Category Archives: CA Workers Comp News

6 Solutions for WC’s Compounded Medications Issue

September 26, 2018 by 

“There is no such thing as an FDA-approved compound medication.” That statement from myMatrixx Chief Clinical Officer Phil Walls underscores one of the main criticisms of these medications; while the drugs within the mixtures may all be FDA-approved, the specific combinations have not been tested and verified.

Safety is just one concern, however. The other is cost; they generally workers preparing medications for article, Compounded Medications — 6 Solutions to Address a Nagging Issue for WCare priced significantly higher than similar, FDA-approved drugs or the sum of their underlying medications.

Both the utilization and the average cost of compounded medications in the workers’ compensation system has decreased in recent years. However, there are still pockets of excessive use. Stakeholders need to maintain a steady and continued focus on efforts to curb the unnecessary use of these pharmaceuticals.

Problems Cited

Compounds are a mixture of drugs intended for a specific patient’s use. According to an FDA report, they are beneficial only in limited circumstances; such as when other medications have failed, a patient is allergic to some of the inactive ingredients or has difficulty swallowing.

The federal agency inspected compounding facilities and noted the following “troubling conditions” that could lead to widespread harm of patients:

  1. Toaster ovens used for sterilization.
  2. Pet beds near sterile compounding areas.
  3. Operators are handling sterile drug products with exposed skin, which sheds particles and bacteria, among many others.

Latest Stats

Compounded medications are not considered first-line therapy for pain or other common conditions of injured workers according to industry guidelines, such as evidence-based medicine guidelines from Work Loss Data Institute, American College of Occupational and Environmental Medicine, and many other state-specific guidelines.

Compounds are available in many applications but are used in workers’ compensation most often as topical products for pain management. Usually, compounded medications are excluded from workers’ compensation formularies, and require prior authorization before they are dispensed to an injured worker.

[SEE FULL STORY HERE]

Access to Medical Treatment for Injured Workers in California

Year 1 Annual Report

by Andrew W. MulcahyMadeline B. DoyleRosalie MalsbergerKandice A. Kapinos

worker in hard hat holding shoulder for article, Access to Medical Treatment for Injured Workers in CaliforniaAn estimated 16 million workers use workers’ compensation (WC) insurance annually in California. Many recent policy changes might have affected access to care for injured workers. For this report, the authors assess the various dimensions of access to care in the evolving policy environment to ensure that injured workers have adequate access to needed medical care and the opportunity to achieve better health outcomes. Access to care is an important domain to monitor, especially among vulnerable populations, as patients with better access to care systems are more likely to receive comprehensive, higher-quality care and are therefore more likely to experience better outcomes.

The key objective of this report is to describe access to medical care among injured workers in the state of California, as mandated by Labor Code Section 5307.2. The authors analyze administrative and medical service bill data to examine changes over time for measures related to access to care for injured workers. The authors aim to highlight potential access-to-care barriers in the WC system and to understand whether changes in the WC system may be increasing access for injured workers.

Overall, there were increases in claims, bill lines, and spending per provider. Although these increases were moderate to large in number, many of the differences were not statistically significant. These results suggest a concentration of treatment for injured workers, in which a relatively smaller number of providers furnished care to injured workers. Increasing concentration could offer opportunities for specialization in the treatment of work-related injuries. On the other hand, increasing concentration could lead to future access barriers related to scheduling.

Key Findings

Provider participation

  • Fewer providers provided care to California WC patients in 2014 than in 2010.
  • The specialties with the largest declines from 2010 to 2014 in WC-participating providers were family medicine/general practice, chiropractic medicine, and pharmacy providers. Most other specialties were relatively stable.
  • Over the same period, there was an increase in the number of WC injuries.

Utilization and payments per provider

  • The average number of claims per provider increased from 2010 to 2014.
  • Payments per provider increased by $8,813, on average, from 2010 to 2014.
  • The observed increases in average claims per provider, bill lines per provider, and payments per provider were likely driven by changes in very large practices or health systems treating many injured workers.

