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Return To Work Risk Management Failure – No Job Bank

May 23, 2019 By JL Risk Management Consultants Leave a Comment

Involving the Physician in Return To Work Risk Management

A huge risk return to work risk management failure begins when the physician evaluates the injured employee for a light or full duty release.

return to work risk management coal miners pic

Public Domain – US

One of my Six Keys to Cutting Workers Comp Costs involves return to work risk management.

When reviewing workers’ compensation files, we see so many times the treating physician does not know the exact duties of the injured employee’s prior job duties.

How can a physician make an exacting return to work? Often, a physician will just write up a generic return to work statement. The more information the Doctor is given, the more exact the return to work abilities or restrictions.

Building a job bank whether on video or on paper or a combination of both is the best return to work risk management technique. Over the years, we have assisted employers in building video or paper job banks.

A large number of employers have job descriptions for hiring employees. Converting the job descriptions to job duties makes the job bank task much easier.

Paying for a Physical Therapist or Occupational Therapist to evaluate the job bank looks great if the job duties ever end up in Workers’ Compensation court. The trouble and expense is repaid by cutting down the return to work costs.

An optional lower cost return to work risk management options centers on having a rehabilitation nurse assist with building and updating the job bank. Many rehabilitation companies provide that service. Knowing which service to use is key to cutting claims costs.

Overall, rehabilitation nurses remain one of the best risk management techniques in existence for workers comp. Some carriers and TPA’s have cut back on using this great risk management technique. That choice shows up on the increased claims costs lists a few months after cutting back on rehab nurses.

Some physicians visit larger employers to see what jobs employees work. I am not sure if physicians will do that now.

The physical maximum weight, repetitiveness, and other job factors need to be forwarded to the treating physician immediately – before the first visit.

Helping the physician usually assists the adjuster reduce your workers comp costs. Always make sure to forward a copy of your job bank to your adjuster on the claim.

The adjuster and physician knowing the injured employees job duties from day one results in a lower reserve on your file. Lower reserves, in turn, cuts comp costs.

Today is the best day to start building your job bank for great return to work risk management.

Filed Under: job bank

OSHA Consultant – Part 2- Keeping Your Cool in a Hot Zone

May 14, 2019 By JL Risk Management Consultants Leave a Comment

Our OSHA Consultant Glen, CSP adds in another part of the Safety Metrics – Keeping Your Cool in a Hot Zone series

Public Use License Vitalov Muratov

“ As the company’s chief financial officer, what can you tell me about your companies experience modifier? “

Answer: “ I know that it is higher than it was last year. If memory serves me well I am 137. I have no idea how to reverse it, and our Insurance Broker seems to be of no help. If we hire you, can you get it turned around? In fact, whoever we offer this position, must have a game plan ready for management within ten days of being hired. You left the interview at 10:30 A.M. At 3:00 PM you get an e-mail with an offer letter.

Fast forward, one week later. You have spent a lot of time fact-finding, and you have put together a game plan for getting the EX.Mod down or below 100. The plan is really a rough draft because there are a lot of records which no one seems to be able to find. A very nice Receptionist who has been with the company for 19 years, shares with you the fact that XYZ has outgrown its corporate offices four times. She also, tells you that a lot of the records are in storage.

Two of the biggest issues is a lack of claims files, and there are no copies of the OSHA consultant logs. There is a way around this apparent impasse, like anything else, it will take a lot of work requesting records.

This is your agenda of topics:

Lack of records and what we can do to get duplicates,
What has been done in the past and why it is not working,
A centralized incident reporting system
Show the CFO and Fanta ( your supervisor ) how you arrived at the fact of $189,637 loss due to the elevated Mod.
And the need for the Safety division of HR to have its own budget.

This writer will only elaborate on topic B and C. For more than a decade, all workers comp reporting has gone through the job Superintendents. If there were ten different jobs going, and in multiple states, each job Super. Would have the authority to send his worker to the local Doc in the Box. If a clerical person or anyone else were to get hurt at the corporate office, the claim would go through the secretary for the V.P. of operations. Most of the claims were initiated by the Work Comp Doctors, from over a dozen different clinics.

