Archives for December 2015

247,120 Slips, Trips, And Falls Devastate 2014 Workers Comp Budgets

December 16, 2015 By JL Risk Management Consultants

247,120 Slips, Trips, And Falls – Increased by 8%

Slips, trips, and falls as a type of WC injury increased by 8% when compared to 2013 figures. According to the BLS (Bureau of Labor Statistics), there were 247,120 slips trips and falls in 2014. This figure was much more stable from 2011 – 2013. For some reason, a spike occurred in 2014.

Breaking down the numbers further, when assuming a 2,000 hourly annual workload, this type of injury accounts for 123 injuries per hour (one every 30 seconds) in the US.

Year	Annual
2011	229,630
2012	223,700
2013	229,190
2014	247,120

One has to wonder the reason for such an intense spike in slip, trips, falls in just one year.

As expected, the Fatalities from this injury type also spiked in 2014. The fatalities increased by almost 10%.

Year	Annual
2011	681
2012	704
2013	724
2014	793(P)
P : Preliminary

This type of injury increase can devastate Workers Comp markets overall. NCCI did not provide a reason for the increase, however, their rating statistics showed that slips and trips accounted for 30% of all claim dollars. Strains also accounted for 30%.

The prevention of this type of injury is key to reducing Workers Comp costs. Zurich has a very interesting slip, trip, and fall assessment guide that safety personnel and Risk Managers may find helpful. The assessment guide even has a great checklist to prevent this type of injury.

The guide is only five pages long. Reading through it will be well worth your time.

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Temporary Partial Disability – Misunderstood Benefit

December 15, 2015 By JL Risk Management Consultants

Temporary Partial Disability

The Workers Compensation benefit Temporary Partial Disability (TPD) is likely one of the more misunderstood benefits. A quick review of the three main types of paid disability benefits under WC are:

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Temporary Total – paid when a workers is completely out of work, usually at 2/3 of the established average weekly wage before the injury. This benefit may switch to Permanent Total in certain cases.
Permanent Total – the injured employee is deemed as never able to return to their prior job. Permanent total benefits may not have a cap in certain states.
Permanent Partial– a benefit paid when an injured employee loses partial use of a body part such as a hand or eye.
Temporary Partial – 2/3 of the difference between the average weekly wage and the current wage the employee is now earning after a return to work.

Most states have caps on one or more of the above types of benefits.

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Temporary partial disability benefits can be difficult to track and pay an injured employee as the employer has to submit the wages earned each week and the adjuster has to make a calculation similar to (Pre-injury Average Weekly Wage – Post Average Weekly Wage) * 2/3 = TPD.

The calculation is not that difficult. Monitoring the payment and then relying on the insured to provide the reduced wage figure each week can be tedious for all parties. An adjuster may have multiple injured employees on TPD at the same time.

Injured employees almost always do not earn the same amount of wages each week. The worst case scenario is TPD being paid incorrectly for a number of weeks. Refiguring the TPD benefits can be a very cumbersome corrective action.

TPD benefits are federally tax-free as are all WC benefits. Each state is very specific how TPD is calculated and paid for the reduced wages.

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FMLA With Workers Comp Return To Work – Expensive Mistake

December 14, 2015 By JL Risk Management Consultants

FMLA With Workers Comp Return To Work

The relationship of FMLA with Workers Comp Return to Work is still an area of much confusion even today. The FMLA has been in existence since 1993.

FMLA Workers Comp Return Department of Labor US badge

I do not claim to be an FMLA (Family Medical Leave Act) expert whatsoever. That issue is best left to the Human Resources (HR) experts. However, when combining FMLA with Workers Comp return to work, each benefit can greatly affect the other. A very expensive mistake can ensue if not handled properly.

The WC adjusting staff is not usually responsible to send out FMLA notice letters to injured employees that are on TTD (Temporary Total Disability). The FMLA notice should follow the same,timing as WC disability leave.

If the injured employee is not put on notice while out on TTD, the FMLA 12 weeks of leave will not automatically expire. The employer needs to send the notice. If not, there may be an instance where the employee is entitled to 12 more weeks of leave while not on TTD even after the Workers Comp disability ends and the usual return to work is offered to the employee.

Business Insurance recently published an article if the injured employee is not put on notice. The Texas Supreme Court sided with the injured employee that a WC claim does not kick in the FMLA period.

A suggestion is the adjuster let the employer’s HR department know when the employee begins a period of TTD. The FMLA requires very tight deadlines on providing the injured employee FMLA notice.

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WCIRB WCAN WCRI = Confusion on California WC Statistics

December 10, 2015 By JL Risk Management Consultants

Confusion on California WC Statistics

WCIRB WCAN WCRI – Three trusted statistical providers that now have me confused on whether or not SB 863 actually had an effect on California’s Workers Comp system.

Workers Comp Reform SB863 WCIRB WCAN WCRI emblem from web

Acronyms –

WCIRB – Workers Compensation Insurance Rating Bureau – The Rating Bureau for California’s WC system
WCAN – Workers Compensation Action Network – An independent group that studies and advocates for reform in CA’s Workers Compensation system
WCRI – Workers Compensation Research Institute – An independent organization that studies WC nationwide and produces reams of good data
SB 863 – A Senate Bill passed and enacted on January 1, 2013 which was supposed to reduce WC costs by controlling certain aspects of the California WC system

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After receiving a press release from WCRI today, confusion abounds as I had thought that SB 863 had failed in its mission. WCRI today published a study of California’s WC system that actually indicated a 5% reduction in medical costs.

Any of my comments on SB 863 are in this J&L Blog search. After searching back through 15+ articles ( wow, I actually wrote that many) on SB 863, I may have broken one of the Cardinal Sins of Workers Comp.

