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Home » Archives for February 2014

Archives for February 2014

One Of Most Trusted Medical Professionals By Injured Workers

February 27, 2014 By JL Risk Management Consultants

Highly Trusted Medical Professionals Include Pharmacists

Pharmacists have always ranked very high on the list of Trusted Medical Professionals.  Almost 73% of a recent survey’s respondents listed pharmacists as a very trusted professional.  Only nurses were ranked higher.

Picture of Trusted Medical Professionals Shake Hand

(c) 123rf.com

Since the late 1980’s Gallup has created a poll asking the public to rank the most trusted professionals.  As one might expect, Congress and car salespeople ranked the lowest.   Why would pharmacists be so highly trusted?

A pharmacist that actually sits on a state review board said that most people will tell their pharmacists things they may not even tell their physician, spouse, or clergy.  According to this article,  pharmacists:

  •  Usually have a long patient-professional relationship with their customer
  • Are much more accessible than most medical professionals, most are available 24 hours a day
  • Weigh out the cost of  medications for a particular customer
  • Are very unbiased in their opinions on medications and ailments
  • Spend longer with their customers than the average 12 minutes that a physician spends with their patients

How does this relationship affect Workers Comp?

  • Picture Male Trusted Medical Professionals Lab Worker

    123RF

    Mail order is great for cost savings but has the pharmacists at a distance

  • It may be wise to authorize a local pharmacist to fill prescriptions
  • Introduce or maintain an element of trust while disabled or treating for a WC injury
  • Claims staff and employers should look to work with the pharmacist especially when receiving an authorization call  from a pharmacy
  • Pay RX reimbursements from injured workers ASAP
  • Find out if the local pharmacist is part of a WC network.
  • Claims staff can ask for generic equivalents when the pharmacy calls for authorization.

One final note is there is nothing wrong with mail order prescriptions.  However, the face-to-face interaction between an injured worker and their pharmacist is very important in their recovery.

©J&L Risk Management Inc Copyright Notice

Filed Under: pharmacy Tagged With: generic equivalents, medical professional, medication, patients, relationship

Oklahoma’s New Anti Drug Abuse Bill Will Affect Workers Compensation

February 26, 2014 By JL Risk Management Consultants

Oklahoma’s New Anti Drug Abuse Bill vs. Work Comp

Oklahoma’s  new anti drug abuse bill should affect WC. Oklahoma Governor Mary Fallin has given her blessing to a new bill that would limit the use of painkillers by requiring physicians to access a database to check on the prior prescriptions of a patient.

Obamacare Anti Drug Abuse Bill Logo

Wikimedia Commons – Obama

A surprising statistic is that 8% of all Oklahomans abuse some type of painkiller.  

The national average is 4%.

Oklahoma articles always pique my interest as I am originally from there.  Drug abuse of many types have been rampant in my home state since the 1960’s.   One reason, in my opinion, is that so many jobs are extremely laborious in the oil and gas industry.   Many oil and gas workers experience chronic back injuries.

If the bill is voted in and signed into law, this will also help control WC costs.  If a WC patient can be monitored for prior prescriptions, then the additional cost of the abused prescription medications along with the lengthened disability period should be reduced sharply.

Assuming that the same of number of WC patients also abuse painkillers (opioids), then an 8% or more reduction in WC costs on medical payments would be incurred by the insurance carriers. However, drug treatment programs for WC patients may spike if abusers are identified by the database and the physician requests a detox program.  One could also assume the number as being much higher for WC patients.

Graphic Oklahoma Anti Drug Abuse Bill vs. Work Comp

StockUnlimited

There are many questions about the database and how it would function with WC benefits:

  • How will the Dr. handle the patient that has too many recent painkiller prescriptions?
  • Will the claims department be notified of any drug-abusing patient?
  • Can the patient just go across state lines to get an additional RX?
  • Will this system also be available to pharmacists as a backup deterrent?
  • Can the adjuster log into the same system? (probably not)
  • How will HIPPA and the Affordable Care Act affect this new law?
  • Can a Dr. override the system or ignore it and prescribe opioids regardless?
  • Will the Oklahoma legislature also require this on WC injured workers?

I will write another article on this bill whenever it becomes law.   This is a step in the right direction for Oklahoma.

©J&L Risk Management Inc Copyright Notice

Filed Under: Oklahoma, Opioid Tagged With: detox program, drug abuse, HIPPA

Loss Run Analysis – Second Step To Cutting Your WC Costs

February 20, 2014 By JL Risk Management Consultants

Loss Run Analysis Second Step To Cutting Workers Comp Costs

The Loss Run analysis is the 2nd step to cutting your WC costs.

