Tag Archives: Comp

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.


6 Opportunities to Improve Your Return to Work Program

July 23, 2018 by 

Lost time from work is a significant driver in workers’ compensation claims.  Consider some of the following statistics:

  • On any given workday, up to 5% of the total US workforce is off work;
  • Lost wages and productivity account for $267 billion per year – with roughly $88 billion of that amount attributed to work injuries; and
  • Time off from work due to injury accounts for additional stressors on employees, employers and the claims management team. This includes increased workplace dissatisfaction, loss of workplace morale, increased overtime (including mandatory overtime costs) and a reduction in the quality of work one performs.

Return to Work icon for article, 6 Opportunities to Improve Your Return to Work ProgramThe bottom line is nobody wins when an employee is off work due to an injury.  Based on these factors, interested stakeholder seeking to improve their workers’ compensation programs and improve efficiency should seek to return injured workers to work – and do so as soon as possible.


Opportunities to Return Employees to Work

Quick and effective return to work benefits all interested stakeholders.  There are countless ways to return an employee to work following an injury.  It takes time and energy, but it has many benefits to the program’s bottom line.  This requires a plan that needs to be in writing and strictly followed to drive program efficiency.

  • Prepare a written RTW policy: This policy should encourage all employees regardless of their age, tenure with the employer or position to return to work following a work injury.  It should require contact between all interested stakeholders.  One key consideration is the number of weeks an employee can perform light duty work with the date of injury employer.  Doing so tends to motivate employee’s to return to return quickly to work.
  • Prepare a written job description: When it comes to job descriptions, the devil is the details.  Important information should conform to the state’s workers’ compensation act and what is considered “suitable gainful” employment.  Items that need to be defined include both the essential and marginal functions the employee will perform.  The wages and hours and employee will work are also important;[SEE FULL STORY HERE]

Know Two Types of Functional Capacity Evaluations (FCE)

When a physician is treating an employee for a back injury or other job related injury, the decision on when to return the injured employee to work is often a subjective decision. The physician who is unsure of the employees physical capability will often turn to the physical therapist for an objective opinion of the employees ability for work. The physical therapist will provide a Functional Capacity Evaluation (FCE) by administering various tests to determine the employee’s functional capacities and limitations.

illustration of physical therapist and patient for article, Know Two Types of Functional Capacity Evaluations

Comprehensive Examination and Evaluation

The FCE is a comprehensive examination and evaluation by the physical therapist that objectively measures the employees level of functioning. The testing will document the employees ability, or the lack of ability, to perform the essential job related task over a specific time frame. The FCE will provide objective information to the physician in several areas:

the employee’s functional abilities and job demands

  1. the disability evaluation
  2. when to return the employee to work
  3. whether or not the employee can return to the job held prior to the injury
  4. the employee’s functional abilities away from the job
  5. to information to design a rehabilitation plan, if needed
  6. the need for other medical intervention and/or treatment


School System Summer Break – 4 Proactive Work Comp Tips

June 12, 2018 by 

Schools Out for Summer graphic for atricle, School System Summer Break – 4 Proactive Work Comp TipsInterested stakeholders in the workers’ compensation process are constantly seeking ways to reduce program costs.

One area includes the discontinuance of workers’ compensation benefits for school employees and teachers suffering from the effects of a work injury during the summer break period.  While statues and case law interpretations vary in each jurisdiction, employers and insurers are generally limited in their ability to discontinue or suspend various workers’ compensation benefits for school employees during this time of year – even if they have no plans of looking for work while under restrictions on their activity.

Schools Out – Time to Discontinue Work Comp Benefits?

While the school year typically runs from late August through late May, employees of school districts around the country sustain work-related injuries every day.  The ongoing effects of those work injuries do not magically disappear for summer break.  Sadly, those hot summer days a teacher, paraprofessional or administrative staff employee would like to spend at a beach, can be spent at home convalescing.  Proactive members of the claims management team might view this as an opportunity to discontinue ongoing wage loss and vocational rehabilitation benefits.  Unfortunately, this is often not consistent with many state workers’ compensation laws via case law interpretation.

One case on point comes from Minnesota, where a school district sought to discontinue ongoing wage loss benefits at the conclusion of a school year.[1]  The rationale for the discontinuance was based on the premise the employee did not intend to work during the summer months, and the result was no loss in wages.  A compensation judge rejected this argument and affirmed by the Minnesota Workers’ Compensation Court of Appeals.


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.


4 Foundational Elements of Return to Work Success

April 23, 2018 by 

When worker’s compensation was created over 100 years ago as the first form of social insurance in America, the number one reason and goal of the program was to return employees to their pre-injury state. Number one reason and number one goal of worker’s compensation was to return employees to their pre-injury state, both medically and from an occupation standpoint, their ability to work.

