|
NEWSLETTERS
NEWSLETTERS
|
In this issue
|
| • |
Case Study: Glass manufacturer avoids loss through Return-To-Work program |
| • |
Keeping employees healthy top workforce issue in 2009
|
| • |
Two keys to reducing costs: prompt reporting and nursing triage |
|
Case Study: Glass manufacturer avoids loss through Return-To-Work program
|
Insured
The business is a commercial glass manufacturer that employs 40-50 workers.
Situation
An employee suffered a shoulder injury while moving large plates of glass. The immediate medical diagnosis by the treating physician was for two weeks off duty. As a result, the employer was faced with a substantial indemnity claim and potential increase in both Experience Mod and annual premiums over the next three years.
Assessment
It was determined that the injured employee had made no effort to communicate to the doctor that the company had a Return-To-Work program, instituted by the Certified WorkComp Advisors (CWCA). Nor had the doctor taken the initiative to learn about the program and available transitional opportunities before submitting his medical evaluation.
Solution
The CWCAs contacted the doctors office on several occasions, explaining the companys Return-To-Work program, and how it would be beneficial to the employer, employee and the doctors office. The doctor agreed and re-wrote the evaluation, prescribing an immediate return to work on restricted duty for two weeks. At the end of the 14 days, the employee returned to full duty status.
Result
As a result of actions taken by the CWCAs, potential malingering and loss time were avoided and the claim was kept out of the indemnity category. This enabled the company to bypass a potential claim of $12,000 and a resulting increase in its MOD and premiums.
|
|
Keeping employees healthy top workforce issue in 2009
|
Challenges for Health Care in Uncertain Times, Hewitts Associates 10th Annual Health Care Report concludes that keeping employees healthy has become the primary workforce issue in 2009 with employers shifting focus from managing costs to managing health risk a cost driver. Recognizing the relationship of employee behavior and health risks to costs, employers now rank promoting employee accountability the number one prevention component of health care strategies in 2009.
How does this affect the way employers approach their health benefits and Workers Compensation programs? One major shift is that more employers are targeting specific health conditions for their employee population than in previous years. Companies targeting asthma, cardiovascular disease, depression, and diabetes increased at least 20% compared to last year. In addition, more organizations are targeting more than one condition. In 2008, only 52% of organizations reported targeting specific conditions, whereas in 2009 the figure increased to 80%.
While employers are recognizing that obesity, diabetes, high blood pressure and other common health conditions are having an enormous impact on the cost of health care, they may be less aware of the impact these conditions can have on the duration and cost of recovery of workplace injuries.
Preliminary research findings of an upcoming report by the National Council on Compensation Insurance (NCCI) on obesity shows that Workers Comp claims unresolved for one year cost three times as much when the injured employee is obese and claims that are unresolved for five years are five times more costly when involving an obese claimant. The cost differential is even greater for smaller claims, in some cases as high as 30 times.
In the past, Workers Compensation has focused on treating specific injured body parts and not put much emphasis on co-morbidity factors, such as obesity, that can increase claim duration and costs. In addition, the stigma associated with obesity, concerns about privacy and lawsuits and the sensitivity of the issue has meant that obesity is addressed in health plans and wellness programs; however, not in Workers' Comp claims, even though it may affect Workers Comp claims.
This is changing, however, according to a recent article by Robert Cencineros in Financial Week, Obesity Supersizing Workers Comp Costs. Martin Wolf, an economist with NCCI Holdings Inc. in Hoboken, N.J. is quoted, One thing we have been seeing a little bit is that when a claim is filed, insurers are gathering additional information on body mass index and weight and height to see if people who show up as obese need additional medical treatment to more effectively address their injury.
Some employers even are collecting obesity data to help fend off future claims that may not be work-related, particularly those involving police and firefighters who must take pre-employment physicals and whose heart attacks and other ailments often are presumed to be work-related, according to Glenn Backus, senior vice president for Alternative Service Concepts L.L.C., a Reno, Nev.- based claims administrator.
Preliminary findings of the NCCI report also note that the percentage effect of obesity on claim costs is lower in states where mandatory utilization review and mandatory bill review stipulations are in place.
Increasingly Workers Comp case managers are incorporating an injured employees health condition into case planning and looking for resources to help the employee address the problem, particularly when it relates to return to work outcomes. This points out the need for a more holistic approach to health and Workers Comp. Too often, the programs are managed in different departments, independent of one another, with risk and safety managers overseeing Workers Comp and HR administering group health and wellness programs. Yet, it stands to reason if you can eliminate bad health habits in the workforce, you will save on Workers Comp costs.
Quit smoking, lose weight, get the right medical tests at the right timethese will help lower Workers Comp costs, says Robert Hartwig, president of the New York City-based Insurance Information Institute (I.I.I). When theres an injury on the job, healthier workers tend to recover more quickly, which then benefits the employer through less loss of productivity and so on.
A comprehensive, integrated look at the health of the workforce means that risk and safety managers should be an integral part of the development of programs to make the workforce healthier. Wisconsin-based printing company, Quad/Graphics found that individuals with low back pain were much more likely to be overweight and smokers, so they turned to their wellness program to address the issue.
