Workplace Safety

Insurers who provide workers comp understandably want to do everything possible to prevent fraud, but it can be difficult to do when claims are fraught with emotion and there’s no possible way to check on every last detail of the case. Instead of just relying on people’s stories entirely, it may make more sense to use fraud analytics for commercial claims to ensure that medical providers, workers and employers are telling the truth about the extent of the damages.

Right now, insurers are mainly using manually processing, and while they do see patterns that indicate fraud, the system is just not as good at showing where the problems are actually stemming from. Whether that’s a specific area, hospital or industry, there’s more ways out there to significantly reduce the chance of fraud. While employees may continue to come up with creative ways to trick their employers, these automated processes can use specific criteria so everyone who works in this field can start inputting their numbers for real results. The way the referrals process works right now, there’s a gap in how the data is being looked at as a whole. This means people miss important factors that could signify fraud.

Medical bills and records as well as policy and pharmacy information could all provide a crucial link to giving people a way to identity bad apples in the system. The information can then be looked at as an entire compilation which could provide a framework for future cases. Currently, many people in the insurance industry have been relying on traditional methods which limits their knowledge and the face of workers comp in general. Unlicensed medical providers may write up false data or hike up procedure costs for workers comp cases, and employers may misrepresent an employee’s job as being much safer than it actually is to lower their claim rates.

One estimate puts payouts of workers compensation at over $7 billion dollars a year. It’s unclear just how much goes toward fraudulent claims, but there are few out there that think it’s not a problem. When there’s money to be made, people come up with some very interesting ways to go about getting their hands on it. It’s also expected that these fake claims will continue to rise in number in the immediate future. Even if there are professionals out there who think the system works by going through each claim by hand, there’s little to be lost here by at least trying out a new form of detection. Any additional insights that can be used to decrease claim payouts for the next few decades will only decrease everyone’s premiums.

The extent most employees know about fire safety in their buildings is likely just when they need to exit the facilities for some sort of drill. It can stop your employees from having any type of urgency, and then people can get complacent about fire safety. Don’t let this happen when you create more awareness and follow the proper procedures.

Identify and Communicate

What’s the most important thing about exiting your building when there’s a fire? Is it that you can’t clog the main exit? It is the most likely ways a fire can start? Is is talking to people about the way they handle equipment? Fires spread fast, and you can bet in an emergency, a scared coworker isn’t going to be thinking about the last fire drill they had. When people panic, they make really unfortunate mistakes. Instead of scaring them, you just need to be sure that they know and that, more importantly, you know how it all works. Sometimes you have just a few precious minutes to ensure everyone is safe. Do you know how long it took to evacuate everyone last time, and how long it would take in an actual fire? If you don’t think that your plan is currently very realistic (and chances are, it may not be), then you need to rethink it and let your employees know. They’ll take their cues from you.

The Nuts and Bolts

Your fire plan must be in writing and visible to employees. The plan must have discuss the major hazards, the way to handle and store materials and how to control ignition sources and flammable waste materials. List the equipment best used to prevent the spread of fire for each type of hazard, and how to maintain your potentially dangerous equipment. Also give the names of who is responsible for preventing fires and those who handle the fuel sources as well. Again, while these should be easy to find, your employees should know the basics without having to reference the plan. They should know of at least two ways out of the building, and be aware of exactly where to meet. If you don’t have a sprinkler system, you may want to consider investing in one. The chances of being hurt go down dramatically, and your employees will not be in a frenzied rush to get to the exit. You’ll also want to have employees who are trained in using fire extinguishers and who know how to check the smoke alarms so that they’re functioning correctly. You may have to contact your local fire department to get the advice on where and how to install them if you’re a smaller business.

Ventilation has always been a major concern for businesses, and companies in China still struggle with even basic dust control. A workplace is made less safe on a daily basis as clutter builds up, safety techniques are ignored and employees start eying the clock right at 3:30. Your company probably has strict rules based on standard regulations, but that doesn’t mean they’re always followed in the light of reality, rush jobs and just plain carelessness. Here are a few reminders to keep it safe.

Mat Placement

It should only take one near-slip for you to start questioning whether or not you have mats in all the right areas. Restaurants in particular can get water on the ground from a variety of places (not just by the service stations), and your employees may not be be looking at the floor all the time. Every day that goes by without an accident in any facility tends to lure people into a false sense of security, but you’re only setting yourself up for a catastrophe.

