Archives for September 2010

Are Death Benefits Payable In WC?

September 30, 2010 By JL Risk Management Consultants

Term Of The Day-Death Benefits

Death benefits are a very important part of a claim where the employee expired due to an on-the-job-injury.

Icon People Crushed Sack of Money Death Benefits Claim

123RF

Under Workers Compensation, benefits are paid to the spouses and dependents of a worker who dies as the result of a work related injury or illness. Dependents are normally deemed to be those surviving spouses and natural children who were part of the worker’s household at the time of death. Children and spouses who were not part of the workers household at the time of death must prove actual dependency.

Dependent children remain so until the age of 18, or 23 if a full time student. Further benefits may be available for a child who is physically or mentally disabled.

©J&L Risk Management Inc Copyright Notice

Federalization Of Workers Comp Takes Another Step

September 29, 2010 By JL Risk Management Consultants

Workers Comp Takes Another Step Toward Federalization

All Workers Comp takes another step towards being a federalized. Check out the Want Ad for the Federal Insurance Office Director Job. According to the NY Times, a new job was posted that indicates the seriousness of establishing the Federal Insurance Office. The new position posted was a Federal Insurance Director.

Picture of workers comp takes another step On Sand

Wikimedia

Wanted: One federal insurance director. Must be an expert in the vagaries of insurance regulation, understand financial markets and have proven leadership abilities. Should be able to work well with the Secretary of the Treasury. Relocation to Washington, D.C., required.

I am not inferring that this person would ever interface that much with Workers Compensation. However, we all must remember that all Workers Comp insurance data must be turned over to the CMS by January 2011. Would the Federal Insurance Office decided to examine this warehouse of data at their fingertips? I will leave that to everyone’s own interpretation. If any one would like to apply, the full job posting text follows.

Job Title: Director, Federal Insurance Office

Department: Department of the Treasury

Agency: Treasury, Departmental Offices

Sub Agency: Office of Domestic Finance

Job Announcement Number: 2010-090RD

SALARY RANGE:	$119,554.00 – $179,700.00 /year
OPEN PERIOD:	Tuesday, September 21, 2010 to Wednesday, October 20, 2010
SERIES & GRADE:	ES-0301-00/00
POSITION INFORMATION:	Full-Time Permanent
PROMOTION POTENTIAL:	00
DUTY LOCATIONS:	1 vacancy – Washington DC Metro Area, DC
WHO MAY BE CONSIDERED:	Applications will be accepted from all groups of qualified individuals.

JOB SUMMARY:

This career reserved position in the Senior Executive Service (SES) serves as the Director of the Federal Insurance Office. The duties and responsibilities of the Office and the Director are established in the Dodd-Frank Wall Street Reform and Consumer Protection Act, P.L. 111-203, which amended Title 31 of the U.S. Code (herein referenced as ‘the Act’).

The authorities of the Office are carried out pursuant to the direction of the Secretary of the Treasury. More specifically, the Office acts under the direction of the Treasury Assistant Secretary for Financial Institutions and the Deputy Assistant Secretary for Financial Institutions Policy, as part of the Office of Domestic Finance.

The Federal Insurance Office monitors all aspects of the insurance industry, including identifying issues or gaps in the regulation of insurers that could contribute to a systemic crisis in the insurance industry or the United States Financial system. The Office has the authority to recommend to the Financial Stability Oversight Council (‘FSOC’) that it designate an insurer (including affiliates) as an entity subject to regulation as a nonbank financial company supervised by the Board of Governors of the Federal Reserve. The Director serves as a non-voting member of the FSOC in an advisory capacity.

The Office consults with the States (including state insurance regulators), regarding insurance matters of national importance and prudential insurance matters of international importance The Office advises the Secretary on major domestic and prudential international insurance policy issues.

In carrying out these functions, the Office may receive and collect data and information on and from the insurance industry and insurers; enter into information-sharing agreements; analyze and disseminate data and information; and issue reports regarding all lines of insurance except health insurance.

The authority of the Office shall extend to all lines of insurance except health insurance, long-term care insurance (except that which is included with life or annuity insurance components), and crop insurance.

Duties

Additional Duty Location Info:

1 vacancy – Washington DC Metro Area, DC

Picture Of Workers Comp Takes Another Step Coworkers In Office

StockUnlimited

The Director will head the Office and provide the Office with executive leadership and oversight. The Director supervises, manages and directs staff to accomplish all functions of the Office. The incumbent:

The Office coordinates and develops Federal policy on prudential aspects of international insurance matters, including representing the United States, as appropriate, in the International Association of Insurance Supervisors (or a successor entity), and assisting the Secretary (with the United States Trade Representative) in negotiating certain written bilateral or multilateral agreements regarding prudential insurance measures, or with respect to the business of insurance or reinsurance. The Office assists the Director in determining whether State insurance measures are preempted by such agreement or agreements.

The Office monitors the extent to which traditionally underserved communities and consumers, minorities, and low- and moderate-income persons have access to affordable insurance products regarding all lines of insurance, except health insurance. The Office also assists the Secretary in administering the Terrorism Risk Insurance Program.

The Federal Insurance Office also performs such other related duties and authorities as may be assigned to the Office by the Secretary.

-Develops and implements policy within the scope of the Office’s responsibilities.

Picture Of Workers Comp Takes Another Step Business People in Hunddle

StockUnlimited

-Monitors all aspects of the insurance industry.

-Consults with the States, and their insurance regulators, regarding insurance matters of national importance and prudential insurance matters of international importance.

-Advises the Secretary on major domestic and international insurance issues.

