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Home » James J Moore

Workers Comp COVID-19 Vaccinations – Part of Return To Work

February 25, 2021 By JL Risk Management Consultants Leave a Comment

Employers Require Return to Work Workers Comp COVID-19 Vaccinations?

I started pondering how the Workers Comp COVID-19 vaccination process would work if an employee were returning to work with or without vaccination.

This morning, I was reading a blog post from a Law Professor from Wyoming University.  I found it through a WorkCompCentral article, but the article is behind a paywall. 

Picture of Workers Comp COVID-19 Vaccination s virus

Public Use Copyright – US NIH

WorkCompCentral still has a freebie daily newsletter.  I signed up for a paid subscription in 2014 (worth it).   

Mr./Dr. Michael Duff (smarter than me) said that the presumption of an injury might be removed if the injured employee refused a vaccination.  

The article started my brain up (after two Keurigs, ok three) with the thought that what happens to a regular return to work and workers’ comp injury return to work if the employee has not been vaccinated for COVID-19 (at least the first shot)? 

Illinois Says No Comp If No COVID-19 Vaccination – Wow

Referring back to Attorney Duff’s article – Illinois may enact a law that says this:

A workers’ compensation bill filed in the Illinois House on February 19 provides, “no compensation shall be awarded to a claimant for death or disability arising out of an exposure to COVID-19 if the employee has refused a vaccination.” 820 ILCS 305/7.5 new

If one reads further down the blog page, Arkansas was also in the midst of legislative wrangling on the same matter.  

My slightly twisted thinking then said – What happens if an injured worker is released to return to work and they are unvaccinated or have refused a Workers Comp COVID-19 vaccination?  

Workers Comp Return To Work Disputes Spike?

Let us talk about the treating physician or an Independent Medical Exam (IME) physician.  The word that is tantamount would be: 

Maximum Medical Improvement (MMI)

Please follow the link if you are not familiar with MMI.  One way to think of it is all the parties’ (employer, employee, claims adjuster, physician, and others) goal is and always will be a return to gainful employment.   

Surgeons Workers Comp COVID-19 Vaccinations treating physicians

Wikimedia Commons – SSgt. Derrick C. Goode, U.S. Air Force

If the injured worker does not receive or refuses a vaccination, does the treating physician say that he/she is at MMI?

That would be a big question that the persons in the above paratheses very likely will have to handle as the pandemic eases and normal return to work occurs in late 2021. 

Could the injured worker’s refusal of a vaccine that keeps them out of work cause them to lose their weekly benefits?  The disputes would sharply spike. 

Workers Comp COVID-19 Vaccinations and The Presumption Legislation

Research into this subject today points to none of the State’s multiple-presumption Senate/Assembly Bills and laws considered this conundrum.  

Letting the Workers’ Comp Judges and Appeals Courts settle this matter may not be the best avenue.  Watch for the states to address this issue soon (or maybe not). Illinois has broken the ice in an indirect manner. 

 

©J&L Risk Management Inc Copyright Notice

Filed Under: return to work Tagged With: above paratheses, gainful employment, slightly twisted, tantamount

J&L Founder James J Moore to Teach Insurance Academy Course Feb 4th

January 28, 2021 By JL Risk Management Consultants

J&L Founder James J Moore Instructor For Academy of Insurance Course 02/04/21

J&L founder James J Moore will teach a one-hour course on February 4th.  The one-hour course will cover occupational disease rules in the age of COVID-19.J&L Founder James J Moore AIC MBA ChFC ARM

According to James -” COVID-19 remains a terrible disease that affects many parts of the workers’ compensation process.   Some states have seen fit to pass multiple COVID-19 presumption rules that may “already be on the books” from the early to mid-1900’s.”

COURSE OUTLINE

Sign up here if you wish to attend the webinar.

The course will cover many of the articles written in this website.  Follow the article links to find out more.

Occupational disease remains one of the unknowns in Workers’ Compensation insurance claims even with the advent of COVID-19.   Are the presumption laws needed to make sure the workers injured by COVID-19 receive proper care and benefits?

Occupational disease claims can be the costliest.  Mesothelioma occupational disease claims may cost $100,000+ per incident.

In this session you will learn:

  • Alvin Toffler’s COVID-19 prediction comes true 30 years later
  • When did Workers’ Compensation begin – hint – it is not the 1900’s
  • How World War II and wristwatch faces became the origin of Occupational Disease laws nationwide
  • Who are the Radium Girls and what were the uses of radium?
  • The difference between an accident and an occupational disease
  • Examples of Occupational Disease laws and rules in certain states
  • How long does the injured employee have to make a claim – unknown part of rule that causes problems
  • Are the COVID-19 presumptions necessary?

    Mesothelioma J&L Founder James J Moore occupational disease

    Wikimedia Commons – Robertolyra

  • Occupational disease vs. personal sensitivity claims
  • Can a COVID-19 claim be denied?

J&L founder James J Moore will take any questions that you have after the presentation and will give examples from his long history claims handling career including sources of more information.  You may contact him after the course with any questions at his email address [email protected]

 

©J&L Risk Management Inc Copyright Notice

Filed Under: James J Moore Tagged With: Occupational Disease laws, one-hour course, presumption laws, wristwatch faces

Workers Comp Consultant Company – J&L – Top 10 Lessons Learned

May 21, 2020 By JL Risk Management Consultants

J&L – 25 Years and Counting As A Leading Workers Comp Consultant Company 

J&L Insurance started in 1996 as a Workers Comp consultant company handling the proper filing of claims forms for large self-insureds.   

Dice with 25 showing workers comp consultant company

Wikimedia Commons -Saharasav

We added services as the market requested it such as premium audit services, general consulting, blog reporting, expert witness services, and Mod audits, actuarial services, and forecasting to name a few. 

I had forgotten the anniversary this past March due to being in the middle of the coronavirus pandemic.  Talking with so many business associates I became amazed at how many now want to strike out on their own and start a business across their kitchen table as I did in 1996.  

Top 10 Lessons Learned  In A Workers Comp Consultant Company 

Couple with workers comp consultant company in office

StockUnlimited

The Top 10 below lessons that I have learned with a Workers Comp consultant company.  The first five are general.  The second five are workers comp centric. 

  1. You are not the same as your last job.  People, governmental organizations, and companies that you have worked with in your last job may not be the customers that you had counted on for business when you started your company.   This lesson becomes a shocker for many people that tends to make them not stay a consultant for very long.
  2. The first five years are rough.  Making an appointment with a prospect and then having them not make the appointment and not return your calls or emails.  Balancing family time and work time can be a very tedious task.  If you can make it five years, most businesses will survive in one form or another. 
  3. The first year comes off as horrible.   Often, your first year has little business generated while you must afford to live and market on a shoestring.  Keeping your head up the first year is very critical.  You will be told no so many times that most people go back to a regular salary-based job. 
  4. One of the most important – do not think you have failed if you go back to a salary-based job as an employee.  You made the choice to not own and run your own business.   I tried to start my own business while working at night and then would go into my regular job during the day three or four times in the 1980s and 1990s.  My heart said go for it with the Workers Comp Consultant company.  My brain said – the bills do not stop, you have more personal bills and now business bills.<<super-critical point. 
  5. The #1 expense that new businesses experience which can easily cause failure – hiring employees too early.   I heard this warning in a public relations seminar that I attended with the local  Chamber of Commerce.  The presenter said that she had made the same mistake and then cut her staff down to four people from over 20.  Could having many employees count as a status symbol? –  Possibly. 
  6. Watch the minimum number of employees that causes Workers Comp insurance requirement.  In some states it is one employee!  Can a new employer afford a $500 a day fine?  Of course not 
  7. Workers’ Compensation has not changed that much in over 20 years.   Many buzzwords and trends have been recycled over the years.  Working across states lines can pose some difficulties, but workers’ compensation has the same variables and procedures.

    Smiling workers comp consultant company Businesswoman

    StockUnlimited

  8.   Blogging remains a requirement in this industry.  Websites are even more of a requirement.  Google, Bing, and other search engines do not rank you in the search results because you have a spiffy website.  Content is king and queen in almost any industry.  Blogging must be in your blood to write a 900-word article such as this one you are reading now. 
  9. Right now – Workers Comp sits on the back burner of the stove.  The pandemic caused a large amount of governmental action.  Most businesses try to survive daily by having remote employees and all the other benefits.  The Affordable Care Act caused businesses to do the same thing to Workers Comp in 2010 – 2016.
  10. Keep educating yourself in insurance subjects even when you do not have enough time to add on a designation or degree.  Reading workers’ comp publications each morning or night and heavily on the weekends keeps you abreast of the current developments.  I read approximately 20 publications to see the trends in this industry.  Many are free if you will sign up for their newsletter.  Some bloggers think they are gurus – be aware of what you read in insurance blogs.   
  11. Bonus – Watch out for the SFNs.  Yes, the Something For Nothings.  Like any type of consultant, your product equals your available time.  Many SFNs think that you can give them free advice.  We receive calls almost every day from someone “just wanting some advice.”  You will develop a sense of the difference between a prospect, potential buyer of your services, and someone just wants you to work as a free consultant.   You must develop those screening skills very quickly to survive. 

This list could go on for 50 more suggestions.  Do not take these as “stamped in cement.”  

One huge advantage that you have if you are a sole proprietor or very small business consultant comes from being able to change your business to fit the market very quickly.  Do not try to make the market fit your business. 

With the pandemic, if you have decided to start your own Workers Comp consultant company or as any insurance consultant, or any type of consultant – do not give up the ship too quickly.  Good luck. 

 

©J&L Risk Management Inc Copyright Notice

Filed Under: James J Moore Tagged With: actuarial services, Affordable Care Act, back burner of the stove, coronavirus, king and queen, stamped in cement, super-critical point.

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: 

  1. 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. 

    Workers in protective masks coronavirus return to work and suit in laboratory

    StockUnlimited

  2. 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.  
  3. 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.   
  4. 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.

    Businesswoman coronavirus return to work wearing H1N1 mask and holding a piggy bank

    StockUnlimited

  5. 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?
  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.
  7. 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. 
  8. 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.

    Globe wearing coronavirus return to work gas mask

    StockUnlimited

  9. 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. 
  10. 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.  
  11. 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

Filed Under: return to work Tagged With: actuarial degree, bandwidth, legal counselor, Remotely starting up, speed up your connection, video meeting

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. 

