Category Archives: Workers Compensation

Top Tips for Assessing Your Workers Comp Program

photo of a face covered in spaghetti noodles
Untangle your Work Comp

What Do I Do?

Those of us who cook know the time-tested technique for testing spaghetti doneness: toss a few strands up against a wall and if it sticks, it’s done – if not, well, it falls off the wall. So, what does spaghetti have to do with assessing your workers’ compensation program?

Many companies
use the dartboard approach to control workers’ comp costs. They look into the global “pot” of work comp practices, pick out one or two, toss a solution against the wall, and hope it sticks. In other words, without really knowing what to do, they decide to “fix” some part of their WC program – an unplanned, unsuccessful and most likely costly approach.

more than 75% of companies try to work backwards toward improvement by reviewing the capabilities of their service providers and vendors rather than assessing the key problem areas in their own companies todetermine the types of services ultimately needed.

Worker’s comp costs
cannot be controlled on a “hit or miss” basis. A solid workers’ compensation program begins with a careful assessment of what is in place now, rather than assessing your service provider’s capabilities. Only by analyzing your company’s current trends and weaknesses are you then able to select appropriate solutions and vendors to integrate into a comprehensive cost control program without overlapor gaps.

A reasoned,
impartial assessment and needs analysis is an indispensable part of an overall quality improvement process. It means determining how effective existing program elements are, not merely whether the elements exist. Solutions and recommendations for changes, upgrades or revisions in current practices are then based on a complete understanding of the “key cost drivers,” factors at the root cause of your company’s high costs.

Where Do I Start? Where Do I Start?

As companies
reposition themselves to be more cost effective and competitive in today’s marketplace, a thorough assessment of a company’s workers’ compensation program identifies problem areas responsible for escalating costs. Only after identifying the causes of these costs, can a company evaluate its program and develop a strategic plan to control and reduce workers’ compensation costs.

Workers Compensation Insurance and the BIG Insurance Picture

A Picture of Health!
A Picture of Health!

Workers’ Compensation is a single line of insurance or business considered part of the Property Casualty group of coverage encompassing general liability, property, auto and others lines. Workers’ Compensation insurance may be purchased as part of a package or “mono-line,” as an individual policy.  There are choices involved and decisions to be made in purchasing workers’ compensation coverage just as when you purchase your own auto policy and select a deductible.

Generally, in purchasing a guaranteed cost policy, your premium remains at the price quoted regardless of the cost of the losses.  Because premiums are in part based on payroll multiplied by a rate, premium audits are conducted generating either additional premium or a premium refund.  Other than that, the price paid in the end should be the price your agent/broker negotiated and quoted.  The insurance company funds losses and bears the lion’s share of the risk however it’s in an insured’s best interests to reduce claim frequency and severity to minimize loss costs.  Loss experience is another facet of premium calculation and out of control losses will drive premium costs up.

Depending on the financial strength of your company and your appetite for risk, there are also programs available allowing a company to participate in the losses financially.  These programs include deductibles and retro’s (retrospective rating).  These vehicles allow a company to participate to a large degree financially to control their insurance and claim costs and essentially bear much of the risk themselves.  Such programs may make good sense for organizations with sophisticated loss prevention and strong claim management or oversight in place.  (workersxzcompxzkit)

While workers’ compensation policies may be generic in meeting your statutory requirements, claims and loss control services vary greatly and differentiate one company from another.  Choose wisely.  The effectiveness of these areas will reduce loss costs and even prevent losses from occurring, which in turn reduce your premium.  Evaluate the financial strength of your company, the loss prevention and claim management programs in place and importantly, the appetite for risk at your organization, to decide whether a guaranteed cost or shared risk program is the way to go.  Also be sure to evaluate the financial strength of the insurance carriers under consideration.

Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: or 860-553-6604.

30 December, 2009 08:27:19 Republished with permission from

Are You Ready for New HIPAA Regs?

Medical Eye Spy
New Rules for Medical Eye Spy

You have some new steps to take should employees’ health info be seen by prying eyes.

