Back To Work During A Pandemic For The Employee – Another Look

March 25, 2021 By Erica Libo

Back To Work – Considerations And Qualifications

Going back to work is like a process of healing. A sick person needed medicine to be healed same as the workers that need to go back to their work.

They needed a job to sustain and fulfill their daily needs. Workers have been through a lot this year, especially last year. They fought a battle that they can’t see if they’ll win or not. They lost a lot of opportunities. Some business has been bankrupt. Some employees lost their job. Luckily, there is still work that continued at home. But how about now? Workers deserve to go back to work.

Woman Back To Work wearing surgical mask

Wikimedia Commons – www.vperemen.com

Being an employee, they shoulder a lot of responsibilities, they take a lot of risks and doesn’t have the assurance of what will be the result, and they become the best person as like what they want. Losing a job is one of the worst nightmares that workers may have been experienced. But returning on it is like grabbing a new life and opportunities.

Returning to work is never been easy compare to the previous years. There’s a lot of things that have been changed. Going back to work today is like your half-body is in a grave. You will risk a lot more than usual. It’s never been easy because there is a lot of qualifications that must comply.

In returning to work, workers should know that the more they interact with other people the more they have the chance and higher risk of spreading Covid-19.
If you are a worker and you are going back to work you must continue the proper ways to protect yourself from the virus. You must continue wearing a mask, using tissues, always sanitize your hands using alcohol, and distance yourself to avoid close contact.
In considering a person who wants to go back to work they need to be sure that they have never been having close contact with the people who have positive cases or never been exposed to the Covid-19 patients.
Workers should practice “going straight at home after work” to help other people not spread a virus and also to help yourself out to take yourself away from anything that could put you at risk.
Always monitor yourself. Be alert from the symptoms you may have.
Practice disinfecting the things before and after you touched them. Avoid sharing things with the other workers especially your personal belongings.

In considering the Return to work of the employees, the business should do the following things:

Businesses should limit the number of people in the workplace for them to meet the social distancing rule that a government has been made. They should have the assurance that workers that have been returned to work should meet the qualifications for them to avoid a severe illness.
Businesses should also limit the customers that are entering the facility to show and obey the proper social distancing. And continue to have a vulnerable employee as like what is stated above.
Businesses must have the permit that is being approved before re-opening.

Magnifying glass on the page Back To Work of book

Wikimedia Common – Karbyn

Here are the guidelines that businesses and a worker must know:

To have a hazard assessment
Proper hygiene
Social distancing
Identification and isolation of ill employee
Returning to work after being ill
To have controls
Workplace flexibility
Training
Anti-retaliation

In making things possible, businesses are not just into helping their company to gain but they are also helping their employees and their loved ones to feel safe and far from the risk.

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

February 25, 2021 By JL Risk Management Consultants

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.

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Coronavirus Return To Work – Top 10 Issues For Workers Comp

April 30, 2020 By JL Risk Management Consultants

Pending Post Coronavirus Return To Work Issues – Top 10 Preparations

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

Picture Coronavirus return to work microscopic

CDC Public Use License

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

The Top 10 Issues are:

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

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

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Employee Treatment Silent X Factor Great Risk Management

May 2, 2019 By JL Risk Management Consultants

Employee Treatment By Employer Silent and Critical Factor

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

Public License 1949

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

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

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

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

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

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

Silent X-Factor in Workers Comp Risk Management

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

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

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

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

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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:

The largest homebuilder in the nation
Two different huge fast food restaurant chains on the east coast
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:

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

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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:

Medical control – without the medical control in place, your costs are going to spiral
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Return to work – the coordination between adjuster, employer, and treating physician is affected with a delayed first report
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.

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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.

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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:

Immediate Reporting of Injuries – no exceptions or excuses – immediately.
Medical Treatment Network – spending time setting this up can make or break a WC program
Return to Work Program – takes more time to accomplish – the savings are huge
Employee Treatment – this one was added in the 1990’s
Adoption by Management – this one was added in 2005 – more on that one in a moment.
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.

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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.

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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

Those three were:

ASAP First Reports of Injury
Return to Work Program
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:

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

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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.

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.

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.

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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.

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

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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.

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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.

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.

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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
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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

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.

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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.

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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

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.

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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
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

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.

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.

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.

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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.

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.

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

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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

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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.

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

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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:

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
Medical network in place – where will your injured employees treat for their injuries?
Return to work plans for an injured employee – a big premium saver if you have a RTW program.
How the employee is treated by the employer – they are still your employee
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.

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

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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.

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.

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?

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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.

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:

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

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:

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.
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.
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.
Employee Treatment by Employer, Doctor, Adjuster – reduces malingering and fraud. Trust by the employee makes the first three keys more easily attainable.
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.
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?