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: alvarezf@jacksonlewis.com

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!

Physicians Strongly Favor Healthcare Reform

Rx for Health Care Reform by Ken Terry
Rx for Health Care Reform by Ken Terry

Here’s an interesting story from a former senior editor of Medical Economics Magazine and author of the book, Rx For Health Care Reform.

Physicians Know We Need Reform

By Ken Terry | August 3rd, 2009 @ 5:23 pm

America’s physicians favor healthcare reform much more strongly than the general public does. In the wake of the AMA’s pledge of support for Congressional reform proposals, a coalition of seven other physician organizations sent a letter backing reform to Senate Majority Leader Harry Reid last week. The medical societies, which included the American Academy of Family Physicians, the American College of Physicians, the American Academy of Pediatrics, and the American Osteopathic Association, said that they represent 450,000 physicians and medical students.

“In the best interest of our patients and this nation, we must pass strong and effective health care reform in 2009,” these organizations declared. “Americans need affordable choices, and stable coverage. Not passing health reform will result in continued rising costs, poorer quality of care, and more people uninsured.”

In contrast, recent poll results show that the percentage of all Americans who support reform is slipping. In mid-June, according to a Wall Street Journal/NBC News survey, the public was divided down the middle on whether President Obama’s reform proposal made sense. In a new poll conducted July 24-27, only 36 percent of respondents supported the plan, while 42 percent said it was a bad idea. The percentage of those with private insurance who disliked the plan rose from 37 percent to 47 percent. A New York Times/CBS News poll yielded similar results.

Although the national cost of the proposal to cover the uninsured is a concern, the central fear of Americans—and especially of those with private coverage—is that under reform, the quality of their own care would decline, while their own costs would rise. People are specifically afraid that their treatment options and their choice of physicians would be limited.

The physician societies, however, expressed the opposite view in their letter: “Some people believe that patients are better off in today’s disorganized insurance market. We believe that the health care our patients receive will be better within a reformed system. As physicians and future physicians, we stand in firm support of the patient-centered changes being outlined in Congress. We are confident that the reforms being proposed will allow us to provide better quality care to our patients, while preserving patient choice of plan and doctor.”


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.

The Heat is Still On!

Hot sun photo from NASA
Hot sun photo from NASA

Since the current heat wave began on July 11, Cal/OSHA has conducted 167 inspections of outdoor workplaces identifying over 200 violations while checking for compliance to the heat illness prevention regulations. Gaining compliance from employers is the goal to successfully reducing the number of illnesses and fatalities for all outdoor workers across the state.

“Our increased enforcement and outreach efforts demonstrate the commitment we have to ensuring the safety and health of California workers,” said Department of Industrial Relations Director John C. Duncan.  “We are also working with industry, community, and labor groups to educate employers and the public so they understand how to comply with the nation’s first regulation to protect workers from heat-related illnesses and deaths.”
Cal/OSHA continues to conduct targeted enforcement efforts, especially during periods of high heat.  This year so far a total of 1,702 inspections have been conducted to enforce compliance with heat illness prevention regulations and 472 violations of regulations have been documented with a total of $415,398 in penalties assessed.
READ FULL ARTICLE from CompNewsNetwork:

6 Training Guidelines for Workers Comp

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

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.

Reduce Your Workers Comp: www.ReduceYourWorkersComp.com/
Workers Comp Kit: www:workerscompkit.com/
Follow Us On Twitter: www.twitter.com/WorkersCompKit
Do not use this information without independent verification.
All state laws vary.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com

Santa Barbara County Swine Flu Update

Beth Soderberg, MSN, CS, FNP-C

The newest member of our professional team, Nurse Practitioner, Beth Soderberg has an extensive background and interest in communicable diseases and she always has up-to-date information.

According to Beth, “Right now I’m educating the Industrial Care staff about the upcoming release of the two stage vaccine for H1N1 Flu (Swine Flu). As of July 8th, 2009 there have been 33 confirmed cases and one hospitalization in Santa Barbara County. And these numbers are not a complete or accurate picture because testing is so limited.”

Beth adds, “For the upcoming fall and winter flu season health care providers need to be ready to offer both information and the new vaccines to our community.”
If you have questions about vaccinations and special programs for Santa Maria businesses, give our Industrial Care Manager, Cody Matthews, a call at (805) 614-9000 or email him here.

Here’s some more details on the Vaccine Administration:

While clinical trials are currently underway to confirm the final process, it is likely that the vaccine administration will be as follows:

  • Seasonal flu vaccine available in August – will be handled normally in all respects
  • Novel H1N1 vaccine will likely require 2 doses – at least for some segments of the population
  • H1N1 vaccine dose 1 will be able to be administered at the same time as seasonal flu vaccine
  • H1N1 vaccine dose 2 will be administered 21-28 days following the first dose

Qualified Medical Evaluator Forms In Spanish

The Division of Workers’ Compensation (DWC) has posted on its Web site a Spanish-language version of the qualified medical evaluator (QME) panel request form for unrepresented employees, including instructions on how to use Form 105 at:

Additionally, an example with Spanish language instructions on how to complete the Employee’s Permanent Disability Questionnaire (DWC-AD Form 100 [DEU]) can be found here.

The forms can be downloaded or printed from the DWC Web site at no charge and are in Spanish. However, the user is directed to complete the answers on the forms in English.
The division is hopeful that the Spanish-language versions of these forms will make the QME process easier to understand for injured workers and employers who are primarily Spanish-speaking.

Swine Flu Update

The World Health Organization (WHO) says the H1N1 flu is the fastest-moving pandemic ever, spreading as much in less than 6 weeks as past pandemic flu viruses spread in more than 6 months. Because of this rapid spread, the agency has revised its reporting requirements so that authorities need not report every case but only clusters of severe cases or deaths caused by the virus or unusual clinical patterns.

Luckily, for Santa Maria, our newest staff member, nurse practitioner Beth Soderberg, is a communicable disease specialist (among other things) and is up to date on the new two stage vaccination process and all things swine flu related.
If you’re a Santa Maria resident and want to know more about the swine flu threat or the newly announced vaccine, please feel free to give her a call (after August 31st) at our offices.

Continue reading Swine Flu Update

Expensive Paperwork

Paperwork is driving up health care costs by as much as $9 billion annually in California, according to a public interest group that suggests physicians and insurers spend way too much time on processing insurance claims.

In California, physicians typically spend about 45 minutes a day on insurance paperwork, according to a report released Thursday by the California Public Interest Research Group.

“If we can do it more cheaply, it’s a win-win for everybody,” said Michael Russo, a health care advocate and staff attorney with CalPIRG. “When costs are skyrocketing, it’s best to go for the low-hanging fruit. This is an area where we spend a lot of money.”

In all, CalPIRG estimates that $9 billion is spent by insurers and medical practices in California to process insurance claims.

“It’s just ridiculous,” said Dr. David Kosh, a family physician in Sacramento. He said his billing staff spends most of its day on the phone with insurers.

Source:: Bobby Caina Calvan | The Sacramento Bee

To read the complete article, visit www.sacbee.com.

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.