-Monitors the extent to which traditionally under-served communities and consumers, minorities, and low- and moderate-income persons have access to affordable insurance products, except health insurance.

-Assists the Secretary of the Treasury and other officials in administering the Terrorism Risk Insurance Program.

-Coordinates Federal efforts and develops Federal policy on prudential aspects of international insurance matters.

-Assists the Secretary of the Treasury (with the United States Trade Representative) in negotiating and entering into certain international insurance agreements, as set forth in the Act.

-Determines whether State insurance measures are preempted by certain international agreements.

– Identifies issues or gaps in the regulation of insurance that could contribute to a systemic crisis in the insurance industry and to the U.S. financial system.

-Recommends to the FSOC that it designate an insurer (including affiliates) for regulation by the Board of Governors of the Federal Reserve System; and advises with respect to any resolution of certain insurance companies.

-Serves as a non-voting member of the FSOC in an advisory capacity.

-Prepares and contributes to policy statements, briefing materials, Congressional testimonies, Congressional reports, periodic status reports covering ongoing issues covered by the Office, official correspondence, and other official pronouncements for the Secretary of the Treasury and other senior Treasury officials.

-Performs other related duties and authorities as assigned by the Secretary.

Qualifications and Evaluations

Hand Presenting Workers Comp Takes Another Step Education Icon Using Magnifying Glass

StockUnlimited

QUALIFICATIONS REQUIRED:

Experience must have been at a sufficiently high level of difficulty to clearly show that the candidate possesses the required professional and technical qualifications and executive core qualifications set forth below.

-The incumbent must have one or more full years of professional experience (or equivalent level) to a GS-15 in Federal service.

TECHNICAL QUALIFICATIONS (TQs): The TQs describe the necessary technical knowledge, skills, and abilities needed to successfully perform the duties of the position.

1. Expertise in insurance markets, products, and knowledge of insurance and reinsurance companies’ operations, accounting, financial reporting, solvency. Demonstrated understanding of economic, financial, and legal concepts associated with insurance and reinsurance companies and broad knowledge of insurance markets.

2. Extensive knowledge of legal and regulatory framework for insurance and reinsurance companies: how they are examined, regulated, and supervised, and the U.S. State and the international regulatory environment associated with them, including applicable model and State laws and regulations. Demonstrated expert specific knowledge concerning State insurance regulatory authorities, and familiarity with current and anticipated Federal legislation and State initiatives impacting the insurance industry. Extensive knowledge of insurance company solvency laws and regulations: how insurance companies are conserved, rehabilitated, and liquidated; and knowledge of the State-based guarantee system.

3. Demonstrated knowledge regarding financial institutions as a whole, including familiarity with all types of financial intermediaries and their structures, as well as the business environment and policy issues associated with financial institutions.

Hand Presenting Workers Comp Takes Another Step Academic Idea Knowledge

StockUnlimited

4. Knowledge of the law and regulations governing not only insurance companies but also those governing financial institutions generally and securities markets, the Federal rule-making process, and the State and Federal financial regulatory structures, including the Office of Thrift Supervision, and the Board of Governors of the Federal Reserve System, as well as foreign regulatory authorities.

5. Demonstrated leadership experience, including administration, project management and human resource management. Expertise in developing and guiding subordinate staff.

EXECUTIVE CORE QUALIFICATIONS (ECQs): The ECQs describe the leadership skills needed to succeed in the Senior Executive Service, and are in addition to the specific technical qualifications listed above.

ECQ 1 – LEADING CHANGE – The ability to bring about strategic change, both within and outside the organization, to meet organizational goals. Inherent to this ECQ is the ability to establish an organizational vision and to implement it in a continuously changing environment.

Competencies – creativity & innovation, external awareness, flexibility, resilience, strategic thinking, vision

ECQ 2 – LEADING PEOPLE – The ability to lead people toward meeting the organization’s vision,

Picture Of Workers Comp Takes Another Step Holding Hands And Walking

StockUnlimited

mission, and goals. Inherent to this ECQ is the ability to provide an inclusive workplace that fosters the development of others, facilitates cooperation and teamwork, and supports constructive resolution of conflicts.

Competencies – conflict management, leveraging diversity, developing others, team building

ECQ 3 – RESULTS DRIVEN – The ability to meet organizational goals and customer expectations. Inherent to this ECQ is the ability to make decisions that produce high-quality results by applying technical knowledge, analyzing problems, and calculating risks.

Competencies – accountability, customer service, decisiveness, entrepreneurship, problem solving, technical credibility

ECQ 4 – BUSINESS ACUMEN – The ability to manage human, financial, and information resources strategically.

Competencies – financial management, human capital management, technology management

ECQ 5 – BUILDING COALITIONS – The ability to build coalitions internally and with other Federal agencies, State and local governments, nonprofit and private sector organizations, foreign governments, or international organizations to achieve common goals.

Competencies – partnering, influencing/negotiating

Additional information on the Executive Core Qualifications is available at www.opm.gov/ses/recruitment/ecq.asp.

Hand Drawing Workers Comp Takes Another Step Evaluation Concept

StockUnlimited

HOW YOU WILL BE EVALUATED:

Your application will be evaluated on the basis of your resume and narrative statements reflecting the quality and extent of your total accomplishments, experience and education as they relate to the technical qualifications and executive core qualifications.

Candidates failing to provide narrative statements addressing the Technical Qualifications will not be considered for the position.

Candidates MAY supply a narrative statement addressing each of the Executive Core Qualifications.

Benefits and Other Info

BENEFITS:

You may participate in the Federal Employees Health Benefits program, with costs shared with your employer.

Life insurance coverage is provided.

Long-Term Care Insurance is offered and carries into your retirement.

