Tag Archives: workers’ compensation

Return-To-Work: Create a Win/Win in Your Work Comp Program

By ReduceYourWorkersComp.com 01/03/2017

photo of employee in wheechair performing transitional dutyNotwithstanding the conventional wisdom, injured workers of any age have an interest in returning to work.  Sadly this is often an over-looked part of many programs as employers and interested stakeholders focus on other issues.  Now is the time to change this thought process.  This is based on the reality that any workers’ compensation program can create a win for everyone by focusing on return-to-work.

Challenges When it Comes to Return-To-Work

There are many challenges employers and other stakeholders face when creating or revamping their return to work program.  Due to these barriers, the people in charge of the program decide to move on and focus on other aspects of their programs.  Some of the main challenges faced by workers’ compensation programs include:

•   The aging American workforce. Continued anemic economic growth places pressures on the average American’s pocketbook.  This has changed the thought process by employees, as they get older.  When an injury occurs, employers and members of the claim management team face challenges of extended vocational rehabilitation, the possibility of retraining and the ugly specter of a permanent total disability (PTD) claim.

•   The ongoing opioid drug epidemic. Change will only occur in the overuse and abuse of prescription opioid-based medications only when the hearts and minds of Americans demand real action.  Until that time, all parties charged with the role of defending a workers’ compensation claim will need to keep an eye on this issue.

Countless other factors impact workers’ compensation claims management.  One practical and fundamental solution is to reduce the costs in a workers’ compensation program through an effective and efficient return-to-work program.


Understand The Work Comp Heart Attack Presumption

By ReduceYourWorkersComp.com 12/01/2016

Painting of a firefighterThe grand bargain of the workers’ compensation system requires employees who allege work injuries or conditions to prove compensability of their claim.

This includes the initial threshold question that it “arose out of” and occurred within the “course of” their employment activities.  While this threshold question applies to all employees equally, there are various presumptions that allow firefighters, police officers and other emergency personal to obtain compensation for heart attacks or other exposures with a lesser degree of evidence.

This is known as the “heart attack presumption,” and is something all members of the claims management team should understand.  They should also be aware as to how to deal with these cases and rebut the presumption when appropriate.

Origins of the Heart Attack Presumption

Employees that work in emergency situations deal with a constant flow of stressful situations during the course of every workday.  This includes rushing to various emergencies, working prolonged and abnormal hours and being subject to constant peril.  The result was a recognition in multiple jurisdictions that these professionals should receive additional protections that while rebuttable, allow them to peruse legitimate claims without having to prove issues of causation to the extent that other employees are required.

Application of the Presumption

It is important to note that the occurrence of a heart attack by a firefighter, police officer or other emergency responders does not automatically trigger compensability.  In order for the presumption to be successful, there is typically a requirement of “an absence of contrary or conflicting evidence on the point and the circumstances which form the basis of the presumption must be of sufficient strength from which the only rational inference to be drawn….”[1]  In other words: Continue reading Understand The Work Comp Heart Attack Presumption

‘Tis the Season of Toasting – A Cautionary Tale from NJ

Employer Loses Intoxication Defense Where Blood Alcohol Level Of Claimant Was .173 Percent

By National Workers Compensation Defense Network (NWCDN) 11/23/2016

photo of cocktail, car keys, handcuffsOne of the most anachronistic aspects of New Jersey workers’ compensation law is that employers pay workers’ compensation benefits even when intoxication is a substantial cause of injury.

In Diaz v. National Retail Transportation, Inc., A-3927-14T2 (App. Div. November 9, 2016), Antonio Diaz was injured moving a heavy lift which fell over on him.  He admitted that prior to work on January 28, 2014, he drank at least two eight-ounce glasses of half whisky and half ice and water.  Respondent’s toxicologist testified at trial that petitioner had a blood alcohol level of at least .173 percent.  Had petitioner been driving, that percentage would have been more than double the legal limit.

Respondent denied the workers’ compensation claim on the basis that petitioner’s intoxication was the cause of the injury based on the expert testimony of respondent’s toxicologist.  Petitioner argued that there was another factor which contributed to the injury, namely a flat tire on the lift.  He said that the lift fell over when it “tilted to one side at the same moment” that he was pulling the lift.  He noted that one of the tires on the lift was flat.

Respondent produced a forensic engineering expert, who testified that “a flat tire didn’t contribute in any way to this accident.” The expert did concede that a flat tire on the lift could have caused the lift to tilt to one side or the other.  The expert conceded that if someone pulled the lift backwards and it had a flat tire, the lift could fall backwards “cockeyed.” The expert said, however, that the lift with a flat tire would tilt only a very small amount, only the one inch that the equipment is off the ground.


National Comp Pharmacy Costs Continue to Decrease!

