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How to Handle a Worker's Comp Insurance Claim Part Two

Written by on 1/3/2018 3:08 AM in , , , , . It has 0 Comments.


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.


How to Handle a Worker's Comp Insurance Claim Part One

Written by on 1/1/2018 3:18 AM in , , , , . It has 0 Comments.


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.


Catastrophic Injuries Need Serious Care Management from Your Work Comp Management Team

Written by on 11/13/2017 1:00 AM in , , , . It has 0 Comments.

Your work comp management team is fantastic at ensuring early intervention for critically injured workers, but are they dropping the ball post-stabilization? Too often the fragmented nature of healthcare delivery falls short of meeting the long-term care needs of catastrophically injured workers.

Myopic Focus
injured workers and their caregivers often find themselves unable to cope with the consequences of injuries when they're discharged too soon or into the wrong environment. This is particularly true if they don't have the knowledge to navigate the challenges of a permanently changed life. This can quickly lead patients down a costly and calamitous path to the ‘vortex of failure.’

How Can Your Work Comp Management Team Prevent Such Catastrophic Consequences?

  • Challenge the System
    Specialized care and rehabilitative service is where the traditional care model often misses the boat. Medically-stable, catastrophically injured patients may fare better in a skilled nursing or residential rehab facility before going home.

  • Understand the Step-Down Process for Catastrophic Claims is Different
    This is not a sprained wrist or rotator cuff injury, catastrophic claims managers need to answer these critical questions before recommending the next step-down:
    • What additional services will the injured worker need to function independently?
    • How will the injured worker re-adapt to life in their ‘normal’ home/community setting?
    • Do they have a close family member/caregiver that can help them cope with the after-effects of the injury?
    • Can the employee return to work?

  • Get the Injured Worker’s Family Involved
    Ensure the long-term knowledge, skills and compassion necessary to support the injured worker are in place.

See the bigger picture. Help your work comp management team prevent creeping catastrophic claims with the help of Minnesota Comp Advisor today.


Opioid Use in Work Comp Injuries Drops 30% Since 2015

Written by on 10/25/2017 1:37 AM in , , , . It has 0 Comments.

In a recent review, The Travelers Companies reported opioid use among more than 500,000 injured workers treated since 2015 has dropped a staggering 30%. How is the insurer forging a new path to successful outcomes without opioids?

The Early Severity Predictor Model
The company’s Early Severity Predictor identifies the probability of an injured worker developing chronic pain, a key cause of opioid dependency. By sharing these results with the injured employee’s physician, other effective treatment alternatives can be sought, such as surgery followed by physical therapy (in lieu of opioids for pain). Such regimens limit exposure to opioids, offering a safer recovery and often producing better long-term medical outcomes.

Impressive Numbers
In addition to the 30% reduction in opioid use, since January 2016 the company’s workers comp cases also saw:
• Surgeries fell by 25%.
• Injured employees receiving alternative treatments recovered and returned to work 10% faster than employees who did not.

Thorough Reviews
The nation’s largest workcomp carrier, Travelers, handles around 250,000 workers comp claims annually. Since the implementation of its Early Severity Predictor model in 2015, in combination with its in-house pharmacy management program, the company has aided employers in reducing medical expenses on identified claims by as much as 50%.

Claims professionals train with on-staff pharmacists, assessing the merits of requests for pharmaceutical reimbursement, ferreting out the potential for overuse and preventing dangerous drug interactions.

Concerned about opioid use affecting the recovery of stellar employees? Opioid use, addiction and overdose cross all ages, genders, and income levels. Do your part in protecting injured workers in light of the nationwide epidemic of opioid overuse and abuse. Learn more from MinnesotaComp Advisor today.


Firing an Employee While They Are Out on Workman's Comp

Written by on 10/23/2017 3:17 AM in , , , , . It has 0 Comments.


Thinking about terminating an employee who has filed a workman's comp claim? Extreme caution is warranted in navigating these dangerous waters.