The first step in cutting your WC costs is reading your Workers Comp policy.  

Picture of Loss Run Analysis Employee Looking at an Alarm Clock

StockUnlimited

Online loss runs are the best method of cutting your WC costs from the claims end.  

Even if you have a few accidents, online access will usually result in immediate loss runs that can be printed or downloaded into a spreadsheet.

If your carrier or TPA offers a method to download information, include everything possible in the download.   The more information you have on a spreadsheet, the potential to save WC $ increases greatly.

If you are using Excel(r) as your spreadsheet provider, you may download many statistical packages from Microsoft free of charge.  Most of the new Excel versions already have these loaded into the package.

I do not like to use the “red flag” terms when referring to loss runs.  There are no actual red flags as the loss runs may not have enough information to add this moniker to any of the claims listed.   The claim amounts that do not look right are the ones you should analyze further.

Without looking at the loss runs, there is really no generic statements that can aid you in your loss run analysis.

The one area that confuses many employers is the term Total Incurred.  This may not necessarily be a column on your loss runs.   There are so many versions of loss runs that you may see Total Incurred listed as:

  • Total Reserves Incurred
  • Total
  • Total Reserves
  • Incurred
  • Paid + Unpaid
Graphic of Loss Run Analysis Envelope

StockUnlimited

The main way to decipher this (before emailing your adjuster) is to find the highest number on the claim when referring to reserves, paid, and incurred.  If the claim is still open, then the highest number will usually be the Total Incurred.

On closed claims, the total pad should equal the total incurred.   Strange things sometimes show up on loss runs.  If those numbers do not match on a closed claim, an inquiry email should be sent in most cases.

After checking out your closed claims, then you should move on to the open ones.   This is where things may become sticky – so to speak.   Claims professionals usually have to be trained very heavily and on the job for more than 5 years to be comfortable with reserving claims.

Reserving is an art more than a science.  The adjuster has to forecast the life of a claim at 60 – 90 days after an accident.  For instance, many years ago I was in a training class on WC reserving with 10 other adjusters.  

Given the same information on three different claims, the instructor asked the adjusters to set the reserves on a  claim.  The reserves ran the gamut on the numbers.    Everyone had different numbers on a minor claim, more serious claim, and then a very serious claim.

Online and sometimes paper-based loss runs will have a status on the claim.   If the status does not look right to you, it is the responsibility of  the employer to:

  • Update the status to the adjuster as you may be talking to the employee weekly if not more often
  • Provide the adjuster with all status updates, they should have everything that you have on the claim- concise information sharing is the key here.
  • Scan and email everything to your adjuster.  Most carrier/TPA claims systems are set up where the adjuster can attach the documents to the claim for their later review.  The more info the adjuster has on file, the more accurate the reserving.

    Picture of Employee Frustrated Loss Run Analysis WC Cost

    StockUnlimited

  • If you do not have a working relationship with your adjuster, then you definitely need to explore who is the adjuster on each of your claims.  Communication with the adjuster from the employer is beyond critical.  
  • Do not just email your agent your loss run and ask for assistance.  There are a few agents which have hired adjusting staff to help clients.  This is an extreme rarity.

Whenever we have questioned an adjuster on a file, we often hear from them that they did not know certain aspects on a file that could have been easily supplied by the employer.

The person setting the reserves that will heavily affect your E-Mod or LDF (self insureds) should always have the most information possible from all parties involved in the claim.   The lack of information being provided to the adjuster can be very costly.  

©J&L Risk Management Inc Copyright Notice

Filed Under: Claims Loss Runs Tagged With: online loss run, Strange things

Rehabilitation Nurse Second Most Seen Provider By Injured Employees

February 19, 2014 By JL Risk Management Consultants

Injured Employees and Rehabilitation Nurses Work Well Together

 The second most seen medical provider by injured employees would be the rehabilitation nurse if assigned to the file. Last week, I covered the medical provider that Injured Employees see the most overall.    

As I have often said, rehabilitation nurses or case managers can be one of the best loss reduction techniques.Workers Compensation Case Managers  or rehabilitation nurses function as multifaceted costs reducers on files.  We received a batch of mishandled files a few years ago.