By WorkCompAcademy.com November 2, 2016

pills pouring out of roll of dollarsSacramento, CA – CompPharma’s 13th Annual Survey of Prescription Drug Management in Workers’ Compensation analyzed the 2015 pharmacy cost data of 30 workers’ compensation insurance carriers, third-party administrators, self-insured employers, and state funds.

Total workers’ comp annual pharmacy spend is approximately $5.5 billion, but it is not possible to more precisely calculate workers’ compensation drug spend.

After a one-year bump up in inflation, work comp drug costs declined again, this time by 8.7%. The 30 payers saw a decline in spend, which they attributed to tighter clinical management, better integration with their PBMs on a variety of services, and specific efforts to reduce initial opioid scripts and decrease the level of morphine equivalents across as many patients as medically appropriate.

Over the last four years, drug costs for payers surveyed by CompPharma have dropped by 11%. This year, seven respondents’ drug costs dropped by 17 points or more. Claim volume changes were only involved for a handful of payers. Respondents attributed the steep decline to more active and assertive clinical management, especially focused on opioids and other potentially problematic drugs.

Over the 13 years the survey has been conducted, the pharmacy cost inflation rate decreased by 26.5 points.
Continue reading National Comp Pharmacy Costs Continue to Decrease!

Lyme Disease Qualifies As A Disability …

… Under The New Jersey Law Against Discrimination

By National Workers Compensation Defense Network (NWCDN) 10/28/2016 07:22:00

Lyme_Disease_InfografhicIn Cook v. Gregory Press, Inc., 2016 N.J. Super. Unpub. LEXIS 1885 (App. Div. August 11, 2016), the Appellate Division reversed a trial court’s dismissal of a plaintiff’s disability discrimination case involving an employee eventually diagnosed with Lyme disease.

The case involved Matthew Cook, who worked as a printing machine operator since 2002.  In 2011, he began experiencing facial numbness, tingling in the hands, and neck pain.  He saw a neurologist who thought he might have a demyelinating disease, recommending an MRI of the brain and spine.

Before Cook went for the MRI, his home was damaged by Hurricane Irene, and he was out of work for almost a week making repairs. He was given a day off from work on September 9, 2011 to undergo the MRI, which showed myelitis.  His doctor recommended next a spinal tap to determine whether he might have MS, Lyme disease, or a virus. His boss granted him time off to get the spinal tap but suggested that Cook really had nothing wrong with him.  The boss said he thought his problem was stress from the flood.  Cook responded that this would not explain a lesion on his spine.

The spinal tap occurred on September 16, 2011, and Cook experienced complications from the spinal tap, including dizziness and headaches.  He stayed in bed all weekend but went to work on September 19, 2011.  He found that his head was pounding as the day went on and he had to leave to go home.  His doctor prescribed fioricet.  He could not work the next day due to severe headaches and nausea.  His doctor prescribed Prednisone to relieve inflammation, but that made him jittery.  His doctor next faxed a note to Cook’s supervisor saying that Cook needed to be out until released later in the week.  Cook called his boss to ask for more time off, but his boss said that Cook better get back to work by Wednesday, September 21, 2011. Continue reading Lyme Disease Qualifies As A Disability …

Outcomes-Based Approaches in Workers’ Compensation Are Reducing Costs, Litigation and Improving MPN Performance

By WorkersCompensation.com 10/12/2016

cartoon for outcome based healthcareNewport Beach, CA  – Outcomes-based network management can improve MPN performance and reduce costs and litigation, according to findings presented by Harbor Health Systems  and the California Workers’ Compensation Institute at the CAJPA 2016 Conference.

During their session, “Starting at the Finish Line: Applying an Outcomes-Based Approach to Workers’ Compensation Physician Networks,” speakers Kent Spafford, Board of Directors, One Call Care Management (“One Call”), and Advisor to Harbor Health Systems, and Alex Swedlow, President of CWCI, explained the type of data that can be analyzed in order to identify high-performing networks and providers, and the results that can be achieved by utilizing top networks.

“Identifying best doctors requires an analysis of multiple variables, including cost, duration, recidivism, and total disability of claims,” noted Spafford. “With these objective measures and the ability to get more injured workers treated by the top twenty percent of scored physicians, results in MPNs are improving in terms of lower costs, less litigation, and shorter claims duration.” Continue reading Outcomes-Based Approaches in Workers’ Compensation Are Reducing Costs, Litigation and Improving MPN Performance

Impact of Mental Health at the Workplace

By Safety National 10/06/2016

name tags: Hello My Name is StressThis session at the 2016 California Workers’ Compensation & Risk Conference addressed some of the latest thinking and research related to the impact of mental well being and behavioral health in the workplace.
Speakers included:
•  Denise Zoe Algire, National Director, Managed Care & Disability, Corporate Risk Management, Albertsons/Safeway

•  Dr. Teresa Bartlett, Senior Vice President Medical Quality, Sedgwick Claims Management Services, Inc.