Employee Treatment Greeting Card

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: fraudulent, free-e-cards, intensified ten-fold, red carpet

Workers Compensation Medical Networks Save Bundle – Used Properly

February 22, 2018 By JL Risk Management Consultants

Proper Use Of Workers Compensation Medical Networks Key To Employee Health And Savings 

Workers Compensation Medical Networks have always provided a large return on investment.  Injured employees receive the best medical treatment and the employer cuts their workers comp costs.  The insurance carrier or TPA claims staff being able to work with the treating physicians to obtain work statuses and medical information will always lower your workers comp reserves.   

Picture Anesthesiologist Draws Workers Compensation Medical Networks Fluid

US Navy Public License

This is the first area in Workers Comp that I realized benefits all parties.  In fact, in the old days, as an adjuster, I had built informal medical treatment networks for:

  1. The largest homebuilder in the nation
  2. Two different huge fast food restaurant chains on the east coast
  3.  Many manufacturing plants 

There were many other companies that benefited from my informal workers compensation medical networks.   I did this while adjusting claims, not as a special project. 

I began the Six Keys List soon after that.   

doctors doing workers compensation medical networks Treatment

Wikimedia Commons By Gracefairchildsfisher

This Key comes with a caveat.   The medical networks built by me were not necessarily from a TPA or insurance carrier provider list.  The providers on those lists usually provide a 15% reduction in services – but are they the proper industrial-minded physicians that you wish to treat your injured employees?   We have to remember that one of the goals is to keep the injured employees as healthy as possible while they recover and return to work. 

The win-win-win of great informal workers comp medical networks come from four different aspects:

  1. The information flow between provider, an injured employee, and the carrier has no logjams. 
  2. The provider is listed on the carrier/TPA’s medical provider list – usually resulting in a 15% discount.
  3. Managing one of my other Six Keys – Return to Work becomes much easier
  4. The injured employee receives the best treatment possible in their area. 

This key actually links to more of the other Six Keys than all the other keys combined.   Having a great workers comp medical network aids another key Treatment of Employee (not medical).   The great research organization, WCRI studied this area heavily.   And yes, how an employee is treated by their employer has a large effect on the outcome of the file. 

Employee workers compensation medical networks check up

Wikimedia Commons – Josie Kemp, U.S. Air Force

As a side note, I had a very severe case of the flu last week and this week.  It was awful.   I ambled to my GP (General Practitioner).  As I take blood thinners, that complicated the issue.   Having the Dr. run test and then tell me I was going to be 100% fine meant quite a bit to me.   Bedside manner goes a long one when treating Workers Comp patients. 

One question is often asked in this area – What if the state is employee-directed care?  A study was conducted on this point which showed most employees will go to the physician recommended by their employer regardless of who directs the medical control in the state.  Unfortunately, I cannot locate the source article as I write this passage. 

This Key is one of the more difficult to immediately install in your Workers Comp program.   However, once that you do, the benefits of a workers compensation medical network become quickly apparent. 

©J&L Risk Management Inc Copyright Notice

Filed Under: medical networks, Six Keys Tagged With: blood thinners, east coast, homebuilder, manufacturing plants, no logjams

J&L Risk Management Consultants Accomplishments This Year

February 13, 2018 By JL Risk Management Consultants

J&L Risk Management Consultants Accomplishments –  Recent News

A few, actually, 15 J&L Risk Management Consultants accomplishments were attained this month or will be reached next month. 

bests risk management consultants accomplishments 10 year badge

  1. We will start our 23rd year next month – whew!
  2. James J Moore, reached his 2,000th article written this month
  3. The blog has 1,710 articles available for reference searching 
  4. Our website reached the one gigabyte mark 
  5. Readership is 7,000 + per week most generated from the weekly newsletter 
  6. We have over 5,000 Linkedin contacts
  7. We have been invited to participate as reporters and speakers for a number of upcoming events 
  8. Best’s Insurance Directory just awarded us with a 10 year Recommended Expert Badge – see above 
  9. Our article have been linked to and re-published numerous times in all forms of media 
  10. We have appeared in  various major press sites – see below 
  11. J&L has rehashed all the articles for the last 11 years – yes the blog is 11 years old this month. 
  12.  We added a full breadcrumb index to make sure you know where you are on the website at all times.
  13. J&L is now in the process of fully linking all articles to make searches easier.
  14. We have reached 100,000 hits in one day – not an anomaly
  15. We were quoted in three major articles last week – cool! 
Picture of Man risk management consultants accomplishments Presentation

Wikimedia – Tomwsulcer

The various publications we have appeared in recently are:

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

OK, so enough about tooting our own horn.  Please excuse us.  Thanks for reading, commenting, linking, and reporting on our articles.

As a free source of great Workers Comp information, we wanted to at least cover the J&L Risk Management Consultants accomplishments now.

We hope to produce more insightful articles over the next few weeks.   Once again, thanks. 

©J&L Risk Management Inc Copyright Notice

Filed Under: James J Moore, JL Quick History Tagged With: A.MBest, Bloomberg, full breadcrumb index, one gigabyte mark, reporters and speakers

Six Keys To Saving On Workers Comp – Let’s Cover Easiest One

May 11, 2017 By JL Risk Management Consultants

The Six Keys To Saving On Workers Comp – Easiest One To Accomplish Today

The Six Keys To Saving On Workers Comp started as the Four Keys.   Still – to this day, almost 30 years after I wrote the First Four – ASAP First Reports is the easiest Key to accomplish.    With today’s technology, reporting claims has been sped up greatly.  Most carriers and Third Party Administrators (TPA’s) provide online claims reporting.  

Picture of Six Keys To Saving On Workers Comp on table

Wikimedia Commons – martinak15

If your carrier or TPA requires you to file them online, then they are doing your company  a great cost  saving service. Some TPA’s and a few carriers now charge an extra $25 – $100 per claim to have your claim input from paper or an electronic file.  

The one unspoken benefit allows your respective claims adjuster to take some type of investigative action.     The First Report of Injury (FROI) legally allows your adjuster to act on your behalf to investigate the claim.   When an adjuster receives a Twilight Zone phone call, the results usually point to the negative.  You may want to follow the link to see how your claim can end up with larger than normal reserves from the very start.    Getting control over the claim involves three areas:

  1. Medical control – without the medical control in place, your costs are going to spiral 

    Hand Putting Money Six Keys To Saving On Workers Comp In Piggy Bank

    StockUnlimited

  2. Return to work – the coordination between adjuster, employer, and treating physician is affected with a delayed first report 
  3. Employee treatment – the more quickly the adjuster contacts the injured employee, the more likely the employee will be satisfied with the handling of the claim.  Waiting around days in limbo will never make the injured employee feel at ease with his/her claim.  

As we all have become used to “instant information“, the time clock is much shorter than in the past on getting the claim on the books and establishing three point contact.  Smart phone apps should help this process along.   To date, I have not seen a good app to enhance claims reporting.   The adjuster must contact the injured employee, doctor, and employer within 24 hours after receiving the claim.  The 24 hour clock starts running even with the additional time the claims supervisor  takes to review the claim before adjuster assignment.    

©J&L Risk Management Inc Copyright Notice   

Filed Under: Six Keys Tagged With: FROI, limbo, Smart phone apps

James J Moore E-Mod LDF Presentation – Mid State Safety Council

December 13, 2016 By JL Risk Management Consultants

James J Moore E-Mod LDF Presentation With Slides Available

E-Mods and LDF’s_NC Midstate_12_13_16 <<<Slides  – File is 7mb

Our founder, James J Moore E-Mod LDF presentation went well at the NC Mid State Safety Council’s Winter Lunch and Learn training session.  

Raleigh North Carolina James J Moore E-Mod LDF Map

Wikipedia – Alexrk2

The slides from the presentation are available for download at this link.   The session was a smaller group in intimate surroundings at Coty Inc in Sanford NC.   

The main takeaways from the presentation were:

  1. A Safety Officer or Safety Department along with Risk Management can be summed up in one score (the LDF or E-Mod) 
  2. Companies and governmental organizations are examining these two departments much more closely in the coming “age of the reduction”
  3. Any safety person should know their Experience Mod number.   The staff may be judged by that number alone. 
  4. Workers Compensation is a delayed system, what you do in safety today may not show up in your WC program for years. 
  5.  The old adage of  ” I am involved with Safety – the E-Mods are covered in another department”  does not fly any longer.
  6. We are out of the Workers Comp system does not apply to large deductible programs or self insureds. 
  7. Safety and Risk Management personnel and complete departments have been eliminated before the results of their efforts were even calculated

    Vector Of James J Moore E-Mod LDF Presentation

    StockUnlimited

  8. The Schedule Rating Factor  can more accurately reflect Safety and Risk Management’s current efforts. 
  9. The Schedule Rating Factor has many elements in it from Safety and Risk Management 
  10. Your E-Mod or LDF is like a personal credit score from hell. 

An attempt will be made to attach the slides to the presentation if it is not too data intensive.   The attached file will be in PowerPoint 2013.   Today’s James J Moore E-Mod Ldf presentation was a standard presentation that he gives a few times a year. 

©J&L Risk Management Inc Copyright Notice

Filed Under: James J Moore Tagged With: age of the reduction, Coty, Sanford NC, summed up

Workers Comp Expert Witness – Tough Row To Hoe

September 8, 2016 By JL Risk Management Consultants

Workers Comp Expert Witness – A Niche’ ?

Being a Workers Comp expert witness over the years has taught me many very interesting experiences.    I thought I would cover a few of those which provided a lesson.

concept of workers comp expert witness emblem from website

123RF

Memorization

One cannot lull themselves into thinking that you can memorize the WC statute, rules, Rating Bureau information and other information.   The path to driving yourself crazy is to try to memorize all of it.   There just no way to store all that information and be a successful workers comp expert witness.

Each State Unto Itself 

Each state has established its own very unique set of rules.  If one wants to see how independent each state is from each other, just pull up their workers compensation statutes, rules, etc.   No two states are alike in all aspects.   There are similarities between states but I have yet to see carbon copies.

