premium auditor from his insurance company. Unfortunately, he was asked to attend an impromptu inventory control meeting. To make matters worse, the auditor was an hour late.

The meeting with the premium auditor took no more than 30 minutes. Fortunately for Bob, the information that the auditor requested was readily available from accounting records. The auditor went on his way, hurrying to the next of what would be five premium audits that day.

Two months later Bob received an invoice in the mail from his agent in the amount of $57,500 additional premium due, all the result of the premium audit. His agent indicated that he “had reviewed the audit” and everything appeared to be in order.

What Bob did not know is that the payroll used for audit purposes had clerical and other technical errors. Also, the payroll and sales figures were assigned to the wrong classification codes as well. The sum total of these errors accounted for $25,000 of the $57,500 premium audit. He also did not know that he would be able to go back and review his past audits and recovery additional premium overcharges.

Bob had no way of knowing the cause of these errors, but his gut told him that the bill was too high and “things did not add up.” Bob approached his insurance agent for help, expecting that this would be an easy issue to correct. Unfortunately, the agent was not trained in auditing procedures and was unable to secure a correction from his insurance carrier. Bob had no other choice but to reluctantly pay the premium audit bill or face cancellation of his current policy.

The inside scoop is that many insurance companies, in an attempt to reduce costs through staff cuts and consolidations, have established parameters limiting the time an auditor can spend working with customers to identify premium reduction factors (premium overtime, severance pay, third party sick pay, etc.). And the experience level of auditors in general has been steadily decreasing as well. Making matters worse, insurance companies have downsized and consolidated. As a result, the underwriting and auditing functions are increasingly being performed by professionals with less and less experience and training in the technical aspects of premium development. To compound the problem further, the very people who are asked to perform your premium audits are expected to do as many audits in a day as possible - it is now quantity, not quality, that counts.

As a result, many companies have been and will continue to pay overcharges for their workers compensation insurance program. Over time the cost of these errors can be enormous. What has consistently bothered me as a risk management professional is that the rating mechanism that is used to calculate your insurance premiums, and upon which your premium bills and audits are based, is extremely complex and hidden from view.

This has translated into a situation where a tremendous number of errors may occur in the calculation of your insurance premiums – and your company is being asked to pay for the mistakes! It has been my experience that the cause of these premium overpayments can vary from simple clerical errors up to and including gross misinterpretation of rating manuals and regulations. They affect multiple policy years - both past policies as well as future policies. These errors impact not only the audit bill. They also impact your workers compensation experience modification. How often to these errors occur? Over 60% of the time.

To help employers identify and recover these premium audit errors CompEraser has entered into an agreement with Reynolds Consulting Group. This organization is routinely finding premium audit errors using their exclusive two step process. They do all the work and provide total transparency in all their activities. Their fees are 50% below other premium audit firms and they work twice as fast. For more information please contact us at info@comperaser.com. We will send you our Special Report titled “Seven Steps You Can Take To Uncover and Recover Insurance Premium Overpayments”

CompEraser’s resources also include the formalization of your safety team, injury prevention, safety training, workers compensation disability management, plus more. These resources are available 24/7 and used irrespective of which workers compensation carrier you select. Its patent-pending technology also provides unique financial reports for monitoring the effectiveness of your safety and health program on an on-going basis. For more information visit our website at www.CompEraser.com.

Employer Control Is The key To Workers Compensation Disability Management

Your organization must take control of its workers compensation claim process from date of injury to closure. Otherwise it will fall prey to the perceived “unholy alliance” created by the various “systems” used by the doctors, lawyers, claim adjusters and regulatory authorities, and you will pick up the tab. At the core of your workers compensation disability management process should be three initiatives that must be implemented immediately after a worker injury occurs:

First, prompt injury response. This initiative is designed to provide prompt, quality medical care to the injured employee, explain the workers compensation system and what the injured employee can expect through the process, establish a comfortable communication flow between the injured employee and the Claim Coordinator (rather than with an attorney), establish a communication flow between the Claim Coordinator and the healthcare provider, investigate and determine the “root cause” of the injury, and promptly report the injury to the claim adjuster. If implemented properly your Prompt Injury Response system will get the workers compensation claim off on the right track, reduce the employee’s need for an attorney, and minimize future problems.

