Archives for April 2020

Workers Comp Humor During The Lockdowns – Working @ Home

April 30, 2020 By JL Risk Management Consultants

Workers Comp Humor Needed Now – My Major Accomplishment and The Theremin

OK, so my attempt at Workers Comp humor or any humor may fall flat. Well, here it goes. Also, my method for securing toilet paper after I ran out. BTW, I am not a hoarder. Four packs were the minimum order.

picture of toilet paper workers comp humor

Major Accomplishment – Hopefully Workers Comp Humor

I was convinced that the toilet paper shortage crisis was a joke unto itself. After six different shopping trips with no luck while my supply dwindled like gasoline in the 70’s fuel crisis.

Shockingly, some of the local stores in Raleigh had replaced their paper goods with other seasonal store items. Uh-oh! I had ordered delivered groceries from Aldi’s free with the first three deliveries. I have an artificial heart valve. I wanted to be very careful – maybe too careful = paranoid.

A search online revealed multiple gougers and overpriced suppliers. RV toilet paper seemed to be all that was left. Luckily, I found three rolls I had stashed for emergencies. They were the local dollar store brand (uncomfortable) but at least I had a few left.

I was up at 4 AM due to acid reflux – Aldi’s has great hot sauce. I decided to try my luck at 4 AM and there it was on Office Depot – but I had to buy a large amount. I ordered it and Voila! it arrived after a few days. Yes, the office supply stores put a few cases online almost every morning if you are an earlier riser or a night owl.

My overseas web consultant was laughing the whole time – he was the person that encouraged me to write this somewhat personal post at an attempt for Workers Comp humor. Most other countries use bidets if available.

The Theremin

You may recognize the Theremin. I tried to play one a few times. I play guitar so I thought – how hard can this be? It was extremely difficult.

License – Wikimedia Commons- Hutschi

The Google Doodle for today is the Theremin. The Theremin was popularized by 50’s science fiction movies and the Beach Boys.

Google Doodle has brought back all their user-involved classics such as the cricket game that is so addictive.

In case you want to hear a good Theremin player with an orchestra check out this YouTube link.

So, there are your workers’ comp humor breaks for the day. Good luck. Be safe.

©J&L Risk Management Inc Copyright Notice

Coronavirus Return To Work – Top 10 Issues For Workers Comp

April 30, 2020 By JL Risk Management Consultants

Pending Post Coronavirus Return To Work Issues – Top 10 Preparations

Coronavirus return to work issues will become the buzzword phrase in Workers Comp over the next few months (rightfully so). Any references to a return to work mean all employees except for #9 below.

Picture Coronavirus return to work microscopic

CDC Public Use License

This complete list may not apply to your company whether you are an insurance agency, claims department, employer, safety and risk manager, etc.

The Top 10 Issues are:

The learning curve or the accident curve. One of the best formulas I was taught while obtaining my actuarial degree was the learning curve. I will save you having to look at the formula. The only thing I will say about it is that the formula involved logarithms. Even very experienced employees tend to have more accidents when returning to work. The machine or process that they may have used compares to starting over again.
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COVID presumptions AOE COE – NCCI produced a great chart on the state activities concerning legislation that will be updated weekly. You should check that chart out – nice work NCCI. Here is the link.
In case of a workers’ comp accident, make sure the medical facilities in your medical treatment network have enough staff to handle your injured employee(s). Waiting for hours to be treated for an injury is not the best way to start off a claim. This recommendation is the most important of the Six Keys.
Make sure that you are not overpaying premiums to your carrier – especially if you are returning a small number of workers to start your business up again. If you are renewing a policy and your workforce is going to be smaller, discuss with your agent about lowering the deposit premium. Caveat – if you start with a few employees, have your deposit premium reduced, and then fully staff, be ready for the premium audit bill.
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Reporting claims to your carrier or TPA – Who is now responsible for reporting your claims if your company did not staff up completely? Does this person know how workers comp works? Do they have a copy of your medical referral network that you use to treat injured employees? Do they have the info in #6?
Carrier and TPA Contact List – Do you know who is handling your claims at this point? Is there a new contact email or phone to reach the claims adjusters on your file? They could be working from home which would likely change the phone number to call them. Emails are still the best adjuster contact.
Remotely starting up – if your company has decided to work remotely before actually physically going back to their workplaces, you may need all the bandwidth you can muster. Check out this article to see how to speed up your connection by 100% with an old school trick. This trick works. I use it if I am hosting the webinar or video meeting. Hint – get out a CAT-5 cable.
Traveling for work – when you have employees that drive as part of their work, #1 above will heavily apply. Even familiar driving routes may seem different to an outside employee after weeks of not working or working out of their homes. The learning or accident curve applies to outside workers.
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Temporarily Totally disabled employees – if an injured employee was unable to return to work before the COVID crisis, how will you now return them to work if the treating physician releases them – have them work from home? Modified duty may be complicated to provide in the current environment.
Check with your legal counsel more than you did previously. I recommend #2 above and check with your legal counselor on interfacing workers’ comp and all the new laws that are in place. None of these 10 recommendations should be taken as legal advice. The coronavirus return to work varies so much from state to state.
Bonus – I do realize that many businesses may not start again for weeks if not months in certain states. Keep this list whenever your state allows your business to start up again.