The problem with this “system” is a lack of accountability, lack of accident info, unnecessary treatment by the Doctors. Management has agreed, that a centralized system makes sense. The CFO, Handson T. Mony wants to know about the Numbers.

Mr. Mony “ I’m a numbers guy, I want to know how we are going to

Track your progress on all of these initiatives. I don’t

Have a problem spending money to save money but

Without the numbers, how do we know if we are getting

What we are paying for.”

Nate “ You sir are a wise man, we will have a way of tracking our

Success but first we need to find our claims records.”

Mr. Mony “ Well I suppose I could have our insurance Broker put us

In touch with the claims Department.

Nate “ That Sir is an excellent idea. Might I suggest, that we have

The broker arrange for a file review with the claims supervisor.”

Mr. Mony “ I like the way you think young man, send me an email of some

Times you will be free, and I will set it up. “

Nate “ Once we have our claims numbers we can determine our

annual claims frequency. Then we can set goals. “

You go on to tell Mr. Mony and Fanta, that there are two ways to track progress. One would be to use our internal numbers. If for example, XYZ had 50 claims in 2018, it could be a reasonable goal to reduce the claims frequency to say 40, or a 20 percent reduction. The other way to set goals would be to compare our company’s claims frequency or severity with the industry average of companies with the same work comp class codes.

Mr. Mony was intrigued by your ideas but he had to end the meeting quickly because he had a lunch meeting. When leaving the CFO’s office, your supervisor says,

“ Nate, are you hungry? Let me buy you lunch, I want to hear more. “

By Glen DuLac OSHA Consultant

Filed Under: Safety

Workers’ Compensation Android iPhone Apps – The Search Returns

May 9, 2019 By JL Risk Management Consultants

Workers’ Compensation Android iPhone Apps Usually Disappoint

My search for Workers’ Compensation Android iPhone apps usually leaves me saying, “Why so few?”

My searches came up with a few selections in 2015, 2016, and 2017. Last year my search for Workers’ Compensation Android Ipphone apps surprised me. The search ended with almost no apps for 2018. Why?

Wish me luck as I jump in the rabbit hole again. I will report the findings to you shortly.

Using the Search term workers compensation – The following is a screenshot of the results.

Workers' Compensation Android iPhone Google Playstore

My old rules used over the last few years:

The app had to have at least 10 ratings
The user ratings had to be 4 stars and above
The app could not be advertising for a service
The app had to work – yes, some did not work

Most of the worker’s compensation apps today never make the four above rules. Let us go with the Playstore search algorithm to find Android apps.

The first one is RoadCash. The app tracks the miles traveled and the medical appointment for travel reimbursement for the injured employee. This app appeared in the search results many years ago.

According to the website:

RoadCash(c) helps workers to claim reimbursement for travel costs incurred due to work-related injuries and health issues. When on workers compensation transportation expenses to the physician, physical therapist, hospital, and pharmacy becomes very expensive. RoadCash eliminates the paperwork and bureaucracy in the travel reimbursement process bringing fairness and justice to millions of injured workers in need.

The app works and performs the task of travel reimbursement.

The second one is Normandy Insurance (c). The app purports to provide you with a quick quote for workers compensation premiums with a few inputs. Most workers’ compensation insurance quotes require a few more inputs. The app was updated yesterday (May 8th, 2019). At least Normandy updates their Android App. Most apps are very outdated. The app borders on advertising. It does return a result, so I listed it.

From their app page:

Let us take the guesswork out of calculating premiums on Workers’ Compensation policies. The Normandy workers’ comp rater calculates premium discounts, safety and drug-free credits, debits and credits for experience modifications and increased limits. With a few data elements, Normandy’s workers’ comp rater will provide you with an accurate Workers’ Comp premium that you can email or text to yourself, or your client. All rates are updated as they change, so you have up-to-date information at all times. Our app highlights the class codes we write in green so you know what you should send to Normandy to get quoted! Spend more time with your customers and less on calculating your quote with this mobile version of Normandy’s newest resource.

The third one that deserves mention is the NYSIF (New York Self Insured Fund) Check (c) app. Late or missing workers compensation check questions generate a large number of phone calls and emails from injured employees. The android app seems very simple. NYSIF updated the app recently.