Employers have done an exceptional job of making the workplace safe; now is the time to focus on the health of the worker. An unhealthy worker is going to cost more in terms of absenteeism, lost productivity and recovery time. Employers who create a wellness culture are better positioned not only to treat injuries effectively, but also incentivize the employee to deal with the root of the problem.
|
|
Two keys to reducing costs: prompt reporting and nursing triage
|
Prompt claim reporting can be a challenge for employers that have experienced reductions in workforces; however, its importance should not be overlooked. Statistics documenting the costs of delayed reporting are plentiful. The Hartford Research Study (2004) found that claims filed a month or more after an injury cost an average of 48% more to settle than those reported in the first week. Even a weeks delay can increase claims costs by 10%.
According to a National Council on Compensation Insurance (NCCI) study, late reporting also means more attorney involvement. 22% of claims reported within ten days are litigated compared with 47% of those reported more than 31 days after the injury occurred. Furthermore, delays in reporting a claim means delays in starting appropriate medical treatment adding to the cost of medical care and wage replacement.
To effectively control claims, a 24-hour injury response process must be in place.
Some employers have taken this a step further and instituted telephonic nursing management to promote prompt reporting and offer immediate injury medical intervention. Called nursing triage, this system has long been used by group health plans to provide members with medical advice and to triage patients to the most appropriate level of care. Now many employers are leveraging the same strategy to reduce their Workers Comp costs.
An employee who is injured at work calls a nurse-staffed case management helpline to report an injury any time of day. Nurses are trained to perform thorough questioning to gather comprehensive injury information, which assists in claims management. The triage nurse handles all the required paperwork and completes the first report of injury, disseminating it quickly to all the appropriate stakeholders, including the employer, supervisor, physician and claims administrator. This allows each stakeholder to respond quickly and optimally impact the claims outcome.
Beyond timely reporting with nursing triage, every injury receives the care and treatment appropriate to its level of medical severity. This process removes the supervisor from the medical component of the claim. Lacking medical skills, supervisors often err on the side of caution, sending employeeseven those with minor injuriesto the emergency room, costing several hundreds of dollars.
Using treatment protocols and sophisticated algorithms, the triage nurse systematically identifies the right course of treatment. With minor injuries, the nurse may provide simple first aid or self care guidelines over the phone, or send the patient to an occupational clinic in the employers preferred provider network.
A Public Entity Risk Institute (PERI) report, The Day of Injury Study 2005, that studied the nurse triage program instituted by the Schools Insurance Authority (SIA) in California concludes that employees were highly satisfied with the nurse triage process and that 94% of all claims requiring only first aid advice remained in a no-claim status 90 days post injury. Litigation rates dropped 67% and remained about 20% below the California state average for Workers Comp claims.
There are other cost-saving benefits of a nurse triage system. Increased utilization of preferred occupational medicine providers and coordination with return to work programs help reduce lost days, indemnity costs, disability expenses and temporary labor expenditures.
|
Q & A: OSHA opinion on horseplay injuries; sports activities
|
Q. When horseplay between workers turns violent is the resulting injury an OSHA recordable?
A. In February 2009, OSHA issued a letter of interpretation regarding an incident between two workers in a construction trailer.
The workers, both supervisors, entered the trailer to change clothes at the end of their shift and engaged in banter that escalated into a physical fight. One of the workers allegedly pulled a knife and stabbed the other in the right bicep, causing a laceration that required sutures.
The contractor sought clarification on whether the injury was considered work-related, and thus recordable, under OSHA regulations. In his response, Keith Goddard, director of OSHA's Directorate of Evaluation and Analysis, noted, "We assume that the supervisors were in the change trailer as a part of their work or as a condition of their employment. If our assumption is correct, the injury resulted from an event (the altercation between the two supervisors) occurring in the work environment and was thus work-related.
Q. An employee has asked the company to sponsor a softball team. If an employee is injured while playing could this become a Workers Comp claim?
A. Company-sponsored sports and recreational activities do carry potential liability. Employers may reduce their exposure to potential liability by:
-Have activities take place off the business premises and outside of normal business hours.
-Stressing that participation is strictly voluntary.
-Do not benefit the business beyond the benefits of improved morale.
-Leaving administration of events to employees, to the extent possible.
-Having employees sign waivers relieving the company of liability for injuries sustained during participation. (Legal counsel should review and approve any use of such forms.)
Employers who decide to implement or sponsor such activities should work closely with their legal counsel to assess potential liability and to minimize their risk.
|
|
Previous Newsletters
May-2009
Apr-2009
Mar-2009
Feb-2009
Jan-2009
Dec-2008
Nov-2008
Oct-2008
Sep-2008
Aug-2008
Jul-2008
Jun-2008
May-2008
Apr-2008
Mar-2008
Feb-2008
Jan-2008
Dec-2007
Nov-2007
Oct-2007
Sep-2007
Aug-2007
Jul-2007
Jun-2007
May-2007
Apr-2007
Mar-2007
Feb-2007
Jan-2007
Dec-2006
Nov-2006
Oct-2006
Sep-2006
Aug-2006
Jul-2006
Jun-2006
May-2006
Apr-2006
Mar-2006
Feb-2006
Jan-2006
|
