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NEWSLETTERS
NEWSLETTERS
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561-683-8383
December 2006 |
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In this issue
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Case Study:
Correct medical diagnosis keeps employer from feeling the pain of a mod increase |
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A gift that keeps giving: Reduced Mod |
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Web-based training for supervisors |
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Case Study:
Correct medical diagnosis keeps employer from feeling the pain of a mod increase
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Case Study: Correct medical diagnosis keeps employer from feeling the pain of a mod increase
Insured:
The insured is a water and sewer pump company and employs 27, locally. There are additional employees in two other states as well.
Situation:
An employee had undergone gall bladder surgery in late January. He was released back to work full duty (without restrictions) three weeks later. On his second day back to work, this employee was moving some cross ties and herniated his healing surgical incision, necessitating further medical and surgical interventions.
Assessment:
Certified WorkComp Advisors (CWCA) began investigating this claim and determined further assessment was necessary. An independent Registered Nurse with experience in occupational injuries was engaged and began an investigation. After reviewing the circumstances of this injury and speaking with the employer to get specifics about the employee's recent abdominal surgery, the nurse concluded that the herniation was a result of complications from the surgery.
Solution:
The independent nurse alerted the carrier to this determination and the claim was denied under Workers' Comp. The carrier agreed that this herniation was a complication of and was directly related to the recent abdominal surgery. The claim was instead submitted to the employee's health insurance plan for coverage.
Result:
This claim was closed in less than three weeks, saving the employer the cost of medical care and potential future wages. Disability guidelines report that a typical uncomplicated incisional hernia costs an average of $21,102 ($10,001 in indemnity and $11,101 in medical expenses). Had this claim been accepted under Workers' Compensation, it would have increased the employer's Experience Mod eight points, or a total of approximately $15,000 over three years (based upon the rate & payrolls remaining constant over the three year period).
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A gift that keeps giving: Reduced Mod
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A gift that keeps giving: Reduced Mod
As WorkComp Advisors, we recognize that insurance companies do not pay for employee injuries, they merely finance them. You, the employer, pay the cost and often this is two or three times the cost of the claim. Our approach is to help you to manage and control your injury costs, so that your Workers' Compensation costs are always under control.
One goal is to get your Experience Modification Factor as low as possible and to keep it there. This requires continual diligence and implementation of processes that have been proven to drive down your costs.
The chart above clearly demonstrates how the mod impacts a premium.
During a declining rate cycle, it is more difficult to lower the Experience Mod. The plan expects that if rates go down, so should injury costs. So, if injury costs don't track downward consistent with the rate decreases, then the Experience Mod goes up. An increase in the Experience Mod can, and often does, wipe out any savings from the rate reduction.
To control costs, it is critical for employers to be vigilant and aggressive in reducing their injury expenses and to stay the course. One of the major mistakes employers make is to hand over too much responsibility to the insurance company in managing injury costs. Insurance companies are neither positioned for nor capable of doing this job alone, primarily because their involvement is after the fact.
Employer involvement is essential and begins before the injury occurs. Preventing injuries goes beyond safety training and involves hiring practices, powerful employee relationships, and a positive corporate culture. After an injury occurs, aggressively managing the injury involves a 24-hour injury response, claim coordinator program, back-on-the-job program, supervisor training, medical clinic relationships, independent nurse and ongoing training.
It is our job as WorkComp Advisors to guide you in implementing these practical and proven processes that drive down costs. |
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Web-based training for supervisors
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"People often end up sitting at home collecting benefits because their employers have made the discretionary business decision not to take advantage of their available work capacity."
- Jennifer Christian, MD, MPH President, Webility Corporation
For supervisors, a difficult aspect of their job is knowing what to do when injury or illness prevents an employee from doing their regular job. The employee's injury disrupts the production schedule, puts pressure on fellow employees and places additional stress on the supervisor.
It's not surprising that a supervisor's first thought is to get a replacement. Yet, there are more effective and cost-saving solutions. This web-based training program is designed for line supervisors as well as Workers' Compensation and disability benefits staff. It is online, self-paced and interactive. Available 24/7, it takes one to two hours to complete and can be done in more than one sitting, if desired. It is provided in conjunction with Webility Corporation.
Keeping supervisors focused on the value of managing Workers' Compensation and preventing injuries is key to controlling your costs.
The course focuses on:
* how to respond when an employee becomes sick or injured and then effectively manage the situation
* how to keep your people safe and productive at work while saving the company money
* how to be a better communicator with members of your team
* how to build the team spirit that is required for high performance
* how to deal effectively with difficult situations relating to attendance and performance
For more information, contact us.
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Working with the claims adjuster
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As WorkComp Advisors, we are your advocate with the claims adjuster. Today, claims adjusters have overwhelming workloads, fewer support resources and less training. Furthermore, about 60% of the claims flow through the system smoothly, 20% need a nudge and another 20% are just plain hard.
Knowing when and how to work with adjusters is critical to be sure that the claim is handled in the most appropriate way to get results and that there is the appropriate reserve on the claim. Effective, timely and organized communication is key. As the employer, you have more information than the adjuster. Be sure to communicate all the details in a thorough and concise way. If something changes, let us know immediately.
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Q & A: Employers ask about claims
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Q. "I was in a jam and recently hired a truck driver without doing a thorough background check. In less than 90 days, he is out of work with a back injury. I have reason to believe he misrepresented himself during the interview. Is this grounds for getting the claim denied?"
A. We have all been in the situation of needing a warm body to do a job. Unfortunately, this often leads to Workers' Compensation claims. Hiring practices are a key element of controlling your Workers' Compensation costs. While we cannot predict the outcome of the claim, you would be on much firmer ground in contesting the claim if you had done a conditional offer of employment, a medical history questionnaire and a preplacement medical exam. Documenting everything in writing and following all the proper procedures gives a much better foundation for your case.
Q. "An employee recently tripped and fell and injured her hip. She is a diabetic and has arthritis. How can I be sure that the claim only includes the treatment for her injury and not the other conditions?"
A. Co-morbidity or the presence of one or more disorders or diseases in addition to the injury and the effect of such additional disorders complicates any claim. This is often a good time to involve an independent nurse. He or she has the ability to discuss the situation with the treating physician as well as working with the injured employee in a way that is supportive and not threatening.
Q. "An employee recently complained about breathing problems and asked to work from his home. The job cannot be done effectively offsite, but I don't want to invite a Workers' Compensation claim. What should I do?"
A. In a recent Rhode Island case, Mulloy vs Acushnet Company, an engineer claimed his asthma was aggravated by chemicals used in the company's plant and argued that the company violated the Americans with Disabilities Act by refusing to allow him to work remotely. The district court found after examining the job description and actual duties that working in the presence of machinery was an essential job function.
While a reasonable accommodation may include job restructuring, the law does not require an employee to accommodate a disability by foregoing an essential job function of the position or by reallocating essential functions to make other workers' jobs more onerous. While this case deals with the American Disabilities Act, you can expect more and more employees to request an accommodation to work at home. Workers' Compensation is no exception. To preserve your right to say "no", you might want to amend your job descriptions to require physical presence as an essential job function.
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