New employees are automatically covered by the Federal Employees Retirement System (FERS). If you are transferring from another agency and covered by CSRS, you may continue in this program.

You will earn annual vacation leave.

You will earn sick leave.

You will be paid for federal holidays that fall within your regularly scheduled tour of duty.

If you use public transportation, part of your transportation costs may be subsidized. Our human resources office can provide additional information on how this program is run.

You can use Health Care Flexible Spending Accounts for expenses that are tax-deductible, but not reimbursed by any other source, including out-of-pocket expenses and non-covered benefits under their FEHB plans.

Hand Illustrating Workers Comp Takes Another Step Inforamtion

StockUnlimited

OTHER INFORMATION:

The materials you send with your application will not be returned.

Send only those materials needed to evaluate your application.

Before entering on duty, you will be required to complete a Public Financial Disclosure Report, SF-278, in accordance with the Ethics in Government Act of 1978. You will need to provide the information annually.

You will be required to serve a probationary period of 1 year unless you have already completed a probationary period in the SES.

Candidates MAY supply a narrative statement addressing each of the Executive Core Qualifications. Unless you have already received certification from an Office of Personnel Management Qualifications Review Board (QRB) in the past, the final candidate will be required to address the Executive Core Qualifications (ECQs) and be certified by a QRB before appointment can occur.

Picture Of Workers Comp Takes Another Step Applying

StockUnlimited

How To Apply

You may apply for this position by submitting the items below by email. Your application, regardless of the format must describe your job related qualifications pertinent to this position. The announcement number must be entered on the first page of your application. Please submit:

(1) Resume OR OF-612 Application for Federal Employment

(2) Supplemental narrative statements addressing the Technical Qualifications. The supplemental statements should not exceed five (5) pages and be submitted as a Microsoft Word attachment.

(3) OPTIONAL: Candidates MAY supply a narrative statement addressing each of the ECQs. Narrative statements should not exceed ten (10) pages and be submitted as a Microsoft Word attachment.

Picture Of Woman Workers Comp Takes Another Step With Coworker at Background

StockUnlimited

(4) If you are a current of former federal employee with reinstatement eligibility, you must submit a copy of your last Notification of Personnel Action (SF50) showing your position, title, series, grade, and eligibility.

(5) If you are a current or former SES, you must submit a copy of your SF-50 showing your appointment.

(6) If a Candidate Development Program Candidate, and your ECQs have been approved by OPM, please provide certificate/document indicating OPM approval.

NOTE: Applicants who fail to submit all information and documents (i.e., an appropriate form of application and professional/technical qualifications narrative) WILL NOT receive consideration for the position.

You must submit your application so that it will be received by the closing date of the announcement. Applications should be emailed to the following email address: [email protected]

APPLICATIONS WILL BE ACCEPTED VIA EMAIL ONLY AND MUST BE RECEIVED BY 11:59 PM (Eastern Time) ON THE CLOSING DATE OF THE ANNOUNCEMENT.

AGENCY CONTACT INFO:

Rachel Davis
Phone: Please use email
Email: [email protected]

Agency Information:
Department of the Treasury
Email Applications
Washington, DC 20220
USA

WHAT TO EXPECT NEXT:

Once your complete application is received we will conduct an evaluation of your qualifications. The most highly qualified candidates will be referred to the hiring manager for further consideration and possible interview.

Workers Comp takes another step to being overseen by a large Federal Bureaucracy.

©J&L Risk Management Inc Copyright Notice

Temporary Total Disability Benefits Important Facet Of WC Claim

September 29, 2010 By JL Risk Management Consultants

Temporary Total Disability Benefits Are Very Important To The Injured Worker

Temporary Total Disability is one of the most common terms. in Workers Compensation.

The acronym is TTD. This level of Workers Comp disability reflects an injury that has rendered the employee completely unable to perform any job functions on a temporary basis. The employee is expected to make a full recovery and return to work. In the interim, compensation paid is usually a percentage of weekly wages until the worker returns to the job.

Picture Of Woman Wrapping Temporary Total Disability Man Injured Hand

StockUnlimited

Each state mandates very specific rules on TTD. The injured employee usually receives a tax-free payment of 2/3 of their pre-tax average weekly wage. There are state-mandated minimums and maximums for this type of benefit. One of the largest tasks facing a Workers’ Comp claims department is paying the weekly benefit checks timely.

Temporary Total Disability usually involves a waiting period. Until the length of TTD reaches a certain length, the waiting period may not be paid.

For example, some states have a waiting period of 7 days that is not payable until after 21 days of TTD.

©J&L Risk Management Inc Copyright Notice

Two Workers Comp Bills Vetoed By California Governor Schwarzenegger

September 28, 2010 By JL Risk Management Consultants

Two Workers Comp Bills Vetoed by Governor Schwarzenegger

The Governator has two Workers Comp bills Vetoed,that opponents said would have had dire effects on the current Workers Comp system in California. Instead of explaining the bills, I included the veto memos from the Governor to the California Senate and State Assembly.

Map Of California Two Workers Comp Bills Composition of California State Senate

Wikimedia Commons – Kurykh

I agree with the first one wholeheartedly. The Governor took a national viewpoint that is consistent with most states.

To the Members of the California State Assembly:

I am returning Assembly Bill 933 without my signature.

This bill would require a physician conducting utilization review in the workers’ compensation system to be licensed in California. Such a requirement would be inconsistent with how utilization review is conducted in other areas of medicine and not in line with best practices nationwide. The proponents of this measure have not demonstrated a need for this disparity in treatment.

For this reason, I am returning this bill without my signature.

