The Rising Cost of WC Legal Defense Expenses: Insurance Business America Publishes Article by Rebecca Shafer

The trade publication Insurance Business America recently published an article by Rebecca Shafer about the rising cost of legal defense funds and the role that producers have in helping clients contain those costs. You can read the article on Page 58 of the magazine, which is embedded below.

Click on the embedded magazine above and turn to page 58 to read Rebecca Shafer’s article, Putting a lid on workers’ compensation litigation costs.

Who Benefits From Our Workers Comp Management Training Guide

The principles in our workers comp management training guidebook apply to any state, jurisdiction, or country. The program improves internal communications and operational best practices of employers. No matter where you are trying to train risk managers, this book will work for you! Of course, you will need to coordinate any new policies including those in our book with your in-house team of professionals.

  • Risk Managers and Safety Directors use this book to train supervisors in workers’ compensation claims management. They learn more about their area of responsibility – post-loss cost containment – adding to their overall knowledge. This book is also used to get management commitment in rolling out a Return-to-Work program, one of the biggest cost savings areas relating to workers’ compensation costs.
  • Brokers, Agents, Insurance Companies, Reinsurers, Adjusters, and Consultants use this book for prospecting and to learn about specific aspects of cost containment; and benefit by passing their knowledge on to their clients. For example, when discussing how to develop a Return-to-Work program and a client asks about “off-site return-to-work programs,” the broker quickly finds that section in the book, reviews it, and passes the answer on to the client, along with a copy of the cost containment book. The book becomes a “lesson plan” tool.
  • Producers and Account Executives give the book to prospects during formal presentations such as annual stewardship meetings to illustrate how their company is on top of workers’ compensation issues. The book also makes a good client gift.
  • Vendors such as doctors, investigation firms, law firms, medical management vendors and triage companies learn how their services might fit into the workers’ compensation marketplace. They learn what is important to employers, and what they look for in medical provider relationships. Many also private-label the book and give it to prospects to show them how the services fit together.
  • Human Resources find it useful in bringing new hires including risk managers, safety professionals and supervisors, up to speed very quickly. Often the HR Director is responsible for some aspect of workers’ compensation or disability leave, and needs to understand more about workers’ compensation cost containment methodology.

Learn more: Your Ultimate Guide to Mastering Workers’ Compensation


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Learn more: Your Ultimate Guide to Mastering Workers’ Compensation

Aggravation vs Exacerbation

These two terms are used interchangeably to describe a worsening of a medical condition that, depending on state statutes, can make very little or a major difference in payment of medical and indemnity benefits.

Aggravation is an increase in the severity of a pre-existing condition where the underlying pathology is permanently moved to a higher level.

Example: An employee with degenerative disc disease (normal aging) occasionally has a backache, but lives with the discomfort. The employee suffers a back injury while lifting a heavy object at work. The pre-existing degenerative disc disease is aggravated when the injury causes the employee to experience permanently a higher level of back discomfort or pain.

Exacerbation is a temporary increase in the symptoms of a pre-existing condition that returns to its prior level within a reasonable period of time.

Example: The employee completely recovers from the injury, returning to the prior level of function, but still with an occasional backache. The worker suffered an exacerbation of the pre-existing condition.

From the Comprehensive Version of the 2014 Training Manual

Your Ultimate Guide to Mastering Workers Comp Costs:

Reduce Costs 20% to 50%

Get Well Cards (Package of 10)

As part of a comprehensive workers compensation program, employers should maintain close communications with injured employees to ensure they recover quickly, do not drop out of the workforce and and return to work rapidly.

Get Well Cards are part of a positive, proactive communication strategy. These are occupational injury get well cards for industrial or professional worksite settings.

Packages of 10 Get Well cards can be customized with your company logo and a special message.

Get Well Cards (Package of 10)

Inside message:
Hope You Feel Better,
You Are Missed At Work!

BUY GET WELL CARDS

Employees appreciate receiving a get-well card. It perks up the spirit and helps the injured worker remain engaged in the workplace. Have fellow workers sign the get-well card. It helps injured workers recognize that the employer has their best interest in mind. Include a gift certificate to the local pizza parlor so the whole family can enjoy a complimentary dinner at a difficult time.

  • Sending the right message – that the employee is a valued part of the business — is one of the most important keys in a successful workers’ comp program.
     
  • The employer’s goal is to communicate to injured workers that staying out of work is not an option, i.e., fostering a psychological desire in the worker to return to work.
     
  • Informal communication allows the employer to “stay in touch” and reinforces the message that the employee is a valuable asset as a human being and worker.
     
  • As a follow-up to the first day phone call and before weekly meetings are scheduled, send a Get-Well Card to the injured employees – it shows you care about their well-being.

