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NEWSLETTERS
NEWSLETTERS
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561-683-8383
January 2007 |
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In this issue
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Case Study:
On-the-Ball Injury Management Lowers Reserves and Saves $$$ |
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InjuryFocusTM
Delayed Recovery Avoidance
A new program to help you identify those employee injuries that can drive your WorkComp costs up |
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10 Tips to Improve Injury Management Results and Improve Your Bottom Line |
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Case Study:
On-the-Ball Injury Management Lowers Reserves and Saves $$$
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Insured:
The insured is a new home contractor.
Situation:
An employee suffered a laceration to his finger while using a saw. The carrier set the highest possible reserves for disfigurement, permanent loss of use, and temporary disability warranted for this type of injury.
Assessment:
Knowing that insurance carriers routinely set high reserves on claims and keep those reserves active until the claim is closed, a Certified WorkComp Advisor (CWCA) resolved to keep close tabs on every aspect of the claim. Along with skilled in-house claims specialists, the CWCA worked with the employer, medical providers and claims adjusters to continually assess the case and adjust reserves accordingly.
Solution:
As soon as the employee was released to full duty, the CWCA asked the insurance carrier to remove any remaining reserve for disability. A short time later, the carrier made a payment to the employee for scarring, and the CWCA requested they remove any remaining reserves for disfigurement. Later, the CWCA argued successfully to lower reserves for permanent loss of use.
Result:
By the insured's next valuation date, reserves on this claim had been lowered by more than $57,000. As a result, the client's experience mod rating was 19 points lower than it otherwise would have been. This translated into a premium savings of more than $4,000.
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InjuryFocusTM
Delayed Recovery Avoidance
A new program to help you identify those employee injuries that can drive your WorkComp costs up
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Early intervention is a key to driving down Workers' Compensation costs. Yet, it is too costly to intervene on every injury since every injury does not require the same level of intervention. For every 100 employee injuries, only one to three might spin out of control. Yet, these few injuries can destroy an otherwise solid Workers' Compensation program and increase costs dramatically.
Is it possible to identify what injuries might spin out of control?
With the right data, lenders predict who will be a good credit risk and who won't. The same is true with employee injuries. With a database of more than 10 million records on injured employees now available, we can predict who will return to full productivity in the expected time period and who may be out for much longer periods. This Predictive Modeling process has been used for years. It is now being applied to job-related injuries.
How does it work?
Two employees with the same physiology and the same injury may have very different recovery durations. By gathering certain information when an employee is injured, we can identify what is known as Delayed Recovery - a disability duration out of proportion to the severity of injury or illness.
What causes Delayed Recovery?
Job dissatisfaction, a history of prior injuries, education level, length of employment, secondary medical issues such as diabetes, cardio-pulmonary problems and a lack of available modified or transition duty jobs. Using predictive modeling, we can spot employees who may experience Delayed Recovery.
Are there certain types of injuries that more frequently result in Delayed Recovery?
Typically, these will be soft tissues injuries. Sprains and strains that are often associated with minor injuries.
What can an employer do to help avoid Delayed Recovery situations?
As soon as an injury occurs, the Certified WorkComp Advisor (CWCA) obtains answers to a series of questions about the employee. Then, based on a weighted algorithm developed through extensive testing, a program provides a Low, Medium or High Predictive Indicator of Delayed Recovery score, along with an appropriate intervention program designed to counter Delayed Recovery. Armed with this plan, the CWCA works with the employer to implement the plan.
Don't just watch claim expenses climb higher over an extended "recovery" period. By working with your CWCA, you identify and mitigate potential problems before they drive up your Workers' Compensation costs.
InjuryFocus is the only web-based, user-friendly program that gives employers the tools to avoid the high cost of Delayed Recovery. To learn more, contact us. |
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10 Tips to Improve Injury Management Results and Improve Your Bottom Line
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Linda Rees-Murray, Injury Management Consultants
1. Telephonic Case Management is most effective in the first 30-days following an injury. Report injuries quickly - within 24-hours - to effectively control claims costs.
2. Allocate Workers' Comp costs directly to profit centers and operating locations. This will improve the effectiveness of your injury management process.
3. Develop provider and clinic relationships. A disengaged provider network slows both recovery and return-to-work outcomes for injured employees.
4. Have an effective Return-to-Work program. A sub optimal program will inhibit the financial impact a nurse case manager can have on the claim.
5. Have a case manager who can negotiate a release to work directly from the medical provider. This skill of negotiation is critical for a successful Return-to-Work program.
6. Be sure your medical case manager provides you with the goals of the rehabilitation plan so everyone knows what to plan for and expect.
7. Communicate these goals and timetable to the injured employee so that everyone is on the same page.
8. Beware the unintended consequences of large managed care networks. Make decisions based on medical outcomes, not discounts. Injured workers will usually listen to the advice of a case manager when it comes to the quality of care.
9. Focus care plans for injured workers on Maximum Medical Improvement (MMI) and Return-to-Work (RTW).
10. Web-based technology allows all stakeholders to see what is happening to an injured worker. Utilize this technology whenever possible.
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