Sincerely,

Wikimedia Commons – Nate Mandos

Arnold Schwarzenegger

To the Members of the California State Senate:

I am returning Senate Bill 145 without my signature.

This bill would prevent a workers’ compensation claim from being denied or impacted by an apportionment determination because the employee’s injury or death was related to the employee’s race, religious creed, color, national origin, age, gender, marital status, sex, or genetic characteristics. This measure, like Senate Bill 1115 (2008), which I previously vetoed, would significantly undermined the state’s workers’ compensation apportionment reforms of 2004. In addition, although this measure purports to address instances where a workers’ compensation claim was improperly denied when a hate crime was committed against an employee, this issue has been addressed by Assembly Bill 1093, which I signed last year.

For these reasons, I am unable to sign this bill.

Sincerely,

Arnold Schwarzenegger

Update – I wonder what the Governor would have thought of the upcoming SB 863 that was signed into law after his tenure.

©J&L Risk Management Inc Copyright Notice

Is A Commutation of Benefits Beneficial?

September 28, 2010 By JL Risk Management Consultants

Commutation – Workers Comp Term

Bills, debts, and personal finances can all be affected by the scheduling of workers compensation payments. Often a lump sum payment is more beneficial or necessary than receiving many individual payments over time. A commutation is an order given by a judge in a workers compensation suit for a lump sum payment of part or all of awarded payments or benefits.

Picture Of Hand Presenting Commutation Mobile Payments And Card

StockUnlimited

©J&L Risk Management Inc Copyright Notice

Is There Apportionment in Workers Compensation?

September 27, 2010 By JL Risk Management Consultants

Workers Comp Term-Apportionment

The tem apportionment is the workers comp term of the day. If a worker has various injuries, some of which may be pre-existing or unrelated to a work injury, a panel of board members will be responsible for determining which of those injuries an employer may be responsible for. Apportionment is the process used to determine what portion of a worker’s injuries are deemed either work related or non work related.

US navy provide Apportionment medical care to injured Indonesian

Wikimedia Commons – U.S. Navy photo by Jacob J. Kirk

©J&L Risk Management Inc Copyright Notice

Discontinuation Notice Not Same As Denial

September 24, 2010 By JL Risk Management Consultants

Term Of The Day – Discontinuation Notice

A discontinuation notice is a very generic “old school” term for suspending or altering a benefit payment.

Fire department holds an Discontinuation Notice Naval air injured man

Wikimedia Commons – PHC(SW/NAC) SPIKE CALL

Temporary Total (TTD) suspension is the most common one.

Every state has some type of prescribed form for removing or altering/lowering benefits. The Workers Comp Commissions deem removing an injured employee from any type of benefit as a serious matter.

If an employer or an insurance company is going to reduce or discontinue an employee’s workers compensation benefits, an employee may be given a discontinuation notice. Your workers comp benefits may be reduced or discontinued due to new information relating to your case, or perhaps your injury has healed and benefits are no longer necessary.

©J&L Risk Management Inc Copyright Notice

Continuance

September 23, 2010 By JL Risk Management Consultants

Term Of The Day – Continuance

A continuance is a postponement of a court hearing or law suit until a later date. During a workers compensation hearing, several continuances may be issued, which will delay proceedings and possibly your pay and benefits.

Picture Of Judges Continuance Court Hearing

Wikipedia – Jeroen Bouman

©J&L Risk Management Inc Copyright Notice

Product Liability Suit

September 22, 2010 By JL Risk Management Consultants

Term Of The Day – Product Liability Suit

A Product Liability Suit is a lawsuit brought on by an employee against a third party and not an employer. If there is the possibility that an injury was caused by equipment fault or failure, a product liability suit may be filed against the equipment manufacturer or another party allegedly involved in the accident.

Picture Of Judge Gavel Product Liability Suit With Paper

Wikimedia Commons – Brian Turner

©J&L Risk Management Inc Copyright Notice

Workers Compensation Premium Auditors – Not Licensed Like Claim Adjusters?

September 22, 2010 By JL Risk Management Consultants

Workers Compensation Premium Auditors Licensed Like Claim Adjusters?

The Workers Compensation premium auditors should likely have licenses like claim adjusters.

Picture of Hand Presenting Licensed Like Claim Adjusters Premium Auditors Concept

StockUnlimited

Workers Compensation premium auditors have never been licensed or actually regulated in most states. I have spoken often to the other premium audit companies for employers about starting an organization that would oversee the employers’ Workers Comp premium audit sector of the insurance industry. After the Workers Compensation consultant debacle in South Carolina, I would say that states need to consider licensing ALL premium or other types of auditors.

The premium auditors are very similar to adjusters in many ways. Adjusters and premium auditors do have fiduciary responsibilities to their customers.

The amount of premiums that an employer pays will always center on the work of adjusters and premium auditors. The adjusters indirectly charge premiums by setting reserves which affect the E-Mod.

The auditors can directly change the premiums by auditing the payroll and company overall.

Hand Presenting Premium Auditors Strategy

StockUnlimited

For some reason, as the insurance industry has evolved, licensing auditors of premiums has never even shown as a blip on the radar screen of regulators. Licensing auditors would be a quick income source for the Departments of Insurance. One has to wonder why a state department allows this untapped quick source of funds to escape their licensing fees. Most workers comp adjusting licenses cost $100 – $200 per year. Out of state adjuster licenses can be very expensive.

Licensing any type of insurance personnel allows the states to control their actions by fining or license revocation. Every state insurance department issues a list of fines or license revocations at least quarterly.

I think we will at least see a large association started of employer premium auditors. That is a great idea, but should the regulation be self-imposed? I have seen little or no attention from any governing body on the subject. What about insurance company based or independent premium audit companies? Should these premium auditors also be regulated?