From their app page:

Quickly learn the status of your workers’ compensation or disability benefits check by entering the
* Claim number
* Last four digits of claimant’s Social Security Number
* Claimant’s date of birth
Receive information about the benefit payment and/or the NYSIF case manager for the claim.

I cannot check to see if the app works. One would assume it must work. If an injured worker accesses their check status, the adjuster’s workload would see a drop. The NYSIF should advertise this app heavily.

iTunes or iPhone Apps

The iTunes store contained no workers’ compensation apps. I possibly did not perform the right search for them. If you have any workers’ compensation Android iPhone apps, please contact me or comment below.

If you have an Android app that does not appear on the search, your company may want to include it as free advertising for the largest collection of apps on earth. If your app appeared in the search and I did not mention it, please let me know.

Copyrights in this article – iPhone, iTunes >Apple Corp., Google Playstore, Android>Google, Inc., Apps>High Road 5, LLC, New York State Insurance Fund, Normandy Insurance Company.

©J&L Risk Management Inc Copyright Notice

Filed Under: App

Safety Metrics – Keeping your Cool in a Hot Zone – Four Part Series

May 7, 2019 By JL Risk Management Consultants

Our OSHA Consultant Publishes a Four-Part Series on Safety Metrics

Safety metrics is the way we will measure our safety program. Without measurements we have nothing.

Safety Metrics measuring out powder with a ruler

Wikimedia Commons – Btmcclain

Every profession has ways of measuring the success and failure of their endeavors. Accountants, look at balance sheets, earning, and ( ROI ) return on investment. The Human Resources Manager will track turnover as well as the cost of recruitment. Finally, the Safety Director will measure Lost Time injuries, accident frequency, and the companies experience modifier; of course, there are other metrics to consider in Safety and Risk Management.

Throughout my professional life and my personal life, I have always hated bureaucracy or corporate inertia. That is why I have always focused on working with small to mid-sized ( between 10 and 100 employees ) companies. Nevertheless, the following fundamentals will have application for large companies, as well as their smaller cousins.

Let us recall those days of yesteryears, (2019 the big recession) and pretend you have been laid off from your job, along with 200 other persons. It has been six weeks and to date, you have yet to land a job in your chosen field. Your searches filter for, Safety, Claims, Risk, and CSP. One day you notice an ad that reads:

Human Resources Generalist needed for midsized company

We are a regional leader in our field, we are 375 employees and

growing. XYZ corporation has a sterling reputation in the

Field of Civil Engineering. Our Human Resources Dept. needs

A self starter who has a strong background in Safety, OSHA

Compliance. No prior Human Resources experience needed, as

long as you are a Work Comp Claims and Safety Guru.

A little bit of research and you soon discover that XYZ (The name has been changed to protect the innocent ) has been in business for twenty years and has had consistent growth for all of that time. Their home office is an easy commute, so you send them a Resume.

Three days later you are called for an interview.

As fate would have it the H.R. Manager Fanta Findgold, is very good at choosing twenty karat gold candidates. Before the interview, she gave our intrepid Safety

Candidate, Nathanial, a twenty question subject matter exam. On the topics of Work comp claims, Safety and OSHA Compliance.

Fast Forward, Nate (Nathanial) was selected to be the new company HR Generalist. He was selected because he aced the written exam, and Fanta, liked the fact that he was a CSP Certified Safety Professional. The CFO, who is in charge of Finance and the Human Resources department sat in on the interview, he was happy to learn that Nate, had been an Insurance Broker, and would be a tremendous asset, in helping with the annual bid process of the Companies insurance portfolio.

In closing this installment, Nate was asked the classic, “ do you have any questions for us? “ This is what Nate said ……..

Read the answer in our next installment to follow in one week Two at the most.

Article by Glen DuLac

©J&L Risk Management Inc Copyright Notice

Filed Under: Safety

Employee Treatment Silent X Factor Great Risk Management

May 2, 2019 By JL Risk Management Consultants

Employee Treatment By Employer Silent and Critical Factor

The following advice on employee treatment by the employer is from an old manual I began in the 1980s and added to over the years. I used to sell it as an income stream. Employee treatment is not necessarily medical treatment.

Public License 1949

I added this area after the original three, as it has become a critical area in saving on WC. With the legal environment in place as it is today in most states, the treatment of the employee post-injury has taken on more of a monetary component.

