Quality of Life, Protected
Efficiently and factually completing the initial phase of the worker's comp insurance claim investigation and treatment results in a shorter recovery and return-to-work timeline by directing medical care. Surgery is performed same-day and the machinist begins recovery.
The specialist understands the emotional/psychological effects of the injury, and is cooperative with a modified-duty, return-to-work program, reducing lost time and wages on the part of the employer and employee. The machinist is discharged from care and returned to full-duty in 8-12 weeks. The injured employee is thrilled with his attentive, empathetic treatment, the competency of his doctor, and his ability to remain at work with full pay (rather than partial disability).
In the interim, the adjuster performs necessary interviews, investigating the injured’s prior medical issues and background which may have impacted the claim, including possible changes to safety procedures with the HSE team.
What Could Have Been
The inclusion of a professional, outside field adjuster mitigated a host of hazards. It avoided a 4-5 hour ER visit and the wait to see a specialist following the required doctor referral. Surgery was not delayed, thwarting the potential for permanent damage, continued pain and therapy. The machinist was not converted to a lawsuit plaintiff, instead continuing a productive lifestyle to the benefit of his family.
Given the pre-established relationship, information was easily shared between the adjuster and treating physician, helping return the employee to work sooner. Cost inflation was controlled, and the company retained a key employee, bringing the process to a fast, felicitous solution.
Wish your worker's comp insurance claims had happier endings? Discover new pathways to success with the help of Minnesota Comp Advisor.
Worker's comp insurance claims are inevitable. Negative outcomes are not. When the proper steps are taken from the onset of the claim through resolution, your team can ensure positive results that support everyone’s best interests.
Not a Hassle
When a worker's comp insurance claim begins, it’s critical not to treat the injured employee as an obstacle. If your head machinist clocks-in, but then suffers injury from a small metal shaving that slices into the fingers of his right hand, how will you respond?
A Human Being
Let’s say you, the supervisor, treat him as a valued colleague and report the accident. Your machinist thinks it’s a scratch, but you consider the potential of serious injury. While he removes his gloves and washes his hand, you call your workplace health and safety (HSE) executive, who dispatches an adjuster to the job site while you bandage the worker.
A Deeper Understanding
The adjuster arrives, discussing the incident with the machinist. The adjuster’s experience compels him to ask the machinist to straighten the fingers affected by the thin, deep cut. When he cannot, the adjuster calls a hand specialist, describing the range-of-motion limitations, and the machinist is transported to the clinic.
A Helping Hand
Along the way, the two have a Q&A on what will commence and why the specialist was called. The drug screening company is called to meet them. The injured employee and adjuster fill out the necessary paperwork, including the medical authorization form from the injured employee.
What does all this personal attention net the employer? Find out in ‘How to Handle a Worker's Comp Insurance Claim Part 2’ from Minnesota Comp Advisor.
Value-based contracting models are already being used by the healthcare system. But in today’s workers comp arena, they are a hot-button topic. A Coventry white paper released earlier this year investigated the potential of this model over the current regime.
The Argument for Value-Based Contracting (VBC)
As opposed to the current workcomp model, in which utilization and care management teams rely on a fee-per-service approach via a discounted network of external vendors, value-based contracting takes a far different approach. Volume-based contracting and fee-for-service care is cast-aside for a payment structure based on performance/outcomes, not services rendered, eliminating the financial incentive to treat more.
Quality Value-Based Contracting Models…
- Unite the goals or payors and providers.
- Pay for better outcomes (superior quality, faster results) regardless of the number of services rendered to achieve them.
- Utilize predictive pricing for payors/providers, with agreed upon treatment costs by injury/illness. (All costs for an episode of care, such as knee replacement, are bundled as one fee. Patient-centered medical homes cover patient care coordination and outcomes under a per member, per month fee.)
- Have an ‘outcome focus,’ relying on a model calibrated to deliver the right combination of services to achieve the best outcome.
- In this ‘pay for performance’ model, preventative care is seen as a way to curb costs and treat injuries and illnesses before they become serious. (Think: creeping catastrophic claims.)
- Data analytics monitor a provider or hospital’s success.
Could the old claims mentality be replaced by value-based contracting? As the industry strives for savings and improved patient outcomes, time will tell. As the regime evolves, Minnesota Comp Advisor will be here for you through it all.
As workers’ comp claims continue to decline in frequency and jobs continue to become safer, you may want to consider looking to other avenues for savings. With employee leave, disability management, and wellness absences continuing to rise in prevalence, and legislation increasingly complex, absence management offers an array of opportunities in controlling costs and preventing headaches.
For these reasons, workers’ comp management providers are supplying their clients with a new benefit: Employee management tips and systems for better management of employee absences.
How Can Your WorkComp Management Program Help You Handle Absenteeism?
Workers’ comp claims management professionals can help businesses manage non-occupational absences by tapping into skills and resources necessary to manage illness and injury-related absences, as both essentially involve the same things:
• Claims processing.
• Reducing incident rates.
• Coordinating services.