Rating Bureaus

The NCCI and WCIRB are the two most popular rating bureaus.   As with the general WC regulations, there are similarities between each state rated by NCCI.   Believe it or not, there are also similarities to the WCIRB ratings and NCCI.  NCCI has to check with each state to make sure that any NCCI rules are accepted by the state.

There are some examples in the press of where states have actually rejected NCCI’s ratings.  Without the differences between each state, the NCCI rating information and rules would be much smaller.

Multifaceted 

Picture Of Workers Comp Expert Witness In Court

StockUnlimited

Being a Workers Comp expert witness is a multifaceted endeavor.   There are many areas that can be considered a niche’ such as:

  • Agency
  • Policy
  • Claims Handling
  • Ratings
  • Premium Audits
  • Self Insurance
  • Many others

The list can be very lengthy.

The Key

One of the main keys to me in workers comp expert witness is how you dress and act overall.   Attorneys assess how you will look to a judge and jury just as much as your knowledge base during a deposition or in any written report.   Acting and writing professionally at all times can never be seen as a negative trait.

©J&L Risk Management Inc Copyright Notice

Filed Under: expert witness Tagged With: carbon copies, multifaceted endeavor, negative trait, niche'

Workers Compensation Cost Cutting – Silent Fifth Key

June 16, 2016 By JL Risk Management Consultants

#1 Workers Compensation Cost Reduction Technique

The art of Workers Compensation cost cutting is one of those specialized areas that may have been put on the “back burner”.   The new healthcare laws and other concerns have dominated the employer landscape over the last few years.

Hand Gesture Workers Compensation Cost Number One

StockUnlimited

Workers Compensation cost concerns seem to now focus on how to find the “bargain.”  Actually,  the bargain that I see most of the time is the shopping of policies.  That is one of many techniques that an employer can use to cut their bottom line.

In 1989, I first wrote the Three Keys To Workers Compensation Cost Cutting.   They were my bedrock for presentations where (gasp!) I used overhead slides.    They are:

  1.  Immediate Reporting of Injuries – no exceptions or excuses – immediately.
  2. Medical Treatment Network – spending time setting this up can make or break a WC program
  3. Return to Work Program – takes more time to accomplish – the savings are huge
  4. Employee Treatment –  this one was added in the 1990’s
  5. Adoption by Management – this one was added in 2005 – more on that one in a moment.
  6. Understanding your E-Mod sheets and premium audits
How Workers Compensation Cost being planned

Wikimedia Commons – Intel Free Press

The main shortcoming I have seen by employers is actually #5.   I am not saying that all employers do this whatsoever.  Many employers do more than this list for their own type of business.  Staying generic as possible is the best way for me to cover all 50 states in bullet points.

The Workers Compensation cost cutting technique #5  if ranked by most important would be #1.  Without an effort by the “big cheeses”  to cut Workers Compensation costs, all prior and future efforts are in vain.

A client will bring me back in after a few moths or years in some instances.  The custom cost-cutting manual will sometimes still be on the shelf where I left it.  If it is an electronic file, it shows the last time anyone accessed the file was the date I finished it previously.

This is the search to bring up the other articles  that have keys to cut your workers compensation cost.

©J&L Risk Management Inc Copyright Notice
 
 

Filed Under: Six Keys Tagged With: bargain, bedrock, big cheeses, electronic file

James J Moore To Present Premium Audit Webinar May 26th

May 18, 2016 By JL Risk Management Consultants

James J Moore – How to Properly Review the Work Comp Premium Audit- And Use it to Your Advantage

J&L’s founder James J Moore AIC, MBA, ChFC, ARM  will present a webinar on premium audits on May 26th, 2016.  The Insurance Journal Academy  is sponsoring the event.

Picture Hand Presenting James J Moore Premium Audit Concept

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Premium audits are one of the most misunderstood parts of the Workers Compensation insurance cycle.

Agents and Risk Managers now need to become more involved in Premium Audits as a customer service advantage over the competition. The session will cover the most confusing Classification Codes.

Subcontractors and certificates of insurance as they apply to premium audits will be covered in detail.  This is one of the areas that generate s so many questions during a premium audit.

Examples of real-world premium audit reviews will be included to show the most common questions or errors with premium audits. A list of the most common premium audit terms will be provided for future reference.

The takeaways from the presentation will be:

  • The main role of agents/risk managers in the Premium Audit process
  • The most misunderstood classification codes
  • Agent/risk manager premium audit timing
  • The most common agent/risk manager mistake that can ruin a good client
  • The policy as a rulebook for audits

James J Moore will also answer questions concerning premium audits at the end of the webinar.

©J&L Risk Management Inc Copyright Notice

Filed Under: James J Moore Tagged With: future reference, real-world, rulebook

James J Moore To Conduct Insurance Academy Webinar February 25th

February 11, 2016 By JL Risk Management Consultants

Webinar – Destroy Your Competition Using Workers Comp Loss Runs

James J Moore, AIC, MBA, ChFC, ARM founder of J&L Insurance Consultants, J&L Risk Management Consultants, and Cutcompcosts.com will conduct  an Insurance Academy© Webinar on February 25, 2016 at 1:30 PM Eastern Time.   The link to sign up for the webinar is here.

Logo Of James J Moore J&L Risk Management ConsultantThe webinar titled – Destroy Your Competition Using Workers Comp Loss Runs is an hour long (including 10 minutes for questions) look at how claims loss runs can be viewed as a treasure trove of information that will put agents ahead of the competition in the area of devout customer service.

These techniques can be implemented whether the client is a first-dollar insured; large-deductible, self-insured, or other type of insurance program.

According to the presenter – “Workers Comp loss runs have long been ignored or briefly scanned for information.   Many areas of loss runs jump off the page to the trained eye. ”    Mr. Moore also commented “The webinar is not only for agents.  Claims adjusters, underwriters and most insurance personnel will find the webinar helpful in this oft ignored area.”

List James J Moore Vector

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The general topics are:

  • Online vs. paper loss runs
  • Verifying the minutia
  • Status reports
  • Loss run timing
  • All-or-none reviews
  • Top 13 adjuster responsibilities
  • Claims reserving cycle
  • Authority levels
  • Number secrets – Elvis’s Gold Cadillac Conundrum
  • Stair-stepping
  • Under-reserved vs Over-reserved
  • Loss run example(s)
  • Three main cost areas
  • Time and expense billings
  • Fines
  • Rehabilitation and bill review charges
  • Team Approach

Loss run examples will be supplied to cover the aforementioned topics with specific examples. A claims veteran of 28 years with a working knowledge of adjusting in over 45 states will walk the participants through a process that can easily be followed long after the webinar.

According to Mr. Moore, “This webinar will be a great accompaniment to the upcoming team building strategies webinar in July 2016.”

©J&L Risk Management Inc Copyright Notice

Filed Under: James J Moore Tagged With: Elvis's Gold, minutia, oft ignored area, webinar

Work Comp Answers – See Article From Yesterday

February 4, 2016 By JL Risk Management Consultants

The Work Comp Answers

The Work Comp answers to yesterday’s cutcompcosts.com article are as follows – if you have not read the previous article, it is advisable to do so as this article may not make sense as a standalone.  Links are provided to the associated articles

Concept of Work Comp Answers Q&A on Street Sign

123RF

  1.  What is workers comp called in Australia? – Compo
  2. Where did WC originate – think a long time ago and not in the US – Ancient Sumeria
  3. The best Workers Comp risk management technique is ____?   Can be more than one answer.    Properly managed field case managers/nurses is the one that I recommend overall.   A trusted industrial-minded initial treating physician is another.
  4. Who is always viewed as an impartial witness on WC claims? The treating physician
  5. How many states allow carrier reimbursement for medical marijuana?   Which state(s)?   One – New Mexico
  6. What is a PEO and define the term.  Professional Employment Organization
  7. What is the designation ChFC and the ARM-P?  Chartered Financial Consultant,  Associates in Risk Management- Public.   I have attained my ChFC and ARM, but not the ARM-P.    I may have to add the -P  some day soon.

    Finger Pointing Work Comp Answers Calling Icon

    StockUnlimited

  8. The normal waiting period for WC benefits is  _______?   Trick question?   There is no waiting period for medical benefits.  I did not say specifically indemnity benefits.
  9. What disease/injury has fallen over 50% due to WC safety measures?  Amazing.   Carpal Tunnel Syndrome (CTS) – and what a disabling injury this can become over time.
  10. The best thing to do to prepare for a Workers Comp audit is ________?   Be as organized as possible.
  11. Bonus – The first article on this blog is dated? ________
  12. Self-serving Super Bonus – What services do we provide as a company?

I did not provide the Work Comp answers for the last two as they were bonus questions.

©J&L Risk Management Inc Copyright Notice

 

 

Filed Under: ChFC Tagged With: Ancient Sumeria, ARM-P, Chartered, standalone

Workers Comp Cost Savings – Onsite Medical Clinics

January 8, 2015 By JL Risk Management Consultants

On Site Medical Clinics = Workers Comp Cost Savings

One of the best ways to increase Workers Comp Cost Savings without sacrificing medical care is to use

Picture Of Walk-In Medical Care Workers Comp Cost Savings Building

Wikipedia Commons – Klaus D. Peter

onsite or near-site medical clinics.  Medical control has been one of my Keys To Workers Comp Cost Savings since 1989.

Onsite or near-site medical clinics can lessen the likelihood that a medical only claim will turn into a claim that festers until it results in a large lost time claim.

A recent article on onsite or near-site medical clinics basically proves this premise.

A recently published National Association of Worksite Health Centers’ 2014 Benchmarking Survey noted these results:

  • Less than 50% of the companies surveyed actually used this great Workers Comp risk management technique
  •  70% of employers providing on-site and near-site clinics said the clinics contributed to improvements in employees’ overall health
  • 75% said their employees had become more engaged in work-site health and wellness programs.
  • The most important WC figure of all – more than 95% of those employers also said the clinics had at least partially improved employee job satisfaction and productivity
Walk In Workers Comp Cost Savings Clinic

Wikipedia – Taeyebar

Happy employees that feel well-taken care of by their employers will almost always result in lower numbers of Workers Compensation claims.  There are numerous studies that indicate job satisfaction (for some reason) lowers the Workers Comp risk for that employee.