Please do not consider any of the recommendations as legal advice only as a checklist for a coronavirus return to work for your employees.

©J&L Risk Management Inc Copyright Notice

Phoned In FROI Response To My Last Article – Excoriated

April 23, 2020 By JL Risk Management Consultants

Phoned In FROI (First Report of Injury) Reader Response To My Last Article

A reader phoned in FROI response left an unapproving voice mail this morning. My last article covered the First Report of Injury coding becoming very important due to COVID-related claims.

Doctor talking on Phoned In FROI while looking at clipboard

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The reader said examples of the sections in the FROI should have been included in my last article.

The old saying – “The customer is always right” rang true in this example. We put the rush on this article to get it in our newsletter for today. Gulp! – deadlines!

The WCIRB (California Rating Bureau) sent out a press release that any Corona virus-related claims will not count in any California employer’s X-Mod.

I had recommended employers use their carrier or TPAs online claims systems. A phoned in FROI or a paper report may cause the carrier’s data inputters to code a COVID-related claim as not related to the coronavirus.

Two First Report of Injury Examples

I decided to show the readers two examples of what you must fill out that make a claim considered and coded as COVID-related. Please note these are image thumbnails – click on them to see a larger image.

Cutout of phoned in FROI section for California WC claim

The two are cutouts of the paper reports of injury. The first one is from California. The second cutout is from our HQ state North Carolina.

The California Form 5020 covers the injury or illness a little more thoroughly than the North Carolina Form 19. I am not sure if either state has or will devise another form or attachment to identify COVID-related claims.

Cannot Fill Them In – Even The Examples

Our legal advisor said that I should not fill in each for examples of how to designate them as COVID-related. That cuts down what I was going to cover in the article.

My advice from the last article I wrote is to try to attach the physician’s statement to the FROI if possible. Be explicit as possible when filling out the report or if you are doing a phoned in FROI.

©J&L Risk Management Inc Copyright Notice

First Report of Injury Coding Goes From Important To Critical

April 23, 2020 By JL Risk Management Consultants

First Report of Injury Coding Now Even More Critical Than Before

The First Report of Injury Coding now becomes something to watch for in the next five years. Well, you should have been watching the coding before now if you had online access to your claims.

Pic of keyboard person First Report of Injury Codeing

Wikimedia Commons Santeri Viinamäki

Why was a decision made to write this article? Last week, I wrote an article on California’s WCIRB.

The article was republished quite a few times out in the blogosphere. You may want to follow the link previous link to see the caveats and how to avoid them for any COVID-related claims in California.

The WCIRB decided to NOT ADD IN any COVID-related claims to an insured’s X-Mod. Yes, if the claim is related to the Coronavirus, an employer will not incur the addition of that claim to their Mod.

NCCI will likely follow suit on not COVID-related claims not pegging to the E-Mod. X-Mod and E-Mod represent the same term. Most Californians refer to the Experience Modification Factor as the X-Mod.

Two Important Areas for Proper Coding

Hands presenting First Report of Injury Coding wed design concept

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Two areas should be considered when filing a claim for the proper first report of injury coding:

Do not file every claim you have as COVID-related. This came in as a question from the article published last week. Are not all claims related to COVID in March and April of this year? No, do not consider them all COVID claims. Do not reduce your integrity with your worker’s comp claims department.
Use your carrier or TPA’s online claims reporting system. Why? The online systems usually allow an employer to differentiate the disease claims. In other words, you are coding the claim properly and someone in the data input department will review your input. Carriers and TPA’s may charge a fee to input a paper claim.

When a carrier or TPA receives the first report of injury (paper, call-in, or online), a few steps are involved for data input to release the first report of injury to the supervisor then the proper lost time or medical only adjuster. Online claims reporting assists in the process. (See #2 above).

One mistake that I have seen over the years that causes much confusion originates with the treating physician not denoting the claim as a disease-based claim. The medical only or lost time adjuster may figure this out, but rarely have I seen adjusters change the coding once the claim is set up except medical only to lost time.

An adjuster will usually review it once for a few seconds. I have seen four claims where the adjuster changed or requested a change to the type of coding.