State Laws Protect Workers
Terminating an employee who has filed a workman's comp claim is not prohibited. Most states, however, impose stiff penalties for those incidences deemed wrongful termination: When an employee is fired because of their claim. This can include fines, jail time, or both.

Tips to Reduce the Risk of Retaliation & Wrongful Termination Claims

  • Know Statutory Worker Protections
    Most state statutes indicate it is unlawful to discipline/terminate an employee who has filed a claim, and is considered a crime.
  • Stay True to Company (Handbook) Rules and Policies . . .
    Including rules for progressive discipline and termination. Does your safety handbook note these specific termination grounds? Has the employee been counseled verbally/in writing?
  • Consider How Similar Situations Have Been Handled
    If termination is harsher than past punishments you have handed out for a similar offense, the firing could be seen as retaliation or discrimination.
  • Carefully Reflect On Facts, Circumstances and Timing
    If an employee was being investigated for misconduct four weeks ago, but suffered an injury 3 weeks later, documented disciplinary actions and witness testimony could support a later termination, as the length of the investigation may not be seen as related to the claim. If you took no disciplinary or investigative steps, however, establishing the termination as unrelated to the workman’s comp claim will be difficult to prove.

Workman's comp waters seem particularly shark infested as of late? The experts at Minnesota Comp Advisor can help you find your way to safety. Learn how we can help you avoid workers comp risks today.


Workplace Safety - Training for Managers on Marijuana Impairment

Written by on 10/18/2017 3:25 AM in , , , , . It has 0 Comments.


As marijuana becomes increasingly available medically and recreationally across the nation, complications surrounding marijuana in the workplace will continue to grow. How can you keep employees safe while still upholding their civil liberties?

Five Ways to Keep Your Workplace Safe Despite Changing Marijuana Laws

  1. Begin with hiring and training practices.
    Before hiring for a given position, consider whether off-duty use of marijuana could affect on-the-job performance and safety surrounding any duty, not just essential ones.
  2. Familiarize yourself with state and federal laws.
    Some states don't require an employer to accommodate employee use of marijuana if it prevents them from fulfilling any of their job responsibilities. For ADA requests, however, HR and legal council may be necessary to determine accommodation of marijuana in the workplace.
  3. Focus on performance.
    Make safety a part of the company culture, beginning with employment and safety manuals.
  4. Learn to recognize impairment.
    Train managers on how to recognize impairment and company procedures should it be a factor, particularly at the time of a workplace accident.
  5. Consider drug testing.
    Familiarize yourself with state/federal drug testing laws and policies, noting the difference between pre-employment and for-cause testing. In the event of an incident, testing could indicate the presence and level of drugs in an employee’s system. It can also be used to determine whether employees are impaired and unable to safely perform job duties.

If you choose to avoid drug testing, consider alternatives such as psychomotor testing, which measures reaction time and coordination and has proven to dramatically improve safety results.

Marijuana in the workplace presenting unexpected challenges? Minnesota Comp Advisor can help. Contact us today.

 


Could Value-Based Contracting Be on the Horizon for the WorkComp Arena?

Written by on 10/16/2017 3:14 AM in , , , . It has 0 Comments.


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.




Pain Management in the WorkComp Arena

Written by on 10/11/2017 3:06 AM in , , , , . It has 0 Comments.


Pain management in the workers comp arena can be particularly challenging. In combination with the glut of pre-existing conditions suffered by many Americans, the complexity of managing injuries within the system can be frustrating for all parties, leading to poorer outcomes for all. How can you thwart the common pitfalls of treatment?

Look at the System from the Eyes of Injured Workers
Attributing negative pain management outcomes to a worker’s desire for financial gain is overly simplistic. Viewing the process from ‘the other side’ and opening communication lines can go a long way toward showing you care about your injured workers’ needs and fostering a speedy recovery.

Do You Understand What Workers Comp Patients Go Through?