Employers do not have to have a clinic onsite to produce these savings.  A local walk-in clinic has been one of my recommendations for years as a way to cut costs.   I have performed multiple studies that show significant reductions (up to 75%) with having a walk-in clinic as an initial medical provider.

An industrial-based or industrial-minded walk-in clinic is even better. The communications flow by industrial walk-in clinics are usually significant.  Almost all walk-in clinics will even take plant tours so that they understand the work processes at employers.

The bottom line is that a local clinic that provides injured employees with quick high-quality medical care along with a proper information flow can be looked upon as a Workers Comp cost savings partner.

©J&L Risk Management Inc Copyright Notice

Filed Under: Six Keys Tagged With: multiple studies, on site medical clinics, plant tours, Worksite Health Centers

Cutting Workers Comp Costs Adds 6th Key – Adoption By Management

June 25, 2014 By JL Risk Management Consultants

Cutting Workers Comp Costs Has New Key Added For Clarity

The subject of cutting workers comp costs added an obvious 6th addition to the list.  In 1989, I originally wrote and presented on what I thought were the Three Keys to Workers Compensation Savings.   I wrote the three from a claims standpoint.

Clipart of Cutting Workers Comp Costs add 6th key

(c) 123rf

Those three were:

  1. ASAP First Reports of Injury
  2. Return to Work Program
  3. Physician Network 

Subsequently, I added in Employee Treatment as a Key.  The article from yesterday contains more info on why I subsequently added in this consideration.

Recently, I added in a fifth Key to Cutting WC- Understand your Premium Audit and E-Mod.   If you are a self insured – Understand Your Loss Development Factor (LDF).

The Affordable Health Care Act has actually done more than move the subject of Workers Comp to the back burner.  It has caused employers to take it off the stove for now.  Workers Compensation is still a budget-buster that may be receiving less recognition as at least a partially controllable budget item.

The new addition to the list (Sixth)  is Adoption of the First Five in the list by Management.    With health insurance becoming more of a concern, Safety and Risk Management departments have been reduced or even eliminated in some cases.

The employer E-Mods and Self -Insured payouts will usually not show the full effect of the Risk/Safety department reduction or elimination for 3 -5 years.

 

 

Euro Money Cutting Workers Comp Costs using scisor

Wikimedia Commons – Nikowsk

If Senior Management or the Company Owners in smaller companies will not adopt any of the first five Keys in the list,  the likelihood of not paying more WC premium or self-insured payouts is almost a certainty.

I have performed statistical tests that showed the first three in the list not being instituted will cause a claim to increase by 400% per item or 1,200% if none of the first three are accomplished.

A recent study by WCRI (see yesterday’s article)  somewhat quantified #4 on the list – Employee Treatment.  WCRI quantified Employee Treatment as being a major concern in WC costs..

Understanding Your E-Mod, LDF, Premium Audits, or Self-Insured Payouts has been discussed very often in this blog.  I will not repeat the information again here.

Female Doctor Cutting Workers Comp Costs Using Laptop With Files In Table

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However, if management does not adopt any of the listed cost savings procedures, identifying the areas of concerns and implementing changes “on paper” is just that – in a book that sets on someone’s shelf or as a computer file that is in the My Documents folder never to be seen again.

Now may be the time to get the book off the shelf and dust it off or dig out the computer file and see what could possibly be implemented without spending any extra cash as the plan may be sitting right in front of you.

That is why I wrote in #6 this week – to remind companies that dusting off the old WC procedures manual may be a great cost- saving move.  At least putting WC “back on the stove” will likely cause the claims and/or premium payouts to decrease in a time when every $ counts.

The addition of #6 now makes the List of Cutting Workers Comp Costs Keys:

  1. ASAP First Reports
  2. Doctor Network
  3. Return to Work program
  4. Employee Treatment
  5. Understanding Your E-Mod, Premium Audit, and LDF
  6. Adoption of #1 – #5 by Management or Ownership

©J&L Risk Management Inc Copyright Notice

Filed Under: E-Mod X-Mod, Six Keys Tagged With: adoption, budget buster, My Documents, senior management

WCRI Proves One of My Five Keys To Workers Comp Savings

June 24, 2014 By JL Risk Management Consultants

Workers Comp Savings – WCRI Proves 4th Key

I wrote the Five Keys to Workers Comp Savings many years ago.  When a great research company agrees with a long-held point, that is always a great sign.  

Picture of Workers Comp Savings ancient number five

(c) 123RF

The Workers Compensation Research Institute (WCRI) recently published another great study.  

The study  Predictors of Worker Outcomes showed employees’ trust of their employers as being one of the “silent variables” that determined any upcoming return to work issues.  

A few of the statistics covered by the WCRI in the study were:

  • Workers who were strongly concerned about being fired after the injury experienced poorer return-to-work outcomes than workers without those concerns.
  • One in five workers who were concerned about being fired reported that they were not working at the time of the interview. This was double the rate that was observed for workers without such concerns. Among workers who were not concerned about being fired, one in ten workers was not working at the time of the interview.
  • Concerns about being fired were associated with a four-week increase in the average duration of the disability.

The WCRI study covered eight states. The eight states are Indiana, Massachusetts, Michigan, Minnesota, North Carolina, Pennsylvania, Virginia, and Wisconsin. The workers surveyed three years post-injury.    

The study results can likely be applied to all states as they were generic in nature. 

In 1986, I originally wrote and presented the Three Keys To Cutting Workers Compensation Costs.   I have since added two more Keys.  In 1989, I added Employee Treatment as the fourth variable.  The addition of a Sixth Key is in progress.   
 

Graphic of Workers Comp Savings Medical Health Badge With Dollar Sign white Shadow

(c) 123RF.com

I had seen so many files were employees that were not treated fairly by their employer post-WC-accident.   These files always cost more as the injured employees basically negated all return to work efforts.   This caused longer periods of Temporary Total Disability and higher Litigation Expenses. 

I had access to a very large pool of public entity data in the late 1990s.  I decided that I would try to analyze the monetary value of not treating employees fairly post-injury.   The files where the employees had kept a good relationship with the employer and vice-versa resulted in an increase of 400% to the value of a file.  


There may be times when keeping a good relationship with the injured employee is just not possible.  Most of the time, the injured employee will respond positively to a fair-minded employer post-injury.  WCRI has proved that point in eight states, if not more.  

©J&L Risk Management Inc Copyright Notice

Filed Under: Six Keys Tagged With: higher Litigation Expenses, predictors, silent variables

Biltmore Corporation – Extensive RTW Program = Low E-Mod

May 16, 2014 By JL Risk Management Consultants

Biltmore Corporation (Asheville) Return to Work  Program

 

The Biltmore Corporation (Asheville, NC)  has an extensive return to work program.

 

I am attending the North Carolina Safety Conference in Greensboro this week.  I attended one of the safety sessions that featured the Biltmore House/Biltmore’s Safety Manager Andy Spradley.  

 

Picture Of Biltmore Corporation

Wikipedia – Ebyabe

One of the main topics in his presentation was the extensive Return to Work program that the Biltmore Corporation has in place where almost any injured employee knows they have a place to return to work to and be gainfully employed after a Workers Compensation accident.

 

The Biltmore Corporation, of course, has a credit Mod – one that is below 1.0.  The Return to Work programs ranks only behind prompt industrial-based medical care in my Five Key/Secrets to Saving on Workers Compensation.   The other associated topic on saving Workers Comp $$ is Biltmore has a complete job bank that is supplied to any treating physician.  

How easy can a company make it for a physician to immediately return an injured employee to work?  The treating physician has a job bank in front of him/her when making the return to work decision.

 

The other one of the Five Keys is how the employee is treated after an injury.  Gainful employment has, is, and always will be the best therapy for an injured worker.  Keeping an injured employee in the mode of working every day is a win-win for all parties.

Doctor Biltmore Corporation Talking To Patient

StockUnlimited

The silent part of the equation is that the WC claims adjusters know that Temporary Total and Temporary Partial disability benefits are not part of the equation.  Permanent Partial Disability and medical would be the only costs that a claims staff would assign to a file.   This is an immediate mod-lowering technique.

 

The Biltmore Corporation also has a working relationship with their WC claims adjusters.  I often see where employers do not involve the claims adjuster in their WC decisions.  Many employers do not even know who their claims adjuster is and my likely have never spoken to the WC claims department.  

Making the WC claims to process a team effort involving the claims adjuster will always reap benefits at the time of policy renewal.

©J&L Risk Management Inc Copyright Notice

Filed Under: Six Keys Tagged With: asheville, credit mod, policy renewal

Bad Santa Grinch – Did Workers Comp Make Me One?

December 17, 2013 By JL Risk Management Consultants

Bad Santa Grinch – Yes I Was Mean And Green Every Year

The Bad Santa Grinch creator

Wikimedia Commons – Al Ravenna

The bad Santa Grinch Workers Comp made.One of the most disturbing trends in my WC career occurred every Christmas.  I started my career in claims.

 Every year just before the Yuletide I was told at least once – “My family, kids, etc. will not be having Christmas because of you.”

That statement disturbed me for the first few years.  A claimant would usually not return to work, have their claim denied, etc.  After a few years I became jaded to the statement.   When I became a claims supervisor I thought – well, I will not have to hear than again – Au Contraire,

Graphic Of Bad Santa Grinch With Brown Dog

Wikimedia – Dr. Seuss

I would usually have to handle an even more upset person telling me that if I did not overrule the adjuster and send out their check, the adjuster and I both were ruining their Christmas.   At least I had another Grinch to feel bad with me.

When I reached the managerial level, I thought there is no way that I will ever have to handle the ubiquitous mad injured employee saying that I was the Bad Santa Grinch.  Once again, the person made their way up the line from adjuster to supervisor and then to me.  They did not actually call me Bad Santa Grinch by then – the term was much more graphic.

As I started my WC consultant company, I thought – well, no more years of hearing that I was Bad Santa Grinch for not mailing  the benefits check.   I did not hear that for a few years until I decided to assist with a file runoff of self insured claims.

My Holiday was complete that season as an injured employee told me that unless I mailed out his RX reimbursement check, there would be no Christmas at his house.  I was so used to hearing that I was Bad Santa Grinch that it almost warmed my heart.

If anyone would like to make me get into the Holiday spirit, please feel free to call or email me and let me know that I am the Bad Santa Grinch.