New Heath Insurance Portability and Accountability Act (HIPAA) security breach rules mean you’ll be responsible to notify each employee affected and the Department of Health and Human Services (HHS).

The rules technically kicked in Sept. 23, but the feds say they won’t enforce them until Feb. 22.

What counts, what doesn’t

Not all the data your Benefits and HR folks collect is impacted:

  • What counts: Individual info from group health, dental or vision plans; healthcare reimbursement flexible spending accounts; pharmacy benefits plans; employee assistance programs; and long-term care plans.
  • What doesn’t: Info related to leave request, accommodation requests, and workers’ comp.

And while you must inform individual employees immediately whenever their health info falls into the wrong hands, you only have to report to HHS right away if more than 500 records are affected.

If less are affected, you’ll need to keep a log of what happened and report to HHS by the following March 1.

Worker Safety Cal-OSHA Appeals Board Rulings Raise Questions

Who Do Rulings Favor?
Who Do Rulings Favor?

The board often reduces or dismisses penalties against companies that Cal-OSHA has fined.

Rosa Frias was working the evening shift at Bimbo Bakeries in South San Francisco when she reached into her bread-making machine to remove a hunk of dried dough.
She screamed as her left hand, and then her lower arm, were sucked into the gears of the Winkler stringline proofer.
That night, the limb had to be amputated above the elbow.
The incident drew a $21,750 fine from the California Division of Occupational Safety and Health.
But Bimbo paid nothing. It appealed to the Cal-OSHA Appeals Board, which dismissed the case on a technicality: The inspector had retired and Cal-OSHA could not prove that he had had permission to enter the factory.

Since that 2003 accident, five more employees in Bimbo’s California plants have lost fingers or parts of fingers in accidents in which inspectors found similar safety violations. In two of those accidents, the appeals board reduced the fines by thousands of dollars.

“That is mind-boggling,” said Linda Delp, director of UCLA’s Labor Occupational Safety and Health program.

It is not, however, unusual for companies to fare well on appeals. A Times review found that the board has repeatedly reduced or dismissed penalties levied by Cal-OSHA over the last few years, even in situations in which workers have died or been seriously injured. The board’s actions have done more than save companies money. They have undermined Cal-OSHA’s efforts to prevent future accidents, according to labor advocates, inspectors and state documents.

Earlier this year, 47 inspectors and district managers at Cal-OSHA, about a quarter of the staff, signed a letter to the board complaining that Cal-OSHA’s “deterrent effect has been significantly undermined as employers learn they can ‘game the system.’ ”
Continue reading Worker Safety Cal-OSHA Appeals Board Rulings Raise Questions

How to Write a Letter to Get An Employee Back to Work from Workers Compensation Injury

Dear Valued Employee
Dear Valued Employee

02 September, 2009 11:04:31 Republished with permission from

How to Get Your Employee to Turn In the Work Ability Form (WAF). You may call it an Injury Form or Medical Treatment Form, or some other name.

The work ability form is the best method to get your injured employee back to work. Studies show  the sooner an employee returns, the smoother your workers’ compensation procedures run. This is true for both the employee and the employer.

Transitional duties take into account an injured employee’s limited or changed abilities is a way to get them back on the job and performing some of their former functions.

It is better to have the worker at your worksite even at lowered production or capabilities than at home recuperating to 100 percent, a feat which may never happen.

Workers’ Comp Kit suggests a formal letter explaining your transitional duty policy to the employee and introducing the work ability form (WAF) to be filled out by the physician.