©J&L Risk Management Inc Copyright Notice

Relapse Benefits

September 21, 2010 By JL Risk Management Consultants

Term Of The Day – Relapse Benefits

Relapse benefits are workers compensation benefits that are received when a worker experiences a relapse or recurrence of a previous injury for which workers compensation benefits were previously awarded. If you are unable to work due to a recurring injury, you may still be able to collect your workers comp payments.

Picture Of Hand Relapse Benefits With Coins And Plant

Wikimedia Commons – 401(K) 2012

©J&L Risk Management Inc Copyright Notice

Concurrent Employment

September 20, 2010 By JL Risk Management Consultants

Concurrent Employment

The Concurrent Employment benefits cause confusion in workers comp claim departments if the adjuster is not informed of other jobs worked by the injured employee.

Being concurrently employed simply means that a worker is employed by more than one employer. Workers compensation pay and benefits are determined by the calculated average weekly wages that an employee works.

Picture of Cupped Hand Concurrent Employment With Employers Icon

StockUnlimited

Thus the benefits that an employee may receive are determined by the number of hours worked at a single firm. If you work multiple jobs, be aware that your compensation pay will be proportional to the number of hours worked for any particular job.

©J&L Risk Management Inc Copyright Notice

Disability Rating

September 17, 2010 By JL Risk Management Consultants

Term of the Day – Disability Rating

Industrial accidents are rated on a scale or schedule in order to provide a reference point for physicians, insurance companies, and employers. Upon being examined by a qualified physician or network doctor, a worker’s injury will be placed on a Disability Rating Scale to determine the level of injury, as well as the time needed for healing. Once these aspects of the injury have been determined, the amount of workers compensation pay can be determined.

Picture Of Man In Wheelchair Disability Rating While Fishing

Wikimedia Commons – Hillebrand Steve

©J&L Risk Management Inc Copyright Notice

Self Insurance – Forgotten Area For Medical Networks

September 16, 2010 By JL Risk Management Consultants

Self Insurance And Medical Networks

Last week, I covered the advantages of Workers Comp self insurance over regular insurance. Today, I wanted to cover an area that is often ignored when setting up a self insurance program. That is the area of medical networks.

Picture Of Hands Presenting Self Insurance With Medical Icon

StockUnlimited

Are you going to turn over your medical networks to the Third Party Administrator (TPA)? Are you allowed to choose your own physicians or will the TPA require you to use theirs? Will switching your TPA cause you to lose your physicians in place? If you are just beginning your self insurance program, how will your company build its medical network? These are but a few of the questions you must cover when choosing a TPA.

Most of the time, the TPA’s medical network will cover most of the physicians your company has dealt with in the past. TPA’s usually do not require that an employers injured workers treat with a certain physician. The big savings here is the usual 15% discount not counting the fee schedule.

It may be prudent to ask for a copy of the medical network in place in your area before signing on with a TPA. Most employers do not ask for the medical network information. It is a very important part of which TPA to use for your Workers Comp claims.

©J&L Risk Management Inc Copyright Notice

Utilization Review

September 16, 2010 By JL Risk Management Consultants

Term Of The Day – Utilization Review

In order to deem a medical treatment viable and necessary, insurance claims administrators will often perform a utilization review. Utilization reviews are conducted according to established rules and procedures, and normally involve the input of the disabled worker’s physician in order to determine the necessity and validity of proposed medical treatments.

Picture Of Nurse Took BP Of Patient Utilization Review Medical Treatment

StockUnlimited

©J&L Risk Management Inc Copyright Notice

Occupational Disease

September 15, 2010 By JL Risk Management Consultants

Term Of The Day – Occupational Disease

An occupational disease is a disease that is contracted by a worker during a period of employment. Common examples of occupational diseases include asbestosis, silicosis, and byssinosis. These diseases are often eligible as workers compensation claims, and workers must be thoroughly examined by a qualified medical evaluator (QME) to properly file a claim.

Wikimedia Commons – Nephron

©J&L Risk Management Inc Copyright Notice

Qualified Medical Evaluator

September 14, 2010 By JL Risk Management Consultants

Term Of The Day – Qualified Medical Evaluator

If a workers compensation claimant disagrees with a diagnosis given by a network doctor, a qualified medical evaluator (QME) may be consulted to examine the injured worker. These examiners are chosen by qualified medical boards across the country, and are accredited from various medical institutions.

Picture of Physician Qualified Medical Evaluator Touch The Screen

123RF

©J&L Risk Management Inc Copyright Notice

Self Insurance For Workers Compensation – Has Big Advantages

September 13, 2010 By JL Risk Management Consultants

Advantages Of Self Insurance – Going Out On Your Own

In my last few posts, I did make Workers Comp self insurance seem to be more of a hassle than it is really worth. My main reason for posting the 11 concerns was to make companies examine their program more carefully before diving into what can be an onerous task. However, self insurance is worth the time, energy, and $$$.

Picture Of Woman Standing Self Insurance With Big Dollar Sign

StockUnlimited

We have helped a number of governmental organizations and private employers analyze if going at it own your own is right for their Workers Compensation situation.

Usually, the main barrier is that the organization cannot supply the Law of Large Numbers with enough premium or claims to make it a worthwhile venture. Barely qualifying for self insurance can make the changeover a roll of the dice.

Many governmental organizations have switched away from voluntary market insurance or large deductible programs over the last 20 years. The task can be difficult. The rewards remain great if patience is one of the Risk Manager’s attributes.

Instead of making this article long and boring, I will post a list tomorrow of the advantages of self insurance. I will go into detail on each one.