**Please note that no checks were due the claimants mentioned in the story.  I was not holding any check just to be mean.

©J&L Risk Management Inc Copyright Notice

Filed Under: James J Moore Tagged With: Bad Santa Grinch, Christmas, consultant, contraire, holiday, Workers Comp career

Pay ACA Penalty File Workers Comp Claim For Medical Treatment

October 29, 2013 By JL Risk Management Consultants

ACA Penalty May Not Deter Workers Comp Claims

 What if a worker decided to pay the ACA penalty and file a WC claims for medical treatment?  The Affordable Care Act (ACA) may cause an unintended spike in Workers Compensation claims.

Affordable Care Act ACA Penalty Logo

Wikimedia Commons – Careilly5801

  One of the concerns over the years in claims departments is an employee substituting Workers Comp for health insurance.   The ACA may also cause medical treatment rationing.Now that almost two million health policyholders that were previously insured have been dropped by their health insurance carrier, could Workers Comp become a safety-net type of accident insurance?    Claims for many illnesses would be immediately denied by Workers Comp carriers .

The “Monday Morning” claimant is one of the huge red flags when a claim is filed for benefits.   A very limited amount of ailments could be filed by reporting Workers Comp claims.  Any home accident could be reported as a claim upon returning to work the next day.

Picture Nurse Preparing Syringe for Injection Focus on Syringe ACA Penalty Medical Treatment

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An  adequate claims investigation will probably uncover the fact that the accident was not related to work.  One of the best places to look is in the history of the injury as recorded by the original treating physician in his/her notes.    One very obvious area is the original date of treatment.  The date may not necessarily match the date of the injury.

Communication between the employer and physician will be tantamount to avoid having to pay for non-work related treatment.   One of the Five Keys To Saving on Workers Comp Claims is having a designated original treating physician.   Some states do not allow the choice of treating physician by the employer.   Other states such as California allow for medical treatment panels or MPN’s.

A rash of Workers Comp claims may not occur due to the ACA.   However,  only two or three claims can wreck what was previously a good Workers Compensation program.

©J&L Risk Management Inc Copyright Notice

Filed Under: MPN, Obamacare, Six Keys Tagged With: ACA, accident insurance, illnesses

Delaware Requires Employers Start Great Risk Mgmt Technique

June 26, 2013 By JL Risk Management Consultants

Delaware Requires Employers  Job Lists To Treating Physician

The State of Delaware requires employers to initiate a great risk management technique.  Return to work is one of the Five Keys To Saving On Workers Comp $.  I have been writing, presenting, and blogging on these Five Keys for over 25 years.   In study after study, files that have an element of return to work strategies overpay 400%  on their claims.

State of Delaware Requires Employers park

Wikimedia Commons – Sixflashphoto

The State of Delaware made a bold and very intelligent move to require employers to provide workers compensation treating physicians with a list of jobs available (along with restrictions/abilities).

Employers should have been doing this already as part of their Workers Compensation risk management program.  It is very striking to me that even large sophisticated employers are not providing treating physicians with what I call a job bank to ease the transition from being temporarily totally disabled to at least a part-time light duty job.

One area that most states look at very closely and critically is make-work.  States, especially in the Southeastern US, do not approve of a job that is made up out of thin air.  These make-work created jobs are not looked well upon by Workers Comp judges.

Pre-established job banks will usually pass the make-work hurdle for return-to-work jobs.  One of the main cost reductions is the rehabilitation nurse/field case manager fees.  I have seen the rehab nurse:

  • Interview the employer’s HR rep

    Woman Delaware Requires Employers Using Computer

    StockUnlimited

  • Write the job description
  • Have the HR department sign off on the job
  • Take the job description to the next doctor’s appointment
  • Have the treating physician sign off on the job
  • Provide all parties with copies of the job description and sign-offs.
  • Follow up with employer and employee once injured employee has returned to work.

At almost $100 an hour, the rehabilitation nurse will spend 20 or more hours going through this process.  Rehab nurse are priceless to Workers Comp, but not in shuffling paperwork between the parties in a WC claim.   The employer should have all light-duty jobs on file in the treating physician’s office – plain and simple.  If not, get out the checkbook.

©J&L Risk Management Inc Copyright Notice

Filed Under: Delaware, job bank, rehabilitation nurse, return to work Tagged With: five keys, risk

Late Reported Claims Info = Increased Mod and Premium

June 19, 2013 By JL Risk Management Consultants

Late Reported Claims Info by Carrier Can Cause E-Mod Increase 

Increased Mod and Premium were due to Late Reported Claims Info from insurance carrier employer.

We received this emailed in question over the weekend.  The business owner was not very happy about receiving a policy amendment and bill during the policy.

Picture Of Man Checking Time Late Reported Claims Info With Woman Walking

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My agent just informed us that we are receiving an increased bill due to a policy adjustment as one of the carriers on our state rating bureau (NCCI in this case) was very late in reporting our claims information to the rating bureau.  Is this allowed?   Do we owe it?

The answer without going into policy specifics was actually yes.  The actual date the Mod E-Mod or X-mod) was promulgated six months before the policy ended will apply to the next policy period.  This is called the Unit Stat date.

However, the insurance carriers and state Workers Comp departments are allowed quite a bit of slack on these dates.  The insurance carrier can report the claims information up to nine months late or three months into your next policy with usually no retribution of any kind.

I always think that the insurance carrier should be fined for running so late.  There are some instances such as carrier insolvency; employer not allowing audit, and others where the carrier is not actually 100% at fault.

Man Hand Holding Late Reported Claims Info Paper

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Some carriers are habitually late.  We have a large multi-state client that has experienced 44 rating changes due to carrier late reporting and certain states’ Workers Compensation departments both filing late with the rating bureaus.

If, which is not the case in this instance, your Mod was adjusted after three months into the policy would be a cause for further investigation.  There is a slightly complicated formula on late reported Mods that needs to be used in these instances.

Also, if your company receives a Mod reduction, there will be a credit to the policy that will very likely be settled up at premium audit time.

©J&L Risk Management Inc Copyright Notice

Filed Under: E-Mod X-Mod, late reporting Tagged With: adjustment, amendment, insolvency, promulgate, retribution

Occupational Therapy – Great Return to Work Technique – Worth It?

May 9, 2013 By JL Risk Management Consultants

Occupational Therapy Can Be Worth The Expensive Costs

 Most Occupational Therapy programs provide a great return to work technique.

Many years ago when I was “riding” a WC claims desk, a file in New Hampshire had a type of provider I had not seen before in my career.  The physical therapist referred an injured employee to an Occupational Therapist.  

Picture Of Patient And Physician Occupational Therapy In Corridor

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I had thought this was just more physical therapy.  Reviewing the Occupation Therapist notes created a few surprises.  Some of the tasks were grabbing steel balls off a simulated conveyor belt and stacking these small blocks of wood into pre-cut patterns.  


This seemed to be a large unnecessary cost to the file.  I denied the bill upfront.  The conversation I had with the OT was tense, but enlightening.  After going through the complete Occupational Therapy plan for the injured employee, it was obvious that this type of therapy was valid and justified payment.  


The Department of Labor has a great webpage  on Occupational Therapists.  OT’s usually perform these tasks:

  • Observe patients doing tasks, ask the patient questions, and review the patient’s medical history

    Logo of Department of Labor Occupational Therapy USA

    Wikipedia commons – U.S. Department of Labor

  • Use the observations, answers, and medical history to evaluate the patient’s condition and needs
  • Establish a treatment plan for patients, laying out the types of activities and specific goals to be accomplished
  • Help people with various disabilities with different tasks, such as helping an older person with poor memory use a computer, or leading an autistic child in play activities
  • Demonstrate exercises that can help relieve pain for people with chronic conditions, such as joint stretches for arthritis sufferers
  • Evaluate a patient’s home or workplace and identify how it can be better suited to the patient’s health needs
  • Educate a patient’s family and employer about how to accommodate and care for the patient
  • Recommend special equipment, such as wheelchairs and eating aids, and instruct patients how to use that equipment
  • Assess and record patients’ activities and progress for evaluating clients, for billing, and for reporting to physicians and other healthcare providers
  • The injured employee from New Hampshire with a saw cut injury to his hand returned to work after being out of work for 4 months  on modified duty that became his full time job.  In my humble opinion, the OT plan should be read by any personnel (adjusters, supervisors, auditors, etc.) involved in the file.  

The return on investment on the file was 8 to 1 when looking at the reserve reduction versus the amount the OT charged for her services.  OT has become more popular and understood over the years.  Sometimes, the adjuster may have to bring up referring the injured employee to OT.   

©J&L Risk Management Inc Copyright Notice

Filed Under: return to work Tagged With: disabilities, medical history, treatment plan

How to Reduce Experience Mods – Presentation Tomorrow in Raleigh

April 23, 2013 By JL Risk Management Consultants

How To Reduce Experience Mods Presentation Raleigh

How to reduce experience Mods will be presented by  James J Moore, our founder,  tomorrow in Raleigh. He will be presenting on the new NCCI or NC Rate Bureau Mod Calculation changes later this month at Job Ready Services in Raleigh.   You can register here

April Lunch & Learn:

 

Wednesday, April 24, 2013

12:00pm-1:00pm

Topic:  E-Mod Rate Changes: How to Reduce Worker’s Comp Premiums

Speaker:  James Moore, JL Risk Management Consultants, Inc.

Picture Of Businesspeople Presentation Reduce Experience Mods In Conference Room

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Cost:  $10.00

For more info, go here. 

The presentation will cover the Six Keys To Workers Compensation Savings.  The Six Keys were developed by James J Moore over the last 30 years.    The main methods to reducing WC Mods involve a higher level of communication between the employer, claims adjuster,  medical treatment personnel, and the employee. 

The presentation will last 50 minutes with 10 minutes for questions.   James Moore will usually take questions during his presentation.   Lunch will be served before the presentation. 

If you attend and need a copy of the slides presented, please email [email protected] and ask for the slides.  

©J&L Risk Management Inc Copyright Notice

Filed Under: James J Moore Tagged With: job ready services, presentation, Raleigh

NCCI NCRB New Mod Calculation Presentation This Week

March 4, 2013 By JL Risk Management Consultants

My Upcoming Mod Calculation Presentation

The NCCI NCRB new Mod calculation are the subject of my upcoming presentation. 