BUY GET WELL CARDS

For customization with your company logo, call Meredith Bastone at 212-897-4787. Send your logo file attachment to her via email at mbastone@Advisen.com

Case Study: Nationwide Transportation Company Sustains 20% Decreased Workers’ Compensation Costs

City School BusA major, nationwide transportation company provides bus services in over 500 U.S. locations. These business units provide bus service in major metropolitan cities, student transportation, and special needs busing nationwide. Some operations have unionized labor. The company needed a comprehensive review of their claims process in order to establish a more cost-effective workers’ compensation insurance program. Workers’ comp claims were the company’s single largest cost after payroll.

Following our recommended approach, the company’s risk management committee, their TPA, and the insurance broker worked as a team for 56 weeks to identify and implement changes in processes throughout the organization. The team provided an integrated pre-loss, claims management, and post-loss control solution. The insurance broker’s claim vice president was an integral part of the team, as was the account executive at the claims administrator.

The program resulted in a 20% reduction in overall loss costs. It included improvement in return-to-work ratio; reduction in claims; and fewer lost time claims compared to medical only claims. This reduction was sustained in subsequent years – in other words, the changes that were made were sustainable.

Here’s How They Did It!

There was very little understanding by senior management about the financial impact of workers’ compensation, and they felt helpless to change the situation. There was no return-to-work program. Lack of a return-to-work program resulted in many employees staying out of work for undetermined, unplanned, extended periods of time. Their high-deductible insurance program resulted in paying the first $250,000 out-of-pocket.

To start, the team located all existing forms, documents, policies and procedures.

These areas were revised as described in Chapter 2: Fundamentals of Cost Containment

The Disability Note was rewritten to include information the company needs such as diagnosis, prognosis, length of time out of work, treatment plan, and date of next visit. Most importantly, medical abilities and restrictions detailing what the employee can do in a transitional duty job are included along with a target return to work date. This additional information put the employer in charge of the return to work process.

The Disability Note is now given to the treating physician by the injured worker at the first appointment. The doctor completes the form, describing in detail everything about the employee’s injury, treatment, and return-to-work expectations. The form is faxed by the doctor to the employer the same day. Knowing when an employee is expected to return to work allows the employer to gain control of the claim from the beginning of the reporting process rather than later when return-to-work issues become murky and the employee has lost interest in returning to work.

These areas were revised as described in Chapter 3: Training and Building Commitment

  1. With over 1,000 open claims, additional staff was needed to manage claims internally at the company. There was no risk manager and no claims staff. There was only one safety director, who had no support. Several regional claims coordinators were hired to manage claims and focus on return to work of injured workers.
     
  2. At a review meeting, members of management, supervisors, and team members discussed the four necessary and distinct steps needed to implement a successful workers’ compensation management program
     
  3. A weekly conference call was held every Wednesday at 10 a.m. with the entire team.
     
  4. The team lead set up the Implementation Timetable to assign responsibility to committee members for tasks and maintain accountability. All team members received an updated Timetable following each weekly conference call.

These areas were revised as described in Chapter 6: Post-Injury Response Procedure

  1. A post injury response procedure was developed and implemented explaining what to do during the first 24 hours after an injury. The procedure was set on laminated cards that describe exactly who does what when an injury occurs. They were posted in obvious places — near an employee’s workplace, in a desk, vehicle, or briefcase for traveling employees.
     
  2. Procedures were put in place requiring ALL employees, supervisors, and witnesses to report immediately every workplace injury; to get medical care; to determine if the injured worker will/will not return to work and when; and to telephone the triage nurse immediately at time of injury to make sure they get the correct level of medical care.
     
  3. To keep in touch with the injured employees not returning to work immediately after their first medical appointments, Human Resources sends out a gift card to a local pizzeria in a get-well card.

 

These areas were revised as described in Chapter 8: Working with Your Insurance Adjusters or TPA

  1. Brought all their service providers together in a Vendors Learn and Share Day to showcase the skills each bring to the process of closing workers’ comp claims in the most efficient and cost-effective way for both employees and employer. New services were added to account handling instructions.
     
  2. Began weekly telephonic claim roundtables to review ten claims weekly for each region; the broker’s claim vice president organized these reviews and the new return-to-work coordinators participated.

These areas were revised as described in Chapter 11: Return to Work and Transitional Duty

  1. Weekly meetings were held with every employee out of work due to an occupational injury. During these meetings, increasing capacity and obstacles to transitional duty were discussed. HR also set up the weekly meetings for all injured workers out of work. Additional communication channels were also established.
  2. Job analysis was performed on each job, then a transitional duty job bank was set up for numerous types of medical restrictions. Transitional Job Task Lists were provided to each business unit during training, so they had a list of viable job options for most types of injury.

