Using Telemedicine in Workers Compensation

Telemedicine is viewed by many as an opportunity to reduce the cost of medical expenses and promote efficiency in the workers’ compensation system.  While this practice may be new in workers’ compensation claims, it should be something claim management teams look at to reduce the overall costs of a workers’ compensation program.

What is Telemedicine?

1925-feb-science-and-invention-sm-coverAccording to Wikipedia, telemedicine is “the use of telecommunication and information technologies in order to provide clinical health care at a distance. It helps eliminate distance barriers and can improve access to medical services that would often not be consistently available in distant rural communities. It is also used to save lives in critical care and emergency situations.”

Telemedicine in Practice

The concept of telemedicine is not new.  In fact, it has been used for over a decade in some areas.  By using the technology in the Internet and advances in other telecommunications, medical practitioners have been using “telemedicine” to care for remote patience.  It has also been used for practitioners to connect to others in the medical community to discuss case studies, review patient histories and provide better care.

Telemedicine is also being used to address a shortage of general practitioners and other specialists.  In most instances, the use of this service benefits doctors by allowing them to see more patients.  It also benefits patients who are not able to travel to a doctor’s office for a scheduled visit or have a disability that inhibits their mobility.

Uses of Telemedicine in Workers’ Compensation

Given the nature of telemedicine, there are a number of practical applications for this practice in the context of workers’ compensation.  These include the following:

  • Reduce the expense of having an on-site medical professional;
  • Allows doctors and triage nurses to assess injured workers from a remote location;
  • Enables medical experts such as radiologists to evaluate images
    and prepare reports;
  • Uses fully integrated technology to access information on a number of cases.

Medicaid and Medicare have also recognized the value and benefits of telemedicine initiatives.  These two important government programs are in the process of evaluating the effectiveness of it as a tool to meet the challenges of the 21st century healthcare system.


Medical Issues in Workers’ Compensation


workers' comp claim with bandaged wristDue to the increasing costs of medical care in the United States, expenses related to the medical portion of workers’ compensation claims continue to be a major driver in the industry.  As a result, it is important for members of claim management teams to understand not only when medical expenses are compensable, but also the types of benefits available to injured workers.



What Medical Bills Do I Need to Pay For?


The first step to understanding when medical expenses are compensable is to understand the statutory requirements in the jurisdiction you are handling.  This is especially important for claim professionals that handle multiple states.  While this may sometimes require guidance from an attorney, the general rule is that medical bills on admitted claims are compensable if they are “reasonable and necessary” to cure and relieve the effects of a personal injury.



What Does This Mean?


While some states are moving away from a liberal construction of their workers’ compensation acts, this standard generally means that care is compensable for a myriad of treatment modalities.  This can often include care beyond a treating physician and staff, but also include a number of specialists:


  • General medical care;
  • Psychological and psychiatric care;
  • Chiropractic treatment;
  • Acupressure and acupuncture;
  • Christian Science treatment;
  • Podiatric care;
  • Surgery, surgical supplies and hospital treatment;
  • Diagnostic procedures such as x-rays, EMGs, MRIs and CT-scans;
  • Prescription and over-the-counter medicines;
  • Durable medical equipment such as braces, crutches, splint, etc.;
  • Glasses, Spectacles, Hearing Aids, etc.;
  • Artificial members; and
  • Various forms of nursing services.


The bottom line in almost all states is that the exposure for medical expense claims on admitted injuries is lifetime medical benefits.


Worksite Healthy Sleep Program: Helping Employees Sleep One Z at a Time

By Robin E. Kobayashi, J.D., LexisNexis Legal & Professional Operations

The CDC reports that 30 percent of civilian employed U.S. adults, which equates to 40.6 million workers, lack sufficient sleep. These adult workers are sleeping less than 6 hours a day, when the recommended amount of sleep is 7 to 8 hours a day. The CDC survey showed a 34.1 percent rate of short sleep duration among workers in manufacturing compared with all workers combined. About 44 percent of workers who worked the night shift experienced short sleep duration compared to 28.8 percent of day shift workers. Workers with high rates of short sleep duration included 69.7 percent of night shift workers in transportation and warehousing and 52.3% of health-care and social assistance workers.

