Tag Archives: workers

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-Step Strategy to Prevent Workplace Violence

June 6, 2018 by 

More than 2 million workers are victims of workplace violence every year. While healthcare clearly leads the industries reporting workplace violence, many other industries are also at risk. Employers and payers can significantly impact the rate of violent incidents by understanding the risks unique to their industries and worksites and developing strategies to mitigate them. 

The Issue

clipboard with violence checklist for article, 3-Step Strategy to Prevent Workplace ViolenceOSHA defines workplace violence as any act or threat of physical violence, harassment, intimidation, or other threatening, disruptive behavior that occurs at the work site. That includes everything from verbal abuse to physical assaults and even homicide.

The most recent statistics show that violence in workplaces is increasing, despite lower overall crime among the general population – including homicides. In healthcare, the numbers are 7.8 cases of workplace violence for every 10,000 employees. In the sales industry, half of the work-related deaths are due to homicide. School districts also report higher rates of violence, aside from the much-publicized mass shootings.

Despite the high prevalence of workplace violence incidents more than 70 percent of U.S. workplaces do not have a formal program or policy that addresses the issue, according to the Bureau of Labor Statistics.

Create the Policy

There are three steps to creating a violence-free workplace.

  1. Assess the risk. First, you need to determine the violence hazards affecting your workforce. They could vary among employees. A healthcare establishment, for example, could have staffers who deal with potentially violent patients in the emergency room, along with nurses in the field. The risks facing each are very different.

ER workers should be aware of potential incidents not only from patients themselves but from family members who may become frustrated. A nurse who conducts home health visits may be vulnerable to risks because she or he is alone. The home health worker should know to ask questions, such as whether there are firearms in the home.

Some ways to assess the risks facing your organization include

  • Find out from staff members whether, where and when they feel threatened.
  • Review past records. Incident reports can reveal areas where violence has occurred, and they should be a focus of prevention policies.
  • Check the research. Studies provide clues to areas vulnerable to violence. Within healthcare facilities, inpatient and acute psychiatric services, geriatric long-term care settings, and urban ERs have been shown to be at higher risk than some other areas.


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.


Steep rise in insect-borne illnesses puts outdoor workers at risk: CDC

Atlanta — Disease cases stemming from mosquito, tick and flea bites more than tripled from 2004 to 2016 in the United States, and outdoor workers remain among those at risk, the Centers for Disease Control and Prevention states in a new report.

photo of tick on leaf for article, Steep rise in insect-borne illnesses puts outdoor workers at risk: CDC
Photo: andriano_cz/iStockphoto

According to CDC, cases of domestic disease such as dengueZikaLyme and plague totaled more than 640,000 in that time period. The agency identifies state and local health departments and vector control organizations as the primary defense, but notes that 84 percent of such organizations lack one or more of five core competencies:

  • Routine mosquito surveillance via standardized trapping and species identification.
  • Treatment decisions devised from surveillance data.
  • Killing mosquitoes and ticks at every life stage.
  • Routine vector control activities, including source reduction or environmental management.
  • Pesticide resistance testing.

The risk for developing insect-borne diseases increases as commerce moves insects to different areas of the country and worldwide, the report states. Mosquitoes and ticks can transport germs, while infected travelers can introduce and spread them.

Symptoms of insect-borne disease include body, muscle and joint pain; fever; rash; headaches; stiff neck; fatigue; and paralysis.

CDC offers tips to prevent insect stings and bites. Among them:

  • Wear clean, light-colored clothing that covers as much of the body as possible.
  • Bathe daily while avoiding cologne, perfume and perfumed soaps, shampoos and deodorants.
  • Maintain clean work areas.
  • Remain calm around flying insects, as swatting may prompt them to sting.
  • Perform daily skin and clothing checks for ticks, which tend to populate worksites near woods, bushes, high grass or leaf litter.
  • Use insect repellent with 20 percent to 50 percent DEET on exposed skin and clothing, reapplying as necessary.


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