Tag Archives: workers comp

Interesting Approach

10/17/18   Julius Young

Recently I became aware of an interesting experiment by the SCIF, the State Compensation Insurance Fund.

Titled the “Injured Worker Incentive Program”, this SCIF program (see link below) promised certain monetary incentives to those who it deemed in compliance with certain benchmarks.

savings graph for article about Injured Worker Incentive ProgramsThis apparently was a small SCIF program, and inquiries by some of my colleagues have resulted in head scratching by various SCIF attorneys who claimed no knowledge of it. The program may not be getting off the ground at this time.

I’ve heard whispers that this program came to the attention of some at the DWC, but to my knowledge there’s been no public discussion of it.

The July 2018 explanatory letter from SCIF notes that “the sooner injured employees return to work, the sooner they feel better.” The letter explains that this program is established to encourage injured workers “to establish and maintain an active and healthy lifestyle”. As a result, “State Fund is prepared to assist you in your efforts by supplying some fitness equipment which you or your physician may think would be helpful.”

Other benefits of the program included:

• Potential eligibility for a $1,000 payment to those who return to work within 7 days of release by a doctor and who remain employed for 6 months;

• Payments of $500 for maintaining pre-injury weight or $1,000 for losing at least 5% of pre-injury weight;

• Potential monetary payments of $1,500 (compliance with treatment), $1,000 (staying within the MPN), and $1,250 (agreeing with the PTP findings to avoid use of the QME medical-legal evaluation process);

• Wellness program participation ($500)

These cash awards were noted to be considered taxable income and as a result 1099 forms would be issued by SCIF.

How should we assess this program?

One could argue that experimentation in workers’ compensation may be a good thing. And some of the program’s goals are laudable, i.e. getting people back to work and supporting healthy lifestyles and “wellness”. Extra monetary incentives for workers could possibly be a tool to drive behavior that arguably might lead to some better outcomes.

It’s an issue that the comp community should debate.

[SEE FULL STORY HERE]

Health Navigation – Finding a Path to Better Health and Lower Costs

September 20, 2018 by 

If you or a loved one has ever been hurt or sick, you know well that healthcare and insurance systems are complicated; the challenges can seem endless and overwhelming.

Health navigation helps individuals and companies through these challenges. It includes clinical services, of course, but it’s much more than that. Knowing what services are needed, where to get them, and in what timeframe are critical elements to getting on the right path to recovery.

Fundamental Premise of Health Navigation

health navigation signage for article, Health Navigation – Finding a Path to Better Health and Lower CostsPeople can’t always tell at the onset how serious an injury or illness is. So, sometimes they go to an ER when they could have gone to a doctor’s office, or they go to a doctor’s office when they could have cared for themselves. Other times people underestimate or don’t recognize symptoms, and look back wishing they had realized how serious something really was – this regret can make them more likely to overreact the next time they are confronted with a health concern.

The fundamental premise of health navigation is getting people the care they need when and where they need it, which removes burdensome guesswork. A best-in-class health navigation provider should:

  • Have clinicians which navigate people to the right level of care at the right time, in the right place.
  • Have systems to help people determine the severity of each case and the best course of action for treatment.
  • Provide the needed care or guide patients in self-care whenever possible.
  • Make a referral when further care is required

People know overtreatments and over prescribing exist, but they don’t know how to tell when it is happening to them. What’s the best practice?

[SEE FULL STORY HERE]

12 Frequent Hard Hat Questions

If the hard hat has sustained an impact, dispose of it immediately, even if the damage is not visible.

workers with hardhats for article, Twelve Frequent Hard Hat Questions

Protecting employees from potential head injuries is a key element of a safety program in virtually all industries. The primary reasons for an organization to require hard hats in the work environment is to help protect employees from head trauma from objects falling from above; bumping into fixed objects, such as pipes or beams; or contact with electrical hazards. Head protection also can serve to help protect employees from splashes, rain, high heat, and exposure to ultraviolet light.

In this article, we will discuss many of the frequently asked questions related to hard hats.

When Is a Hard Hat Required?
OSHA requires, in 29 CFR 1910.135, that if the following hazardous conditions are present, then head protection is required:

  • Objects might fall from above and strike employees on the head
  • There is potential for employees to bump their heads against fixed objects, such as exposed pipes or beams
  • There is a possibility of accidental head contact with electrical hazards

Other countries or organizations may have additional requirements, but most regulations are hazard based and start with a thorough workplace hazard assessment.