If you are reading this and you are self insured, what advantages do you see over regular market insurance? If you are thinking about becoming self insured, what would be the future advantages that would see for your company? If you prefer first-dollar Workers Comp insurance, what do you see as the advantages of fully transferring the risk to your carrier?

By the way, the preceding sentence is not necessarily true. Why? I am full of questions this evening. You can reply to this post or drop me an email with comments if you wish.

Next Up – The List Of Self Insurance Advantages

©J&L Risk Management Inc Copyright Notice

Form 18 North Carolina Industrial Commission

September 13, 2010 By JL Risk Management Consultants

Term Of The Day – Form 18

This Form 18 is important to Workers Compensation.This is the first form to be filled out by employees who have been injured on the job. This is a report to employers on the nature and condition of the injury, and must be filed within 30 days of the injury in order to be considered a viable claim. This form may be different from the forms needed to file occupational disease claims.

North Carolina Industrial Commission Form 18 Emblem

i.c.n.c.gov

©J&L Risk Management Inc Copyright Notice

Outpatient Treatment Definition

September 10, 2010 By JL Risk Management Consultants

Term Of The Day – Outpatient

An outpatient is someone who has been hospitalized for 24 hours or less, but continues to visit a hospital or medical facility for treatment or diagnosis. Similarly, outpatient surgery is surgery that is performed on a patient without overnight hospital admittance. Different workers comp insurance rates and coverages may apply to you or your workers, depending on the type of treatment or surgery that is being performed.

Picture of Doctor Talking To Woman Outpatient Treatment

Wikimedia Commons – National Cancer Institute

Workers Comp Self Insurance – Five More Things To Consider

September 9, 2010 By JL Risk Management Consultants

Workers Comp Self Insurance Concerns

Below are Five Workers Comp Self Insurance concerns when reviewing your policies and audits.

Earlier this week I posted on what companies should consider before pursuing self insurance as a means to reduce Workers Comp costs. We had a large enough response to the article that I thought I would add five more concerns.

Clipart of Workers Comp Self Insurance Badge

StockUnlimited

Your Experience Modification Factor (E-Mod) will not be a 1.0 if you ever leave self insurance. NCCI and all of the other state rating bureaus all have added in rules if your company tries to jump in and out of self insurance as a way to keep your E-Mod low. This simply will not work any longer.
Self Insurance and a large deductible program are two totally different insurance programs. One of the most glaring differences is that with a large deductible program your E-Mod is still reported to NCCI and/or the applicable rating bureaus.
Will your company use your TPA’s services such as bill review, medical and vocational case management, pharmacy, or providers’ network? The TPA’s services may make self insurance not as economical as one might think. I have to be careful here as I received a letter recently threatening a lawsuit for revealing how much a TPA was charging extra for their services.
Have you explored PEO’s, self insurance pools, carve out programs or other types of Workers Comp insurance?
StockUnlimited
Have you thoroughly examined your company’s internal processes in handling Workers Comp claims? We have seen where an employer or governmental entity will become self insured to get away from or change their problem areas with the insurance carrier. Actually, the problems may still be there internally and be even more costly under self insurance.
Bonus – Is the management of your company going to buy into the self insurance processes? If not, a change to self insurance may not be the best approach.

There are many other concerns I could post on overall. These six and the prior five are the ones that we see most often when we assist large companies with self insurance statistical analyses

Correction to Previous Article On Our Website Traffic

September 9, 2010 By JL Risk Management Consultants

Correction On Website Traffic

A correction on our Website Traffic on previous article. After almost 600 posts we do occasionally make mistakes. We had earlier said that this blog was in the Top 7% For All Web Traffic. We had used a statistics package with input from a third party website analysis company. The following is the correction.

Graphic Of Car With Website Traffic Icon

Wikimedia – Stannered

J&L’s Blog Ranked In Top 7% Of All Websites Analyzed

A recent analysis by an independent third party website analysis firm (Hubspot.com) indicated that http://blogs.cutcompcosts.com scored in the Top 7% Of All 2.8 Million Websites Analyzed by their algorithm. J&L Risk Management Consultants provides the blog as a free resource for forward-thinking Workers Compensation discussion. They also provide a weekly newsletter that is read by over 10,000 people worldwide per month.

“This was a quite a surprise” said James Moore, principal of J&L and author of the blog. I did not expect our score to improve that sharply. Businesses are trying to find ways to survive in these tough economic times. Our increased ranking means that employers are beginning to look even closer at Workers’ Compensation premiums and Third Party Administrator fees as budget killers.”

Moore went on to say “I do the blog as a way to pay back the Workers Comp community. We do not advertise on the blog and do not provide advertising space for other companies.”

The blog was started in 2005. It was revamped in 2007 due to the changes in technology that allowed improvements to the blogosphere. J&L always welcomes suggestions for blog topics at [email protected]

Mediator in Workers Comp Resolves Disputes

September 8, 2010 By JL Risk Management Consultants

Term Of The Day – Mediator

Workers compensation cases often do not go to court, but are settled between employer and employee with the help of a mediator. A mediator is a generic legal entity whose job is to help resolve disputes without engaging in a full court trial. Workers compensation suits are often mediated by a third party, which may be selected from a list of approved and available mediators that specialize in workers compensation suits.

Picture of Mediator Hand With Two Small Man Shake hands

StockUnlimited

Workers Comp Self Insurance Conversion – Five Questions To Ask

September 7, 2010 By JL Risk Management Consultants

Workers Comp Self Insurance Qualifiers

Most of the Workers Comp self insurance qualifiers center around the employer’s ability to have enough money to pay claims.