Only 3% of claims start as fraudulent, but over 30% have some element of fraud by the conclusion of the claim. Poor treatment by the employer is the usual cause for an employee to seek legal help.

E-cards are a wonderful and free or almost free way to send the employee a card after their injury. Most people now have some type of email address. If not, then a card in the mail will usually help the employee stay out of the legal system.

Calling the employee after each Dr. appointment lets the employee know you care and is a great way to keep up with the status of a claim.

The injured employee remains an employee for your organization. The days of firing an employee when they are injured on the job are long gone.

The employer is the eyes and the ears (and unfortunately the complaint bureau) in the field. Having great communications with the adjuster including any of an injured employee’s concerns avoids unnecessary litigation later in the claim.

Silent X-Factor in Workers Comp Risk Management

Other than rehab nurses, this Key is rarely discussed as a Risk Management technique. If the injured employee and employer were not very compatible before a workers comp claim, the feelings are intensified ten-fold.

WCRI studied the return to work paradigms by injured employees after the claim has resolved post-return to work. Injured employees mentioned the trust of their employer as the main factor on how they felt about their Workers Comp claim.

We all know that healthy communication builds trust. I am not saying that employers should roll out the red carpet for an injured employee.

The main way to treat injured employees post-accident is the same as what any employee would expect of their employer. Common sense should rule with the subject of employee treatment.

©J&L Risk Management Inc Copyright Notice

Filed Under: Six Keys Tagged With: free-e-cards, Temporary disability TTD return to work

Reporting Work Injuries To Your Carrier – Golden Rule

April 23, 2019 By JL Risk Management Consultants

The Golden Rule For Reporting Work Injuries Keeps It Simple

Employers not having a rule for reporting work Injuries to the workers’ compensation carrier has caused many employers to end up paying very large claims on what should have been small ones.

The Golden Rule for reporting workplace injuries is at the end of this article.

golden rule reporting work injuries painting

Wikimedia Public Use License Norman Rockwell

The decision to write this article was made after I happened upon a popular agent’s website that had these three pieces of advice to lower a company’s workers comp costs. The words from that article were changed not to violate the copyright and not to point out the exact-reference article.

Train your supervisory employees for reporting working injuries to the carrier (this statement was OK by me).
On-site first aid may be all that is required and not report the incident to the workers’ comp carrier (OK by me except for claims festering).
A simple doctor’s office visit may be all that is needed, but no need to report to the carrier – Red Flag Alarm

I am consulting on a few massive claims presently where the carrier was not advised of a claim until weeks or months later. The claims fill almost 6 – 10 brown folders of information each.

One of the hallmarks of the claims – the initial lost time adjuster received the dreaded twilight zone phone call from a medical provider after the injury ended up being much more serious than

The claims should have been (mostly) small claims where all the pieces of the puzzle were in place to have the injured employee treated properly medically and returned to work timely.

Claims reporting can be equated with the old Fram Oil filter line – “You can pay me now or pay me later.”

The Six Keys (Secrets) To Saving on Workers Compensation Claims which I wrote in the 1980s has as its #1 Key – Timely First Reports of Injury. The dominoes start to fall if the claim is not reported timely. The other keys cannot be attained if the Workers’ Comp claims staff receives a stale FROI. The adjuster has no choice but to put up very large reserves on the file.

The usual results total an approximately 400% increase to those claims. How do I know? I tracked over 7,000 public entity files in the 1990s. As the Director of Risk Management, I recorded on a spreadsheet the claims that reached my level of authority. Almost all had the same four characteristics in one form or another.

I then tracked the same results when I was assigned claims as a consultant. The claims almost always had the same characteristics. The only other characteristic from the claims staff side was the adjuster did not make three-point contact and investigate the claim timely even f the FROI was filed timely.

A Workers; Compensation claim’s loss control ends 48 hours after the claim. The treating Doctor is in place. Controlling the medical remains the best method for controlling Worker Comp payouts and reserving on a claim.

The Golden Rule For Employers Reporting Work Injuries is:

If an injured employee has to leave the employer ‘s premises or stops work except to receive First Aid, the claim should be reported immediately to the carrier or TPA (Self-Insureds).