Proper Ventilation

It’s not just dust that causes problems, but also fumes from chemicals that can make an employee sick over time. Any type of combustion equipment or forklift releases gas you may not have taken into account when designing the protocol for the space. Plus these are issues that only become apparent with time. Vents get clogged up with dust and debris, and even tiny blocks mean that your employees are breathing in the wrong kind of air. If you can’t remember the last time you cleaned and checked the openings of the facility, then you’re putting yourself at major risk.

Clutter Cleanup

Clutter is unfortunately a fact of life, and it can be a frustrating experience. Maybe you don’t want to throw objects away, but you also don’t have anywhere to store them. Extra clutter gives your employees that many more ways to trip over, bump into or otherwise injure themselves. You will need to make difficult decisions about what to keep and what to throw away though. If you feel like you can’t bear to part with any of them, then you need to consider our next tip.

Proper Storage

Storage compartments needs to be stacked and ordered in such a way that nothing is spilling out and your items are able to be located quickly. This is much easier said than done, but it may just take a day to reorganize what you already have. Cold storage facilities come with a number of rules about keeping your materials and chemicals safe, so you need to at least understand the theory behind the rules. If worst comes to worse, you may want to buy more space for yourself – either within your facility or in a nearby storage locker.

While you can’t keep up with every development in technology, you can follow the overall trends to understand how it impacts your business. At the Workers Compensation Research Institute (WCRI), doctors reviewed how it’s brought about a new economy, what it can mean for workers comp and how you prepare for the additional changes.

Regulation Unknown

The sharing economy only continues to grow, with 42 percent of people having used it and more than one if five people having profited from it. Technology gives workers new choices about how they can make money, and it gives older Americans a way to supplement their retirement funds. Applications like Lyft and AirBnB keeps people active and productive rather than sending out resumes into the ether. You may not currently make your living in an industry that uses contractors rather than full-time employees, but that could very well change based on the climate of workers and their demands. People today want more freedom, and there’s evidence to support that giving them flexibility will help, not hurt, profits. However, it poses certain threats to workers safety as well. It’s unclear how much responsibility the parent company bears when a worker is hurt on the clock. Certainly, it’s in the company’s best interests to deny that they bear any responsibility at all, but what does that mean for the worker then? As the government tries to cut through the red tape and current laws to make final decisions that you can be confident will stick, you would be smart to stay aware of how technology is influencing workers both in general and in your particular industry.

Monitoring in Safety

Employers should always have some idea of the way a worker performs their job, but sometimes the boss can’t catch small mistakes that add up over time. For example, let’s say you work in a warehouse where your subordinates need to lift boxes all day. Perhaps one worker is stretching his back just a bit too much every time he lifts one. He doesn’t notice his wrongful maneuver until he pulls a muscle 6 weeks later. Wearable technology is already letting companies know when an employees is in danger of hurting themselves from overexertion. It could continue to improve so employees can stop themselves from going too far in a variety of tasks. Cutting back on preventable injuries is just another way technology is mingling with even the most low-tech of jobs. A warehouse employee may not care about the software behind what he’s wearing, but he will care that doesn’t have to spend 6 weeks in a back brace on his couch.

Workers compensation cases touch many lives and many industries. Insurance employees, medical professionals, government officials, employees and employers all influence each other in different ways. And of course, a main motivator for everything in life is money. When people lose focus of this fact, it’s can lead them to be surprised about new developments. We’ll take you through how fee changes might affect you so you’re at least prepared should you start seeing any type of fishy behavior.

The Workers Compensation Research Institution held a conference where two doctors talked about their experience with fee changes. In the majority of states, they found that group health rates are lower than those of workers compensation. For the exact same services, the payer of workers comp is shelling out more than they would if the injured had gone through a group health service. Physicians across the board were found to have raised their prices if they weren’t charging as much as the fee schedule standard. It should be noted that most of these fees are some variation of Medicare fees (typically about 30 percent higher), but not every state operates this way. For example, Illinois works on billed charges, so much higher costs for the state than for group or Medicare.

In states where the fees are lower, there’s evidence to suggest that providers are simply classifying more injuries as work related so they can fall under the workers compensation price categories. This essentially helps balance out their net gain from offering care to workers. This means there’s a reason for them to lie regardless of exactly how the fee structures are made – they’ll simply be different reasons for each one. Because the decision rests with the doctors with little interference from outside sources, they can basically claim whatever they want.