The lack of sleep may lead to the development of chronic diseases and conditionssuch as diabetes, cardiovascular disease, obesity, and depression. In addition to soaring health care costs to treat these chronic diseases and conditions among workers, businesses must also contend with safety issues and lost productivityworkplace sleep pod.

new study published in the Journal of Occupational and Environmental Medicinepoints out that chronic sleep deficits can cost up to $3,156 per employee. The problem is how to reach workers who could benefit from healthy sleep guidelines and healthcare. The study examined a novel approach to how businesses can deliver an effective healthy sleep program through a workplace wellness facility.

Cognitive-Behavioral Therapy

According to the study, there have been numerous studies on the effectiveness of cognitive-behavioral therapy for insomnia (CBT-1) to help people sleep better both short- and long-term. CBT-1 even carries an evidence-based medicine “stamp of approval” for treatment of chronic primary insomnia and comorbid insomnia symptoms. CBT-1 covers “sleep hygiene, stimulus control, guided imagery, self-talk (cognitive restructuring of dysfunctional thoughts about sleep), meditation, and relaxation techniques”, among other things.

As the study indicates, the question then becomes how to deliver CBT-1 effectively to employees?


Setting The Standard For Safety Controls Workers Compensation


Every now and then it is good to go back to safety basics.  At times throughout the course of a year we will veer off on tangents about certain aspects of safety.  It is time to reset for the year, and go back to the main structures of a safety program–what it is, how it works, and why it is effective.  How will you limit, decrease, and eliminate your workers comp costs this year?

Run a Safe Operation

Run an actual, real, safe, work operation.  That means as a business C-suite occupant you know that on the work floor you have machines with real guards in place, carpets free from rips and holes, non-fraying ropes or ties, anti-slip surfaces on steps, clearly marked Workers on Steel Girder, high in the sky,  having lunchhazards, and clean floors.

Upon first glance it all seems too simple.  If you do what you are supposed to do, and have what you are supposed to have, safety will all fall in to place.  This is only part of the battle, but it is an important part.  If/when workers see all of this attention, and new equipment, and investments in safety, they start to think in safe modes as well.  If the atmosphere and culture of the shop looks like nobody cares, then your workers are not going to care for their own safety either.

Elect or Appoint an Emergency Response Team

Quick, Bill just caught his hand between two pieces of moving machinery.  Point to Steve, “Steve you are next to Bill, what do you do?”

If you were to stage a severe accident in your shop, what do you think the results would be?  Would everyone react like the Armed Forces and efficiently get Bill taken care of while someone calls 911 and pages the floor supervisor?

Or would 13 people run around pale-faced while unable to speak while Bill bleeds out on the floor? Continue reading Setting The Standard For Safety Controls Workers Compensation

Alcohol and Workers Compensation

sign for Drug and Alcohol-Free WorkplaceAlcohol abuse in the workplace has long been a contention for denial of workers compensation benefits.  However, while most jurisdictions have either legislated or set precedence for these declinations, it is still the employer’s burden to prove the injury was solely caused by alcohol intoxication.  In addition,the employer must have a low to zero tolerance in their job site alcohol policies, and the employer must furnish proof for enforcement of the alcohol program.

Unlike other substance abuse items, alcohol puts one toxic component (ethanol), in the body.  This tends to limit damage for underlying pathologies.  Still, over time alcohol can have pronounced effects on health, life style, and job performance.  Slowness of comprehension and speech, malnutrition, poor job performance, loss of personal hygiene and appearance are to be observed.  Frequent confrontations with fellow and supervisory personnel are often a sign that the employee’s behavior is not normal.  There may be physical deterioration such as weight loss, slower physical responses and judgment issues.   The most commonly known damage occurs in the liver.


Set guidelines that are legal, clear, comprehensive and enforceable.  Obtain professional assistance in developing the plan.  Include methods of dealing with enforcements, punishments, and confrontation.  It is also a wise idea to have a rehabilitation program as an alternative to termination. A good employee is worth salvaging. Be sure every employee is made aware of the program and obtain their written confirmations.