Mental health is a key component of wellness. It is a state of well-being in which an individual can cope and become a contributor. It includes how someone feels, thinks and acts and helps to determine how we handle stress, relate to others and make choices. Ultimately, mental health is about balance, resiliency and the ability to return to normal when something goes wrong. Mental health is also directly associated with performance in the workplace.

Studies show:

•  16% of people in the workplace are depressed and 57% of those
are untreated.
•  14% have chronic fatigue, with 83% untreated.
•  15% suffer from anxiety, with 66% untreated.
•  6% have chronic sleeping problems, with 61% untreated.
Continue reading Impact of Mental Health at the Workplace

Fired Worker Says Adderall Was Part Of The Job

By Cameron Langford

negatibe side effect of Adderall, info graphcSherman, TX (WorkersCompensation.com) – A finance manager for a Texas car dealership claims in court that his boss gave employees prescription Adderall to boost production, which hospitalized him with “heart-attack conditions,” and the boss fired him after he spent a month in rehab.

Brandon Davis sued Berkshire Hathaway Automotive dba Crest Nissan of Frisco on Aug. 8 in Federal Court. The dealership is the only defendant.

Davis says in the lawsuit he was the dealership’s top-producing finance manager and had the highest customer-service rating among his peers, which was not lost on his bosses, who noted those accomplishments in a letter of recommendation.

But Davis says when the dealership hired a new finance director, Justin Hamaker, in the summer of 2015, the workplace abruptly changed.

“Plaintiff noticed that his fellow finance managers did not seem as tired as plaintiff on long working days and nights,” he says in the complaint.

”During a discussion with Hamaker, Hamaker indicated to plaintiff that he had provided Adderall to the other finance managers and would do the same for plaintiff. Hamaker indicated the Adderall was necessary to work long hours and achieve high numbers.”
Continue reading Fired Worker Says Adderall Was Part Of The Job

Rotator Cuff Tear May Be A Covered Disability Under ADA

By John Geaney

rotator exercise chartMichael Cannon applied for a job with Jacobs Field Services (hereinafter JFS) as a field engineer for a Colorado mining site.
The company made him a job offer conditioned on his passing a post-offer medical examination.

During the post-offer exam, Cannon revealed to the doctor that he had an inoperable rotator cuff tear and had taken Ultram (a brand name version of the opioid Tramadol).  He said he still had the prescription but was no longer taking it. In fact, he passed the drug test portion of the post-offer examination.

The doctor cleared Cannon provided that JFS offered accommodations of no driving company vehicles, no lifting, pushing, or pulling more than 10 pounds and no working with his hands above shoulder level.

Less than two hours after receiving the doctor’s report, the company’s technical operations officer at the mining project wrote that the job offer should be rescinded because a field engineer must be capable of driving and lifting.  Ladder climbing was an essential function of the job.

Further, the job site was located in the mountains with rocky terrain over several miles, so driving was essential.  This decision to revoke the job offer was not communicated immediately to Cannon.

A Human Resources Manager later contacted Cannon, expressing concerns about his ability to perform the essential functions of the job.  Cannon offered to contact the Occupational Health Department to address concerns that he was still taking Ultram (he said he was not).  He also brought a note from his doctor stating that he could climb ladders by maintaining three point contact with either arm. Continue reading Rotator Cuff Tear May Be A Covered Disability Under ADA

Fitness-For-Duty And Functional Capacity Exams: Important Tools In Reducing Workers’ Compensation Costs

Fitness for duty logoBy National Workers Compensation Defense Network (NWCDN) 05/14/2016

We have all seen this situation: an employee with a physical job has major surgery and is given restrictions by the treating doctor, who issues an MMI note (maximum medical improvement).

When temporary disability benefits are stopped, the employee immediately calls to see about returning to work.  The employer indicates that it cannot take the employee back with such heavy restrictions.  The next day the treating doctor issues a note clearing the employee to return to work with no restrictions.  One month later the same employee reinjures his back at work severely, leading to another surgery and hundreds of thousands of dollars or even total and permanent disability. The hit to the employer’s workers’ compensation budget becomes astronomical.

What went wrong? Why does this sort of thing happen so often? This is the first of a two-part series on the critical importance of fitness-for-duty exams and functional capacity evaluations in the New Jersey workers’ compensation system.  In this blog, we will focus on mistakes employers make and why fitness exams can result in enormous savings for employers. The next blog will focus on how to do fitness exams correctly and how to avoid law suits when arranging fitness exams.
Continue reading Fitness-For-Duty And Functional Capacity Exams: Important Tools In Reducing Workers’ Compensation Costs