First Report of Injury Coding Follow-up

The easiest way to follow up in making sure the coding matches the injury (disease) involves online access. Most carriers and TPAs have a coding section where you can review to see what coding was entered. If you have online first report capabilities this is a simple task. Paper loss runs make this a much more difficult task.

©J&L Risk Management Inc Copyright Notice

WCIRB XMod Decision Gives Employers COVID Reprieve – Sort Of

April 16, 2020 By JL Risk Management Consultants

WCIRB XMod Decision Includes COVID-related Claims With Three Caveats

The WCIRB XMod decision this week should provide employers somewhat of a break for incurring COVID-related claims. WCIRB is the Workers Compensation Insurance Rating Bureau of California.

world covid outbreak map WCIRB XMOD Decision

A question was sent to NCCI (National Council on Compensation Insurance), as I write this article, to see if the rating bureau for 40 states is going to do the same. I know the answer but wanted to verify it. Check out next week’s article to see what was discovered with my NCCI communique.

The three caveats with on the WCIRB XMod ruling do not involve the WCIRB directly. By the way, the WCIRB treats me very well when I have questions for their staff. I attended their most recent mini-conference at their Oakland HQ in January.

The three caveats involve your insurance carrier or Third Party Administrator (TPA) and the reporting employer. Think about the situation for a moment. What the carrier or TPA inputs from the First Report of Injury (FROI) becomes beyond critical information.

Some readers may likely think that TPAs do not report claims to the rating bureaus. Two of our agent clients have placed policies with carriers that use TPA’s for claims handling. Whatever the TPA inputs the carrier reports.

Caveats for WCIRB XMod Decision

Hand holding pencil with WCIRB XMod Decision bacteria and scientific notes

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The three caveats are:

The employer has to report the claim accurately as being related to COVID. No assumptions can be made with the FROI. If you have the treating physician’s note that relates the claim to COVID, attach it to the FROI.
Even more critical, the TPA or insurance carrier MUST CODE the claim as COVID. This is where the proverbial rubber meets the road. No matter what occurred in the claim, if it is not coded as a COVID claim, then #1 above and #3 below will mean very little.
The physician must relate the claim to COVID-19. Without this diagnosis and report, the claim likely will not be reported as a COVID-related claim and will peg to your XMod.

More minor caveats exist. The three above cover enough ground.

FROI and Claim Verification

How do you verify that the COVID-related claim will be excluded From Your XMod?

Have a working relationship with the claims adjusters handling your claims – you do know who they are, correct?
Attach the treating physician’s note to the claim – may not be allowed in a few states
Email the claims adjuster 15 days after filing the FROI to verify that the claim is considered COVID-related

Take the time to make sure your company or organization does not pay a higher premium after the benefit of the WCIRB COVID decision.

©J&L Risk Management Inc Copyright Notice

COVID Compensability Conundrum – Who’s Covering What?

April 14, 2020 By JL Risk Management Consultants

COVID Compensability Conundrum – Coronavirus Causing Workers Comp Claims?

Adjusters Will Deal With COVID Claims

The COVID Compensability Conundrum will arrive later this year when workers comp claims adjusters have to make difficult and complicated claim decisions.

NCCI COVID Compensability Conundrum-19 Rotovirus simulation

Wikimedia – See previous author info

Most states have a disease statute. Not many states include personal sensitivity claims in their rules and regulations.

One of the most prevalent difficult workers’ compensation claims decisions involves the adjuster determining whether or not the alleged work comp injury or disease came from a source that exposed the claimant to a higher degree of susceptibility than just being in the general public.

This type of claim causes much consternation between the adjuster and the injured employee when the file is denied due to the exposure not being more at work than the claimant would find in the general public.

A cold or the flu was never accepted by any claims department that I am familiar with regardless of the job title.

Many members of the worker’s comp press published articles over the last three weeks pertaining to First Responder coverage. Governors are likely to order coverage for First Responders.

Exposed Workers

How about these workers:

Nurse adjusting COVID Compensability mask

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Grocery store workers
Grocery delivery
Pharmacy staff
Bank staff – handling cash
Restaurant employees – drive-thru or takeout
Post office
Shipping services – UPS, FedEx
Home care workers

As one can see, the list goes on and on. Determining where the exposure occurred is complicated at best.

The adjuster’s job will become even more difficult. How would an adjuster make this COVID Compensability Conundrum decision have more fortitude?