Picture Of Man Working Mod Calculation On Table

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I will be presenting on Tuesday March 5th for the Charlotte Association of Insurance Professionals  on the new E-Mod (Experience Modification Factor) calculation.   All North Carolina Workers Compensation policies that are renewed after 4/1/2013 will see these changes.

I had written on the possible implications of the new Mod calculations last year.   The new circulation letter concerning E-mod changes from the North Carolina Rate Bureau is contained below.

November 8, 2011
CIRCULAR LETTER TO ALL MEMBER COMPANIES
Re: Workers Compensation Insurance
NCCI Item E-1402 – Experience Rating Plan Changes

The North Carolina Rate Bureau recently filed and the North Carolina Commissioner of Insurance
approved changes to NCCI’s Experience Rating Plan Manual for Workers Compensation and
Employers Liability Insurance based on information shown in the above referenced NCCI item
filing. A copy of this filing is attached.

Woman Working Mod Calculation On Shop

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The Experience Rating Plan changes are designed to:

1. Update the Primary/Excess Split point; 
2. Revise the Maximum Debit Modification formula; and
3. Revise NCCI’s Experience Rating Plan Manual for Workers Compensation and
Employers Liability Insurance.

The proposal would update the Primary/Excess Split point to $10,000 as of April 1, 2013, to $13,500
as of April 1, 2014, and to an increased, indexed value as of April 1, 2015. An increase in this split
point will make the Experience Rating Plan more responsive to small losses.

The Maximum Debit Modification formula would change, allowing even the smallest experience rated
risks to have a maximum debit modification of 1.10 compared to the 1.00 that applies today.
The attached Informational Exhibits provide preliminary details regarding the nature of these changes.
For the purpose of comparison, North Carolina’s G value as of 4/1/2012 is 9.95 (or equivalently, a
State Average Claim Cost or SACC of $9,950).

Additional information, including details on required changes to rating variables, will be included with
the respective rate filings.

Contact the Information Center at 919-582-1056 or via email at [email protected], if you require
additional information
Sincerely,
Sue Taylor
Director of Insurance Operations

©J&L Risk Management Inc Copyright Notice

Filed Under: James J Moore, Split Point Tagged With: indexed value, new circulation, split point

First Reports Of Injury – File Them Online Now Or Pay 400% Later

October 31, 2012 By JL Risk Management Consultants

First Reports Of Injury Should Be Filed ASAP – No Excuses

Workers Compensation First Reports of Injury (FROI) are an employer’s first step in Loss Control.  Loss Control is not the same as Loss Prevention.  Loss Control to me is defined as the prevention of future losses AFTER an occurrence of a claim.

Picture of First Reports Work Injury

(c) 123rf.com

In fact, immediate filing of the first report of injury is one of my Five Keys To Cutting Workers Comp Costs.  In  a study of two different large collections of claims, I found that not filing a FROI quickly will increase claim costs by 400% on the average.  *** Thanks to Frank Pennachio of The WorkComp Advisory Group for pointing out the mistake I made on the original post of this article.   

Involving your claims adjuster very early in the process will always cut workers comp costs.  In fact, the adjuster can rarely proceed without the filing of the FROI.  One can look at the FROI as giving the adjuster permission to proceed on the claim.

One of the most important aspects of  an employer that files FROI’s quickly is the impression that the employer is on top of their claims.  Remember that this is the same person that will be setting reserves on this file and on files in the future.  The FROI is the first impression that the adjuster has on the claim for your company.

Picture of First Reports Work Injury Claim Form Bandage and pen on top

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Laggard companies (insurance company lingo) will always have higher reserves on their files, plain and simple.  If your company does not care enough to file an injury report timely, it is seen as a negative connotation on the file.

Electronic/online FROI filing has been around for quite some time.  This is an example of an insurance carrier’s online filing page.   In fact, some companies charge extra to input a claim off paper.  Filing a paper FROI when online filing is available is seen by the clams staff as a negative connotation similar to late reporting of injuries.

Your company is almost guaranteed higher reserves than normal when the first time your claims staff or adjuster hears about the claim from a medical provider.  What can the Workers Comp claims staff do when the medical provider is the first one to report the claim?   They are going to refer them back to the employer as the FROI has not been filed.

Picture Xraymachine First Reports Injury

Wikipedia – Thomas Bjørkan

Once again, this is the same person that will be setting the reserves on the file that figure directly and are the most important variables in your E-Mod (X-Mod) or Loss Development Factor if you are self-insured.   First impressions do count.

Insurance companies and TPA’s all keep very close track of the time it takes to file the FROI.  The term is called “lag time.”  It is measured from the time the claim occurs until an employer files the claim.  If you mail it in, the days it takes for the FROI to be processed by the employer, mailing time, and for the carrier to process the mail all are figured into your lag time.

The easiest way to avoid all this is to file your claims online.  If for some reason, your carrier or TPA does not have an online claim filing system, you should fax them.  If a carrier or TPA does not allow for online claims filing, their claims processes should be viewed  as antiquated at best.

Companies often contact us concerning their high E-Mods and ask us to help reduce them quickly. This is one of the areas we examine upfront in our E-Mod reduction programs.

©J&L Risk Management Inc Copyright Notice

Filed Under: claims adjuster, First Report of injury, FROI, Lag Time, Six Keys Tagged With: antiquated, connotation, loss prevention, track

NC Mid State Safety Conference Announcement – Presenting

September 13, 2012 By JL Risk Management Consultants

NC Mid State Safety Conference Announcement

I am speaking at the NC Mid State Safety conference on the NCCI split points and how they will affect your Workers Comp. This info will also apply to self insureds.

NCCI of NC Mid State Map Conference

ic.nc.gov

This is an all-day conference with great BBQ. I am the Treasurer of the group.

The conference info is below along with a registration form. If you are interested in being a vendor at the conference, please email Michelle Morgan at [email protected]

If you have any questions on the conference, please feel free to email me at [email protected]mpcosts.com. I hope to see you there.

Thanks.

Mid-State Safety Council Annual Workshop

October 9, 2012

Topics:

Ergonomics

 

Mindy Smith, ErgoSmith Consulting

Emergency Preparedness

 

Steve Naylor, EnviroSafe Consulting

Workers Compensation Update

James Moore, J & L Risk Management

Business Continuity Planning

 

Jack Moyer, NC Water Marketing Lead

Wellness In the Work Place

Wanda Smith, Alamance Regional Medical Center

Where: Mebane Arts & Community Center

622 Corregidor Street

Mebane, NC 27609

When: October 9, 2012

Registration begins 8:30 am – 9:00 am

Program – 9:00 am – 2:30 pm

Who Can Attend: Anyone interested in Safety and Health

COST: $50.00 (includes lunch, door prizes and vendors)

Registration Form Below

We accept credit cards, checks and cash! When registering please provide: Your Name, Company Name, Address, E-mail and Payment

 

 

Mail Completed Registration Form Below and Payment to:

Mid-State Safety Council

Stephanie Glasgow

OWASA

400 Jones Ferry Road

Carrboro, NC 27510

919-537-4223

Email: [email protected]

Company Name:

______________________________________________

Meeting/Event Name and Date:

__________________________________

Number Attending:

__________

Contact Person:

_______________________________________________

Mailing Address:

______________________________________________

City/State/Zip:

_________________________________________________

Email:

_________________________________________________

Telephone: (_____) ______________________

Checks should be made payable to:

Mid-State Safety Council.

 

©J&L Risk Management Inc Copyright Notice

Filed Under: James J Moore Tagged With: BBQ, NC Mid State Safety Council split points, workshop

Not Reporting Claims To The Carrier – You Can Pay It Now Or Pay 400% More Later

January 18, 2011 By JL Risk Management Consultants

Not Reporting Claims Can Be Very Expensive 

One way to pay more for WC claims is not Reporting Claims to your insurance carrier.  The second part of the title is from the Fram Filter commercials. I had come up with four areas, which I have posted to blogs and our website often, on the Four (Now Five) Keys To Cutting Your Workers Compensation Costs.

Clipart of Reporting Claims form

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When an employer delays or avoids reporting their First Reports of Injury (FROI), that employer will pay an extra 400% on their Workers Comp premiums. I performed two massive data studies using anonymous public Workers Comp data 10 years ago and then again two years ago. One of the hallmarks is that medical only and small lost time claims festering (a term I coined) costs employers big $$$.

If claims go unreported or delayed:
• Proper investigation by insurance staff cannot be completed
• Medical control is compromised
• Access to medical and other documents can be hampered
• Medical bills not process for fee schedule and PPO reductions
• Injured workers’ questions not answered, feel like they are in limbo
• Higher amount of attorney involvement
• Fines and penalties possible
• Time limit on certain defenses tolled

Female Doctor Writing Reporting Claims On Desk Clinic

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I could go on with the list, however I think you see my point. J&L is dedicated to saving employers Workers Comp premium by using time-tested techniques. Not involving your carrier or TPA is not a Risk Management cost savings technique. It may work well in the short term, but not in the long term.

One of my PowerPoint slides says All Claims Are Set in Stone after 48 hours. I will cover that point next time. If you wish to receive our newsletter, which is a summary of the blog, sign up for our weekly email. The signup box is down the right side of the page.

©J&L Risk Management Inc Copyright Notice

Filed Under: Six Keys Tagged With: cost savings, Fram Filter, hallmarks

Footnote References For #3 Return To Work – Readers Requested

July 28, 2010 By JL Risk Management Consultants

Footnote References For Return To Work Requested By Readers

The footnote references are for #3 Return to Work.  

I had been asked by numerous blog and newsletter readers for APA citations on my research. The two studies are cited below. Please check out my next post to see what #1, #2, and #3 could be costing your company. 

Woman having phone call footnote references at office work

Wikimedia Commons – Bill Branson

Moore, James J (1999). Research On 7,000 Public Entity Claims. The Keys To Cutting Workers Compensation From The End To The Beginning , pp. 18-20.

Moore, James J (2006). Research On 12,000 Public Entity Claims. The Keys To Cutting Workers Compensation From The End To The Beginning , pp. 26-28.

I hope these footnote references will help with referencing the two articles and my prior research.  Please note that both references are the study of public entity claims.  