Second, perform an initial compensability test BEFORE the claim is submitted to the adjuster. Many state and federal workers compensation laws provide a degree of protection to the employer in certain situations including employees injured while under the influence of illegal drugs or alcohol, facts that prove that the employee was not actually injured on the job at all, and medical treatments that do not relate to the injury itself. In addition, the workers compensation claim management team may uncover subrogation possibilities that can mitigate the ultimate cost of the injury.

Third, offer medically approved temporary duty. In those situations where the employee was disabled and unable to return to work, it is critical that the claim management team find medically approved work that can be offered. This initiative should include ADA-compliant, Temporary Duty return to work programs that will help the claim management team quickly identify temporary duty jobs, obtain medical approval of these tasks based upon the injured employee’s work capacity, make the formal offer to the injured employee, and respond proactively to the employee’s decision to accept or reject the temporary duty offer.

Employer control over its workers compensation disability management process will dramatically reduce both insured and indirect workers compensation costs. The Resource Library within the CompEraser system is loaded with all the tools, forms and checklists you must have to control each workers compensation claim from beginning to closure. Resources also include the formalization of your safety team, injury prevention, safety training, workers compensation disability management, plus more. These resources are available 24/7 and used irrespective of which workers compensation carrier you select. Its patent-pending technology also provides unique financial reports for monitoring the effectiveness of your safety and health program on an on-going basis. For more information visit our website at www.CompEraser.com.

Compliance Or Defiance – You Snooze You Lose

Closely tied to the reduction in workers compensation costs is the need to comply with the myriad of state and federal laws that impact the workers compensation claim management process. This is an extremely challenging and constantly evolving task for all claim management team members. For that reason a Human Resource Compliance Officer should be assigned to the claim management team, as well a legal advisor, to assist in this important area. The following are just a few of the laws that you confront every day:

• The applicable state workers compensation act;
• Key federal workers compensation and employer liability laws;
• International workers compensation law;
• The Family Medical Leave Act (FMLA);
• The American With Disabilities Act (ADA);
• Health Insurance Portability and Accountability Act of 1996 (HIPAA);
• State and federal laws affecting the use of illegal drugs and alcohol in the workplace;
• Workers compensation fraud statutes;
• Privacy laws;
• Laws addressing the use of illegal use of drugs in the workplace;
• OSHA recordkeeping requirements, including the OSHA log.

These laws and regulations are actually on the tip of the iceberg when it comes to human resource compliance and they are extremely challenging to apply in worker injury situations. If implemented properly, however, they actually provide a solid basis for the claim management team to control key aspects of the claim process. If performed improperly or inconsistently, however, they may result in fines and penalties for both the organization and the members of the claim management team personally.

The Resource Library within the CompEraser system is loaded with all the tools, forms and checklists you must have to comply with the myriad of state and federal human resource laws and OSHA regulations. Resources also include the formalization of your safety team, injury prevention, safety training, workers compensation disability management, plus more. These resources are available 24/7 and used irrespective of which workers compensation carrier you select. Its patent-pending technology also provides unique financial reports for monitoring the effectiveness of your safety and health program on an on-going basis. For more information visit our website at www.CompEraser.com.

Consistency Is The Key Workers Compensation Claim Management

Every activity related to the administration and management of a worker injury should be performed in a consistent manner. If this is not done at least two outcomes may result, and both are bad:

• Employees will view the workers compensation claim management process to be unfair, unreliable and threatening. As a result, they will be hesitant to participate in the accident investigation process, perform their role in the Prompt Injury Response and Temporary Return To Work Programs, and may retain an attorney.
• Actions on the part of the organization, as well as individual members of the claim management team, may be deemed discriminatory. Also, there are potentially severe fines and civil penalties associated with this discrimination.

The following are proven methods that your claim management team should use consistently in accordance with its claim management policies and in strict compliance with state and federal employment laws:

1.   A Prompt Injury Response Program designed to be delivered consistently every time an employee is injured on the job. While the nature of virtually every injury is different, the way in which the claim management team responds to it should be the same. This program should provide a prompt injury response “track” that designed to put the entire claim management team in motion so that the employee receives prompt, quality medical care, the “root cause” of the injury is determined, compensability is established, the claim adjuster is promptly notified and, if needed, initial steps are taken to initiate the Temporary Return To Work Program.

2.   A Temporary Return To Work Program designed identify possible temporary duty jobs, obtain formal approval from the treating physician that these jobs match the injured employees physician limitations, and formally offer these jobs. All must be done in strict compliance with the American With Disabilities Act (ADA). Temporary Return To Work Programs are an essential component in a successful workers compensation claim management program.