Picture Of Young Woman Holding Board Five workers comp self insurance Mark

StockUnlimited

One of our most requested services is to see if self insurance is a valid option for a large company. If your company is considering the switch to self insurance, there are five questions to consider before switching to paying out-of-pocket for Workers Comp claims.

1. Will your company qualify with your respective state Workers Compensation Board or Industrial Commission? With so many companies filing for bankruptcy, the state agencies are much more picky than in the past. There are minimums that must be satisfied before even applying. For instance, many states have a minimum liquid assets requirement of $500,000.

2. Will your company have enough of a budget cushion in case your first self insured year is much more costly than forecasted? We have rarely seen this happen, but it is a risk that may possibly need to be funded.

3. Is your company prepared to do a RFP (Request For Proposal) to find a TPA (Third Party Administrator) to process your Workers Comp claims? It may not be a wise choice to have your current insurance carrier handle the claims through their TPA unit.

Hand Presenting Workers Comp Self Insurance Dollar Fund Icon

StockUnlimited

4. Is your company or governmental unit prepared to assign the task of tracking the funds spent by the TPA? Unlike normal Workers Comp insurance, the task of monitoring the TPA will be a laborious task.

5. Is your E-Mod low at this point? Self insurance may possibly be more expensive if your governmental unit or company has a low E-Mod such as a .6 or .7. E-Mods this low may counteract all the overhead that is charged by insurance carriers. This area will require a large amount of financial analysis to compare low E-Mod regular Workers Comp insurance to self insurance.

I could add a few more to the list. I may add in another post later this week on this subject.

Actuary – Insurance Definition

September 6, 2010 By JL Risk Management Consultants

Term Of The Day – Actuary

Wikimedia Commons – Dave Dugdale

An Actuary is an insurance agent that computes dividends, rates, and risks according to statistical evidence and records. Actuaries play an integral role in the calculation of workers compensation insurance rates. Their assessments are vital in determining how much you will be paid if you are involved in a workers compensation law suit.

Subcontractors vs Employees From IRS

September 5, 2010 By JL Risk Management Consultants

The IRS Subcontractors vs Employees

The following is from the IRS website on Subcontractors compared to the employees. I have printed this in the past. The last IRS update to the page was less than a month ago.

Independent Contractor (Self-Employed) or Employee?

It is critical that you, the business owner, correctly determine whether the individuals providing services are employees or independent contractors. Generally, you must withhold income taxes, withhold and pay Social Security and Medicare taxes, and pay unemployment tax on wages paid to an employee. You do not generally have to withhold or pay any taxes on payments to independent contractors. If you are an independent contractor and hire or subcontract work to others, you will want to review the information in this section to determine whether individuals you hire are independent contractors (subcontractors) or employees.

Before you can determine how to treat payments you make for services, you must first know the business relationship that exists between you and the person performing the services. The person performing the services may be –

Picture of Woman Vs Man subcontractors With Arms Drawing On Wall

123RF

In determining whether the person providing service is an employee or an independent contractor, all information that provides evidence of the degree of control and independence must be considered.

Common Law Rules

Facts that provide evidence of the degree of control and independence fall into three categories:

Behavioral: Does the company control or have the right to control what the worker does and how the worker does his or her job?
Financial: Are the business aspects of the worker’s job controlled by the payer? (these include things like how worker is paid, whether expenses are reimbursed, who provides tools/supplies, etc.)
Type of Relationship: Are there written contracts or employee type benefits (i.e. pension plan, insurance, vacation pay, etc.)? Will the relationship continue and is the work performed a key aspect of the business?

Businesses must weigh all these factors when determining whether a worker is an employee or independent contractor. Some factors may indicate that the worker is an employee, while other factors indicate that the worker is an independent contractor. There is no “magic” or set number of factors that “makes” the worker an employee or an independent contractor, and no one factor stands alone in making this determination. Also, factors which are relevant in one situation may not be relevant in another.

The keys are to look at the entire relationship, consider the degree or extent of the right to direct and control, and finally, to document each of the factors used in coming up with the determination.

Subcontractor vs Employee – Insider IRS Guide Great Explanations

September 4, 2010 By JL Risk Management Consultants

IRS Guide To Subcontractor vs Employee Determination

I was going to reprint the IRS’s guide to Subcontractor vs Employee. Lately, we receive this type of question more than the Premium Audit Bill inquiries. I then came across The Training Manual used by the Internal Revenue Service for separating employees and subcontractors. It is a public document.

Picture Of IRS Subcontractor vs Employee Building

Wikimedia Public Use

The .PDF file is here It is a 160 page guide for auditors and other IRS personnel. Reading the guide may be a little tedious, but the concepts covered are very informative on subcontractors and employees. The time spent on the guide will be well worth it when considering who/what companies are subcontractors.

The main consideration from what I have read is the control the contractor has over the subcontractor. If the contractor has a large amount of control then the contractor could be viewed as an employee. This will be a new item for months to come as the states crackdown on employers that are paying employees as contractors.

The state tax and the workers compensation commissions are beginning to pursue the employers that have non-payroll employees.

I will still print the short version in the next post.

This Workers Comp Blog Makes Top 7% For Website Traffic

September 3, 2010 By JL Risk Management Consultants

Workers Comp Blog Makes Top 7%

For Website Traffic the Workers Comp Blog makes top 7%. Yes – we printed our own press release.

A recent analysis by an independent third party website traffic analysis firm indicated that http://blogs.cutcompcosts.com was ranked in the Top 7% Of All Website Traffic. J&L Risk Management Consultants provides the blog as a free resource for forward thinking Workers Compensation discussion. They also provide a weekly newsletter that is read by over 10,000 people worldwide per month.

