July 2016 - J&L Risk Management Consultants

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

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

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:

Recovery of physical health and functioning
Return to work
Earnings recovery
Access to medical care, and
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.

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.

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Work Comp Reserves And Twilight Zone Phone Call

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:

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.

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.