The Resource Library within the CompEraser system is loaded with all the tools, forms and checklists you must have to consistently implement Prompt Injury Response and Temporary Return To Work Programs. Resources also include the formalization of your safety team, injury prevention, safety training, workers compensation disability management, plus more. These resources are available 24/7 and used irrespective of which workers compensation carrier you select. Its patent-pending technology also provides unique financial reports for monitoring the effectiveness of your safety and health program on an on-going basis. For more information visit our website at www.CompEraser.com.

Failing To Communicate Throughout The Workers Compensation Claim Process Will Drive Up Costs

It has been often said that “big doors swing on small hinges.” When it comes to workers compensation cost reduction the “big door” is “huge cost” and the “small hinge” is “communication.” It is absolutely essential that your claim management team communicate with the injured employee, healthcare providers, claim adjusters, and attorneys early and often throughout the claim process. Otherwise their “systems” will control them. This communication should be provided both in verbal and written form and well documented. And, because this communication will be performed by many members of the claim management team, it is essential that the team members communicate effectively with each other as well.

Here are proven communication techniques that work effectively:

1. Formalize and communicate your claim management policy. The organization must develop and communicate claim management procedures and policy. Claim management policy establishes the ground rules for everyone in the organization to follow in the event an employee is hurt on the job. These policies must be fully understood by all members of the claim management team so that infractions are accurately identified and proper action is taken in accordance with organizational policy.

2. Explain the claim process to the injured employee. Successful organizations are proactively communicating with their injured workers throughout the claim management process. This starts the very first day the employee is injured and includes an explanation of what they can expect from the claim process, how their medical bills are going to be paid, and who they can contact for questions.

3. Establish claim procedures with the claim adjuster. It is critical that the claim management team have a formal and detailed meeting with the claim adjuster(s) who will handle the organization’s workers compensation claims. At this meeting the claim management team should review communication procedures with insurance company adjusters so that everyone is on the same page. It is also important to review the organization’s entire claim management process with the claim adjuster and discuss how the organization expects them to communicate with members of the claim management team as they adjudicate each type of claim. In this regard, it is important that the claim management team work with the insurance company to write “Claim Service Directives” that are consistent with mutual expectations.

4. Establish prompt response procedures with the treating physician. The first 48-hours after a worker injury are critical and the healthcare facility has a vital role in it. It is recommended that the organization’s Prompt Injury Response Program be discussed in detail with the treating physician so that everyone is on the same page. If the claim management team senses that the healthcare provider wants total control over the claim process this should be a sign of future problems. It is also recommended that the claim management team discuss the fact that the organization offers a Temporary Duty Program in full compliance with state and federal laws and that it expects all medical providers to fully support the organization in its effort to identify and assign these temporary tasks where medically permissible.

5. Always have on-going communication with the injured employee. The claim management team must stay in constant contact with the injured employee from the date of injury until they are released to come back to work. The injured employee must communicate with the Claim Coordinator at least on a weekly basis and the Supervisor must be in periodic contact with the injured employee as well.

These techniques will significantly reduce both the direct and indirect workers compensation costs, improve your overall workers compensation claim management program, and improve workers compensation disability management.

The Resource Library within the CompEraser system is loaded with all the tools, forms and checklists you must have to successfully communicate with your injured employees. Resources also include the formalization of your safety team, injury prevention, safety training, workers compensation disability management, plus more. These resources are available 24/7 and used irrespective of which workers compensation carrier you select. Its patent-pending technology also provides unique financial reports for monitoring the effectiveness of your safety and health program on an on-going basis. For more information visit our website at www.CompEraser.com.

Beware: The Lack Of Compassion Always Raises The Cost Of Worker Injuries

It is often stated that the employer’s most valuable asset is its employees. Most employers invest thousands of dollars selecting and training employees. They also spend thousands of dollars on employee benefit programs and work conditions in order to minimize employee turnover. At the heart of this effort is the development of a positive, trusting, productive relationship between the employer and employee. A work-related injury is, among other things, a major test of this relationship. If the organization fails to show compassion, fails to provide prompt, quality medical care, or treats the employee in a judgmental way this relationship may be destroyed. To make matters worse, employees talk and the word will spread throughout the organization.

