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A 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%.

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