The rule applies even if the employee just leaves for the rest of the day and is expected back the next workday. The 48-hour clock starts ticking when the employee stops work.

Please note this is a general rule – certain injuries such as burns or chemical exposures need to be reported even if the employee stays at work. Consult your state’s rules on these specific situations. This article does not apply to recording OSHA recordable incidents. Your carrier or TPA may have certain reporting requirements.

The advent of online claims reporting speeds up the reporting work injuries timeclock greatly.

©J&L Risk Management Inc Copyright Notice

Filed Under: First Report of injury

Occupational Illness Rates by Industry – Great BLS Data Surprising Results

April 16, 2019 By JL Risk Management Consultants

2017 Bureau of Labor Statistics Occupational Illness Rates by Industry – Surprising

Workers; Compensation Illness by Industry Rates shows which industries had the highest rates of occupational illness.

Occupational illnesses are defined by the BLS as:

BLS considers an occupational illness to be any abnormal condition or disorder—other than a case resulting from an instantaneous event or exposure—that is caused by an exposure to factors associated with employment.

Please note this does not include injuries by accident. The subject becomes convoluted as some states workers’ compensation systems consider some illnesses to be accidents and vice-versa. For now, let us stick with the BLS definition.

The table below comes from the BLS’s most recent release. Yes, the data covers a year in the past. However, the numbers have such a breadth and depth that lagging behind one year would be expected for such a massive data collection and reporting task. Compiling and stratifying the data must be quite an enormous undertaking.

The Occupational Illness by Industry Rates Table

The BLS table ranks the Top 20 as:

Top 20 Illness Rates
Light truck and utility vehicle manufacturing (Private industry)	233.1
Animal (except poultry) slaughtering (Private industry)	199.2
Automobile manufacturing (Private industry)	131.8
Police protection (State government)	93.7
Farm management services (Private industry)	89.6
Glass container manufacturing (Private industry)	87.4
Beet sugar manufacturing (Private industry)	85.5
Seafood product preparation and packaging (Private industry)	83.1
Dried and dehydrated food manufacturing (Private industry)	82.0
Amusement and theme parks (Private industry)	81.2
Meat processed from carcasses (Private industry)	81.1
Correctional institutions (State government)	81.0
Nonferrous forging (Private industry)	79.9
Ambulance services (Private industry)	78.4
Poultry processing (Private industry)	77.6
Aircraft manufacturing (Private industry)	76.0
Footwear manufacturing (Private industry)	70.5
Soil preparation, planting, and cultivating (Private industry)	69.6
Motor home manufacturing (Private industry)	69.3
Iron foundries (Private industry)	68.6
Polish and other sanitation good manufacturing (Private industry)	59.2
Ship building and repairing (Private industry)	57.9
Metal can manufacturing (Private industry)	57.0
Motor vehicle gasoline engine and engine parts manufacturing (Private industry)	54.4
Hospitals (Local government)	53.8

Please note that I excluded the NAICS numbers. The formula for figuring out these BLS-calculated rates is:

The incidence rates represent the number of illnesses per 10,000 full-time equivalent workers and were calculated as: (N/EH) x 20,000,000, where N = number of illnesses EH = total hours worked by all employees during the calendar year
20,000,000 = base for 10,000 equivalent full-time workers (working 40 hours per week, 50 weeks per year)

The BLS included only higher rate industries. As a statistics person, I would say that is a great cut-off point. Any industries with less than 500 recordable cases were excluded to remove any skewing by small data sets. The data sets were categorized using the NAICS system.

The comparison also excluded farms with fewer than 11 employees.

Examining The Table

The industries that stood out as ones with surprisingly high illness rates:

Glass container manufacturing
Beet sugar manufacturing
Dried and dehydrated food manufacturing
Amusement and theme parks
Footwear manufacturing

I will check with our OSHA Consultant Glen on why those industries have higher rates. Approximately 10 years ago, I looked at the same information. As I remember, hospitals were the number one public entity illness exposure.

Welding is one job task that always seems to cause a higher rate of illness.

©J&L Risk Management Inc Copyright Notice

Filed Under: injury rate

California Dynamex Decision – Another Workers Comp Crisis Recycled?

April 4, 2019 By JL Risk Management Consultants

California Dynamex Decision – Overreaction or Harsh Reality?

