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NEWSLETTERS
NEWSLETTERS
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In this issue
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Case Study: Discovery of Coding Error Saves Modular Home Manufacturer $5,000
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The 'perceived boss' may be the silver bullet in controlling Workers' Compensation costs
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Health and wellness programs in the workplace reduce lost time due to hypertension and diabetes
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Case Study: Discovery of Coding Error Saves Modular Home Manufacturer $5,000
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Implementation of comprehensive Workers' Compensation program saves Modular Home Manufacturer $5,000 and lowers Experience Mod
Insured
The company is a manufacturer of modular homes with more than 40 employees.
Situation
The company's Experience Modification Factor had climbed steadily to 1.07 and management did not understand why.
Assessment
Certified WorkComp Advisors (CWCAs) were called in to review the claims after one of the owners attended a Workers' Compensation cost reduction workshop.
The Advisors discovered that the insurance company had made a coding mistake with a series of claims relating to knee, shoulder and hand injuries. Some had been miscoded as indemnity claims instead of medical-only claims. This company is in one of 38 states where medical-only claims are discounted 70%, while claims involving indemnity and medical are charged at 100%. This coding error had driven up the company Experience Mod.
Solution
The CWCAs requested that the insurance company inform the rating bureau of the error and correct both the coding and the Experience Mod.
In addition, the CWCAs developed a Workers' Comp plan for the company, including regular meetings with management to review Workers' Comp issues, setting up mandatory safety meetings, coordinating loss control services and claims monitoring.
In addition, a relationship between the company and an occupational medical clinic was established for the treatment of job-related injuries. Working with the clinic, drug testing and return-to-work programs were implemented. A return-to-work program helps keep the injured employee focused on recovery at work and assists in reducing both medical expenses and time off the job.
Result
As a result of the work by the CWCAs, the company's Experience Mod dropped from 1.07 to 1.00, netting the company a $5,000 annual premium savings, while the overall Workers' Comp plan will produce continued cost reductions over the years.
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The 'perceived boss' may be the silver bullet in controlling Workers' Compensation costs
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There is an obvious, yet often overlooked, factor in controlling the costs of Workers' Compensation. It is the immediate supervisor, or more accurately, the person who is the perceived boss of the injured employee. While this may seem like a no-brainer, in the typical injury management process the supervisor's involvement ends after the due diligence of reporting and investigating the accident and resumes when the injured employee returns to work. During the injured worker's recovery period, there is a "supervisor's gap," while the medical provider and insurance company take control.
On the surface, the "supervisor's gap" makes sense. The pressures and frustrations created by the unexpected absence of the injured employee are felt immediately, disrupting production schedules and increasing demands on fellow employees. Taking care of the tasks at hand becomes the supervisor's focus, while the medical provider focuses on the care of the injured employee and the insurance company monitors the claim. In some cases there may be a case manager or HR person assigned to the employee, but the perceived boss is temporarily disengaged.
Even if the medical provider is an occupational health expert firmly committed to following treatment protocols aimed at returning the employee to work, the "supervisor's gap" can cause delays in getting the injured employee back on the job. Researchers from Brigham Young University's Department of Economics examined the effects of workers' satisfaction with their employers' response to a Workers' Compensation back claim over a 12-month period. They then compared it to the effects of their satisfaction with health care on post-onset patterns of employment. The focus on back pain is relevant because of the frequency of the problem and because, for many workers, back pain follows an episodic course of periods of recovery and employment interspersed with periods of pain and work absence.
The results are presented in "It Pays to be Nice: Employer-Worker Relationships and the Management of Back Pain Claims," an article in the Journal of Occupational & Environmental Medicine by Richard Butler, PhD, William Johnson, PhD and Pierre Cote, D.C., PhD. Validating the powerful role of immediate supervisors, they conclude that workers' satisfaction with their employers' behavior has a much larger impact on employment stability than does their satisfaction with health care providers. The implications of this finding for employers are significant:
1. Cost savings: reduction in number of lost time claims
The study finds that workers who are satisfied with their employer's response are more likely to have a medical only claim (64% versus 56%) than those who are dissatisfied. Also, for those workers who do have at least one lost time claim, there is a lower likelihood of multiple episodes of injury-related absences. Only 32% of those satisfied with their employer's response end up with multiple episodes of injury-related absences whereas 58% of those dissatisfied with their employer's response had multiple absences.
2. The workplace response is key
Even companies with strong return-to-work programs can be challenged by seemingly conflicting objectives and adversarial attitudes. By reintegrating workers who are not yet "100%," employers and employees benefit from maintaining a skilled workforce, reduced stress on co-workers (who are expected to cover for absences), and improved employee/management relationships where workers have a greater sense of security and commitment. At the same time, there are concerns about how productivity is affected and in some cases injured workers are treated with suspicion as to the legitimacy of their claims.
