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NEWSLETTERS
NEWSLETTERS
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561-683-8383
October 2006 |
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In this issue
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Case Study:
Supervisor training helps change injury pattern |
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What employers need to know about the recovery of injured workers |
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Common questions regarding alternate-duty work assignments |
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Case Study:
Supervisor training helps change injury pattern
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Insured:
A manufacturing company with 175 employees, total salaries of $6.6 million and annual revenue of $14 million in 2005.
Situation:
>From 2000 to 2006, the employer's average annual Workers' Comp costs were in excess of $80,000 per year. During that same period the manufacturer averaged 35 claims per year, causing the Experience Mod to rise to 1.12.
Assessment:
Certified WorkComp Advisors (CWCA) reviewed the client's WorkComp program in February 2006. They found that the employer had no established return-to-work program nor did he have a policy regarding the reporting of on-the-job injuries. They also found that the supervisors in the manufacturing plant were unaware of how Workers' Compensation works and how they can have an impact on the employer's costs.
Solution:
The CWCAs began by implementing the basic programs developed by the Institute of WorkComp Professionals including return-to-work, light duty assignments, employee-hiring practices and injury reporting procedures. They then held an education session for supervisors that proved to be the most enlightening part of the program. The CWCAs explained how the Experience Mod worked and how it was affecting the employer's bottom line. They also discussed the importance of the return-to-work program and how supervisors, since they have the most direct contact with the employees, play a significant role in keeping the overall claim dollars down.
Result:
Just six months into the current policy term, there have been only six claims, three of which were for reporting purposes only with no dollars paid. The cost of the remaining three claims has totaled only $3,200. While it's too early to make comparisons with previous years, it appears that the supervisor training is paying off. The employer and the supervisors were so pleased with the information and the savings that in August, they invited the CWCAs back to speak. At that meeting, several supervisors said they had brought what they had learned in the first meeting back to the employees and were able to see a marked difference in attitudes. The supervisors and employees now see that they are truly a part of the process and how they can help make the company for which they work more profitable.
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What employers need to know about the recovery of injured workers
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The Workers Comp problem
Workers' Compensation rates have been trending downward, as have the number of job-related injuries. Even injuries totaling $50,000 or more dropped for the first time in 2005.
But before we let loose the balloons and congratulate ourselves on what is clearly a notable achievement for American business, there's another side of the story that deserves serious attention.
Since the advent of managed care, Workers' Compensation medical costs have been going up. This may seem counter- intuitive since a major objective of managed care was to control medical expenses. Although managed care helped contain and even reduce medical fees, the positive benefits were eroded by increased utilization of medical services.
At the same time, companies continue to send injured workers to hospital emergency rooms where they may wait for hours to be seen by those who are not familiar with occupational medicine. Too many times, they are dropped off or accompanied by a worker. They can also be sent to the emergency room alone in a cab. It is quite possible that they will not hear from a company until they return to the job.
Since 90% of job-related injuries are first-time occurrences, workers don't realize they can get caught between a couple of obstacles: a cost-driven medical system on the one hand and a business culture that isolates them on the other.
Is it any wonder that injured workers are often confused and turn to friends for advice and counsel that lead to feelings of resentment and then to litigation?
If this all-too-common scenario is to change, employers must exert leadership. They have a major stake in making sure injured workers are cared for properly and know they are wanted back on the job as quickly as possible. It's also the employer who has the most to gain from controlling Workers' Compensation costs.
The total care solution
What is needed is a total care approach to work-related injuries. In effect, what every injured worker deserves is the right physician delivering the right treatment at the right time to facilitate the employee's return-to-work as quickly as possible.
While this seems like a worthy objective, it can be illusive. For example, Ohio employers are required to sign up with a managed care organization as part of a reform program to reduce Workers' Comp costs. Has it worked? Not according to a report in the Cleveland Plain Dealer. Over the years since the requirement has been in place, costs have not gone down. In fact, the newspaper pegs the cost of reform at $1.6 billion. While the number of claims has dropped by 48%, the annual cost to manage the system, including managed care, has gone up by $167 million.
1. Evidence-based medical treatment
The Ohio experience is quite different from what has happened elsewhere. For example, the Louisiana Workers' Compensation Corporation, a private, tax-exempt mutual insurance company, working with the Johns Hopkins University School of Medicine, set up a small, state-wide health care provider network that was based on the premise that "quality medical management aggressively applied by empowered, yet, accountable physicians trained and disciplined in common occupational care management methods and unencumbered by pre-certification requirements, will minimize or eliminate disability in the shortest time possible."
At the heart of this type of approach are evidence-based medical treatment guidelines that help reduce excessive utilization of medical services, identify counter productive procedures and focuses on clinical medical care that has the objective of returning the injured worker to full functionality as quickly as possible.
The results in Louisiana are significant. For example, the program is estimated to have saved 6,500 working days over a 12-month period and the dollar savings amounted to more than $915,294, less a small management fee.
"A Preliminary Investigation of the Effects of a Provider Network on Costs and Lost-Time in Workers' Compensation" by Bernacki, Tao and Yuspeh in the Journal of Occupational and Environmental Management, January 2005 summarizes the success of the Louisana network:
* The average and median costs of a non-network claim was $12,542 and $5,793 compared to $6,749 and $3,015 for a network claim.