Front Line Notice

It must be noted that many persons with alcohol abuse issues may easily subdue the outward signs of alcoholism.  This makes it difficult for the employer to realize a problem exists.  It behooves the immediate supervisor in close contact with the employee to observe and document any changes in the employee’s behavior, attitude, or other outward appearances noted above.

One sign that the employee may be drinking on the job is a change in personality after arriving on the job.  Dullness to euphoria or vice-versa is often a sure sign. Frequent visits to the restroom or locker room with changes of personality after return are another sign.  Containers with alcohol can be easily hidden under clothing.  Thermos or other liquid holding containers may even be in plain sight.


Five Foods To Forego…Everyday Choices Pose Health Concerns

chart depicting health risks of processed meatsExperts frequently remind us that fresh fruits and vegetables, especially those that come in rich, vibrant colors, should hold a valued position on our tables at meal time. These foods contain nutrients that are known to stave off serious, debilitating diseases. Unfortunately, many people in our “always on the go” American lifestyles choose convenience over quality.

Eating fruits and veggies is great practice for your good health. Think colorful food selections that grow from the earth.

The food you eat should be processed by your body, not a factory. Fill up most of your plate with fruits and veggies and skip the less-than-stellar selections listed below to build your plate for power.

The top five foods every consumer should leave off the grocery list:

5. Deep Fried Foods:
Cooking at high temperatures can result in the formation of toxic chemical compounds that are not good for your health.

4. Processed meats:
The Harvard School of Public Health reports that eating processed meats may increase one’s risk of heart disease and diabetes when a diet consists of regularly eating about 50 grams (1.75 ounces) of processed meat per day. Processed meat includes deli slices, sausage and bacon.

3. Soft drinks (diet or regular)
Most sodas contain food dyes and preservatives. It is uncertain how safe these drinks are and they provide very little by way of healthy nutrition and nutrients.

2. Condiments in a bag:
Mustard and ketchup in small packets are engineered to remain stable. They contain additives that your body doesn’t need.

1. Refined and artificial sweeteners
We don’t know if these substitutes are harmful. Claims are confusing and these substitutes provide no healthy nutrients.


Worksite Wellness Programs: Why Workers’ Comp Insurers and Small Businesses Should Team Up

By Robin E. Kobayashi, J.D., LexisNexis Legal & Professional Operations

Robin E. Kobayashi, J.D., LexisNexis Legal & Professional Operations  Small businesses employ 56 percent of the U.S. workforce. They get pounded each year with the high costs of doing business, and they often lack the financial resources, staffing, expertise, management buy-in, or motivation to help reduce some of those costs by implementing a worksite wellness program.

Consequently, small businesses should perk up their ears about a hot-off-the-press study in the Journal of Occupational and Environmental Medicine, in which Pinnacol Assurance, a workers’ comp insurer in Colorado, teamed up with 260 small businesses to help them implement worksite wellness programs. This study was unique because a workers’ comp insurer, and not a health insurer, helped small businesses—at no cost—set up a workplace wellness program and provided continuous guidance on design and execution of the program.

What does this study mean for small businesses across the nation? It could mean that an alternative model exists where a “plug-and-play” type of workplace wellness program developed by a workers’ comp insurer could succeed when targeting small businesses.

Definition of Small Business

For the purposes of the study in question a small business had less than 500 employees and no more than $7 million in average annual receipts.

How the Study Was Set Up

The study examined, for a period of five years, Pinnacol Assurance’s “health risk management” (HRM) program, which was offered for free to 55,000 policyholders, 99.6 percent of whom were located in Colorado. The Pinnacol Assurance leadership reasoned that “poor health has a negative effect on workers’ compensation costs” and that “health risk management will become as fundamental to managing risks as safety management is currently.”

The HRM program was voluntary. Pinnacol Assurance and insurance agents actively recruited employers to participate. Employers also self-enrolled. In the end, a total of 260 small businesses enrolled in the HRM program. These businesses came from a range of economic sectors.

Goals of the HRM (Workplace Wellness) Program

The goals of the program aligned with the goals of the small businesses which participated in the program:

  1. Improve employees’ healthy behaviors
  2. Reduce workers’ comp rates and costs
  3. Enhance work productivity