The actual results of a system change are not going to start really showing for two (at the beginning) to five years (full effect). WC is a delayed system. Immediate changes do not show for many months. I have seen Safety and Risk Manager jobs being eliminated as companies do not wish to be patient in our “instant information and results” workplace of today.

According to WCRI, some of the main reasons for the 5% decrease in costs were:

Reduced fee schedule rates for services at ambulatory surgical centers (ASCs)
Elimination of separate reimbursement for implantable medical devices, hardware, and instruments for spinal surgeries
Requiring a $150 fee to file liens against an employee’s workers’ compensation benefits and a $100 activation fee for liens already filed.

There will be more information published by WCIRB WCAN WCRI in the future. One has to only anticipate an improved situation in California (or will it be improved).

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Retroactive and Waiting Periods May Affect Disability Length

December 9, 2015 By JL Risk Management Consultants

Retroactive and Waiting Periods

Retroactive and Waiting Periods for Workers Comp temporary total disability (TTD) are supposed to heavily affect the time that an injured worker stays out of work – or do they? Yesterday’s article covered if Waiting Periods are actually still valid in today’s world.

Wikimedia Commons – Robbert van der Steeg

Most waiting periods in Workers Comp are 7 days. Most retroactive periods are 21 days. The waiting periods are very state-specific.

An interesting study was performed by a group of Liberty Mutual researchers. The study was published in the Journal of Occupational Medicine and Environmental Medicine. The subject matter was low back pain injury data from 49 states’ WC programs.

I read over the study quite a few times. What I gathered from the results is that there is a trend that shows that longer retroactive and waiting periods result in injured employees staying out of work longer.

However, the amount of claims in which this situation even occurs is so small (5%) that is was not significant as far as a cost factor. Feel free to consult the study using the previous link.

Chart #3 in the study summarizes the findings.

One concern that I have is the motivated worker that returns to work quickly may be penalized by the retroactive and waiting periods in his/her claim.

Some companies and organizations have chosen to subsidize the waiting period and pay the employee for their waiting period.

I do disagree with employers supplementing the injured employee’s’ TTD for the 1/3 reduction in their pay while out of work. See this J&L blog article for the reason to not pay supplements.

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Are Workers Comp Waiting Periods Really Worth It?

December 9, 2015 By JL Risk Management Consultants

Workers Comp Waiting Periods

Most Workers Comp waiting periods are 7 calendar days retroactive to 21. This means that any injured worker will not be paid for the first 7 days unless the disability period extends to 22 days.

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Workers Comp waiting periods are almost always measured in calendar days and not workdays.

Does this seem fair? Is the waiting period actually an anti-return-to-work variable?

There has been a large amount of debate recently over the fairness of requiring an injured employee to be penalized for returning to work before the 22 days expire.

Does the waiting period in concert with the retroactive period cause employees to stay out longer to ensure they will receive all 22 days of Temporary Total benefits?

The other side of the coin is the initial reason Workers Comp waiting” periods were legislated into being was the avoidance of the “WC paid vacation.” The waiting period was seen as a deterrent to employees taking off a few days here and there by reporting an accident and receiving subsequent treatment that will keep the injured employee off of work for a few days.

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The calendar for an injured employee usually runs similar to:

The employee is injured
The employee is out of work 14 days before the first check is mailed. This will make the employee to not even have the first benefit check until 18 days after an accident. The 18 days is if the claim is reported and accepted immediately.
The investigation may cause the claim to have the first disability check mailed out even later.
The injured employee will not see the first week of TTD until the third check is cut.
The third week and first week of benefits may not be received until 25 – 28 days after the injury. This time-lagged situation may cause the employee to have only one week off TTD until a month in time has passed on the claim.

In my humble opinion, many attorneys are hired by the injured employee due to lag in benefits in the first month that is in no way the fault of the insurance carrier or TPA.

A recent study was recently published on the effects of different waiting period lengths and retroactive periods. This will be covered in tomorrow’s article.

Best Workers Comp Markets Are In 14 States

December 2, 2015 By JL Risk Management Consultants

Workers Comp Markets Are In 14 States

Map of 14 States Workers Comp Markets Graphic

Wikimedia Commons – Andrew c

The best Workers Comp markets in the US exist in 14 states. According to an annual R Street policy study, these 14 states had the best Workers Comp markets (scored 10 of 10):

Alabama
Florida
Georgia
Iowa
Illinois
Indiana
Mississippi
North Carolina
Nebraska
South Carolina
South Dakota
Tennessee
Virginia
Wisconsin

The states that scored the lowest (4.3 or lower of 10) were:

Idaho
Maine
Montana
North Dakota (fourth lowest with 2.9 score)
Ohio (tied 2nd lowest with 2.1)
Rhode Island
Washington (lowest score of zero)
Wyoming (tied 2nd lowest with 2.1)

Woman Showing Workers Comp Markets Chart On White Board

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WC was a small subset of the larger study on the overall insurance market comparisons. The WC section begins on page 25 of the study.

Standard deviations were used heavily with points added to and subtracted from the national norms (means).

One would expect the states that allow no competition to score the lowest. A large amount of weight was given to having only one insurer in the state.

The measurements used in the study were:

Concentration – number of carriers supplying coverage, monopolistic funds were seen as overly concentrated
Residual – availability of insurers of last resort or state funds,
Loss Ratio – as compared to the national average

I do agree with the study as to the extent of measuring market competitiveness. Workers comp markets only covered 10% of the total study. The study is one to download and read for more than just the WC numbers.

The study was very thorough even if some numbers/scores were determined arbitrarily.