All these strategies and more are found in our training manual. Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50% (Comprehensive Edition) discusses all of these techniques and suggests ways to bring workers’ compensation practices into line with industry best practices. Many forms and documents are available through Advisen at mbastone@Advisen.com.


Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc., is a national expert in the field of workers’ compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers’ compensation costs and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling training manual on cost containment, Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.

Contact: RShafer@ReduceYourWorkersComp.com.

Case Study: International Media Outlet Reduces Workers’ Comp Costs 30% In One Year

A worldwide publishing mogul employing 30,000 employees in diverse positions (clerical, reporters, heavy-machine operators, and fleet drivers) was having no success containing workers’ compensation costs, which were rising every year.

The employer knew they were vulnerable to work comp claims because back injuries, carpal tunnel syndrome, repetitive stress disorders, slips, trips, falls, and motor vehicle accidents were common. Machinery related accidents resulted in more serious and costly claims for amputation and broken and/or crushed limbs. Repetitive trauma claims were common among employees such as reporters using computers constantly. Professionals with repetitive trauma syndrome (RTS), fearful of losing their careers, often worked through pain, causing their injuries to become far worse than normal.

The Risk Manager selected our team to help identify their main issues, develop solutions, and create a training program. The goal was to put the employer “in charge of” the work injury process. Once these changes were in place the employer noted improvements in:

  1. Adjusters learned the program and brokers gained more trust by showing them these resources.
  2. The company reported a 20% reduction in number of claims, and
  3. There was a 30% reduction in workers’ compensation losses in the first year, and in each ongoing year.

Here’s How They Did It!

After surveying their workers’ compensation management practices, the team discovered the company was strong in:

  • Hiring Practices: Using background checks, drug testing, and reference checks.
  • Medical Care Coordination: Employing a nurse at the on-site core facility to manage/document injuries; assist in drug testing.

However, they also identified three areas needing improvement:

  1. Communication with Employees (Chapter 7)
  2. Reduce Repetitive Injuries (Chapter 10).
  3. Direct Medical Care by improving penetration rate to company PPO network. (Chapter 13)

The team began by assessing what was currently in place, then they compared their results to industry Best Practices and developed a Plan for Action tailored for the employer’s workplace.

These areas were revised as described in Chapter 7: Communication with Employees.

  1. Weekly meetings were scheduled with injured employees. At these meetings, the focus was placed on the return-to-work aspect for the worker, especially setting up a target return-to-work date and assignment of a modified duty job.
  2. An experienced technical writer was hired to draft a brochure telling employees what to do when they feel pain — even the very slightest pain. The brochure described how an injury starts when they feel pain; it is then they need to start taking steps such as icing the wrists. Most importantly, they need to do simple exercises such as stretching, and take frequent breaks to avoid injury.
  3. Automated computer alerts reminded workers to take a break once an hour and workers were taught mild stretching exercises.

These areas were revised as described in Chapter 10: Wellness Programs

  1. The risk assessment team was surprised to learn that repetitive trauma claims (carpal tunnel syndrome and tendinitis) were common among employees such as reporters using computers constantly. Often, employees work through pain rather than seeking treatment immediately and actually end up worsening their condition, due to their job dedication.
  2. A wellness program was instituted to teach workers how to both avoid and treat repetitive trauma. An ergonomic specialist was called in to review the chairs and desks and to teach workers how to sit and what aids to use such as wrist supports at the keyboard, small bench under the feet to give correct alignment to the back, and use of light-weight hand “gloves.” Small packets of ice were kept in nearby refrigerators so employees could apply ice to the problematic areas of hands and wrists. They were taught that often the first symptom of carpal tunnel syndrome is pain at night and that using wrist supports at night is helpful.

These areas were revised as described in Chapter 13: Directing Medical Care

  1. The employer started using a third-party administrator’s medical reviewer to review medical records on all claims to be sure the injured employee is being treated appropriately and returns to work as soon as medically able either to full duty or in a transitions duty position.
  2. A part-time Medical Director was hired for their on-site clinic to treat not only workers immediately but also to track workplace safety. The medical director also makes referrals to other medical services as needed  and supervises the return-to-work process.

All these strategies and more are found in our book! Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50% (Comprehensive Edition) discusses all of these techniques and suggests ways to bring workers’ compensation practices into line with industry best practices.

