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Home » Archives for July 2016

Archives for July 2016

Unique Study of Worker Outcomes – Webinar July 28th – WCRI

July 15, 2016 By JL Risk Management Consultants

RE: Worker Outcomes – How Do Employees Fare After The Injury?

High View Of Man Worker Outcomes Standing Amidst Businesspeople

StockUnlimited

A measure of worker outcomes post-injury was first measured by WCRI (Workers Compensation Research Institute).  I had found this study to one of the fresher studies in Workers Comp.   To register click here.

Workers outcomes was one of the least understood and shoddily studies subjects until the WCRI started surveying employees after the fact.    This study provided an angle that most of the WC industry decided to not track beyond settlement and/or claim file closing. (sadly)

There are a few articles in this website which cover WCRI’s assessments of worker outcomes.  The first time I had seen any data from this study was in January 2015.  This is my favorite of all the WCRI studies as the groundwork for this study had to be massive.

According to WCRI’s Dr. Savych. “By examining outcomes of injured workers, policymakers and stakeholders can better understand how different state systems compare in order to identify and prioritize opportunities to improve system performance.”

The areas of the study that will be covered in the webinar are metrics such as:

  1.  Recovery of physical health and functioning
  2.  Return to work
  3.  Earnings recovery
  4.  Access to medical care, and
  5.  Satisfaction with medical care.

The webinar will be state-specific or in other words which states outperformed the others in reference to the five aforementioned areas.

Doctor And Woman Patient Worker Outcomes Examining X-Ray

StockUnlimited

  • In what states did injured workers report higher rates of being able to go back to work and stay employed after initial return to work?
  • How did recovery of physical health and functioning vary across study states?
  • In what states did injured workers report higher rates of experiencing “big problems” getting desired medical care?
  • What percentage of injured workers across the 15 states was satisfied with their overall medical care?

The 15 states included in the research are

  • Arkansas
  • Connecticut
  • Florida
  • Georgia
  • Indiana
  • Iowa
  • Kentucky
  • Massachusetts
  • Michigan
  • Minnesota
  • North Carolina
  • Pennsylvania
  • Tennessee
  • Virginia
  • Wisconsin.

©J&L Risk Management Inc Copyright Notice

Filed Under: WCRI Annual Conference, Workers Compensation Research Institute Tagged With: earnings recovery, groundwork, injured employee, measure

Work Comp Reserves And Twilight Zone Phone Call

July 14, 2016 By JL Risk Management Consultants

How To Negatively Affect The Initial Work Comp Reserves

The Work Comp reserves on a file are based on a more complicated formula than just an educated guess.   One of the quickest ways to have the claims staff set very high initial reserves is by starting the file with the term I coined a few years ago.     The Twilight Zone phone call always has these frustrating characteristics:

graphic of clouds work comp reserves emblem from website

Wikipedia

  • No first report of injury has been filed by the insured
  • The Twilight Zone phone call is for some type of authorization
  • The caller cannot figure out why the adjuster cannot provide an authorization on the spot
  • The adjuster has to drop everything, call the employer and ask for a first report of injury
  • The First Report of Injury has to be input quickly.
  • Then the adjuster has to call back whomever was seeking a treatment authorization
  • The adjuster is left with a conundrum of authorizing something without having fully investigated the file.
  • This type of situation is usually a trend with some employers, not an isolated occurrence

Within 60 days, the adjuster will be tasked with setting reserves on the files.    After the aforementioned occurrence, the natural reaction of the adjuster is to possibly set the reserves higher than normal.

This is a different type of reputational risk.   If the adjuster or claims staff recognizes that a certain employer has a trend of providing them with Twilight Zone phone calls, the natural reaction to the reputational risk will be offset by the adjuster setting the reserves at a higher level than normal.

Twilight Zone Work Comp Reserves View

StockUnlimited

The 60 day work comp reserves are usually the ones that are on the file at its conclusion unless the injury worsens.   The claims staff setting higher work comp reserve levels  will result in the employer incurring a higher E-Mod (X-Mod) or LDF.    This is just one example of how having a great working relationship with the adjuster will pay off handsomely in the long run.

The timely filing of the first reports of injury is one of my Six Keys To Cutting Work Comp Costs.   With the ability to now input claims directly into the claims systems, there is little excuse for an extremely last first report of injury.

©J&L Risk Management Inc Copyright Notice

Filed Under: Reserves Indemnity E-Mod, Workers Comp Reserving Tagged With: adjuster, tratment authorization, Workers Comp reserves

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About Me

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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: • Risk and Insurance Management Society (RIMS) • Entrepreneur Magazine • Bloomberg Business News • WorkCompCentral.com • Claims Magazine • Risk & Insurance Magazine • Insurance Journal • Workers Compensation.com • LinkedIn, Twitter, Facebook and other social media sites • Various trade publications

 

Recent Posts

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  • Pennsylvania Employers – Workers Comp Premium Refunds Possible
  • Workers Comp Premium Auditor Does Not Know My Final Bill Amount?
  • Workers Compensation Fraud In New Jersey – Video Says It All
  • Medical Only Claims Adjusting – One Super Critical Task To Consider
  • PEO Data Session – NCCI Data Conference Earlier This Month
  • Report Medical Only Claims To Carrier – Saves Later Headaches
  • Workers Comp Bad Faith – Adjusters Look Back Over Their Shoulders?
  • Workers Comp Premium Savings Generated With Website Updates

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