• Navigating the complexities of return-to-work and associated absences.
• Costs associated with absenteeism.
• Compliance with pertinent laws.
Are You Skirting Absence Management Disaster?
With the strong correlation between health behaviors and claims costs, and the link between employee absence and lost revenue, it pays to have a plan for managing absences of all kinds - from both the injury management and health and wellness perspectives.
From FMLA and ADA to jury duty and blood donor leave, federal and state mandates continue to grow increasingly complex. Ever-changing rules elevate your risk of violation without expert outside assistance and employee management tips. Fortunately, claims management firms are in the perfect position to provide them.
Looking for a few outside-the-box employee management tips to control your rapidly-changing labor landscape? Minnesota Comp Advisor has the total health of your company covered. Discover more about our amazingly flexible skills and solutions today.
2017 is well underway. What’s in the works for worker's comp insurance this year?
Keep an Eye Out for These Changing Worker's Comp Insurance Issues
• The New Administration
Former President Obama was headed toward federal reforms including minimum state benefit standards. President Trump, however, is a vocal opponent of federal regulations, leaving this issue on hold.
• Healthcare Reform
Healthcare reform has the potential to affect benefit requirements, quality of care, the calculation of premiums, and claims filings — if and when anything passes. Stay tuned...
More recently, OSHA had shifted resources from education to enforcement.
With a successor yet to be named by the Trump Administration a new direction is expected, but like healthcare reform the path remains unclear.
The broadening of regulations and enforcement increased under the Obama Administration are expected to relax, with the federal government less likely to expand the boundaries of existing ADA/FMLA laws.
• Workcomp Rates & Premiums
More driven by changes in market competition than changes in exposures, the previous hyper-competitive marketplace is expected to slow as new entrants respond to long-tail losses hitting the books.
• Long-Tail Exposures
Long-tail exposures, premiums collected today for tomorrow’s losses, will require close scrutiny in the coming years. What could inflate your costs? Raised life expectancies, costlier new drugs and treatments, medical science advancement in prosthetics, and more.
In 2017, there’s expected to be continued emphasis on alternatives to opioids for acute and chronic pain, with expanding coverage.
Are you staying aware of the worker's comp insurance issues that could significantly impact your bottom line? Minnesota Comp Advisor has you covered. Contact us to learn about new ways you can save today.
Catastrophic injuries are complex, costly, life-altering events for injured workers and their families. In this next installment, we’ll continue looking into the path to improved catastrophic workman’s comp claim outcomes.
Other Considerations for Catastrophic Claims:
• Comorbidity Complications
Comorbidities such as diabetes, heart disease, high blood pressure, poor circulation, obesity, and age greatly complicate injuries and recovery. By identifying these factors and monitoring corresponding issues, a catastrophic claims team can better circumnavigate pitfalls.
• Ask the Worker
The worker knows best which treatments/equipment are working/lacking. Today’s technology allows for this information to be directly compared with physician notes, case management reports, and claims data to provide a broader picture and better outcome.
• Include the Family
The catastrophic claims team should also meet with the family to discuss care progress and pitfalls, as well as clarify care and recovery expectations.
• Understand Home Care May be Unavoidable
Most suffering catastrophic injuries will never return to work. Worse, some may not gain full independence. In these situations, options of 24-hour home care, nursing care, and family care must be carefully considered based on dynamics and injuries, to ensure quality of life.
• Consider Environment/Modifications
Environment can significantly impact post-discharge plans. Payers may have to cover the additional costs of home modification/relocation necessary to meet care needs.
• Don’t Overlook the Importance of Ongoing Monitoring
Regardless of the point in the path of the injured worker’s journey, regular file reviews are essential to identifying red flags. This safeguards compliance, and ensures the continuation of proper, quality care.
Helping workers avoid catastrophic workman’s comp claims is job #1. If the unimaginable occurs, know that Minnesota Comp Advisor is here to help. Learn how today.
Do your employees know the safest way to do their work? Workers in-the-know on job site hazards and control measures can make your workers comp management path far easier.
Arm Employees with Knowledge
Written safe work practices and procedures are the first step toward job site safety and an integral component of any occupational health and safety program. These include guidelines for helping workers perform their tasks safely, and may not require step-by-step procedural instructions.
Written practices should note necessary safety controls (ventilation, personal protective equipment, etc.), and be used alongside in-person training on these protocols, including how to use equipment. Protocols should be constantly evolving and under continuous review.
When developing a new plan, allowing management and existing employees to review procedures ensures all bases are covered. The plan should outline who needs training, including new workers, returning workers, and those changing jobs, and training time required.
A checklist for each worker can help track training practices and compliance, ensuring their readiness in multiple areas such as first aid, emergency response procedures, personal protective equipment use, lockout/tagout programs, WHIMIS, TDG, etc. Some industries/hazards require more, so ensure all essential training needs are covered.
Special Youth Safety Concerns
Additional training for younger workers is required, as they are at greater risk of workplace accidents. Employers must ensure a plan is in place, and workplace plans and procedures are clearly communicated and well-understood. This includes the supervision of younger employees safely completing tasks before they embark on solo work.