Transitional duty graphic for article, 4 Foundational Elements of Return to Work SuccessHello, my name is Michael Stack, CEO of Amaxx. And if that is the truth, which it is, the number one goal of worker’s compensation is to return employees to their pre-injury state, the best way to do that is with a very effective return to work program. Now there’s a lot we could talk about with return to work.

There’s a lot of different nuances, but what I want to discuss today is where I see companies falling down the most. And that’s right out of the gates in the policy, in the transitional duty policy, and the strategy and the philosophy as to how an organization even looks at setting up a return to work in the first place. Because if you’re not doing this right out of the gates, then you’re setting yourself up for failure, or at least you’re setting yourself up to not be as successful and have things run as smoothly as they could.

4 Foundational Elements of Return to Work Success

We’re going to cover four critical elements to return to work or transitional duty policy that you need to have implemented at your organization to set things up properly. Let’s talk about what these are.


First thing is it needs to be temporary. Return to work needs to be temporary, and this should be no more than 90 days. The vast majority of healing should be occurred in most injuries … of course, you need to be flexible on this in order to accommodate for the ADA … but as you’re communicating this, as you’re setting this up, the vast majority of cases, temporary transitional duties should last no more than 90 days. And if you’re not on that path, then you need to bring up some other claim interventions to get things going in the right direction. So number one is temporary.

Similar to Employee’s Current Position and Flexible

Number two is it needs to be similar to their current position. As you’re looking at creating a transitional duty job, the first place to look is that it’s similar to their current job. Look at the functional abilities that you get from their provider, from the medical provider, Continue reading 4 Foundational Elements of Return to Work Success

WCRI Conference to Highlight Trends, Solutions to Opioid Dependence in WC Read more: www.ReduceYourWorkersComp.com Blog – Work Comp Roundup http://blog.reduceyourworkerscomp.com/blog/#ixzz5ADUnw98M Copyright Amaxx Risk Solutions, Inc. Under Creative Commons License: Attribution Non-Commercial No Derivatives

March 19, 2018 by 

“We find extensive opioid prescribing leads to longer duration of temporary disability. When we compare the effect of longer-term opioid prescriptions with no opioid prescriptions, the effect is to triple the duration of temporary disability benefits.”

chart of top 10 WC cost drivers for article, WCRI Conference to Highlight Trends, Solutions to Opioid Dependence in WC  Read more: www.ReduceYourWorkersComp.com WCRI Conference to Highlight Trends, Solutions to Opioid Dependence in WC http://blog.reduceyourworkerscomp.com/2018/03/wcri-conference-highlight-trends-solutions-opioid-dependence-wc/#ixzz5ADXykgVK  Copyright Amaxx Risk Solutions, Inc.  Under Creative Commons License: Attribution Non-Commercial No DerivativesThat finding from the Workers Compensation Research Institute highlights the latest trends in the opioid epidemic as it relates to the workers’ compensation industry. It represents the first evidence of a causal relationship between long-term opioid use and disability duration. The authors will be on hand to delve into the research and the topic during WCRI’s Annual Issues and Research Conference in Boston this month.

Latest Evidence

The WCRI researchers looked at data from 28 states for low back pain injuries between 2008 and 2013 where workers had more than 7 days of lost work time. Additional findings were:

Local prescribing patterns play a significant role in whether injured workers receive opioid prescriptions. In certain states and particular areas within states, injured workers are more likely to receive opioid prescriptions than in other areas. When they compared injured workers with the same injuries in different areas, they found that a 10 percentage point increase in the local rate of longer-term opioid prescribing was associated with a 2.6 percentage point higher likelihood that a similarly injured worker would receive longer-term opioid prescriptions.

Opioid prescriptions persist, despite recommendations against them. While most medical guidelines do not typically recommend prescribing of long-term opioids for low back pain, about 12 percent of WCRI’s sample had them prescribed, and about 39 percent of workers had at least three opioid prescriptions.


Safeway’s Program to Identify and Intervene with “At-Risk” Employees to Enhance Recovery


At the 2015 Natillustration for at-risk employeesional Council of Self-Insurers Annual Meeting, Safeway discussed their claims early intervention program.
The presenters were Anita Weir, Director of Medical & Disability Management and Denise Gillen-Algire, Director of Managed Care & Disability.

Understanding the Dynamics of Delayed Recovery:

  • A small number of claims drives a large percentage of the costs.
  • Clinically simple or routine claims are seeing increasing medical and indemnity costs due to poor recovery.
  • Some people develop persistent pain and delayed recovery due to non-medical psycho-social risk factors (poor coping skills).
  • Medical diagnosis legitimizes injured workers’ sense of distress (i.e. I have a disc bulge that is causing my pain).

Early Intervention Program Overview:

  • Initial pilot on low back claims (80 claims).
  • Clinical risk management screening questionnaire was given at the primary treating physicians office during intake.
  • Risk for delayed recovery was identified very early in the claim.
  • Additional disciplines including physical therapy or cognitive behavioral therapy were provided immediately.
  • Of those 80 claims in the pilot program, all returned to work and none had surgery.
  • Current program now screens all claims at two weeks post injury. This includes medical only and lost time claims.
  • Add on costs for screening tool and cognitive behavioral therapy is approximately $2,500.

