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

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%.


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.