The California Dynamex decision hit the Workers Compensation airwaves and blogosphere over the last few weeks.

picture of agreement California dynamex decision signing

Public Domain – US DOE

An article by WorkCompCentral noted reactions across the country. I cannot link to the article as it is behind a paywall.

Check out this article on the previous recycled crises – no, this one is not counted as a recycled crisis yet. A great article by Tony Marks in Forbes Magazine covered the case very well – more from a franchising perspective.

The California Supreme Court retooled the contractor-subcontractor relationship into three points of consideration: (distilled for brevity)

The degree of control by the main contractor
The subcontractor performs work that is not the usual work performed by the contractor
The subcontractor has a business that is independently established in the same trade from the contractor
I added in this one as carriers are now including it in their workers’ comp audits – the subcontractor is not integral to the contractor’s existence.

Bullet point #4 was added by me as this question has been asked of me by a few California companies that have recently gone through the premium audit process.

The case of Curry v. Equilon Enterprises, LLC (2018) (CA Court of Appeals) limited the four tests in the area of joint employment. The link takes you to a search for the case.

IRS Has Great Tests for Subcontractor vs Employee

The Internal Revenue Service has a great test that still satisfies most of the concerns when deciding on whether a worker is a subcontractor or employee. The IRS has more worker classifications such as Statutory Employee, Non-StatutoryEmployee, and even a governmental employee.

Yes, I realize it may not fit every state. The three tests are:

Behavioral Control
Financial Control
Relationship of the Parties – contracts are important

A great PDF from the IRS can be found at this link. The PDF breaks the three elements down even further. Of course, discussing everything with your tax professional is always recommended by the IRS. The California Dynamex decision should be a conversation starter.

One area from the PDF that I had not covered was the test the IRS gives when doing an employee audit. They are:

Consistency test – everyone that has the same job type is paid as a subcontractor
Reasonable basis test – this one needs to be covered in the same manner as the IRS

In order to meet the reasonable basis test, you must have treated the worker as a subcontractor because you reasonably relied on:
· a court case or ruling to support your position,<<interesting statement
· a prior IRS audit,
· a long-standing practice in your industry, OR
· demonstrate, in some other manner, any other reasonable basis for treating the worker as a subcontractor

Tennessee Says 20 Point Test

According to Business Insurance Tennessee wants to have a 20 point test that was established by the IRS. I do not see 20 points in the IRS websites. The Legislature may be counting even the test subsets as a test.

Tennessee referring to the IRS test may be seen as a good sign for consistency. The IRS standard may be the best method for considering whether a subcontractor is not an employee, regardless of the Calfornia Dynamex decision.

Bottom line – even before the California Dynamex decision, the states and Feds started enforcing the contractor rules more stringently.

Filed Under: California

Workers Comp Data Carveouts Move Data To Dangerous Ground

April 4, 2019 By JL Risk Management Consultants

Workers Comp Data Carveouts – Are You Guilty of Sampling Errors?

The concept of Workers Comp data carveouts surfaces more now that employers look to enhance their workers’ compensation saving programs.

picture of sampling workers comp data slicing

Wikimedia-DSCF1348

Workers comp data carveouts start when a company, organization, consultant, etc. decide to use oversampling of a small set of data to justify a larger set. The reverse will work under certain circumstances.

For example, and I have seen this happen often – using California data results on any kind of workers comp statistics to think that the same result will occur in another state.

I often do phone consulting for investment companies that are looking to place the work in the workers’ compensation space. The investors will want to look at two or three different states and then use the results derived from those states to try to expand their investing across the US.

I do not use Wikipedia that often as a source. Two sentences were taken from their page on oversampling/undersampling.

Both oversampling and undersampling involve introducing a bias to select more samples from one class than from another, to compensate for an imbalance that is either already present in the data, or likely to develop if a purely random sample were taken.

Many articles appear on this website concerning statistical madness. Sampling errors can be a form of statistical madness.

The Whole Picture

Many software packages do allow companies to isolate one state when examining a Mod calculation. Isolating one state can be Ok to look at just that one state. The mistake is made when a single state company wishes to expand to other states using the data from their HQ state.