It's easy to understand this conflict. Although responding in the best interests of the employee will ultimately benefit the company, it can be difficult to keep the long-term goals in focus, with the immediate demands of production. Deadlines remain the same and supervisors have the same productivity requirements. They think most about getting a replacement for the injured worker and don't understand the value and potential cost savings of returning the injured employee to work sooner rather than later. The supervisor develops an attitude that dealing with the injured employee only adds to an already demanding workload and lets the employee fall off the radar screen. Unwittingly, the company conveys to the injured worker that maximizing profits is the priority and not the well-being of the worker.
Injured workers who feel alienated by the employers' reaction to their claim will be reluctant to cooperate and may extend the duration of their absence or have more frequent reoccurrences, as found in the study by Butler, Johnson and Cote. The bottom line: increased Workers' Compensation costs.
3. Supervisors need to be trained in a continuous communication strategy
Employers rarely assess their response to workplace injuries from the perspective of their employees. Production issues and injury prevention measures govern the employer's actions. Yet, equally important, but often neglected, is the building of a relationship of trust with the injured employee. This relationship must begin prior to the injury and must exist through the entire continuum of care after the injury.
The most effective way to develop trust is with clear, frequent, supportive communication from the supervisor. Supervisors should be encouraged to maintain supportive and regular contact with workers who are off the job after an injury, even if a return to work is not imminent.
Consider the case of a systems analyst at a leading international supplier. Prior to her disability, the analyst enjoyed a positive, supportive relationship with her supervisor. Since her disability, the contact has been strictly from HR personnel for administrative purposes, the medical provider and the insurance company. The employee feels abandoned and undervalued, resulting in little motivation to return to work. The contact from HR is no substitute for the empathic response she had expected from her supervisor.
A qualitative study, "Employee Perspectives on the Role of Supervisors to Prevent Workplace Disability After Injuries," published in the Journal of Occupational Rehabilitation, cites several authors who find negative employer responses and lack of employee contact as important correlates of prolonged disability. While in some cases the neglect stems from supervisors' workload and attitude, in other cases supervisors may censor their interactions with injured workers after the filing of a claim because they believe they are interfering with a strictly medical or human relations issue. Unless supervisors are given permission and trained in a continuous communication strategy, they will be unwilling to overstep their boundaries, creating the perilous "supervisor's gap."
The study suggests a leadership style that is more people-oriented and focused on human relation aspects of supervision may be better suited for managing workplace disability. While the supervisor in the case of the systems analyst possesses these qualities, the "supervisor's gap" created a communications barrier that resulted in a negative outcome for both the employee and employer.
The failure of the employer to see the supervisor as having an active role in the recovery of the injured worker may explain the reluctance of supervisors to become involved. Supervisors often don't appreciate the power of their role- that the importance of the injured worker's perception of their relationship is likely to be even greater than that of the relationship with the doctor.
How do supervisors build that positive perception with an injured employee? It has far more to do with people management skills than with disability management abilities. It requires active listening, being responsive, showing concern and empathy, validating the employee's pain, demonstrating respect and fairness and following up. Furthermore, it means engaging the injured employee in problem solving, communicating to the employee that returning to work will accelerate the healing process, and working with the employee in conjunction with the doctor.
Once employers recognize that return to work is not solely determined by medical conditions but is a composite outcome of health, social, work and personal conditions, they will better understand the importance of supervisor training. One hundred eight supervisors from seven employers in New England participated in a brief, management-supported supervisor training program in disability management conducted by Robert McLellan, Glenn Pransky and William Shaw. The study, published in the Journal of Occupational Rehabilitation, suggests that the program led to a small, but sustained change in supervisor attitudes.
Despite the absence of any interval training or specific reinforcement, the one-year post-training assessment identified communication factors as most important in the supervisors' efforts to reduce disability among workers. Asking how the employee was feeling and expressing support and respect for the employee were ranked number one and two. The responses of the supervisors suggested at the time of the injury, "improving emphatic work site intervention was considered a more critical change than providing employees better access to medical care."
In May 2006, Certified WorkComp Advisors conducted a training session for 34 supervisors of a social service agency. In one six-month period, the employer experienced 27 Workers' Compensation claims totaling $89,000. Supervisors played no role in managing employee injuries and made no effort to stay in touch with employees or return them to work on modified duty.
The training session explained how claim costs impact Workers' Compensation insurance premiums, how to work with an occupational medical clinic, how to support employees and manage a comprehensive return to work program. With this new awareness, over the next six months claim frequency was cut to 11. Amazingly, these 11 claims totaled less than $1000.
Properly trained, supervisors can be a significant source of social support that in turn can accelerate return to work. With appropriate communication, supervisors can ease the stress of injury and absence from work by expressing a positive attitude that makes the employee feel they are wanted back at work and are not considered a burden. In addition, supervisors know the personalities of their employees and with frequent communications, they can best identify problems in the return to work process and seek the appropriate help.