Ultimately reducing the total cost of worker injures is all about winning the hearts and minds of employees. Only by sharing the same organizational values and demonstrating these values throughout the pre-injury and post-injury stages of the worker injury can this be accomplished over the long term. As an example, the following are the suggested guidelines for performing the accident investigation with compassion:

1. Treat the employee like you would like to be treated. The “Golden Rule” will serve you well. Anytime you are unsure of what to do or how to do something, just ask yourself “How would I like to be treated in this situation?” More often than not the employee feels the exact same way.

2. Show concern. It is very important to show sincere concern for the employee’s injury, no matter how minor it is. Always take care of the employee’s injury first, and then begin the interview.

3. Put the employee at ease. Use a friendly approach in dealing with the employee. Avoid sarcasm, blame, and threats. Use tact in clearing up any discrepancies in the employee’s story.

4. Explain why the incident investigation is necessary. Emphasize that fact-gathering and prevention is the organization’s objective and not faultfinding. Convey that the organization is sincerely trying to find out what happened and what can be done to prevent it from happening again.

5. Listen carefully. Get the injured employee’s story first before asking questions. Be sure to listen very carefully and avoid interrupting the employee.

6. Avoid “why” questions. Ask any necessary questions that you feel are appropriate but void any “Why” questions as they tend to make the employee defensive. While asking a “Why” question is part of the “root cause analysis” process, it should not be used during the employer interview process as it will only make the employee feel uncomfortable and resist answers.

7. Always repeat your understanding of the story. It is very important that, after listening to the employee, that the investigator repeat exactly what he or she understood the employee to say. This verifies that the investigator has understood what was said and allows the employee the chance to correct the story if necessary. If there are still misunderstandings, the investigator should take the time to correct the misunderstandings to both party’s satisfaction.

8. Always ask the employee for suggestions. Employees are an excellent source of safety suggestions. Up until the injury occurred the employee was probably thinking: “This will never happen to me” - but it did. Take the time to discuss ways to prevent the reoccurrence of the situation. This may also be an excellent training opportunity.

These techniques will significantly reduce both the direct and indirect workers compensation costs, improve your overall workers compensation claim management program, and improve workers compensation disability management.

The Resource Library within the CompEraser system is loaded with all the tools, forms and checklists you must have to successfully show genuine compassion to your injured employees. Resources also include the formalization of your safety team, injury prevention, safety training, workers compensation disability management, plus more. These resources are available 24/7 and used irrespective of which workers compensation carrier you select. Its patent-pending technology also provides unique financial reports for monitoring the effectiveness of your safety and health program on an on-going basis. For more information visit our website at www.CompEraser.com.

Best Practice Step #1 To Preventing Workers Compensation Premium Overcharges – Use Correct Classification Codes

To rate your workers compensation policy the insurance industry uses classification codes that are similar to the Standard Industry Classification (SIC) and NAICCS codes developed by the government.  Each classification code has its own corresponding rate that is multiplied by the payroll (per $100) associated with the operations included in the code.

You will want to use the code(s) with the lowest rate(s) and your underwriter will want to opt for the code(s) with the highest rates. To make things even more difficult, some operations are easy to classify because there is only one “governing code,” and others are very difficult because numerous codes may apply. For example, over 60 classifications might apply to construction operations. As you might imagine, there frequently is a wide disparity between rates for the classification codes that may apply to your operation. Therefore, it is very important that you and your agent carefully review your operations each year and verify that the proper classification code is being used.

With proper documentation it is possible to correct your workers compensation classifications. You can even go back 2 or more years and recover past premium overcharges and then correct your workers compensation experience modification as well. Depending upon the size of the errors and resulting overcharges this could result in a sizable premium reduction to your organization.

CompEraser provides premium audit recovery services for organizations who feel there past workers compensation audits, classifications, or experience modifications are incorrect. For more information please email us as info@comperaser.com.

Also, you can benchmark your premium audit practices, plus many others, using CompEraser’s exclusive, on-line safety benchmark survey. You can select any or all of 12 different categories. A summary report is provided immediately on-line. Visit our website at www.CompEraser.com. Resources also include the formalization of your safety team, injury prevention, OSHA compliance, safety training, prompt injury response, workers compensation disability management, plus more. These resources are available 24/7 and used irrespective of which workers compensation carrier you select. Its patent-pending technology also provides unique financial reports for monitoring the effectiveness of your safety and health program on an on-going basis.

Beware: Over 60% Of Workers Compensation Policies Have Costly Rating Errors. What About Yours?

The calculation of your workers compensation premium is more than merely multiplying estimated payroll numbers by rates. Believe it or not, over 60% of the time your workers compensation is issued incorrectly, resulting in substantial overcharges. It has been our experience that four reasons why these errors exist.