Picture of Injured Employees with Nurse

StockUnlimited

 The main theme was there were no rehabilitation nurses assigned to them. We immediately assigned out a nurse on almost every file.  

These files were at least one year old with an injured worker who had drawn Temporary Disability benefits since the date of the injury.  The files were all settled or closed within eight months.

The rehab nurse will usually visit the injured worker at home to assess their medical condition, return to work, considerations, and other important factors when they create their initial report.   Rehab nurses are not there to spy on employees.

Many times the rehab nurse will accompany the employee to the physician’s office for their medical appointments.  This is very helpful in cases where there is a complex medical condition or often the rehab nurse acts as a medical term “translator” of  sorts.

The main benefit is that the injured employee feels there is someone they can call if they have any questions about their medical treatment and return to work besides the adjuster.

One of the most critical jobs that a rehab nurse performs is as a hub for a return to work analysis between the physician, employee, and employer.   The state of Delaware is the only state that I know of that requires a job bank provided by employers for a successful return to work.

The rehab nurse will often:

  • Picture Injured Employees and Rehabilitation Nurses 

    Wikimedia Commons – Djstoney

    Obtain a job description or descriptions from the employer

  • Discuss the modified duty jobs with the employee
  • Discuss the jobs  and provided job description to the treating physician
  • Have the treating Dr. sign off on the appropriate job description
  • Facilitate the communication and assist with the return to work

The above bullet points are all performed by field case managers.  There are many state laws on how the rehabilitation nurses or case managers can operate under the WC statutes.

©J&L Risk Management Inc Copyright Notice

Filed Under: rehabilitation nurse Tagged With: medical provider, mishandled files, multifaceted costs

Bureau of Labor Statistics Provides Huge Amount of Workers Comp Data

February 19, 2014 By JL Risk Management Consultants

Bureau of Labor Statistics – A Wellspring of Data

The Bureau of Labor Statistics  can be found at bls.gov

Logo of Bureau of Labor Statistics United States

Wikipedia

One of the great providers of Workers Compensation data is the Bureau of  Labor Statistics .   One has to know where to look to find the best WC data.   Some of the data has to be extrapolated for it to make sense.   Many Workers Comp statistics are not straightforward.  Some of the statistics are basically indirect.

The Injuries, Illnesses, and Fatalities page has a plethora of data on WC.   The calculator page has been upgraded often.  The calculator page enables anyone that accesses the data to have cross-sections of data that is borderline amazing.

The One Screen data analysis on the calculator page allows almost any type of analysis.  This is where I send people when asked where to find great analysis besides the rating bureaus (NCCI, WCIRB, etc).

The state specific data is one of the quickest ways to analyze WC injury information.

I have used the BLS website for many years.   The data is accurate.  If you check on even some of the rating bureau reports, you will see a footnote credit to the BLS.

Some of the latest numbers from the BLS are:

NONFATAL INJURIES AND ILLNESSES, PRIVATE INDUSTRY

Total recordable cases:
2,976,400 in 2012

Cases involving days away from work:
905,700 in 2012

Median days away from work:
8 in 2012

Cases involving sprains, strains, tears:
340,900 in 2012

Cases involving injuries to the back:
177,580 in 2012

Cases involving falls, slips, trips:
219,630 in 2012

  

©J&L Risk Management Inc Copyright Notice

Filed Under: BLS, Bureau of Labor Statistics Tagged With: borderline, cross-sections, specific data

All Of Our Brickstreet Clients, New Email Address Changes

February 11, 2014 By JL Risk Management Consultants

Our Brickstreet Clients – New Intake Email Address

Brickstreet has recently changed their claims intake email address. One of the Five Keys To Saving Workers Comp $$$ is filing first reports timely.   Their StreetConnect services should also be used if you want to file your first reports as soon as possible.

UPDATE! Claims Intake Email Address Change

2/6/2014

Graphic of Brickstreet Key to Success

StockUnlimited

At BrickStreet, we stress that all workplace injuries are reported within 24 hours. Early reporting helps us, our policyholders and your injured employees. BrickStreet offers several different options for claims reporting to try and make it as easy as possible. We want to ensure our policyholders are aware that the claims intake email address has recently changed. All claims must be submitted to our new email address – [email protected].  Please visit your specific jurisdiction’s website to obtain a copy of the correct First Report of Injury form.

As a reminder, other methods of early reporting are as follows:

  • Telephone: call 866.45BRICK (866.452.7425), select “policyholder” and option 1.
  • Electronically through StreetConnect. Contact your agent for information about becoming a StreetConnect user.
  • Faxing the First Report of Injury to 1.877.293.5513 or 304.941.1294.