For most employees, being injured at work is a first-time occurrence. It can be a confusing and depressing experience that can negatively shape an employee's attitude or it can be an opportunity for the supervisor to "be nice" by demonstrating care and support for an injured worker, improving morale, allaying fears and accelerating recovery time.
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Health and wellness programs in the workplace reduce lost time due to hypertension and diabetes
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According to a new study presented at an American Heart Association-sponsored conference in Washington, health and wellness programs can improve employee health and reduce lost time from the job. The study also found that absenteeism declined significantly among those with hypertension and diabetes.
Employees who took part in the program improved their blood pressure control by 9% - the number of employees with normal blood pressure increased from 28% to 37%. At the same time, the number of employees missing work as a result of hypertension dropped to 15.6% from 25.8%.
Employees with diabetes improved the control of the disease by 15% - the percentage with normal blood sugar increased from 43% to 58%. In addition the percentage of those missing work due to diabetes dropped to less than 17% from 50%.
Over a three-year period (2004 - 2006), 2100 employees at a municipal utility in Jacksonville, Fla who participated in a comprehensive wellness program, including health education, screenings, and coaching were monitored. The utility has a predominately male workforce (median age 47) and with the aging, male dominated workforce there was particular concern for cardiovascular disease.
Workplace accidents also dropped from 83 in 2003 to 25 in 2006. Of the 83 incidents in 2003, 20 resulted in time away from work, compared with seven of the 25 incidents in 2006.
Employees had started their own worksite health program in 1989, taking out a loan for the equipment while the company provided the space. Over time, the company began to notice benefits to helping workers stay fit. According to the lead author of the study, Sharon A. Clark, D.H.Sc., "The program has grown to where it is now part of the company's strategic plan."
Coaching was an important part of the program. In addition to knowing that something should change, individuals need the motivation and interest to change their habits and lifestyle to improve their overall health.
For information on health and wellness programs, contact us.
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New rules of Electronic Discovery have important implications for employers
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On December 1, 2006, the electronic discovery-related amendments to the Federal Rules of Civil Procedure went into effect. The pre-cursor to the amendments was the case of Zubulake v. UBS Warburg, a gender discrimination/ retaliation suit against a former employer. The discovery request asked for all documents concerning any communication by and between UBS employees concerning the Plaintiff. While UBS produced approximately 350 pages of documents, including 100 pages of emails, Zubulake produced 450 pages of emails herself.
The court found that UBS failed to adhere to its own document retention policy and ordered UBS to pay the cost for Zubulake to depose certain witnesses relating to the destruction of evidence. The case put businesses and their counsel "fully on notice of their responsibility to preserve and produce electronically stored information." In other words, businesses cannot claim to be computer illiterate.
The upshot of this case is the importance of developing and implementing a reasonable document retention and destruction policy. The policy should adhere to federal, state and local regulations and documents should be retained and destroyed in accordance with the policy. There should be a plan to locate and preserve electronic data on secondary sources such as PDA's, voice mail, instant messaging, etc. There should also be a policy regarding the use of personal cell phones, text messaging, home computers, flash drives, web pages, etc. for work-related issued.
If litigation is commenced, all purging should be stopped; key players identified and a "forsenic mirror image" of the computers of key players made: key personnel should be quickly notified of a litigation hold and also when the hold is lifted; a meeting between your lawyers and IT personnel should be held as soon as litigation is initiated.
As technology continues to expand the channels of communication, it is important to establish a clear policy that meets with the approval of your legal counsel.
("How the New Rules of Electronic Discovery Affect Your Business" - A Program by Clay Mingus, Elarbee, Thompson, Sapp & Wilson LLP.)
Claim reserves are the estimated cost to resolve existing claims and are established by the claims adjuster. It is important to note that reserves for unpaid claims are counted as if they have been paid in calculating the Experience Modification Factor and therefore are an important determinant of your Workers' Compensation costs.
Reserves should be set based on the most likely outcome of the claim, following the claim investigation. Estimates of the amount of time the injured employee is expected to be out of work, indemnity payments, cost of medical care, rehabilitation and legal expenses are all factors used to determine the estimated reserve.
Reserves can change for a number of reasons. There can be a failure to grasp the full significance of a claim and to plan an appropriate resolution. The adjuster is merely adjusting to events as they unfold. It's also possible that the employee is not motivated to return to work and has developed a "disability attitude" or that there is no return-to-work program in place to accommodate the worker's restrictions.
Proper management of claims is important not only to reduce costs, but also to identify cases that are malingering or may have reserves set too high. Certified WorkComp Advisors are trained to understand your business and monitor reserves to be sure that they precisely reflect the particular situation and receive the attention they need.
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