What Industry Standard or Approval Do Hard Hats Need?
This can vary by country or global region because there are various standards in place. In North America, the current standards are the American National Standards Institute (ANSI) Standard for Head Protection, Z89.1 (current version is 2009) and the Canadian Standards Association (CSA) Industrial Protective Headwear, Z94.1 (current version is 2005). These two standards share the “Type” and “Class” descriptors, which makes it easier to ensure that the right hard hats are selected for your application. However, as you will see below, the tests are slightly different, so a hard hat manufacturer must test to all standards that it chooses to meet, based upon the markets in which it wants to sell.

[SEE REST OF THE STORY HERE]

How to Use HIPAA to Obtain Timely Medical Records

Are you hip to HIPAA?

August 27, 2018 by 

Members of the claims management team obtain medical records on a frequent basis when investigating workers’ compensation claims. It is important they do this promptly given the many constraints of workers’ compensation laws. Given the nature of these requests, state and federal privacy laws come into play. Failure to understand these laws and their requirements can lead to delay and problems down the road. Now is the time to better understand these laws and how to incorporate them into your team’s best practices.

It All Starts with HIPAA

HIPAA logo for article, How to Use HIPAA to Obtain Timely Medical RecordsThe Health Insurance Portability and Accountability Act of 1996 (HIPAA) serves as the basis for healthcare privacy and the dissemination of medical records in the United States. The law was enacted in 1996 to address the many issues medical providers were facing and to protect the privacy of all individuals. In essence, it serves as the baseline for standards enacted at the state level for all covered entities.

Understanding the Basics of HIPAA

To understand the law, it is important to understand when it applies and whom it protects. HIPAA applies to all “covered entities,” which are defined under 45 C.F.R. §160.103, as:

Health care providers who transmit “protected health information;”

Entities that process personal health information (healthcare clearinghouses);

Health plans such as Group Health Plans; and

Any business partner of a “covered entity.”

It is also important to note that the federal law applies to “protected health information,” otherwise known as PHI. This is information defined under 45 C.F.R. §164.501, which is individually identifiable health information maintained or transmitted in any form, whether electronically, on paper or orally.

Exceptions to HIPAA in Work Comp

Employees at healthcare providers are required to know and understand HIPAA and have a duty to protect a patient’s PHI. Continue reading How to Use HIPAA to Obtain Timely Medical Records

Overcome 3 Common Return to Work Barriers

info graphic on factors that can be barriers to returning to work, for article: Michael B. StackMembers of the claims management team and other interested stakeholders in a workers’ compensation program need to be proactive when it comes returning an injured employee back to work. This includes being ethical and hardworking when it comes to vocational rehabilitation matters. This is especially the case when it comes to overcoming common barriers in the RTW and rehabilitation process. Failure to do so can result in increased workers’ compensation costs and other added expenses.

Who is Responsible

The employer is the most important and impactful party in return to work. The best practice is for the employer to develop the position of a “RTW Coordinator.” This should be a person who is knowledgeable in human resource matters, state and federal disability and discrimination laws, and accessible to the entire workforce. The RTW Coordinator should also be responsible for all interactions with the injured worker on behalf of the employer and maintain documentation related to a workers’ compensation claim.

Responsibilities of the Employer: This party is responsible for reporting the work injury and helping with the investigation. The employer should take action in letting the employee know their rights, which is often required under a state workers’ compensation law. They are also responsible for identifying available light-duty work opportunities and monitor the employee’s recovery.

Responsibilities of the Insurer: Coordinate with the employer on all work injury matters and pay for all workers’ compensation benefits the injured employee is entitled to under the law. The insurer can also make recommendations on light duty job opportunities and provide education to their insured.

[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]

What Is A Workers’ Comp Vocational Consultant?

July 12, 2018 by 

Vocational consultants are not needed on most of your worker’s compensation claims; just the severe claims. When an employee has a level of permanent partial disability, to the point that the impairment from the injury will prevent the employee from returning to work, a vocational consultant is required.