    [SEE FULL STORY HERE]

6 Effective Claim Handling Tips For Undocumented Employees

July 24, 2018 by Michael B. Stack

farm workers for article, 6 Effective Claim Handling Tips For Undocumented EmployeesInterested stakeholders in workers’ compensation need to pay attention to the changing workforce as immigration continues to change the composition of the American workforce.  This includes being mindful of immigration laws and making good faith efforts to comply with the Immigration Reform and Control Act and the employment of individuals authorized to work within the United States.  Notwithstanding these efforts, people without such proper documentation enter the workforce and become injured.  This creates problems for employers and insurers that can add costs to a claim.

Understanding the Basics

The Immigration Reform and Control Act controls employment practices in the United States.  Under this law, only American citizens or non-citizens with the proper work permits are allowed to perform work legally.  However, employers continue to employ people without proper authorization – in some instances knowingly engaging in this type of employment practice.

A state’s workers’ compensation law defines eligibility for benefits.  In many instances, one’s legal employment status does not serve as a bar to benefits after following a work injury.[1]  The issue of hiring someone not legally allowed to work in the United States is not going away.  The only true way to deal with such issues is to make good faith efforts when verifying someone’s work status.  The reality is even if an employer undertakes these efforts, people not legally allowed to work will continue to seek employment.

[SEE FULL STORY HERE]

Navigating the ADA Minefield in Work Comp

July 16, 2018 by 

icon graphic for article, Navigating the ADA Minefield in Work CompInterested stakeholders in any workers’ compensation program need to be aware of the many issues when it comes to running an effective program.  One of those includes being aware of how the American with Disabilities Act (ADA) impacts their program and post-injury efforts to return an employee to work.  Failure to do so can result in fines, penalties and lack of good will.  Now is the time to pay attention and prepare.

What is the American with Disabilities Act?

The ADA was passed was signed into law in 1990 as an amendment to the Civil Rights Act of 1964.  The law prohibits certain discriminatory practices based on an individual’s disability.  The law was amended one most recently in 2008, when President George W. Bush signed amendments to the law that expanded the scope of the ADA to include additional areas of coverage.

Important matters to consider in the context of workers’ compensation claims include the following:

  • Disability: This is defined by the statute to include “a physical or mental impairment that substantially limits one or more of the major life activities;” and
  • Qualified Individual with a Disability: The ADA only applies to an “individual with a disability who, with or without reasonable accommodation, can perform the essential functions of the employment position.”

    [SEE FULL STORY HERE]

3 Questions to Eliminate Return to Work Disincentives

May 31, 2018 by 

You have implemented a corporate return-to-work program, but your projected workers’ compensation savings haven’t yet materialized. Supervisors are telling you they can’t get employees back to work, and even if they could they don’t WANT them to return to work. We’ve all heard it.

graphic of carrot and stick for article, 3 Questions to Eliminate Return to Work Disincentives It may be time to examine the impact of collateral resources, often resulting in employees out on workers compensation receiving more income and benefits than they would have if they were working.

Common Disincentives to Returning to Work:

  1. Salary and Wage Continuation: Some companies pay 100% of salary in lieu of having an employee collect workers compensation for injuries of short duration.
  2. Occupational Injury Pay Supplements: Many firms pay supplemental benefits to make up the difference between workers compensation benefits and regular earnings.
  3. Open-Ended Job Return: Instead of holding jobs open indefinitely, employers should hold jobs open for a specific time period, such as six or nine months.
  4. Vacation and Sick Time: Companies frequently allow vacation and sick time to accrue for employees on workers compensation. Some even allow employees to “borrow” more sick time if they need to stay out of work longer.
  5. Short-Term Disability: In some companies, disabled employees receive STD benefits in lieu of salary after six weeks. But the standard definition for disability may differ from workers comp, allowing an employee to collect both.
  6. Perk Continuation: Employers often maintain ancillary benefits and privileges such as car allowances, club and professional dues, company store privileges and periodical subscriptions for employees on disability.
  7. Loan Protection Policies: Individual insurance policies are available to pay mortgages and consumer loans such as car loans and credit card debts in the case of a disability.
  8. Unemployment CompensationIn a few states, an employee receiving workers comp also can qualify for state unemployment benefits.