The results were loaded into multiple spreadsheets for analysis.   The spreadsheets have long since been lost due to a large computer crash of the laptop and backup drive simultaneously .  <<not good.

The first study was also performed as background work when I was a Risk Manager for a quasi-public entity.  The second study was performed as background work when we doing claims department proficiency audits.  

These two studies and research of other studies were the basis for My Six Keys To Workers Comp Savings. 

©J&L Risk Management Inc Copyright Notice

Filed Under: Footnotes Tagged With: APA, entity, study

Being Named As Rebaters – Sign of Success?

October 7, 2009 By JL Risk Management Consultants

Named As Rebaters – J&L Risk Management at ISO Conference

J&L was recently named as rebaters at an ISO conference.I had heard many times of the saying “You know that you are successful when bad things are written about you.”  I am not sure of the saying’s source.

Graphic Of Man Sitting On Bar graph Named As Rebaters Holding Key

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At a recent ISO national meeting, we were named as one of the 11 bad workers comp review companies that are basically spewing out untruths to make a profit. If I remember correctly, there were three premium auditors that worked on the presentation. They even had links to the “awful” websites/companies such as ours. I wonder if the ISO had thought to screen the presentations. The ISO is such a good organization to allow presentations such as this one.

They had a quote or two from the blog – of course without my permission – that said untoward things about the insurance companies. The comments of course were taken completely out of context. With almost 360 blog posts, taking a part of one sentence and holding it up to the light does not make much sense.

Graphic Named As Rebaters Check

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The one thing that concerned me is that we were identified as rebaters. Rebaters used in this sense is a totally inaccurate term. Rebaters are agents or brokers that will refund back part of their commission to a client to be able to sell the client a policy. As all of our web pages point out at the bottom, we do not sell insurance. One has to wonder how accurate these auditor presenters are on their audits if they actually had professed that we were rebaters which is totally the wrong term. Rebating is an illegal act in the insurance world.

Please note that we are not rebaters in any way or form. We review Workers Compensation policies and reserves for statistical inaccuracies that may result in overcharges for employers. We do these reviews on a contingency or hourly basis. We also are expert witnesses on premium disputes. We often do performance file reviews for Self Insureds.

I wonder what the next inaccurate bad press will say about us? I hope they at least check the definitions of the words they are including in their articles.

©J&L Risk Management Inc Copyright Notice

Filed Under: Called Rebaters At ISO Conference Tagged With: auditor presenters, expert witnesses, spewing

Hallmark and American Greetings Can Be Great For Loss Control

July 18, 2009 By JL Risk Management Consultants

Hallmark and American Greetings Cards Are Great Risk Management

The Hallmark and American Greetings cards help control Work Comp Costs. One of our blog readers reminded me that I did not post an article on how greeting card companies can be great for reducing Workers Comp claims costs. I usually cover this topic when I am speaking or writing about the fourth of my Six Keys to Reducing Your Workers Comp costs. The Fourth Key is Employee Treatment by The Employer.

Picture of Hallmark and American Greetings Card in Store

123RF

Hallmark and American Greetings are very inexpensive ways to keep in contact with injured employees. This is especially true when an employee is first injured. Sending a card or e-card is a great idea as the injured employee is watching a large number of attorney ads on TV. Quite often, the injured employees will receive letters from attorneys not long after their injury. I have heard of some companies sending flowers if the employee was severely injured.

The Workers Compensation insurance carrier will usually send a letter of explanation of benefits to the employee. This is a good business practice. The letter is not a substitute for a card or an e-card. Phone calls are also good if they do not disturb the employee.

Floral Hallmark and American Greetings Card

StockUnlimited

Hallmark and American Greetings have free e-cards. The best ones are the e-cards that are provided if your company joins for $13/year. Almost everyone has an email address. If the injured employee does not, it may be a good idea to keep a few cards on hand to mail out in case of an accident.

This suggestion may seem to be a minor one. However, I have seen the savings for many companies that started sending greeting cards to their employees. Good communication between the injured employee and employer usually leads to a quicker return to work, which saves Workers Comp $. As I have said and posted very often, the injured employee is still your employee.

©J&L Risk Management Inc Copyright Notice

Filed Under: Greeting Cards Tagged With: attorney ads, free-e-cards, hallmark

Five Secrets To Cutting Your Workers Compensation Costs

June 25, 2009 By JL Risk Management Consultants

Five Secrets To Saving On Work Comp Costs

The five secrets to save on Work Comp Costs are actually based in common sense.  

Boy Whispering Into Girl Ear Five Secrets Picture

StockUnlimited

I have in a roundabout way over the last few weeks covered a few of the secrets (that are not so secret) to cutting your company’s Workers Comp costs.

The five are:

  1. Timely reporting of the injury to the insurance carrier/TPA – The carrier or TPA cannot begin a timely investigation without the First Report of Injury 
  2. Medical network in place – where will your injured employees treat for their injuries?
  3. Return to work plans for an injured employee – a big premium saver if you have a RTW program.
  4. How the employee is treated by the employer – they are still your employee 
  5. Understanding Your Premium Audit – review it and ask questions when you receive the premium audit bill. 

If you look over the last few posts, the first three have been covered. I will cover #5 – Understanding Your Premium Audit in the next post or two.

#5 was added after considering that the final part of the policy process is a premium audit.   Your premium audit can be thought of as the final bill for your policy.  There will be quite a few upcoming articles on premium audit.   

A Sixth Key will be added to the list in the future.  I have two different secrets or keys that I am considering adding to the list.   Both could be added  to the list.  However, I will likely stop at Six instead of Five Secrets.

Update – The Sixth Key has been added to the original five.  Please check here for the Six Keys. 

©J&L Risk Management Inc Copyright Notice

Filed Under: Six Keys Tagged With: premium saver, timely investigation

Employer Can Do One Thing To Quickly Wreck Workers Compensation

June 14, 2009 By JL Risk Management Consultants

Employer Can Do This To Quickly Wreck Their Workers Compensation Program

There is one thing that an employer can do to wreck their Workers Comp program. It is a mistake that can be remedied very quickly.

Picture of Employer Can Do Run Fast Over Traps

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The mistake is not reporting claims timely. With so many of the states requiring the adjuster to make a compensability decision within a short time frame, the employer must report the accident quickly. Most companies do report accidents from their main office very quickly. It is when they have branch offices and/or divisions/departments that problems occur with timely reporting.

This is one of the Five Keys To Saving On Workers Comp that I have written and spoken about for many years. Letting the workers compensation adjuster know of an accident quickly allows for a more thorough investigation. The injured employee will receive their proper benefits when they need them if the investigation begins quickly.  

Most claims are stamped in stone within 48 hours after their occurrence.  Reporting a claim more than a few days late to the insurance carrier or Third Party Administrator sets the stage for an expensive claim.  

Picture Of Employer Can Do Discuss Employees

StockUnlimited

One of the effects that employers may not realize is the adjuster that is setting the reserves on their claims will very often base some of the reserves on the “reputation” of the employer. An employer that chronically reports claims late may be seen as more of a higher risk. The adjuster may set the reserves much higher which will cost the employer a much larger amount of premiums. The worst first impression to an adjuster is an employer that reports their claims late.

Late reporting can also affect an employer at renewal time. Quite often, an adjuster will let the underwriting department know when an employer has reported a claim late. These late reports are usually compiled and provided to the underwriter at the time of renewal. We have often seen employers not being renewed by their insurance carriers for reporting late.

©J&L Risk Management Inc Copyright Notice

Filed Under: late reporting Tagged With: expensive claim, five keys, reporting claim

AMA – Startling Workers Comp Return To Work Statistic

June 11, 2009 By JL Risk Management Consultants

AMA Early Return To Work Saves Workers Comp Funds

Doctor AMA talking to her recovered patient

Wikimedia Commons – National Cancer Institute

I was attending a lunch conference on Workers Compensation Return to Work earlier this week. The presenter provided this statistic from the AMA  (American Medical Association). The stat was based on the longer an injured employee is out of work, the less likely they will ever return to work.

The percentage of workers that return to work after being out of work for:

  • Less than 8 weeks – 50%
  • After 26 weeks – 18%

There was also a study performed in the 1980s and the 1990s that said an employee that is out of work more than six months will return to work only 50% of the time. I had performed a statistical analysis of the same type on a group of public sector files. The most startling statistic was that only a very small percentage of employees out of work for more than one year. I think the number was 7%.

Return to work is becoming more of a financial defense strategy for companies. Having a return to work program is very critical to reduce Workers Compensation costs. It is one of the easier methods to reduce Workers Comp payouts.

There are a few good methods to establishing and facilitating a Return to Work program. I will cover them in the next post along with the reasons for the low % of return to work after such a short time off work.

©J&L Risk Management Inc Copyright Notice

Filed Under: return to work Tagged With: financial defense strategy, percentage, short time off work

Quick Apology To Our Readers For Bad Blogger Day

March 27, 2009 By JL Risk Management Consultants

A Quick Apology To Our Devout Article Readers

Graphic of Social Media Quick Apology Icons

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A quick apology to all readers. We have been informed by Blogger that some of the previous and archived posts may not be or may not have been accessible.  This may have resulted in a 404 Error, especially if you are using Google, Yahoo, one of the search engines, or our search box to find one of the blog posts.  If this happened to you, please excuse the inability to find that certain blog post.

We also send out the posts in a newsletter every Thursday.  If you wish to receive our blog post newsletter on Workers Comp, please use the sign up button in the right margin.  Thanks.

Update – On September 14, 2014, we switched over to WordPress.   If you want to be an author of any type of articles, WordPress will fill the need quite well.  

Google gave approval to using WordPress in many of their online manuals and videos.   Google’s Matt Cutts provides great comment on WordPress here.   

WordPress resulted in a slog for us.   Each article has to be hand converted by our talented website consultant.   Erica performed an ept job on the 1,650+ articles. 

©J&L Risk Management Inc Copyright Notice

Filed Under: James J Moore Tagged With: 404 Error, Blogger, Matt Cutts, newsletter, WordPress, yahoo

Workers Comp Claim Medical Costs – Fast Way To Reduce?

November 24, 2008 By JL Risk Management Consultants

Workers Comp Claim Medical Treatment

Do the Workers Comp claim medical treatment costs affect my claims cost the most? 