First, there are errors made in the initial classification of your business. Your workers compensation rates are based upon classification codes that, in turn, are determined by the insurance industry. The rules and regulations regarding the assignment of classification codes are very complex. To make matters worse, as your operation changes your classification code may change as well. Because most insurance agents are not trained in the art of understanding this web of regulations, many workers compensation policies are misclassified, resulting in premium surcharges.

Second, there are countless errors in the calculation of your experience modification. Probably the most confusing aspect of workers compensation rating is the experience modification factor. Behind this factor, which has a direct impact on your insurance premiums, is a myriad of calculations that are based upon your loss experience, classification codes, audited payrolls, just to name a few. To make things worse, an error in your experience modification stays with you for three years!!

Third, there are errors in the determination of your audit premium. Unfortunately, many insurance company premium auditors are under tremendous pressure to audit as many insureds as possible. On top of that they are poorly trained in the nuances of the workers compensation audit manual. As a result, payrolls are often reported incorrectly. They either are overstated, not limited by legitimate audit rules, or misclassified. Either way you pick up the tab.

Finally, the entire system is based upon a method of reporting data that almost guarantees mistakes. There are many reasons for this. First is simply the “human element” – people making mistakes. Then there is the “garbage in – garbage out” scenario. On top of that there are timing issues with reporting the data to the bureau that calculates the experience modification, and NO ONE IS PERFORMING A QUALITY CONTROL CHECK!! Over the next two weeks I will be providing nine “best practice” suggestions to avoid these premium overcharges.

CompEraser provides premium audit recovery services for organizations who feel there past workers compensation audits, classifications, or experience modifications are incorrect. For more information please email us as info@comperaser.com.

Also, you can benchmark your premium audit practices, plus many others, using CompEraser’s exclusive, on-line safety benchmark survey. You can select any or all of 12 different categories. A summary report is provided immediately on-line. Visit our website at www.CompEraser.com. Resources also include the formalization of your safety team, injury prevention, OSHA compliance, safety training, prompt injury response, workers compensation disability management, plus more. These resources are available 24/7 and used irrespective of which workers compensation carrier you select. Its patent-pending technology also provides unique financial reports for monitoring the effectiveness of your safety and health program on an on-going basis.

Six (6) Situations When Safety Awareness Programs May Be An Answer To Your Safety Problems

Do you have a safety awareness program in place that effectively promotes and rewards safe behavior?

It is critical that your organization evaluate the employee’s acceptance of its safety culture. This inevitability will be reflected in the number of unsafe acts and other unsafe behaviors committed by employees. One of the incredibly frustrating aspects of coordinating injury prevention programs is that “on paper” the program, with its rules, procedures, methods, etc., is functioning properly and yet the company may still be experiencing worker injuries. In fact, it may be possible for the frequency of claims to decrease over an initial period of time and the average cost of workers compensation claims to actually increase. Injury prevention programs that focus on employee attitudes and thinking are a having dramatic, long-term effect on the employee behavior and, in the process, are successfully reducing both the frequency of injury and the average cost of worker injury claims.

The following are recurring problems that can be effectively addressed with the proper implementation of a safety incentive program. First is the persistence of unsafe acts. According to the National Safety Council, only 80-85% of work-related injuries are due to unsafe work conditions. The remainder of work-related injuries is due to unsafe acts. Literally employees are the biggest hazard to their own safety and health. Safety incentive programs, if properly designed, will greatly reduce workplace injuries that are due to unsafe acts.

Second is continued difficulty in motivating a few “uncooperative” employees. As the safety and health team evaluates the effects of the organization’s safety effort it may find that the program has had general success but that there still remain a handful of employees who are resisting the program. Again according to the National Safety Council, approximately 80% of workers compensation claims involve only 15% of the workforce. Peer pressure, created by a properly designed safety incentive program, can greatly motivate those uncooperative employees to work in a safe manner. The program is actually using the “safety culture” to motivate those few uncooperative employees to change their attitudes and habits regarding safety – or leave on their own accord.

Third is unacceptable number or length of lost-time injuries. As the safety and health team evaluates and monitors lost-time claims it may begin to notice a trend towards employees staying off the job more than medically necessary. According to insurance industry statistics, the average injured worker remains off the job three (3) to four (4) times longer than medically necessary. In 90% of job-related injuries, recovery and return-to-work can occur within a few working days. A properly designed safety incentive program can have consequences for such behavior, again through the strength of the “safety culture.”