    [SEE FULL STORY HERE]

Tips to Understand OSHA Rights and Responsibilities to Drive Safety

May 2, 2018 by 

The Occupational Safety and Health Administration (OSHA) was created at the federal level on December 29, 1970, with the goal of assuring “safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education, and assistance.”  Since its creation, the agency has evolved and become commonplace in the workers’ compensation scene as a means of investigating work injuries and providing information to interested stakeholders.  Parties seeking to reduce workers’ compensation program costs should understand OSHA and view the agency as a partner in making workplaces safe for employees. 

work safety and injury statistics poster for article, Tips to Understand OSHA Rights and Responsibilities to Drive SafetyUnderstanding OSHA Basics

 There are many misconceptions about OSHA.  It is important to those seeking to provide a safe workplace to understand better the requirements and how the agency is responsible for enforcing safety standards.

OSHA standards and agency overview covers most private sector employers.  While it does not cover many state and local government agencies, employees of these entities are subject to protections by the federal act and applicable state programs.

The federal act also allows states to create their own OSHA programs.  In these jurisdictions, the state agency receives funding from the federal government to run its program.  This allows states to develop their own standards, provided they meet the federal minimums required under the Act.  There are currently 22 OSHA approved programs that include: Alaska, Arizona, California, Hawaii, Indiana, Iowa, Kentucky, Maryland, Michigan, Minnesota, Nevada, New Mexico, North Carolina, Oregon, Puerto Rico, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, and Wyoming.

[SEE REST OF THE STORY HERE]

11 Ways Supervisors Can Enhance Your Workers’ Compensation Program

Supervisors are critically important to the effectiveness of your injury management program. They are often the first person on the scene of a workplace accident and may know the injured worker better than anyone else in the organization. They set the tone for how well the injured worker responds and engages in the recovery process.

Employees in charge of other workers who view their role in the workers’ compensation process as just an annoyance do a disservice to injured workers and the organization. Employers should take steps to ensure supervisors appreciate the value of the workers’ compensatioin case of workplace injury poster for article, 11 Ways Supervisors Can Enhance Your Workers’ Compensation Programn program and have a thorough understanding of how they can positively contribute to it.

 

Injury Response

While some organizations have detailed step-by-step plans in place for handling workplace injuries, many don’t; or even if they do, most employees are typically not well versed in the protocol. That’s why it is imperative to continually train supervisors on all the various aspects of the workers’ compensation system and how they fit into it.

For example, if one of your workers went to his supervisor after sustaining an injury, how would the supervisor respond? Would he know, or have a list of steps to follow, a medical provider to treat the worker, if needed? Would he know to address the worker’s medical needs first?

Here are some of the initial procedures supervisors should have down pat:

  • Get injured worker medical attention. First and foremost, make sure the worker gets medical attention if needed. If so,

Where to go

  • How to get the worker there; i.e., should he drive himself, and, if not, who should drive him
  • What, if anything to take with him
  1. Communicate appropriately. Extensive research has been done on the impact of a supervisor’s language and tone toward an injured worker. Questioning the truthfulness of the worker, for example, can have a dramatic impact on outcomes. Negativity threatens the worker and research has shown the odds are there will be twice as many days out of work than if there is a positive response from the supervisor.
  2. Whom to contact. Is there a department/person/number the organization has for reporting injuries? For example, is there a nurse triage system in place?

    {SEE FULL STORY HERE]

Top 5 Take Away Points from 2017 National Workers’ Comp & Disability Conference – Part 1

Here’s the first installment from the Conference by Michael Stack , CEO of Amaxx.

January 9, 2018

“We’re about a month out from the conclusion of the National Work Comp and Disability conference held again this year in Las Vegas, back at Mandalay Bay. The general theme of the conference itself was really focusing on much of what, frankly, I teach and believe in, which is really the outcomes for the injured workers that drive down workers’ compensation costs, creating a true win-win scenario. I want to talk to you about my top five takeaways from the sessions that I attended.”