StockUnlimited

“This was a quite a surprise” said James Moore, principal of J&L and author of the blog. I expected an upturn due to businesses trying to find ways to survive in these tough economic times. Employers are beginning to look even closer at Workers’ Compensation premiums and Third Party Administrator fees as budget killers.”

Moore went on to say “I do the blog as a way to pay back the Workers Comp community. We do not advertise on the blog and do not provide advertising space for other companies.”

Tort Is Rare In Workers Comp Due To Exclusive Remedy

September 3, 2010 By JL Risk Management Consultants

Term Of The Day – Tort

A tort is rare in Workers Compensation insurance. The word originates from Old French and Medieval Latin tortum, meaning twisted. In modern English, a tort is a civil wrong that is committed by a tortfeasor, or wrong-doer.

Whether committed intentionally or through negligence, if it results in injury or death to another party, the injured party may be eligible to file a claim. A defendant would then have a legal right to a civil action, in which they may be eligible for monetary compensation.

Picture of Judge Gavel Tort Is Rare And Law Sacle

StockUnlimited

Update – In 2018, a Wisconsin Appeals Court ruled that torts do exist in Workers Comp. This decision altered the term exclusive remedy for Workers Comp. Exclusive remedy basically means that WC benefits offered to a claimant is their only source of remedy against their employer.

However, this does not mean that a claimant is barred from pursuing a third party other than the employer for benefits beyond workers compensation. Then again, the employer usually has the right to join in the third party lawsuit.

The third party situation often involves an automobile accident the injured employee sustains while driving for this/her employer.

Most court decisions do not allow a tort between employee and employer.

West Virginia Workers Comp Is Doing Well – For The Most Part

September 2, 2010 By JL Risk Management Consultants

West Virginia WC Doing Much Better

The insureds in West Virginia used to keep us busy questioning how their Workers Comp premiums had been calculated. We still have a few WV clients. Commissioner Cline and the West Virginia Insurance Commission are to be congratulated for their efforts.

As I said before, they had a tiger by the tail when the Workers Comp coverages were switched from the old State Fund to Brickstreet and then to the open market. A pure open market will always enable employers to receive the best quotes and services. Brickstreet has lost substantial market share. That was an expected development. This is no reflection on Brickstreet’s performance.

StockUnlimited

Brickstreet did retain coverage for a large percentage of the West Virginia state employees. This was by agreement when the carrier was founded in 2006.

The industries that we have still seen overcharges (as in other states) are the Oil and Gas Industry along with the Construction Industry. This is not a concern for only WV. We have seen this nationwide over the last few years.

Update – Bricstreet has become more of a regional carrier. They now write policies in many states outside of West Virginia.

Why Does State Have Second Injury Fund?

September 2, 2010 By JL Risk Management Consultants

Term Of The Day – Second Injury Fund

Administered by the individual state, the Second Injury Fund reimburses an employer for a portion of claims caused by an on the job injury to an employee with a pre-existing permanent partial disability.

Picture Of Hand Put Coins In Second Injury Fund Piggy Bank

StockUnlimited

This reimbursement program encourages employers to hire employees with disabilities.

An added benefit to employers is the possibility of a lower E-mod because reimbursement ultimately reduces claims cost. A lower E-mod can easily result in reduced premiums.

Ombudsman – Do All States Have One For WC?

September 1, 2010 By JL Risk Management Consultants

Term Of The Day – Ombudsman

An Ombudsman impartial individual who is responsible for investigating complaints in order to mediate a fair and equitable settlement between aggravated parties. It is originally a Swedish term. In some parts of the world it is a government official appointed to investigate complaints against the government made by citizens.

USA Department Of State Ombudsman Emblem

Wikipedia – United States Department of State

An Ombudsman helps injured employees with their claims. Most states have at least one in their Workers Comp departments. If an employee hired an attorney, the ombudsman cannot help them.

We are procuring a list of all states that have these very helpful individuals. J&L added a webpage to the website that includes a list of every state.

Archives for September 2010

Term Of The Day-Death Benefits

Workers Comp Takes Another Step Toward Federalization

Temporary Total Disability Benefits Are Very Important To The Injured Worker

Two Workers Comp Bills Vetoed by Governor Schwarzenegger

Commutation – Workers Comp Term

Workers Comp Term-Apportionment

Term Of The Day – Discontinuation Notice

Term Of The Day – Continuance

Term Of The Day – Product Liability Suit

Workers Compensation Premium Auditors Licensed Like Claim Adjusters?

Term Of The Day – Relapse Benefits

Concurrent Employment

Term of the Day – Disability Rating

Self Insurance And Medical Networks

Term Of The Day – Utilization Review

Term Of The Day – Occupational Disease

Term Of The Day – Qualified Medical Evaluator

Advantages Of Self Insurance – Going Out On Your Own

Term Of The Day – Form 18

Term Of The Day – Outpatient

Workers Comp Self Insurance Concerns

Correction On Website Traffic

Term Of The Day – Mediator

Workers Comp Self Insurance Qualifiers

Statutory Duty Levels the Playing Field

Term Of The Day – Actuary

The IRS Subcontractors vs Employees

The following is from the IRS website on Subcontractors compared to the employees. I have printed this in the past. The last IRS update to the page was less than a month ago.

Independent Contractor (Self-Employed) or Employee?

Common Law Rules

IRS Guide To Subcontractor vs Employee Determination

Workers Comp Blog Makes Top 7%

Term Of The Day – Tort

West Virginia WC Doing Much Better

Term Of The Day – Second Injury Fund

Term Of The Day – Ombudsman