Fourth are continued problems with claim fraud. According to insurance industry statistics, 20-35% of all workers compensation claims are either fraudulent or exaggerated, in whole or in part. Upon reviewing the organization’s prior claim history and employee practices the safety and health team may determine that there is a problem in this area. Employees usually know who is taking advantage of the system. Such fraudulent behavior, if not addressed, will become a “behavioral norm” in the company. A properly designed safety incentive program will dramatically reduce fraudulent claims.

Fifth is when there is a need to give safe performance a “pat on the back.” For those organizations that have an excellent safety record and wish to keep it that way a safety incentive program is a good way to reward safe work habits and awareness. Also, a safety incentive program can keep the safety and health program fresh and interesting.

Sixth, when there is a need to reinforce other safety and health initiatives. It is important to remember that attitudes motivate behavior. A safety incentive program, if properly integrated into other safety activities, will greatly heighten safety awareness and, as a result, motivate employee behavior in the direction the safety and health team wants it to go.

If the organization has implemented all the basic components of a safety program and has determined that one or more of the above exists, then there probably is a strong need to consider some sort of safety incentive program.

Now you can benchmark your response to this question, plus many others, using CompEraser’s exclusive, on-line safety benchmark survey. You can select any or all of 12 different categories. A summary report is provided immediately on-line. Visit our website at www.CompEraser.com. Resources also include the formalization of your safety team, injury prevention, OSHA compliance, safety training, prompt injury response, workers compensation disability management, plus more. These resources are available 24/7 and used irrespective of which workers compensation carrier you select. Its patent-pending technology also provides unique financial reports for monitoring the effectiveness of your safety and health program on an on-going basis.

There Is Many A Slip Between The Cup And The Lip – And It Can Drive Your Workers Compensation Costs Through The Roof

OK, you have done a great job identifying temporary duty jobs to offer to your injured employee. You make the offer to the employee but find out that they employee starts doctor shopping. Then you have to wait, work with the new physician, and possibly make another offer for temporary duty. All this takes time, costs money, and is frustrating. What is missing?

To answer this question you should ask yourself: “Are we getting written acceptance from the treating physician of our temporary duty offer?” If the is “NO” then you are opening yourself up to problems and losing CONTROL of the temporary duty process. It is critical that once the temporary duty jobs have been identified they be submitted to the treating physician for review and written approval. This is a step that many organizations overlook. Many organizations find that a failure to secure this written release has three potentially serious ramifications:

The FMLA leave cannot be legally terminated. The employer may require that the employee provide medical certification that, among other things, “stipulates the probably duration of the condition.” Unless the employer can rightly intervene the employee, once on FMLA leave, can remain in this status until FMLA benefits are exhausted. By securing the medical release the treating physician is essentially stating that the “duration of the condition” has ended and the employer can so notify the employee.

The organization is in seriously weakened position before the workers compensation regulatory commission. Most jurisdictions require that there be medical support for the release of the employee to return to work. Also, if the injured employee has retained an employee they will probably seek out another opinion. Naturally this opinion will state that the employee cannot come back to work. However, armed with a bona fide, good faith temporary duty offer supported by the treating physician the organization’s position is greatly strengthened.

Confusion may drive the injury to an injury. One of the main objectives of the Prompt Response Program was to put the injured employee at ease and convey genuine concern for their welfare so they do not see the benefit in retaining an attorney. The workers compensation claim process is foreign to them and, at this stage of the process, an offer to return to work in temporary status may appear to be a demand. If not handled correctly this may drive the injured employee toward an attorney. On the other hand, if their treating physician has approved the temporary duty position the injured employee will be far more willing to accept it and return to work in most cases.

For these reasons, securing from the treating physician their written acceptance of the proposed temporary duty position is critical. It may take a little time but it is time well spent. You remain in CONTROL, the employee will return to work in a temporary duty capacity faster, and the total cost of workers compensation will be significantly reduced.

CompEraser comes with on-line, on-demand resources needed to CONTROL the temporary duty program, including this important step in the process. Resources also include the formalization of your safety team, injury prevention, OSHA compliance, safety training, prompt injury response, workers compensation disability management, plus more. These resources are available 24/7 and used irrespective of which workers compensation carrier you select. Its patent-pending technology also provides unique financial reports for monitoring the effectiveness of your safety and health program on an on-going basis. For more information visit our website at www.CompEraser.com.