Here are some tips for your letter:

1. Send it priority mail via the United State Postal Service with delivery confirmation.
2. Explain what transitional duty is and it is a company policy.
3. Let the employee know the transitional job will be reviewed each week as during recuperation.
4. Enclose the work ability form and explain the employee is required to have the medical provider fill it out.
5. Encourage your employee to let the provider know ALL restrictions can be accommodated by your facility.
6. Let the employee know the form is due back within seven calendar days and the transitional duty job begins on the day the form is returned.
7. Let the employee know the form is due back within seven calendar days and the transitional duty job begins on the day the form is returned.
8. Assure them the company health director will work with them to develop tasks appropriate to their current medical condition and state. (workersxzcompxzkit)
9. Be sure to include claim number and all relevant addresses and contact information on the letter. Continue reading How to Write a Letter to Get An Employee Back to Work from Workers Compensation Injury

Seven Highly Effective Habits for Work Comp Return to Work Success

7 Is Your Lucky Number
7 Is Your Lucky Number

Republished with permission from

Making a Habit of Return-to-Work

Twenty years ago, Stephen Covey published what’s now an enormously popular book, The Seven Habits of Highly Effective People. More than 15 million copies of The Seven Habits have been sold in roughly 40 languages.

Before you write off Covey’s book as just more self-improvement hoopla, consider this: You can use the seven habits to build a highly effective return-to-work process. Ultimately, you can reduce your claim costs and improve your productivity.

Habits One and Two: Lay the Groundwork You will work with your employees to develop your return-to-work process. But first, you will lay the groundwork on your own.

Habit one teaches you to be proactive. Proactive people believe they are a product of their choices, not their circumstances. You should not accept injuries as a cost of doing business. You should choose to invest the time and resources to develop a return-to-work process. The goal of your process will be to help injured workers get well and back on the job.

In habit two, you learn to begin with the end in mind. Write a policy statement that confirms your commitment to the return-to-work process. Your policy should stress the importance of operating safely and getting immediate medical care for injured workers. It should also explain that the company will work with injured employees to help them recover and return to the job, either at full or modified duty, as soon as medically appropriate.

“A good return-to-work process eliminates surprises,” said Pat Crawford, return-to-work education coordinator at the Texas Department of Insurance’s Division of Workers’ Compensation. “Everyone should know what to expect if they get injured on the job. We encourage employers to post their return-to-work policy in high-traffic areas and give every employee a copy,” Crawford said.


On Again Off Again – Intermittent Leave

Walking the fine line between ADA and FMLA regs
Walking the fine line between ADA and FMLA regs

An understanding of where the Family and Medical Leave Act, the Americans with Disabilities Act and state regulations intersect is required when determining whether an employee is “entitled” to be intermittently absent from work because of a medical condition. Individualized assessment is necessary to determine if intermittent leave is required as a “reasonable accommodation” under the ADA, in part because repeated absences from work most likely mean the person is unable to perform “essential job functions.”

ADA evaluations must be job-related and consistent with business necessity. The FMLA, on the other hand, entitles employees to intermittent leave when “medically necessary,” a determination made through completion of the certification form DOL WH 380. An FMLA-qualified medical condition may or may not be work-related.

Under the FMLA, employees must provide advance notice of their need for intermittent leave, but only as much as is practical under the circumstances. Practicality remains open to legal interpretation. An evaluating occupational medicine physician may consult with an employee’s personal physician about an employee’s medical condition – such as depression or migraine headaches that may cause intermittent absences – but only after first getting the employee’s permission.

This tip courtesy of Francis P. Alvarez, J.D., Jackson Lewis LLP, White Plains, NY; email:

The professionals at Central Coast Industrial Care can help you with a lot of the answers.

In the meantime check out 5 FMLA Questions Almost All Managers Can’t Answer!

Controlling Drug Costs

Worth their weight in gold
Worth their weight in gold

According to the most recent research we’ve seen, prescription medicines account for 14% of Workers’ Comp costs.
So, of course, it makes sense to enlist the help of your medical services provider to be more efficient in this area.