For questions pertaining to the areas listed below, please direct your email as follows:

  • Premium Audit- [email protected]
  • Return to Work- [email protected]
  • Safety Services- [email protected]

©J&L Risk Management Inc Copyright Notice

Filed Under: Brickstreet Tagged With: email, five keys, street connect, workplace

Physical Therapists – Seen Most Often By Injured Workers

February 11, 2014 By JL Risk Management Consultants

Physical Therapists – The Medical Provider Seen Most Often

Physical therapists see injured workers more than any other medical provider.

This was a question that a client emailed to me earlier in the week.

Picture of Physical Therapists with Injured Workers

Wikimedia Commons – Airman 1st Class Alystria Maurer

  What medical provider does the injured worker see more in a WC claim? The answer was not so obvious at first until I reviewed an old WC, then the answer became obvious.  The most popular medical provider on most claims is, of course, the physical therapist.

Many claims do have the element of physical therapy.  

The claim where the employee is out of work longer almost always involves PT.   Have you looked at the PT’s that your employees are seeing?  If not, this is an area that is often overlooked even if an employer has a  full medical network or panel.

The PT can affect the claim very heavily.   Now that I think back into my career when the PT heads south on the insurance carrier/TPA/employer, the claim will usually tank.   I am not saying that there are very many PTs in the WC marketplace where this occurs overall.

Most PT and Occupational Therapists are encouraging people.  

The personalities of the PT and the injured worker, adjuster, or physician may clash.  This usually results in a much more expensive claim.

Justifying a medical provider of any type by “being in-network” as a savings tool  (usually 15%)is great.  However, if the savings will seem small to a claim that spins out of controls – often without the knowledge of the employer or adjuster.

Picture Physical Therapists Medical Provider

Wikimedia Commons – Mass Communication Specialist 1st Class Anastasia Puscian

I created a large study for a PT Network provider a few years ago.   The one area that stood out in the study was that a medical savings of 15% is puny when the wrong provider is treating the WC patient.  Most employees consider the PT on the same level as their treating physician – especially after seeing the PT every weekday for two weeks or a month before seeing the treating physician.

I used to question the need for PT until I crushed my left guitar-playing hand.   The first link at the top covers what happened to me.

©J&L Risk Management Inc Copyright Notice

Filed Under: Physical Therapy Tagged With: massage, occupational therapist, PT

CBO Predictions Mean Ouch For Workers Comp

February 6, 2014 By JL Risk Management Consultants

CBO Predictions Bad Sign For Work Comp

The CBO predictions mean a big ouch for WC.

The recent revision by the Congressional Budget  Office (CBO) in reference to future employment numbers is dire at best.  The CBO Charts are here.   Please note the file is a PDF file and not a webpage.The political ramifications will not be covered overall.   The data will be the only areas examined.

Rating of Labor Force Participation CBO Predictions Bad Sign

Wikimedia Commons – Rcragun

The CBO is basically the best source for the Federal Government’s budgetary figures.  As we all know that when the labor force declines dramatically, Workers Comp payrolls and premiums will decrease proportionally.

One has to look no further than the following chart in the title page of the report to immediately see the decline in labor force participation.  There is a valid argument that increases in wage can offset the decline.   However, the increase in wages will very likely not even approach the lost payrolls.

Insurance carriers are going to have to make up this ground somehow.  Most economic models say that when demand for a product decreases, the price for that same product will decrease.  This is not true for WC rates.

The pricing models in place for WC charges more for each dollar of coverage when the payroll is smaller.  This is due to the risk of an accident cannot be offset by the lower premiums paid by employers.  Insurance carriers are not trying to increase profits.   Smaller employers pay more per unit of WC coverage.   This is an insurance market norm.   Check here for a further analysis of a shrinking WC market.

This could possibly also cause the market to harden for WC though there are other variables that would need to change to cause this to happen by 2020.

Picture Thumbs Down at Decreasing Bar Chart CBO Predictions Bad Sign

StockUnlimited

Hopefully, the CBO may be over-projecting job losses in the coming years.  If not, then many companies may end up paying more premiums on a smaller profit margin.  There may be another market force in effect. which may offset some of the premium increases.  If the situation or the CBO’s forecast changes, I will then post another article on the situation.