New for 2015 in Workers Comp Guidebook

New workers comp cost-cutting topics covered in 2014 include:

  • Wellness programs
  • Working with unions
  • Layoff planning
  • Exacerbation vs. aggravation
  • Physical therapy
  • Physical and occupational rehab
  • Transportation and translation services
  • Employee communication and training
  • Safety and loss control
  • Injury triage
  • Structured settlements
  • Using MDs proactively
  • Collateral source benefits
  • Employee screening
  • Special investigations best practices
  • File review techniques
  • Medical treatment guidelines
  • Hospital bill review
  • Measuring return to work program effectiveness
  • Proactive drug management techniques
  • Chiropractic care
  • And ways to keep a small claim small

We now offer this valuable information in several options to best suit your needs.

Comprehensive” Edition

This edition covers everything from pre-loss planning to post-loss implementation in one 186-page book.

“Volume I” covers Pre-Loss Planning

WC insurance, fundamentals of cost containment, training & building commitment, injury management best practices roles & responsibilities, reporting the claim, post-injury response procedure, communication with employees, working with insurance adjusters or TPA, safety and loss control, and wellness programs.

“Volume II” covers Post-Loss Implementation

Return-to-Work & transitional duty, other indemnity cost containment methods, directing medical care, medical cost containment, fighting fraud & abuse, rehabilitating injured employees, managing prescription drug use & abuse, claims resolution & settlements, and federal employees compensation act.

MORE ABOUT THE BOOKS

“Mini Book” Summarizes Each Chapter

This 18-page version is excellent as a handout to clients and prospects. The 2014 guidebook covers the new topics shown above.

MORE ABOUT MINI BOOK

Workers Comp Book Helps Employers Cut Workers’ Comp Costs 20% to 50%

Amaxx Risk Solutions and Advisen Offer Comprehensive Guide for Employers, Insurance Brokers, TPAs, Carriers and Consultants

NEW YORK — Jan. 25, 2014—Mastering Workers’ Comp Costs, a new book from Amaxx Risk Solutions, provides detailed steps on how to develop a workers’ compensation cost-containment program proven to cut costs 20 percent to 50 percent.

Mastering Workers Comp Costs - 2014 Comprehensive EditionThe author, Rebecca Shafer, attorney and risk consultant, has worked with organizations of all types reduce workers comp costs using strategies and techniques described in the guidebook.

The two-volume workers comp guidebook is based on years of field research and implementation. Volume I covers pre-loss planning; Volume II covers post-loss implementation.

The step-by-step guidelines show how any employer can control workers’ comp costs with tighter administration and improved return-to-work efforts, steering them toward best practice strategies. Dozens of cost-reduction techniques are covered along with details for implementation.

The 2014 guidebook covers many new topics, including wellness programs, working with unions, layoff planning, exacerbation vs. aggravation, employee communication and training, safety and loss control, injury triage, structured settlements, using MDs proactively, collateral source benefits, employee screening, special investigations best practices, file review techniques, medical treatment guidelines, hospital bill review, measuring return to work program effectiveness, proactive drug management techniques, chiropractic care and ways to keep a small claim small.

Mastering Worker’s Comp Costs is available online for $249 at Advisen Corner. Volume I: Pre-Loss Planning and Volume II: Post- Loss Implementation can be ordered separately at $149 apiece.  Customized covers for agents, brokers and associations are available, and there is bulk pricing for orders of six or more copies.

An ebook version for Nook, Kindle and iPhone/iPad will be available February 1 from Amazon, Barnes & Noble and Sony. Also available is a 20 page mini-book covering key points in summary format.

For 25 years, Amaxx has helped companies in all industries reduce workers’ compensation costs. Companies working with Amaxx consultants have consistently cut workers’ comp costs from 20% to 50%.

Advisen manages business information and market data for the commercial insurance industry and maintains critical risk analytics and timesaving workflow tools for over 530 industry-leading firms and is the technology partner of Amaxx Risk Solutions. Advisen is headquartered in New York.

Media Contacts:
Michael Stack, President, Amaxx, LLC, MStack@ReduceYourWorkersComp.com
Rebecca Shafer, Author, Amaxx Risk Solutions, Inc. www.WCManual.com

Chapter 1 Summary – Workers’ Compensation Insurance Basics

Workers Compensation Basics

Workers Comp Basics

Workers’ compensation is required in all states (except TX), territories, and other developed nations for injuries and illnesses that occur in the course of employment. Under workers’ compensation:

  • Injured employees are provided with guaranteed medical and wage loss benefits without proving the employer is at fault.
     
  • Employees give up the right to sue the employer.

Companies pay for insurance according to the level of their risk. Premiums and deductibles usually increase when workers’ compensation is NOT handled efficiently.

Depending on company size and injury complexity there are many players involved in the workers’ compensation industry, such as:

  • Insurance Company
  • Broker / Agent
  • Employee
  • Third-Party Administrator
  • Employer
  • Service Providers / Vendors
  • State Commission or Board
 

For more information about this chapter, see the Table of Contents

 
 

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