  • Delays in treatment despite severe pain are a known contributor to slow/poor recovery outcomes.
  • Accident investigations to determine liability/wrongdoing.
  • The constant need for approval/vetting of desired treatment protocols to gain relief/function.
  • Fear of job loss and financial insufficiency.
  • Reduction in the capacity to contribute at home and at work.
  • Loss of personal control and self-efficiency that can lead to hopelessness, depression, and ‘illness behavior.’
  • The need to constantly ‘prove’ pain, a subjective symptom, to show injuries as genuine for continued treatment.
  • Isolation from coworkers, friends, and family.

Set Injured Workers Up for Success
Go the distance, encouraging return-to-work by instituting light duty protocols or necessary equipment/environmental adaptations. Use this as the foundation for your caring support, boosting the social support system of injured workers, and putting them on the path to lifestyle and financial normalcy.

Pain management and productivity in the work environment can go hand-in-hand. Discover new ways to succeed with Minnesota Comp Advisor today.


The Increasing Complexity of Work Comp Claims Due to Narcotic Use

Written by on 10/9/2017 3:27 AM in , , , , . It has 0 Comments.


Chronic pain affects a staggering 100 million Americans. Its prevalence continues to rise, and with it, so does the incidence of those using prescription narcotics like opioids for pain. The workers comp industry is working hard – and succeeding – in curbing narcotic use in chronic pain cases (especially compared to the public center). However, this mode of treatment continues to be a wrench in the works of positive treatment outcomes.

Deep Impact
When a workers comp claim involves narcotic use, claim costs rise $20,000 more, on average, than those without. Other increases include indirect costs, such as the probability of chronic work loss – where the incidence is six times greater when opioids are involved.

How Can You Help Buck the Trend?

Intervene Early
The faster injuries are reported and addressed, the better the prognosis.

Evaluate Often
Drug utilization review should occur often, at specific points in the claim, with drug types and duration of use closely monitored, and alternatives to narcotics prescribed whenever appropriate.

Monitor Claims
With the help of third party administrators that take advantage of predictive analytics for monitoring claims expenses. These can help you identify claims patterns surrounding narcotic use so you can pinpoint problems and brainstorm collaborative solutions for improving patient outcomes.

Strive for Return-to-Work
Any time a worker is injured to the point they lose time from work, there is a risk they may not return-to-work. With narcotics usage, this risk is significantly higher. Boost success with frequent employer/employee contact and modified duty whenever possible.

Curb narcotic use with proven tactics, doing your part to help control the rising opioid epidemic. Contact MinnesotaCompAdvisor to learn more today.


Your 10-Step Guide to Managing Catastrophic Claims

Written by on 10/4/2017 3:03 AM in , , , , . It has 0 Comments.


Catastrophic workman's comp claims are especially challenging to manage. Care of injured workers is often fragmented, with multiple providers and no holistic, long-term plan of care. Without centralized management, optimal care and quality of life cannot be achieved, leaving health to deteriorate and costs to creep to alarming levels. Fortunately, there are ways to proactively and successfully manage catastrophic claims.

How Can You Pave the Way to Effective Catastrophic Claims Management?

Understand the scope of the problem.
Catastrophic workman's comp claims account for only 1% of claims – but 20-30% of total medical spending in the workcomp arena. Medically complex and costly, such injuries require sophisticated care, equipment, and rehabilitation. Such life-altering injuries require a high-touch, compassionate response and include:

  • Brain/spinal injuries
  • Vision loss
  • Para/quadriplegia
  • Severe burns
  • Multiple traumas or amputations

Strive for collaborative care.
Safeguarding patient well-being while controlling costs is possible. Whether in-house or through a third-party provider. Develop a collaborative, team approach to provide ongoing coordination of services from primary care to equipment, drug utilization, home care and support.

Report early.
Notify your catastrophic claims team while the injured worker is still in the hospital to ensure a smoother progression from hospital to home care, especially in the event medical equipment such as a wheelchair is necessary.

Don’t overlook the big picture.
Comprehensive evaluation(s) of long-term needs are key to a successful transition. An in-depth evaluation of injuries, comorbidities, home and family situations, and injured worker feedback can head-off unexpected and costly complications.

Uncover other ways to pave the way to more effective catastrophic workman's comp claims management in part 2 of this Minnesota Comp Advisor series.


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