Key Implementation Components

  • Cognitive behavioral therapy does not create a “psych” claim.  There are CPT codes for this therapy that do not create a psychological diagnosis code.

Continue reading Safeway’s Program to Identify and Intervene with “At-Risk” Employees to Enhance Recovery

Workers’ Comp Claim Reporting Delays Will Cost You

Workers Compensations Premiums by state for United StatesThe Longer You Take To Report A Claim, The More It Will Cost You

The longer you take to report a workers’ comp claim to your insurer or TPA, the more you run the risk of the claim costing more money.  This is due to a myriad of factors, the most important being that the sooner your adjuster gets the claim, the better they can control all aspects of what is going on.
Several online studies have shown a relationship between late reporting and increased claim costs, but it is hard to have a direct correlation.  This is because every claim is different, every person is different, every injury has different circumstances, and so on.  There is no blanket analysis applicable to just you, the employer.
I do however have a great example.  I came across some information from a Carrier where they did an internal study. It appears that they took the claims as they were, by associating reporting lag time with the costs on the file, in order to have something to show clients how reporting can be directly related to costs. This study encompassed thousands of claims, of all types of injuries, but the common thing is that they were all work comp claims.  The injuries were broken down by body location, injury type, and by claims that had litigation or not. I do not believe this was a report to be published, so the name of the carrier/TPA will be withheld, as will any other information which may point out to which carrier/TPA performed this study. Of course this study can’t apply to everyone, since this carrier has certain clients, of differing sizes, operating in certain states, etc.,
but it is one of the best examples I have seen.
Reporting Delay Study Findings:
1.  Injuries reported within 2 weeks of occurrence are 18% more expensive than those reported within 1 week of occurrence, and injuries reported between the 4th and 5th week following the injury were 45% more expensive.
2.  The biggest finding involves back injuries, which as a group are 35% more expensive if not reported within the first 7 days post-injury.
3.  Soft tissue strains and sprains are 13% more expensive if not reported within 7 days of occurrence.  For example, carpal tunnel injuries—whose onset are difficult to pinpoint in general—are 11% more expensive if the reporting comes after the first week of reporting.
4.  22% of injuries reported within 10 days are litigated, and 47% becomes litigated when the reports arrive more than 31 days following the injury. Continue reading Workers’ Comp Claim Reporting Delays Will Cost You

Consider Computer Ergonomics to Reduce White Collar Work Comp Claims

illustration of good computer egronomicsRepublished with permission from ReduceYourWorkersComp.com

Blue-collar employees are not the only ones that have workers compensation claims. Office workers, especially those that sit in front of a computer all day, are having their share of workers compensation claims. Carpal tunnel syndrome, neck aches, and back aches are common musculoskeletal disorders and they are on the rise.  Additionally, eye strain, headaches and stress on the body from poor computer mechanics can interfere with the employee’s productivity

The wrong placement of the keyboard, the monitor, the mouse, the chair or the work surface can produce unnatural stress on the body, especially if the employee is forced to sit and work in an unnatural position.  Poor posture, tilting to either side, leaning forward or stretching to work, all produce pressure on the neck and spine.

Proper body positioning at the computer is important enough that OSHA has put forth guidelines designed to reduce the number of injury claims that result from improper body alignment with the keyboard and monitor.  The goal of the guidelines is to create neutral body positioning.  When the body is in a neutral position, the joints of the body are naturally aligned.  This minimizes the stress on the muscles, tendons and ligaments.

The OSHA guidelines for computer ergonomics include:

  • Hands, wrists and forearms are straight, in-line and roughly parallel to the floor.
  • Head is level or bent slightly forward, forward facing, and balanced.
  • The head is in-line with the neck and torso.
  • Shoulders are relaxed and upper arms hang normally at the side of the body.
  • Elbows stay in close to the body and are bent between 90 and 120 degrees.
  • Feet are fully supported by the floor or a footrest may be used if the desk height is not adjustable.
  • Back is fully supported with the appropriate lumbar support when sitting vertical or leaning back slightly.
  • Thighs and hips are supported by a well-padded seat and generally parallel to the floor.
  • Knees are about the same height at the hips with the feet slightly forward.

In addition to having the body properly aligned with the keyboard and monitor, the employee should all take the following steps to reduce the likelihood of creating a musculoskeletal problem:

  • Stand up and walk around for a few minutes periodically.
  • Stretch the torso, legs, arms, hands and fingers.
  • Dangle the arms by their side, shift the position of their legs and shrug the shoulders.
  • Make small adjustments to the chair and backrest.
  • Look away from the computer and refocus the eyes on a distant point.
  • Vary the work in order to utilize different muscles Continue reading Consider Computer Ergonomics to Reduce White Collar Work Comp Claims