 

 

Take Away #1: Alliance of Woman in Workers’ Compensation

logo for Women's in Workers' Compensation Leadership Forum for article, Top 5 Take Away Points from 2017 National Workers’ Comp & Disability Conference – Part 1Let’s talk about takeaway number one, which comes from the Alliance of Women in Workers’ Compensation Leadership Forum which was held the day before the official conference started. Now, the presentation was given by Margaret Spence. Margaret did a tremendous job at that presentation and at that leadership forum. To be frank, it had a fairly big impact on my own life in this past 30 days. Let’s talk about some of the things that she discussed and while this presentation was obviously directed towards women. Obviously, I’m not a woman, so I can’t fully appreciate and empathize with the experience of a professional woman in today’s environment or in the years past.

But I will tell you that the stories that she was describing, some of the challenges that women face, that she described both in the past and, currently, today in 2018 was a bit disheartening. It was a bit disheartening to hear that that still exists in our world, particularly, as I’m raising two young daughters. From my perspective, one of the underlying themes as it was given from the female perspective was to acknowledge and appreciate the struggles that women have come through and still face today, But having the courage and the confidence to break through it. One thing I’ll add from the male perspective and the perspective I think is very similar.

From the male perspective to appreciate and acknowledge the struggles that women have faced in the past and often continue to face today, but having the confidence and the courage to break through that, because while some of those prejudices may still exist in our world today, they should not exist in your world. If you take an honest and genuine look at yourself, and you see that those prejudices still exists in your world then you need to take the steps to correct it.

[SEE THE COMPLETE SERIES HERE]

California Wildfire Health Hazards and OSHA Warnings

EH&S News, NES Safety Topic – October 26, 2017
Written by: Brittiny Harris, NES, Inc.

Wildfires Create Smoke Inhalation Hazards

California is dealing with one of the most disastrous fire seasons in its history, and with these fires come serious smoke inhalation hazards.

The loss of life is tragic, and the loss of property is extreme. Beyond these concerns, fires have ravaged many California cities and surrounding areas, spewing huge amounts of smoke into the atmosphere and covering surfaces in a thick layer of toxic ash. Smoke inhalation hazards are a prominent problem that firefighters (and firefighters’ support personnel), cleanup crews, industrial hygienists, private citizens, and all others in the affected regions are dealing with and will continue to encounter as a result of these wildfires.

Many of these smoke inhalation hazards are created not only from the burning trees and grass but from burning houses. As they burn, houses produce highly dangerous gases, chemicals, and fine particles that can cause severe health issues if inhaled. The paint, metal, batteries, and many more products commonly found in and around houses create dangerous fumes causing serious smoke inhalation hazards for employees trying to contain the fire and for residents in the area.

Given the massive scope of the 2017 California wildfires, a tremendous amount of smoke and ash has been released into the atmosphere. It is therefore important to realize that prevailing winds can carry significantly dangerous quantities of smoke tens and even hundreds of miles from its originating source.

OSHA Warns About Smoke Inhalation Hazards

The Occupational Safety and Health Administration (OSHA) has taken action to advise employers on how to protect their employees from smoke inhalation hazards and from the painful side effects of the ash toxins. OSHA advocates three different methods to protect people who are close to the fire and dealing with smoke inhalation hazards.

Smoke Hazard Safety Measures

Engineering Controls

OSHA’s first recommendation is to always have engineering controls in place. These include keeping indoor areas smoke free with clean air from ventilation systems. The general population has been advised to adjust air-conditioning units and use car vent systems to recirculate the air in order to avoid allowing outside air into the car.

Administrative Controls

The next line of defense endorsed by OSHA is administrative controls. When smoke inhalation hazards are present, keep employees, children, and the general population around the affected areas indoors. Limit time spent outside whenever possible.

Personal Protective Equipment

OSHA also recommends employees use personal protective equipment (PPE), specifically respirators along with any barriers that can be used between your skin and the hazardous smoke.

