Lower WC Costs 20% to 50% - Reduce Workers Compensation Expense Step by Step

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Chapter 1 Summary – Workers’ Compensation Insurance Basics

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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

Next: Fundamentals of 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.

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

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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

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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

Bulk Pricing available when purchasing over 5 copies.

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Learn more: Your Ultimate Guide to Mastering Workers’ Compensation

Aggravation vs Exacerbation

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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.

Get Well Cards (Package of 10)

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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.

For more information about these cards, contact us.

New for 2015 in Workers Comp Guidebook

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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%

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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 $299 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, [email protected]
Rebecca Shafer, Author, Amaxx Risk Solutions, Inc. www.WCManual.com

Implementing a Pharmacy Benefits Management Program

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Drug costs are not only the fastest growing component of medical care but also one of the most neglected areas of workers compensation cost control. Proper utilization of pharmacy benefits management (PBM) can result in substantial savings.

 

It is important for risk managers, insureds, and third party administers to understand how to get the most out of a PBM program.

 

Why Use Pharmacy Benefits Management?

 

To protect the employer against inappropriate prescription use.

 

Risk managers should learn about:

» Authorized drug formulary
» Evidenced based drug guidelines
» How to access medical personal
» Receiving prior authorization of non-formulary drugs
» 3 aspects of program review
» 14 key PBM service points
 

Additional PBM Factors

 

  • Prospective and retrospective components.
  • Prescription monitoring programs
  • Toxicology screening
  • How to implement a PBM program

 

 

Taking Charge of Workers’ Compensation Fraud Cases

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While workers comp claims are dropping across the US, the amount of questionable claims is rising, according to a recent study of workers’ compensation fraud cases. The most common fraud cases are related to workers who exaggerate injuries, or completely fake them, as well as file for injuries that did not occur within the workplace.

The Los Angeles Times reported on September 24, 2013:

“Over the last 2 1/2 years, the number of workers filing compensation claims has dropped from 3.35 million in 2011 to 3.24 million in 2012, according to the National Insurance Crime Bureau, a nonprofit company supported by more than 1,000 insurance companies. Based on claims filed in the first half of this year, the number is on track to drop again, the bureau said. But in the same period, questionable claims have risen from 3,474 in 2011 to 4,460 in 2012 and are on pace to rise again in 2013, the bureau reported.”

How prepared is your company to handle these rising fraud cases?

If you answer “No” to any of the following questions, read on to find out how Advisen’s Workers Compensation Management Program guidebook can help you.

  • Do you know how to determine the appropriate length of REAL MEDICAL disability or how long an injured worker SHOULD be out of work?
  • Does your company TAKE CHARGE of the injury process immediately after the injury — or do the employees be in charge?
  • Do you know the seven reasons to investigate a workers comp claim?
  • Do your supervisors know the “red flags” of fraud?
  • Are you using all SIX types of investigation?
  • Do you know the FOUR times NEVER to use investigation?
  • Are your adjusters able to identify medical terminology that signifies malingering?

The 2013 edition of Workers Compensation Management Program addresses ALL of these questions (and more) while walking you through the process of setting up appropriate procedures to reduce your WC costs 20%-50%.

Now, thru December 31, 2013, get the #1 selling WC cost containment guide for $100 off.

To purchase a copy, CLICK HERE.

Topics covered includes:

  • Workers Compensation Basics
  • Fundamentals of Cost Containment
  • Working with Your Adjusters or TPA
  • Injury Management Best Practice Roles and Responsibilities
  • Communication with Employees
  • Reporting a Claim
  • Post-Injury Response Procedure
  • Directing Medical Care
  • Return to Work and Transitional Duty
  • Other Indemnity Cost Containment Services
  • Medical Cost Containment
  • Physical Therapy & Physical Rehabilitation
  • Pharmacy Benefits Management
  • Controlling Fraud and Abuse
  • Training and Building Commitment
  • Claim Resolution and Settlement
  • Safety and Loss Control
  • Federal Employees Compensation Act

Related guidebook chapter summary:

Fighting Fraud and Abuse

Imprinted for Brokers, Carriers, and Associations

Books are available in bulk with your branding printed on the front and back covers. Learn more.

Want Something More Condensed?

The “Mini-Book” provides an abbreviated version of our complete manual’s 18 chapters and is a great handout for your clients. Each chapter is summarized onto one page for concise, valuable information at their fingertips.