Adjuster Investigation on COVID Compensability

The five main investigative tools for adjusters are:

Job Description – did their job expose the claimant more to COVID than being in the general public? Is there really a general public now with the lockdown orders?
Recorded interview – #1 above should be covered very well here
Treating Doctor’s notes – the person has to have a COVID diagnosis – did the physician relate it into the job – extremely important.
First Report of Injury – an often overlooked investigative tool
Initial discussion with the employer – for obvious reasons

Do not be surprised if the Governors /Insurance Commissioners create orders to pay for COVID work comp claims

As we all sit home and wait to go back to the office, or work harder telecommuting – I thought this quick article on the COVID Compensability Conundrum would cause claims departments to start thinking about these types of claims as more people are tested over the next few weeks.

COVID-19 Pandemic Statistical Madness Rears Its Ugly Head

April 3, 2020 By JL Risk Management Consultants

COVID-19 Pandemic Statistical Madness – Whose Numbers Are Correct?

The COVID-19 Pandemic statistical madness has reached epic proportions. I usually do not stray from Workers Comp articles. That is why you read this blog and the newsletter. However, the recent numbers flashed on screens across the world gave me pause.

simulation of COVID-19 Pandemic Statistical Madness

Wikimedia Public Use License – Graham Beards

I usually quote a large number of statistics such as X-Mods, LDF’s, and other organization’s studies. Those numbers, except for a few organizations, are usually static. They vary a small amount. Typically, the rating bureaus and the BLS provide great numbers.

The White House’s press briefings were based in solid numbers until the models were unveiled over the last 10 days. Models and predictive analytics go together. I am a fan of neither as the numbers can change quickly when covering any type of datasets.

One example of models that are supposedly magically correct is the hurricane models. The graphic below shows the variance in the predictions of hurricanes from 2012-2016. If the forecasters were accurate, then the line would be flat-lined at zero. This graphic is not the case.

Graph of Hurricane Prediction COVID-19 Pandemic Statistical Madness

The associated article to the above graph can be found here. One quote from the article that jumped off the screen was:

…..hurricane models are not good at predicting rapid intensification events such as Maria because so few of them occur.

You are asking, wait – your article title refers to the coronavirus, but now we are on hurricanes? Take a look at the same organization’s article on COVID-10 pandemic statistical madness. Check it out here, no really – take a look and my article will start to make sense.

Chart after chart in that article shows that the COVID-19 experts disagree significantly on the Coronavirus statistics. COVID-19 remains a rarity, so knowing the outcomes compares to forecasting a hurricane.

My suggestion is to keep an open mind when the barrage of numbers starts every morning on COVID-19. Check out the Google Doodle on any Google Search Page

for a great mini-guide on and avoid the COVID-10 Pandemic Statistical Madness.

Workers Comp Medical Network Penetration Increases Utilization Costs

April 2, 2020 By JL Risk Management Consultants

Workers Comp Medical Network Penetration Means Higher Use – NCCI Study

A recent NCCI Study indicates that a higher Workers Comp medical network penetration rate results in a higher rate of utilization. Check out the study here on their website. The study reads as a little complicated, but bear with the study. The details are worth the read and your patience. (NCCI > National Council on Compensation Insurance).

Woman with book Workers Comp Medical Network studying at desk in library

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Blog and newsletter readers will benefit from reading the whole study and drawing conclusions from it. NCCI verified what I had been saying for over a decade. When the prices of workers comp treatment decrease, such as an adjustment in a state fee schedule, utilization increases.

The definition of network utilization is the quantification or description of the use of services by persons for the purpose of preventing and curing health problems, promoting maintenance of health and well-being, or obtaining information about one’s health status and prognosis.

The focus word here is quantity.

Previous Studies Had Same Conclusion

Many articles have appeared in J&L’s blog over the years on this subject. I have performed studies for physical therapy groups, medical networks, carriers, TPA’s and investment groups on the use of medical networks. One of the by-product conclusions was that utilization offsets price when comparing the two variables.

According to NCCI –

…a higher proportion of in-network claims in a state relates to comparatively greater utilization of services for in-network claims. In turn, this associates greater network penetration with greater utilization of services to treat in-network claims, compared with out-of-network claims.

Missouri Has Highest Network Use At Highest Cost??

Let us see each state’s Workers Comp medical network penetration rates. One of the more interesting states in the below chart is Missouri. Last week, J&L produced an article on the extremely high costs of medical care in the Show Me State. Missouri has the highest use of medical networks in the nation. Why are the costs so high if the Missouri medical network penetration rate is the highest?

My best estimate would be that the medical costs are so high in Missouri (304% above the median state) that the medical network price may still be high. The use of the medical network is very high due to carriers and employers attempting to reduce medical costs. The graph below and the one in the previous article on Missouri medical costs point this out exactly.

Graph of NCCI Chart Workers Comp Medical Network Penetration

Click the chart for a better resolution. The bubble charts on pages 28 and 29 of the NCCI study on workers comp medical network penetration summarize the points very well.