Picture man hand touch screen icons Workers Comp Claim medical Cost

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In my opinion, controlling the workers comp claim medical treatment is the quickest way to cut your Workers Comp costs. Controlling the medical costs not only means using the medical networks to reduce the cost of the medical bills, but to control the doctors that treat your injured workers. A great industrial-minded treating doctor can also control the weeks out of work and the permanent disability rating.

As I have commented quite a few times in this blog and in my presentations, the main reason to maintain control of the employees’ medical treatment in a Workers Comp claim is that all Workers Comp courts, state bureaus, etc. consider the treating physician as being the only impartial witness in the claim. The medical testimony is usually going to be the “ultimate decider” in the claims process.

I have never seen the Workers Comp judge throw out the treating doctor’s medical testimony completely. So, the bottom line is “Control the medical treatment and your company will control the claim costs.” I have performed quite a few studies that shows this to be very true.

California started using MPN’s (Medical Provider Networks) in 2005. That is the one of the reasons for the sharp decreases in Workers Comp insurance rates in CA.

©J&L Risk Management Inc Copyright Notice

Filed Under: Controlling Workers Comp Medical Treatment Tagged With: permanent disability, state bureaus, workers comp judge

My Insurance Designations Listed and What They Mean

July 6, 2008 By JL Risk Management Consultants

My Insurance Designations – What Are They?

Insurance designations can be very helpful in building a thorough knowledge of the insurance process.  

Signing Insurance Designations guest book

Wikimedia Commons – Ildar Sagdejev

One of the questions that I often receive at Workers Comp presentations is, “what are the initials at the end of my name, and what do they mean?” (AIC, MBA, ChFC, ARM)

AIC – Claim professionals handle a wide variety of claims, including property, auto, workers compensation, and bodily injury claims. Earning the AIC designation can improve your technical claim handling abilities as well as your communication and negotiation skills. You can take the standard multiline approach, which covers personal lines as well as commercial lines, property, and liability; or, you can choose among four specialty paths if one of them would better suit your career needs.

ChFC – The Chartered Financial Consultant® (ChFC) designation program focuses on the comprehensive financial planning process as an organized way to collect and analyze information on a client’s total financial situation, to identify and establish specific financial goals, and to formulate, implement, and monitor a comprehensive plan to achieve those goals.The ChFC program provides financial planners and others in the financial services industry with in-depth knowledge of the skills needed to perform comprehensive financial planning for their clients.

Picture Of Man Insurance Designations With Couple At The Back

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ARM – The Associate in Risk Management (ARM) designation is the undisputed professional credential for persons involved in the risk management field. The ARM designation signifies that an individual working in this field has attained a comprehensive understanding of the risk management process, from analysis to implementation and monitoring, risk retention and transfer, and the latest in advanced risk financing techniques.  The ARM designation now has different career paths included in its curriculum. 

All the designations are offered through the AICPCU institute.   The institute is the best place to attain insurance designations. 

©J&L Risk Management Inc Copyright Notice

Filed Under: AIC, ARM, ChFC, MBA Tagged With: AICPCU, Associate in Risk Management, Chartered Financial Consultant

Workers Comp Claims Review Expert – How Do You Find Proper One?

January 2, 2008 By JL Risk Management Consultants

Workers Comp Claims Review Experts Can Be Hard To Find

Graphic Of Sacks Of Money Workers Comp Claims Review And Coins

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Choosing a great Workers Comp claims review expert is some of the best strategically invested money in a company’s budget. The main things to look for in your search are:

  • Designations – such as AIC, ARM, CPCU, etc. Our next post will cover some of the designations. These designations are granted after a candidate passes national exams for a certain number of courses.
  • Years of Experience – while this is a great indicator, we have performed review work after a so-called very experienced claims consultant that did not review the files very well.
  • From One of the Big Companies – this is not an indicator of the level of service you will receive as it is down to the individual claims consultants in the companies that will service your account.
  • Experience in a Certain State – this is not a big factor as one might believe. The main thing to remember is a claims consultant that has multi-state experience shows adaptability to different state systems.
  • Prior Claims Adjusting Experience – there are some claims consultant companies that have no or few employees with actual claims adjusting experience.

    Consultant Workers Comp Claims Vector

    StockUnlimited

  • Statistical Backgrounds – this is critical for file by file reviews and is important for finding trends in the claims reserving
  • No Conflicts of Interest – any person that may make a commission off your Work Comp policy may not be able to give an uninfluenced opinion.

I did not put these in any order of importance.   Each file review is unto itself.  The best of both worlds is to have a reserve/claims expert company that also reviews the premium calculations. A shameless plug – we are one of the few companies in existence that do both.

Up Next – Designations – What are they??

Our main Website is https://cutcompcosts.com/

©J&L Risk Management Inc Copyright Notice

Filed Under: expert witness Tagged With: company budget, invested money

Four Factors That Are Critical When Accident Happens

November 9, 2007 By JL Risk Management Consultants

Four Factors When The Claim Occurs Are Critical

The four factors are:

  1. How was the employee treated by their employer at the time of the claim?

    Vector Graphic of Number Four Factors in Orange Color

    StockUnlimited

  2. Did the employer have a medical network established to send the employee to for treatment? Was that employee sent to an established network medical provider?
  3. How quickly was the Work Comp First Report of Injury filed with the insurance carrier or TPA?  Time is critical at this point in the claim.  Delays cost money. 
  4. Did the adjuster talk with the employee, employer, and physician within 24 hours of receiving the first report of injury?  The immediate three point contact should be a standard in all claim departments. 

The clock is ticking when an employee reports an injury. I have studied Workers Compensation claim trends for over 20 years. If #1 – #4 above is not completed in 48 hours, the cost of Workers Comp claims jump tremendously.   Actually, 24 hours is even better if logistically possible.

One of the most complicated claims adjuster situations occurs when a first report of injury arrives at 4PM on a Friday.  Is the adjuster responsible to make the Three Point Contact the following Monday?   The claim does not stop outside of business hours.   Investigating the claim within 24 hours remains one of the best Risk Management tools in existence.   Medical control  becomes tantamount to controlling costs and providing the injured employee with the best medical treatment available. 

If the answer to any one of the four above questions is No, your company will be trying to control much higher than normal claims costs and paying at least 1,600% more claims $.

These four factors can make or break a good workers compensation claim investigation.   Try to make these four factors work for your company. 

Next Up – Payroll (Premium Audits) – the mother of all Workers Comp budget busters

©J&L Risk Management Inc Copyright Notice

Filed Under: Six Keys Tagged With: three point contact, Work Comp First report

Workers Comp Blog Readers Ask Another Great Question On Our Services

October 25, 2007 By JL Risk Management Consultants

Great Question From Our Workers Comp Blog Readers

Another Question from Our Workers Comp Blog readers – There are a few companies that do Workers Comp premium reviews such as J&L. Do you do anything different than your competitors?

Graphic of Two Competitor Workers Comp Blog Readers Reaching The Trophy

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Answer – There are a few things that separate us from our competition.

The main two are:

  • Premium Audits/Reviews – I am a former Systems Engineer and programmer. We use homegrown software in doing our premium reviews. We are able to find more inconsistencies or errors in the premiums paid than our competitors. Our software drills down into the Workers Compensation data much further than the packaged software that is on the market as of today. As I have an actuarial/statistical, computer, and claims background, we are able to apply unique models to the data for analysis.
  • Reserve Audits/Reviews – I have a heavy claims background that allows us to initiate a reserve review and a premium review at the same time. No premium review company has this level of expertise in both these areas. Ask one of the premium review companies about reserve reviews and they will usually tell you that they know of someone that they can refer you to in another company or they will refer you to a sub-contractor.
Hand Presenting Audit Workers Comp Blog Readers Concept

By StockUnlimited

We are able to analyze both areas to the fullest. We start with the premiums paid and work our way back to the E-Mod and then to the reserves on the Workers Comp files. We then analyze the reserves to make sure that the files are reserved properly. We do all of the statistical processes “in-house.”

I regret sounding like advertising, but it is the truth. We are not in business to be like the other companies.  J&L is unique at what we do for our customers. 

Next Up – News Article Analysis

 

©J&L Risk Management Inc Copyright Notice

Filed Under: James J Moore Tagged With: Blog readers, Reserve Audits

Workers’ Comp Costs – Six Keys To Saving Premiums

August 21, 2007 By JL Risk Management Consultants

Reduce Your Workers’ Comp Costs – Six Keys (updated)

Update – Six Keys To Saving on Workers’ Comp Costs.

Picture of Piggy Bank Workers' Comp Costs and Money

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The mainstay of all my presentations is the (used to be three) “Five Six Keys to Saving on Workers’ Comp Costs.” This is a time-tested list that will reduce Workers’ Comp costs for any employer in any jurisdiction. These come from over 20 years of analyzing claim costs, and a study that I performed with over 7,000 Workers’ Compensation files. They are:

  1. Timely Filing of the First Report of Injury – within 24 hours- this is easy to fix.  Your company’s operation manuals should have a section on handling and reporting injuries.   Your operations manual training should contain a section on reporting injuries. 
  2. Physician’s Network – where does the employee treat?  Your company operations manual should have a section on where to send the injured employee if injured or seriously injured.
  3. Return to Work Program – prevents large cases.  All companies should have a return to work program.  The physician network should have a copy of all job descriptions known as a job bank.
  4. Employee Treatment by Employer, Doctor, Adjuster – reduces malingering and fraud.   Trust by the employee makes the first three keys more easily attainable. 
  5. Making Workers’ Comp a Priority – do you just write a check to the TPA or carrier?  Taking WC off the back burner usually results in savings.  
  6. Understanding The Premium Audit Process- how your final bill has been calculated.  The Premium Audit is the final bill from the carrier.   Many articles in this blog have been written on premium audits. 
I found that in a study of the 7,000 Workers’ Compensation files, that if an employer does not do just one of #’s 1 – 4, the claim cost will increase by 400%. And yes, if none of the first three are done properly the employer will pay 1,200% more than a similar employer that is attending to all of the first three of the five.
I will cover all of them individually over the next five weeks. I will be releasing a manual in the next month that goes even deeper into detail.
 
Tomorrow – How is Your Workers’ Compensation Premium Calculated?
 

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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

 

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