Vocational Consultant Evaluates Ability of Injured Employee to Work

vocational rehabilitation consultant tee shirt for article, What Is A Workers’ Comp Vocational Consultant? A vocational consultant evaluates the ability of the injured employee to work and then assist the employee in finding employment within the physical limitations of the employee. The typical course of the vocational process is for the vocational consultant to perform a vocational assessment including vocational testing, perform a labor market analysis, a transferable skills analysis and assistance with job placement.

To access the injured employee’s ability to perform a different occupation, vocational testing is used. Testing to measure the employee’s educational achievement, aptitude, interests, and level of intelligence may be used to gauge what the employee’s skills are. These tests are the first steps in a vocational assessment for the employee.

The vocational assessment for each employee is done on an individualized basis. To make a complete evaluation of the injured employee’s abilities, the vocational consultant will:

  • Complete a detailed interview to obtain the employee’s background information on formal education, trade schools, prior work experiences, interests and hobbies
  • Based on the results of the detailed interview of the employee, a
    transferable skills analysis will be completed
  • Vocational testing to verify the level of the transferable skills the employee has will be completed

    [SEE FULL STORY HERE]

5 Ways To Facilitate Better Return-to-Work Rates

May 9, 2018 by 

The longer an injured worker is off the job, the more it costs the company and the less likely he is to return — ever. Since that can add up to major expenses for an organization, the goal should be to keep injured employees on the job or, if that’s not possible, get them back to work as soon as possible.

icon style graphic for aricle, 5 Ways To Facilitate Better Return-to-Work RatesMost injured workers are back on the job within 4 days. But there are times when that is not the case — even if the injury itself is not that severe. There are myriad reasons employees don’t return to the job. Using a few simple strategies can aid the process.

  1. Stay in network. The medical providers that are part of your network should be well versed in occupational health issues, especially when it comes to returning the injured worker to work. Physicians in the know understand that it is not only in the employer’s best interests, but the employee’s as well. Research clearly shows people recover and heal faster when they are participating in constructive activities, rather than sitting on the couch. Physicians who are part of the employer’s medical network understand these factors and are more likely to pursue returning the worker to the job site, at least in some capacity.

However, it does not always work out that way, and the employee may go to a physician of his choice for various reasons. Even in states without employer-directed healthcare, the employer can at least recommend certain providers. Someone from the company should also be designated to drive the person to the physician’s office. Doing so will make the worker more likely to agree to be seen by the provider recommended.

Some injured workers say they are ‘fine’ at the time of injury but later seek medical care. All injured workers should be provided with a list of in-network or recommended providers. If the employee later decides to head to a physician, he may be more likely to go to one suggested to him.

Employers need to be clear about the workers’ compensation process and demonstrate their caring and concern for the injured worker. This can be done with effective communication — both formal and informal (see ‘communicate’ and ‘brochures’ below).

[SEE REST OF THE STORY HERE]

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.

Temporary

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

Operation Safety: A Case Study in Preventable Workplace Falls

Falls from heights and elevated surfaces continue to be a driver in signage graphic for article, Operation Safety: A Case Study in Preventable Workplace Fallsworkers’ compensation costs across the United States.  Now is the time for employers and other interested stakeholders to take a stand against falls.  It will not only reduce workers’ compensation program costs but increase morale within the workplace.

A Case Study in Preventable Workplace Falls

Falls within the workplace continue to be the leading cause of workplace deaths despite improvements and availability of cost-effective safety equipment.  This is mainly prevalent in the construction industry where workers engage in daily activities in a variety of settings and conditions.  This includes smaller residential construction projects, which account for a disproportionally high number of catastrophic workers’ compensation claims.  Preventing these incidents all starts with a proactive contractor dedicated to improving the safety on their job site.

Preventing falls from heights and elevated surfaces can be prevented by simple strategies:

  • Advance planning that includes understanding the job site and unique conditions employees might face when performing their work activities;
  • Making sure all employees and others on a construction site have the necessary safety equipment. This includes making sure the equipment is properly working and free from defect; and
  • Providing the necessary training on how to correctly use the safety equipment used in the workplace. A surprising number of work injuries and deaths occur when this equipment is not correctly used by employees. 

Communication is Key!

The first step in preventing falls in the workplace is communication.  When it comes to workplace safety and a known safety risk, interested stakeholders can never communicate to its workforce enough.  This communication must also be effective.  Steps contractors can take should include:

[READ FULL STORY HERE]