Workers’ Compensation rating contains too many variables to think that how your company is rated in one state will allow your company to know what would happen data-wise in another state. Most E-Mod formulas have 33 calculations to arrive at the final number.

An employer would need to operate in the additional states for a few years before the actual results are known – remember that Workers Comp is a delayed lookback system.

If an employer is operating in multiple states but looks at one or two of their main operational states as the bellwether for other states, they would be oversampling and undersampling at the same time. The main operational states would be oversampled and the remaining states would be undersampled to the point of not being sampled at all.

I left the link above in the Wikipedia statement on bias. Bias in statistics leads to unnatural and inaccurate results. I have actually sliced out sections of data as the employer wanted that section to be analyzed. I did not guarantee the results as being a good forecast.

Workers Comp data carveouts usually occur when analyzing one state, a year or other data out of any analysis – mainly the Experience Modification Factor or Loss Development Factor (LDF). One needs to look at the whole picture.

Bottom line – be very careful when using workers comp data carveouts for decisions.

Filed Under: statistics Tagged With: Carveouts, lookback

Workers Comp Physician Networks Importance Reaches Critical Mass

March 28, 2019 By JL Risk Management Consultants

Workers Comp Physician Networks Now More Critical to Cut Comp Costs

One of the Six Keys or Secrets to cut your work comp costs becomes even more important now due to a fact covered later in this article. Workers Comp physician networks are a great risk management technique that involves little cost and a little effort to put in place.

pic of workers comp physician networks IV bag

Wikimedia – Smokefoot

I wrote the Six Keys as Four Keys that I saw as important when adjusting claims in 1988. I then added two more as time passed and I was exposed to more workers comp reading material – thanks Interweb.

Workers Comp physician networks became your go-to way as an employer after safety. Yes, the old boring slogan – the least costly accident is the one that never happens- remains the best way to cut your workers comp costs.

I have given the presentation at least 25 times on how I picked up a file from a suddenly unemployed adjuster. Reviewing the file was a shocker as the main treating physician was a biofeedback specialist (nothing against those practitioners). When I show a diagram of an out-of-control medical treatment network, many mouths open wide in astonishment. A $400 claim turned into a $745,000 claim due to no medical treatment network.

Setting up the Network – Quick Primer

One main consideration to cover is where the injured employee should treat in the general vicinity of their workplace. A physician’s office must communicate well. Treating physician communication covers:

Sending timely medical reports and bills
Answering claims adjuster inquiries
Understanding the job description for a return to work
Communication with rehabilitation nurse (if assigned)
Referring to a second-level physician in the network (if necessary) – (i.e.) Orthopaedic Surgeons, etc.
In emergency situations, medical treatment networks should be ignored
The best person on earth to ask about immediate great medical treatment – the claims adjusters.

Adjusters who are reading this will add in at least a few more bullet points.

Salient Point On States With Employee Choice of Care

Some states do not allow direction of medical treatment whether by a panel or directed by the employer. Most studies have shown that injured employees will actually still see an employer-recommended physician even if they can choose the medical provider.

I apologize for not sourcing those studies.

Why Is A Workers Comp Physician Network Critical Now?

WCRI, NCCI, WCIRB, any of the independent rating bureaus, and many studies have pointed out a very major fact which is:

# of claims severely decreasing – good news
Cost of claims severely increasing – bad news for risk per claim

Check slides 23 and 24 of this NCCI presentation that I attended last year. These are national figures. You may want to read the whole group of slides. It will be worth your time.

https://www.ncci.com/Articles/Documents/II_StateAdvisoryForumState_SC_2018.pdf

The average claim according to a WCRI nationwide study was $42,000+. When an employee reports an injury to their respective employer, the time to take action is RIGHT THEN. The employer at that time needs to:

Direct medical care to your network or;
Offer a panel is states that require a panel or;
Recommend a physician in states where the employee can those their medical treatment

Each claim now impacts your E-Mod or budget (self-insureds) more every policy year. Self-insureds are paying more per claim directly out of a budget.

Bottom Line – Controlling medical costs upfront by referring an employee to a trusted industrial-minded physician cut your work comp costs dramatically. With the number of claims decreasing, an opportunity to control losses may not as often come an employer’s way as in the past.

Filed Under: Risk Management