* The average and median lost-time days for non network claims was 95 and 58 compared to 53.4 and 34 for network claims.
The use of treatment benchmarks or guidelines provide an objective basis for evaluating job-related injuries and help keep attention focused on a return to full functionality.
2. Evidence-based return to work
Even with such positive medical results, proper medical care is only one component of a total care program. There must also be recovery support at the workplace, one that involves an evidence-based return-to-work program.
It's worth pointing out that many return-to-work programs have not been successful, from either the perspective of employers and injured employees. Employers often view return-to-work as "make-work" and employees can be leery since they feel co-workers and supervisors will view them as slackers. In all honesty, these perceptions can be all-too- accurate.
The failure to see the workplace as having an active role in recovery from a job-related injury may help explain why return-to-work has not been embraced more fully by employers and employees. It is more appropriate to view them as two sides of the same coin, as does the American College of Occupational and Environmental Medicine.
The College describes the physician's role in return-to-work this way, "Successful return-to-work involves primarily the employee and his or her employer with the attending physician providing detailed recommendations for graded work and activity resumption."
It goes on to suggest that "the employer's role is to ensure that the workplace culture supports a timely return to meaningful work, for example, by ensuring that flexible work is available and that any restrictions and limitations recommended by the patient's physician are observed." When return-to-work is designed around evidence-based guidelines, there's a solid basis for mutual understanding between the injured worker, the medical provider and the employer. The Official Disability Guidelines 2006(ODG) of the Work Loss Data Institute contains information based on more than 10 million cases from the Centers for Disease Control and OSHA and provides "evidence-based disability duration and benchmarking data on every reportable condition." These serve to identify return-to-work opportunities to get injured workers back on the job in a time frame based on medical evidence.
It should be pointed out that when taken together, effective medical care and a beneficial return-to-work program may very well require more physician involvement than is authorized by a third party provider. The prudent employer, recognizing the value the right physician brings to facilitating the recovery at work process may well recognize the value of offering payment for additional services, as well as using the physician or clinic for employee physicals, drug testing and other services.
The goal is to is to provide every injured worker with the right physician delivering the right medical treat at the right time to facilitate the employee's return-to-work as quickly as possible. With this evidence-based process, the Workers' Compensation costs go down.
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Common questions regarding alternate-duty work assignments
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"How should the alternate-duty assignment be offered to the injured employee?"
An employer should put the offer of alternate-duty to the employee in writing. It must be for a position that has restricted duties that are within the employee's work abilities as determined by the employee's treating physician and described in a Work Status Report.
This written offer that would be signed by both employee and employer should include:
* The Work Status Report, outlining the restrictions under which the employee can work
* The location at which the employee will be working
* The schedule the employee will be working
* The wages the employee will be paid
* A description of the physical and time requirements that the position will entail
* A statement that the employer will only assign tasks consistent with the employee's physical ability, knowledge and skills and will provide training, if necessary.
One primary goal of a return-to-work program is to keep the employee connected to the workplace. In addition to clearly defining the expectations, this process is a way to reinforce the employee's value to the organization.
"How long should an alternate-duty assignment last?"
Alternate work assignments are transitional - designed to help the injured worker return to his or her original job as soon as possible. In some cases this may only be a few days, whereas others may be as much as 90 days.
There are standards regarding disability duration as noted in the article above. The expected duration of the alternate assignment should be communicated and understood by all parties - the injured employee, the treating physician and the employer - prior to beginning the assignment. Some modifications to the schedule may be needed, however, clearly defining the expectations at the beginning of the process sets goals and establishes a framework for the employee.
In some cases, inexpensive accommodations can be effective in helping the employee fully recover. According to the Job Accommodation Network, 70% of accommodations cost less than $500 and 20% cost nothing at all.
If the process takes longer than expected, you'll want to determine why. It could be that the treatment has not been adequate, that the injury was not fully diagnosed, or that the employee likes the alternate-duty job and wants to stay in it as long as possible.
Benchmarks give you the measure by which to evaluate the progress of the employee's recovery.
"How should the alternate-duty assignment be monitored?"
At the time an alternate-duty assignment is made, the employer should meet with the employee and supervisor to be sure both clearly understand the work limitations and abilities of the employee. The focus should be on both the work restrictions and abilities of the injured employee - what the employee can and cannot do must be clear to both parties.
Diary your file weekly from the date of injury to review the employee's status. After each medical visit, follow up with the treating physician to determine if the employee is making progress and if he or she can take on additional responsibilities. The goal is to gradually increase the employee's duties until he or she is able to return the original job.
Continue to get feedback from the employee and the supervisor on "how things are going." The employee and supervisor must have an open line of communication, so that any issues can be dealt with right away. Employees need to realize that employers care about their full recovery and that they are expected to show progress to remain in the alternate-duty assignment.
Successfully administering alternate-duty assignments involves a process and, therefore, the commitment of time and staff from the employer. Yet the benefits of cutting Workers' Compensation expenses and the costs associated with replacing workers far outweigh the costs of administration. Furthermore, the employees themselves benefit from improved morale and self-esteem, faster recovery, wage continuation and fewer re-injuries. The results of a well-executed return-to-work program are lower costs, improved morale and increased productivity - all contributing to an improved bottom line.
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