Workers’ Compensation and the Holistic Approach

A Holistic Blueprint:

 

Designing, Implementing and Controlling Workers’ Compensation Costs

 

Due to the unique and complex nature of the workers’ compensation system, only a holistic approach — one considering all elements within context can succeed in reducing an employer’s workers’ comp costs.

 

Employers, insurers and brokers working together have strong incentives to attack the costs of workers’ compensation. An effective program begins with education. First, a needs assessment must be conducted to determine what knowledge gaps exist. The risk manager must gain the support of senior management, employees and physicians to implement a holistic program. If there is resistance from senior management it’s important to find out why the costs are high. Getting your National Workers’ Compensation Score™ is an excellent starting point. Much like a credit score, the employer knows how many best practices they have implemented.

 

Employers Benefits By:

 

1.      Seeing major improvements in workers’ compensation costs.

 

2.      Taking control of the entire workers’ compensation process, potentially cutting costs by 20% to 50%.

 

3.      Providing aggressive and comprehensive pre-loss and post-loss management initiatives affecting all areas of workers’ compensation.

 

4.      Pre-loss: Includes safety programs and extensive communication with senior management, supervisors and rank-and-file employees.

 

5.      Post-loss:  Centers on internal procedures to better manage claims, provide appropriate medical treatment and run an effective return-to-work program.

 

12 Blueprint Elements

 

1.      Examine the organizational structure. Look for areas encouraging employee disincentives to return to work. Form a corporate workers’ compensation team under one director.

 

2.      Produce simple usable data to effectively monitor the post-injury response and judge its success.

 

3.      Communication is vital between the employer, employees, the insurance company and the physician. Show how cost cutting benefits the workers. Use simple, well-designed written, audio and visual tools to convey the company’s message.

 

4.      Employment interviewing focuses on selecting employees with behaviors consistent with injury prevention and return-to-work success. Consider pre-employment placement screening.

 

5.      Return-to-Work program’s goal is zero lost workdays returning all employees to work regardless of their status, tailored to meet the needs of each employee.

 

6.      Coordinate the company’s workers’ compensation program, the Americans with Disabilities Act and the Family and Medical Leave Act. Despite the challenges do not allow these laws to become a return-to-work barrier.

 

7.      Transitional Duty Jobs require a team effort on the part of the employer, insurance carrier, claims administrator and broker. Be aware of the three types of transitional duty programs.

 

¨      Modified Duty: The employee returns to the original job with job modifications designed to allow easier performance of the required tasks. The employee returns to the original job with reduced hours and follows prescribed exercises and strengthening routines.

 

¨      Alternate Duty: The employee returns to a different job, one physically less demanding than the previous job. The employer must be creative in job placement.

 

¨      The Goal: Ideally 90% of employees return to work within four days. Best practice is 90% of employees never leave the workplace, receiving treatment on- or off-site and returning to a transitional duty job as soon as they are medically able to do so.

 

8.        Coordinated medical care refers injured employees to specific physicians, integrating the protocols and goals of the overall workers’ compensation management program and coordinates with health insurance, i.e., managed care. Managed care, if set up properly, reduces medical and indemnity costs, fine tunes medical treatment, creates a care-plan, sets a return-to-work date and requires periodic re-evaluation between the physician and case manager.

 

9.        Questions for the Managed Care Vendor

 

¨      Does the managed care vendor have enough providers in its network to deliver prompt service and provide adequate geographic coverage?

 

¨      What mechanisms are in place for provider evaluation and other issues related to quality of care?

 

¨      How does the managed care program integrate with the claims administrator?

 

¨      Are providers willing to visit the facilities and learn about the employers’ corporate culture and needs?

 

¨      Do network doctors come off as caring and concerned, or rushed and rude?

 

¨      Are providers return- to-work oriented?

 

10.    Form a partnership with the right insurance company or claims administrator appointing a dedicated adjuster who understands investigation. Look for allowing a 24-hour turn around time in response to injury reports; the employer retaining right to choose legal counsel, settlement authority, second injury and subrogation.

 

11.    Fraud is prevented and detected when all parties involved in workers’ compensation — supervisors, managers, claim adjusters and medical providers, work as a team.

 

12.    Surveillance by qualified investigators is used to verify the extent of the disability, establish the ability of the employee to do transitional duty work and determine if the worker is working elsewhere. Be aware of all legal ramifications of investigative work.

 

For more information and tools, see WC Cost Reduction Tips. www.reduceyourworkerscomp.com/lower-reduce-workers-comp-costs.phpThere are several free forms and tools on the site.

 

Note:  Do not use this information without independent verification. All state laws are different.   Consult with your corporate legal counsel before implementing any cost containment programs.

 

Robert Elliott, senior vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality. Contact him at: Robert_Elliott@reduceyourworkerscomp.com or 860-553-6604.

 

©2008 Amaxx Risk Solutions, Inc., All rights reserved under International Copyright Law

Published by: Admin on December 17th, 2009 | Filed under Attorneys Personal Injury