OSHA does specify that respirators are only needed if the air is designated to be “unhealthy”, “very unhealthy”, or “hazardous” according to California Code of Regulations (CCR) Title 8 §5141 General Industry Safety Orders. N95s disposable respirators through P100s respirators are not required to be fit-tested, but they do come with user instructions and are a valued option for PPE. OSHA urges respirator users to shave facial hair and to avoid wearing a hat over the straps of the mask in order for it to fit correctly. OSHA, however, does recognize that the respirators do not protect against exposure to gases, vapors, oils, pesticides, and other chemicals. It should also be noted that the respirators do not provide oxygen, they only filter out harmful particles; because of this, there is a higher risk of heat illness among those who already have trouble breathing.

OSHA cautions employees who are using a respirator to always be aware of how they are feeling while using the respirator. If the employee is feeling dizzy, faint, lightheaded, nauseous, or disoriented in any way, he or she should remove the respirator, proceed to a safer area, and get medical attention. Employees are advised to use a new respirator every day and dispose of dirty respirators and any respirators that become hard to breathe through.

[SEE FULL STORY HERE]

Stop Workplace Falls While Decking the Halls!

November 30, 2017 by 

Workplace safety is important during the holiday season.  Stressing this topic can also reduce workers’ compensation program expenses.  This is especially true as employees are decking the workplace halls — you want to avoid falla falls, falla falls, falls, falls falls!

slips, trips and falls graphic for aritcle, Stop Workplace Falls While Decking the Halls!

The Real Expense of Workplace Safety

Failing to have a safe workplace impacts, everyone.  Employees get injured; overtime costs go up; all employees get stressed.  It also reduces productivity and adds unnecessary costs to the hiring and replacement of talented individuals who cannot return to work.  It adds to healthcare costs in the United States and places an unnecessary burden on emergency rooms.  Now is the time to prevent workplace injuries.

Slip, Trips and Falls in the Workplace

The Occupational Safety and Health Administration (OSHA) tracks injuries and deaths that occur in the American workplace.  Approximately 15% of all deaths in workers’ compensation settings occur when someone falls in a same level or multi-level incident.  Only motor vehicle accidents account for more workplace deaths.

The economic impact of slip/fall injuries is astronomical.  The National Safety Council estimates these types of injuries cost American industry over $13 billion per year.  This averages out to be about $40,000 per incident.  The consequence of poor training and safety compliance continues to grow.  Interested and proactive claims management teams can make a difference and reverse this troubling trend.  It also starts with educating insured on fall avoidance and other safety issues.

Creating a Culture of Safety

OSHA does require training for all employees subject to slip/fall dangers.  Those interested in making a difference in their workplace need to go beyond the minimum requirements

Prevent same level slip and fall injuries:

  • Keep work areas free of clutter, dust and other debris;
  • Require employees to wear low-heeled shoes with no-slip surfaces;
  • Ensure that rugs and mats have skid-proof backing;
  • Avoid having non-tracked flooring installed in workspaces;
  • Discourage horseplay in the workplace. This can include specifically prohibiting conduct that can result in slips, falls or other related injuries;
  • Keep rooms free of clutter, especially on floors; and
  • Use correct lighting in stairwells and hallways.

Employees working at heights such as catwalks, ladders, and scaffolding are in extreme danger for severe injury from falls.  Important measures to implement in the workplace should include:

  • Development and implementation of a fall protection program. This includes training and ongoing evaluation of safety measures for employees and management to use daily;
  • Avoid unprotected side and openings. When these settings are unavoidable, use of a guardrail, safety net or fall arrest systems are paramount;
  • Provide instruction on the safe posting and use of ladders;
  • Purchase and require the use of OSHA compliant ladders when engaging in workplace activities; and
  • Inspection of ladders and scaffolding before and after all use.

While this list is not all-inclusive, there needs to be a proactive approach to employee safety when working at heights.  It is also important to engage management on these issues and foster a culture of compliance with safety procedures and injury avoidance.

Conclusions

The holiday season should be a time of joy and gratitude—not emergency room visits.  While slip/fall injuries will never be eliminated, they can be avoided.  Taking a proactive approach reduces workers’ compensation costs and allows people to focus on the holiday season.

Read more: www.ReduceYourWorkersComp.com Stop the Workplace Falls While Decking the Halls! http://blog.reduceyourworkerscomp.com/2017/11/stop-the-workplace-falls-while-decking-the-halls/#ixzz50QdWkZ1s
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