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Chapter 6 Summary – Post-Injury Response Procedures

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Post-injury response procedures are a set of written guidelines detailing roles and responsibilities from when a work-related injury first occurs through the first 24-48 hours. The procedures map the steps employee, supervisor, and witnesses must take immediately following a work-related injury.

Using a consistent post-injury response procedure allows the company to exercise its management responsibility to ensure injured employees receive prompt medical care and then return to work quickly.

Written procedures include clearly defined best practices for:

  • Employees
  • Supervisors
  • Medical providers, including onsite providers

Employers need to develop/implement these tools and documents outlining steps to take from injury to recovery:

  • Post-Injury Response Procedure
  • Employee Brochure
  • Employee Instructions
  • Work Ability Form
  • And More

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

Previous: Reporting the Claim
Next: Communication with Employees

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Chapter 7 Summary – Communication with Employees

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Communication with Employees
Communication with Employees

A strong communication strategy is the key to a successful workers’ compensation management program. Both proactive and reactive communication is critical to saving money in a company’s workers’ compensation program by training employees before an injury occurs and reacting correctly after an injury occurs in the workplace.

Proactive communication is written/verbal communication the employer disseminates to employees about the company’s policies, programs, and procedures expected of them following a work-related injury.

Reactive communication is the post injury communication the company establishes and maintains with its injured workers so they remain psychologically connected during recuperation and focused on the final objective of returning to work as healthy, productive employees.

Workers’ compensation best practices include:

  • Using a mission statement to outline the organization’s worker compensation policies and employee expectations.
  • Outlining injured employee benefits and delivering those benefits on time.
  • Using formal communication with injury response steps and written policies.
  • Using informal communication such a “Get Well” card.
  • And More

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

Previous: Post-Injury Response Procedure
Next: Working with Your Insurance Adjusters or TPA

To order our guidebook, click the button that meets your needs:

For more information about our workers comp cost-reduction book, contact us.

Chapter 18 Summary – Claims Resolution and Settlements

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Resolving and settling workers’ compensation claims is a complex process requiring adjusters, medical providers, attorneys, and workers’ compensation coordinators to have an in-depth knowledge of multiple areas of the law, including workers’ compensation, product liability, and general liability legal issues.

The effective adjuster develops the talent to negotiate the claim by emphasizing its strengths. Prior to starting the settlement negotiations, the adjuster outlines in an Action Plan the strengths and weaknesses of the claim, obtains settlement authority, and develops a strategy to stress the reasons the claim should be settled for the amount the adjuster recommends.

Establish Value of the Claim

As part of any negotiation, the adjuster must establish the value of the claim and a settlement range for the claim based upon the strengths and weaknesses evaluation. Establishing future medical costs and the degree of medical disability is critical to a fair settlement value. In some states, medical costs cannot be closed or settled but other parts of the claim can be.

Ability to Return to Work

Lack of future employment and the disabled employee’s inability to return to work increases the value of a claim. The longer the employee has been out of work, the higher the settlement range is likely to be. For this reason, adjusters and workers’ compensation coordinators must determine if there are other positions available for the employee with permanent disability restrictions. It is generally better to find a position within the organization, but there are times when employment must be found elsewhere. Try to find employment for the employee as close to, or higher than, the original wages because the settlement will be larger if the post-injury wages are lower than the pre-injury wages.

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

Previous: Managing Prescription Drug Use and Abuse
Next: Federal Employees Compensation Act

To order our guidebook, click the button that meets your needs:

For more information about our workers comp cost-reduction book, contact us.

Chapter 8 Summary – Working with Your Adjusters or TPA

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Working with Your Adjusters or TPA
Working with Your Adjusters or TPA

Employers and risk managers need to know the services provided by their insurance company and/or their third-party administrator (TPA). If employers are not satisfied with the performance of the adjusters assigned to their account, they need to know how to correct the problem.

Cost Reduction Areas to Consider:

  • Bundled services
    When the same insurance company provides the insurance and administers the claims.
  • Unbundled services
    The insurance and claims adjusting functions are separate.
  • Deductible affects control
    The higher the deductible, the more control the employer has over how claims are handled. Self-insured organizations have the most control over their claims.
  • Communication and meeting with claim partners and handlers
    Best Practices require regular communication.
  • Reviewing open claims regularly
    Discuss claims and transitional duty opportunities; assess employee return-to-work status; fine tune plans of action; check for fraud; and develop a time line for claim resolution.
  • Account handling instructions address:
    • Settlement authority
    • Timing of status reports
    • Subrogation waivers
    • Recorded statements
    • And More

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

Previous: Communication with Employees
Next: Safety and Loss Control

To order our guidebook, click the button that meets your needs:

For more information about our workers comp cost-reduction book, contact us.

Chapter 13 Summary – Directing Medical Care

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Keeping in contact with injured workers and the employee’s medical providers is an important step to integrating injury-related medical care. Employers and risk managers need to gain the cooperation of medical providers to convey how the company cares about its employees.