©J&L Risk Management Inc Copyright Notice

Filed Under: statistics Tagged With: CBO, Congressional Budget Office, employment numers, PDF

Mississippi Court Indirectly Uses WALSH Jurisdictional Test for WC

February 6, 2014 By JL Risk Management Consultants

Mississippi Court Uses Walsh Jurisdictional Test (Sort Of)

Alabama and Mississippi were the two choices for the 5th Circuit Court of Appeals. (See yesterday’s article on a bad faith case).   The  Court very likely did not use the WALSH jurisdictional test.   However, the results were the same.  I have actually seen a judge use this test in a decision.

State of Mississippi Judiciary Logo

Wikimedia Commons – User:Connormah

The WALSH jurisdictional test for Workers Compensation claims is a great guide for an adjuster when an accident happens with multiple states involved with a claim.  Employers should also apply it when they are considering whether or not employees are covered by a valid WC policy. 

I have actually seen trucking companies that had a claim denied by a carrier as there was no coverage for a certain state.  Many policies are written on a multi-state basis.  Some are written to cover just one state.  That is why reading the Workers Policy in full will inform an employer whether or not multi-state coverage is in effect.

There are a few states that can cause nightmares for employers with no coverage.   The monopolistic states and states with their own rating bureaus are areas of great concern for jurisdictional coverages.

For instance, if an employer only had West Virginia coverage, but did not have coverage in Ohio, a monopolistic state.  If an employee is injured and files for benefits in Ohio, then what happens to the West Virginia carrier’s policy.   Would they pay out-of-pocket for the employee’s injuries?  Ohio only allows coverage to be written through the Bureau of WC.

The WV employer might have applied the WALSH test to discover certain employees should have been covered by an Ohio policy.

Male Patient Mississippi With Bad Injury On Head

StockUnlimited

From the article on the Alabama/Mississippi case, the WALSH test would have appeared similar to this:

  • Worked – Mississippi
  • Accident – Mississippi
  • Lived – Mississippi
  • Salaried – Alabama
  • Hired – Alabama

The most important factor is where the employee worked most of the time.   The least is where the employee was hired – the location of the contract of employment.  Mississippi is easily the correct jurisdiction.

©J&L Risk Management Inc Copyright Notice

Filed Under: Alabama, Mississippi, Ohio, WALSH WC Jurisdiction Choice, West Virginia Tagged With: hired, jurisdictional test, pay out-of-pocket, salaried, worked

Alabama and Mississippi – Bad Faith Case From Workers Comp Claim

February 4, 2014 By JL Risk Management Consultants

Alabama and Mississippi Bad Faith Springs From WC Claim 

Alabama and Mississippi had a bad faith case filed from a Workers Comp claim.

Picture Of Gavel Alabama and Mississippi In Judge Hand

StockUnlimited

Adjusters are usually protected from any type of Workers Comp mistake or oversight.  The Exclusive Remedy doctrine has always protected other parties including employers, adjusters, and other insurance personnel from bad faith suits.

The Exclusive Remedy doctrine usually means that if an employee accepts workers comp benefits, then that is the only avenue of collection of benefits from his/her employer.  Every now and then a case makes it through and or around the WC courts or Industrial Commissions .

According to this article by Business Insurance (click here), an employee that was paid Workers Comp benefits in Mississippi  could also file a bad faith action.   The ruling said:

The “Mississippi Supreme Court recognized, under common law, that an injured worker may recover damages from a workers compensation insurer for an independent tort, outside the scope of the worker’s employment, when the insurer intentionally and in bad faith refuses to pay workers compensation to which the worker is entitled

The four elements that I saw from the ruling are:

Two Man Alabama and Mississippi Shake Hands

StockUnlimited

  • The bad faith claim release was not part of the WC settlement
  • The US District Court in Mississippi said that Alabama was the proper jurisdiction
  • The employer was based in Alabama
  • Mississippi allows bad faith suits out of WC

The US District court  was overruled on their determination that only Alabama had jurisdiction as the employer was based in Alabama.     

The Court of Appeals applied the WALSH test for jurisdiction when overruling the US District Court.  There are more circumstances in the case.   It may be a good idea to follow the link provided to read the article.  

I will cover the WALSH jurisdiction test tomorrow. 

©J&L Risk Management Inc Copyright Notice

Filed Under: Alabama, bad faith, Business Insurance, Mississippi, WALSH WC Jurisdiction Choice Tagged With: Exclusive Remedy, intentionally, overruled

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James J Moore
Raleigh, NC, United States

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:
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