Here’s some advice for employers on drug utilization controls from consultant Maddy Bowling:
1. Focus on the treating physician because he or she is the key to controlling pharmacy spending and length of disability.
2. Use data analytics to understand prescribing patterns and identify when, where and what is driving the company’s pharmacy spend as part of the claim in the first 30, 90, 90 to 120, and 120 days and beyond. Keep track of treating physicians, where treatment is provided, types of injuries and occupations involved, specific prescribed drugs and their associated costs. Use this information to intervene more proactively on the next claim.
3. Remember that network penetration is only as good as the company’s ability to control costs through fee management, utilization management and disability/lost work time management.
4. Connect the dots to other workers’ compensation cost containment efforts: Pharmacy management cannot be performed in a vacuum. For example, talk to providers about prescribed medications and their anticipated effects on return to work. Physicians play a critical role in return-to-work plans.
5. Use data and triggers to identify “creeping” catastrophic claims before they reach $50,000; intervene in cases over that limit. The goal is to get people back to work.

… and some tips From Dr. David Deitz of Liberty Mutual:
1. Pay attention to what the physician does. Control of physician prescribing behavior is much more important in workers’ compensation than it is in group-health settings.
2. Beware of regulatory loopholes. They abound, and vary from state to state.
3. Understand that diversion of prescription analgesics is a problem in both group health and workers’ compensation.
4. Workers’ compensation pharmacy management is labor intensive and requires clinical as well as claims-handling expertise.

And remember that the staff of Central Coast Industrial Care is your partner in achieving cost effective health care for your employees and insuring that we can get them back to work quickly and safely.

6 Training Guidelines for Workers Comp

28 July, 2009 03:27:20 Republished with permission from

Training ALL your employees to know injury procedures before a work-related injury occurs – just as you would plan a fire drill – is instrumental in holding down your company’s workers’ compensation costs.

Six Training Guidelines to Follow

1. Implement a training seminar, lasting one hour, to introduce and reinforce injury management program concepts to your management and to distribute new workers’ compensation materials. The goal is to inform management of workers’ compensation concepts and how workers’ compensation costs are affecting the company.

2. Schedule an in-service training session for supervisors to train them in correct post-injury responses in the event of a work-related injury.

3. Like fire drills, when a work-related injury occurs, every supervisor and employee must be able to demonstrate exactly what to do, where to go, and how to obtain help.

4. Convene small-group employee training sessions to discuss post-injury response training and integrate new roles and responsibilities into the work culture.

5. Training includes instructing employees on who to notify when a work-related injury occurs and what their responsibilities are if they witness a work-related injury.

6. Have employees sign an in-service acknowledgement indicating they have received post-injury response training.

Author: Robert Elliott, J.D.

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Top 10 Best Emergency Actions!

Top Ten Supervisor Best Practices When Handling Work Related Injuries

Supervisors are the front-line reporters of work-related injuries and accidents and bear the primary responsibility for making sure employees perform post-injury response procedures in accordance with the employer’s workers’ compensation policies.

Ten Actions Supervisors Must Take
1. Make sure injured employees take a Work Ability Form (WAF) with them when they go to the medical provider.
2. Accompany injured employees to the medical provider.
3. Inform medical providers the WAF must be returned (by mail or fax) to the supervisor (or injury coordinator) within 24 hours of a work-related injury. If the supervisor has a problem retrieving the completed WAF from the medical provider within 24 hours, the issue should be referred to the injury coordinator for action.
4. Compile a Post-Injury Package consisting of completed WAF together with Witness, Supervisors, and Employee Reports of Incident and fax to injury coordinator.
5. Train employee subordinates in the basics of workers’ compensation benefits such as Rights and Responsibilities under the WCMP, Post-Injury Response, and Transitional Duty Program.
6. Demonstrate to employees how to obtain emergency medical care for injured employees.
7. Demonstrate to employees how to get non-emergency care for injured employees. (workersxzcompxzkit)
8. Describe what forms and documents to give to (and get from) an injured employee.
9. Participate in weekly meetings with the injury coordinator and injured employee.
10. Train employees in post-injury response roles and responsibilities.

Central Coast Industrial Care has posters and business card size “Who to contact in case of injury” materials available at our office.
You can also download a PDF  of the 8″ x 10″ version here.