In order to take control of the medical process, risk managers need to be familiar with different types of physicians and medical advisors. Some of the most common are:

  • Primary Treating Physician
  • In-house Medical Advisor
  • Preferred Provider Organization Doctor
  • Independent Medical Evaluation Physician
  • Specialists
  • On-site Occupational Clinic
  • Physician Peer Reviewers
  • Remote Health Services

The employer must know how physician selection is handled in each state – primarily: Who may select the treating physician/clinic: the employer or the employee?

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

Previous: Other Indemnity Cost-Containment Methods
Next: Medical Cost Containment

To order our guidebook, click the button that meets your needs:

For more information about our workers comp cost-reduction book, contact us.

Chapter 10 Summary – Wellness Programs

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Employers taking an active interest in the medical status of their employees have a far-reaching positive impact. Both employer and employee benefit by eliminating unhealthy lifestyle habits.

  • The employer experiences lower insurance costs and higher productivity when the employee is on the job working.
  • Employers offer incentives to encourage employees to attain acceptable ranges of body mass index, blood sugar, blood pressure, cholesterol and to attest to being tobacco free.
  • The employee experiences better health and an enhanced lifestyle by participating in employer-provided wellness programs and gains improved return-to-work readiness if injured.
  • An employee incentives can include cash payments equal to a percentage of the cost of an individual health insurance policy.

Negative Effective of NOT Having a Wellness Program

Comorbid conditions, such as obesity, smoking, poor physical condition, diabetes, migraines, chronic pain, and substance abuse often complicate injuries and, when surgical repair is involved, recovery can be longer and more expensive.

Types of Wellness Programs

  • Weight Control
  • Smoking Cessation
  • Depression/Anxiety Awareness Treatment
  • And More

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

To order our guidebook, click the button that meets your needs:

For more information about our workers comp cost-reduction book, contact us.

 

Chapter 3 Summary – Training and Building Commitment

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Before implementing a workers’ compensation management program, all employees must be made aware of changes, and senior management and supervisors must be trained in using new forms and procedures.

Key Training Activities

  • Identify and catalog day-to-day responsibilities.
     
  • Factor in new processes and procedures to develop an implementation strategy for existing and new responsibilities.
     
  • Communicate new processes to all employees.
     
  • Disseminate new policies and procedures.
     
  • Promote the program via memos, brochures, posters, newsletters.
     
  • Reinforce management commitment of top managers.
     
  • Identify and document transitional duty jobs.
     
  • Incorporate new policies/procedures into new hire packets.

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

Previous: Fundamentals of Cost Containment
Next: Injury Management Best Practices Roles and Responsibilities
 

To order our guidebook, click the button that meets your needs:

For more information about our workers comp cost-reduction book, contact us.

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

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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.

To order our guidebook, click the button that meets your needs:

For more information about our workers comp cost-reduction book, contact us.

 

Chapter 19 Summary – Federal Employees Compensation Act

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Federal employees injured on the job are entitled to workers compensation. There are several different federal workers compensation programs related to different populations of workers, but the majority of federal workers fall under the provisions of the Federal Employees Compensation Act (FECA).

FECA provides medical and wage loss compensation benefits to civilian employees of the United States for disability due to injury or disease sustained while in the performance of work duty. FECA also provides for the payment of benefits to dependents if a work-related injury or disease causes an employee’s death.
FECA Basics

  • Who Pays for FECA Costs
  • How is FECA Administered
  • Selecting Medical Providers
  • Medical Benefits
  • Lost Wages Federal Employees Receive
  • Permanent Disability or Death
  • Registering as a Federal Medical Provider
  • Cost Control Challenges
    1. Compensation
    2. Medical
    3. Legal
    4. Administrative
    5. Three-Level Claimant-Oriented Process
    6. Presidential Protecting Our Workers and Ensuring Reemployment
  • And More

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

Previous: Claims Resolution and Settlements

To order our guidebook, click the button that meets your needs:

For more information about our workers comp cost-reduction book, contact us.

Chapter 14 Summary – Medical Cost Containment

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Medical costs CAN be controlled or contained using a variety of strategies. Third-party administrators and insurance company claims administration teams offer various services to reduce medical costs.

Medical cost control is fee management achievable by either:

  1. reducing the number of treatments,
  2. reducing the cost of treatments, or
  3. purchasing premium services.

This last option, costing more initially, reduces the length of time an employee is out of work.

The services available to reduce medical costs include:

  • Injury Triage
  • Preferred Provider Organization
  • Telephonic Nurse Case Management
  • Field Case Management
  • Mental Health RNs
  • Chronic Pain Programs
  • Aging Workforce Programs
  • Peer Review/Utilization Review
  • Medical Directors and Medical Advisors
  • Independent Medical Evaluations
  • Durable Medical Equipment
  • At-Home Recovery Services
  • Medical Bill Review
  • Chiropractic Care

The employer must understand how these services work and the value they bring to the company’s unique workers’ compensation situation. It is not a “one size fits all” solution for cost reduction. For example, telephonic nurse case management incurs certain fees, requires the nurse case manager to hold certain licenses depending on jurisdiction, and is used when claims are complex or in lost time claims where length of time out of work is disproportionate to the injury.

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

Previous: Directing Medical Care
Next: Fighting Fraud and Abuse

To order our guidebook, click the button that meets your needs:

For more information about our workers comp cost-reduction book, contact us.