Ready to implement a safety program at your business? The workers comp management experts at Minnesota Comp Advisor can help. Contact us today and learn how.
The Family and Medical Leave Act (FMLA) helps employees balance the medical needs of family members with workplace demands. The wrong employee management here, however, could put you in violation – and cost you big. Here’s what you need to know…
Only employees who’ve worked for you at least 12-months (1,250+ hours) prior to requesting leave are eligible. Businesses must also be eligible: Typically workplaces holding 50+ employees who work within 75 miles of its location, though this varies by state.
Employees can take up to 12-weeks of unpaid leave during a 12-month period, up to 26-weeks for military spouses. This can be a single 12-week period (or less), leave on an hourly/intermittent basis, or leave in the form of a part-time schedule. You may require your employee to use available paid time such as PTO, vacation or sick time first, but it is important to know that this will count against the 12-week allotment.
Proof of Injury
There are specific documents the employee has to provide to allow an employee to qualify for the FMLA, one being a “Certificate of Health Care Provider”. The employee must provide to the employer as evidence of a qualified disability.
Restoring your employee to their previous position is ideal, but not required. You MUST however, return the employee to an equivalent job, with equivalent pay, benefits, and terms of employment. You do have an obligation to keep your businesses running smoothly, but cannot demote those seeking leave to a subordinate position on-return.
Don’t let employee management mistakes leave you in a difficult position. Minnesota Comp Advisor is here to help. Contact us today.
It's a well-understood fact, getting employees back to work is a great way to manage workcomp insurance expenses. But are you pushing too hard?
Changing the Tide
Of the 70-80% of companies engaged in return-to-work programs, many are pushing these programs more aggressively in recent years due to their benefits: BLS data shows declines in virtually all major occupational injury and illness rates. OSHA shows these programs, combined with improved safety measures and more rigorous care, have put the brakes on runaway costs. Since the mid-1980s, more and more workers are returning to work before fully healing, engaging in restricted work regimens with temporary assignments, shortened hours, and job modifications. But how soon is too soon?
Pushing the Limits
With the ever-growing push to get people back on the job, controversy has arisen with emotional pitfalls-a-plenty. ‘Aggressive’ and ‘early’ return-to-work programs alongside ‘light-duty’ assignments are causing workplace brouhahas, to be replaced with more PC, less emotionally-charged verbiage and procedures.
Ensuring a Smooth Return
- Proactively devise - and refer to - written policies for return-to-work procedures, understanding that they take time. Educate all managers, supervisors, and employees on the return-to-work policy and expectations.
- Sell supervisors/management, who can make or break programs, and must understand the return on investment versus lost time and financial drains effecting job security.
- Be careful not to seemingly ‘harass’ workers in your efforts to control costs.
- Choose meaningful (not coddling or embarrassing) transitional assignments – and don’t devise them last-minute.
- Ensure all parties, from the employee to their physician and supervisor, are on-board.
Looking for new ways to manage workcomp insurance expenses? Take a load off with the help of Minnesota Comp Advisor today.
Like a runaway freight train, the opioid addiction epidemic in America continues to gain speed. It's destroying lives, decimating families and communities, and overwhelming emergency response centers, hospital rooms and morgues. The death toll continues to rise daily. Sadly, many unknowingly contribute to this destruction. From business accidents to medical personnel fueling the fire with legal prescription painkillers, it’s time to close off the pipeline to addiction, beginning in the workplace.
Prevent Opioid Addiction in the Workplace: Join Us in the Battle
From 8am-12:30pm, Wednesday April 5, 2017, please join us for a free seminar at the DoubleTree Bloomington Minneapolis South (7800 Normandale Blvd) for breakfast and a discussion on “Closing the Pipeline from Workplace Injury to Opioid Addiction.”
With Presenting Speakers:
- Leslie "Lexi" Reed Holtum
Executive Director, Lobbyist, Steve Rummler Hope Foundation
Once Steve Rummler’s fiancé and integral to the passage of Steve’s Law, as well as ensuring the access of first responders to the resources necessary to uphold it, Lexi’s past Washington D.C. testimonies have been pivotal for pushing changes to current prescribing practices, addiction treatment, and resources. In long-term recovery from the disease of addiction herself, she offers an in-depth, multi-faceted perspective of the opioid epidemic.
- Christopher Johnson, MD
Also on the medical advisory committee and board of directors for the Steve Rummler Hope Foundation, Dr. Johnson also chairs the Minnesota Department of Human Services Opioid Prescribing Work Group.
- James S. Pikala, Attorney
Area attorney with over 30 years’ experience in workers’ comp laws.
- Phil Walls, RPh
Chief Clinical Officer, myMatrixx
Clinical pharmacist, with over 35 years of experience in benefits and workers’ comp.
Fight opioid addiction in the workplace. Tailored to CFOs, risk managers, HR staff, medical providers and insurance professionals; reserve your seat today by calling Mary at 612-236-1771. Hurry, space is limited!