As an employer, you should be aware of how your state structures the fees. Louisiana and California haven’t had their fees restructured for a while, and thus are quite low. Look to who has the incentive to lie. Obviously your employee has an incentive to lie that their back was injured at work rather than moving a sofa to the other side of their house, but the doctor may have motivation to side with the sofa-moving employee too. The study concluded that if reimbursement rates go up by 20 percent, then the doctor is 6 percent more likely to call your employee’s soft-tissue back injury a work-related injury. While that’s not certainly not a reason to panic that you’ll be inundated with fake claims, it is a reason to stay alert to how fee schedules are currently operating where you are so you can question and clarify if need be.

Knowing how the machine is working from every perspective in workers comp policy means that you can better make a budget and plans for the future. Workers comp has only existed since 1901, and you should be aware of the major reforms that have come since then. It’s clear around the country that we still have a long way to go before providing workers with the care they need in the most efficient manner.

The numbers rolling in from 2015 come with good news and bad news. One recent study in California showed that while workers comp claims were down, suggesting that both employers and employees were practicing smarter habits, the severity of the claims seems to be headed up. We’ll look at some of the numbers in context.

This report analyzed about 3,500 claims and found that costs for workers comp have declined slightly due to the number of people filing has declined. However, due to the serious nature of the injuries, it has not declined nearly as much as you might suspect. Between 2005 and 2014, paid claims increased by just under 5.5% due to the sever nature of the injuries. One theory of why this is happening could be because the work force in California is aging, with more people at risk for bodily harm in all types of working scenarios. The survey also shows that claims that go to court which are only about 20%, account for more than half of the total amount paid out for every claim. The whole point of workers comp is to eliminate lengthy lawsuits for the benefit of both the employer and employee.

Meanwhile in places like Florida, Michigan, and Illinois, there is a lot of attention being paid to how claims are processed and what’s contributing to the problems in the system. Flint’s water crisis has sparked debate, and talk of reform is up. Some see this as a political matter while others see it as a case of simple greed. This may or may not cause country-wide changes during this election year, but it suggests that there will be efforts to fix the holes in the future. Workers comp only gets so much attention, but that doesn’t mean that elected policy makers aren’t against reintroducing the topic when it seems fit to garner public attention.

Regardless of the trends, safety does need to be at the forefront of your mind for the upcoming years. If you do have an aging workforce, then you may want to invest in more gear and training to promote safety. Keep your communication level up with employees about major stories, and always be aware of new measures you can take to care for your employees.

There is no exact science for adjusting an injured employee’s workload, but there are factors to keep in mind before you start doling out the assignments. Your employee can and should return to the job even if they can’t perform their former job entirely, but not necessarily to their exact same role. Here are just a few tips before you begin the transition process.

Be Prepared for Some Bumps

This isn’t necessarily going to be easy, and it can get frustrating. You can’t shut down your whole operation just because one person needs special treatment. However, you owe it to the injured employee to work with them, not to mention you risk your chance of being sued for wrongful termination should you decide that the person’s work schedule or duties aren’t working out.

Rethink Your Schedule

This is where you need to practice some major flexibility. Can the employee work part-time or can the full scope of their duties be partially reduced? Can they perform work-related activities at their home to prepare for coming back to work? Talk to them, give some options and make it work.

Rethink Your Structure

If you don’t have hard and fast rules set for workers comp injuries, even if it’s never happened before, then you need to sketch out a plan. While every worker and injury is different, corporate guidelines (which hold true for everyone across the board) gives workers a sense of comfort in the process. Your rules should have timelines and extremely clear expectations. Also, they should not attempt to treat the worker like an invalid. Most employees aren’t trying to get out of doing their job. Increasingly giving them more work as they’re ready will encourage them to return to their full capacity sooner rather than later.

Involve Other People

You should be consulting with the employee’s doctor to get accurate information about their progress. Also, the employee themselves should be able to let you know what they’re capable of based on their personal recovery path. Once the employee feels needed and trusted again, this may motivate them and stimulate their ability to heal even faster.

Planning Ahead

A single claim can get expensive between time and money lost, and you may need to spend additional money for extra equipment or accommodations to an employee return. However, you likely can’t afford to fight an expensive lawsuit if you were at fault for an injury. Liable parties may be required to pay for care that stretches on for years. This is just the chance an employer takes, so you need to plan ahead with a conscientious budget for salaries, care and adjustments when they come back.

Owning a business or even managing one comes with a huge set of responsibilities, but there are probably only a few that really get attention on a daily basis. Sometimes meetings are called to bring attention to this matter or the next, but it likely gets buried along with the information you don’t regularly use. How can you expect to know your workers comp coverage policies if it’s not something on the pressing list of concerns for the day? Here are a few tips to understanding more so you can have fewer exposures to fraud.

Workers comp is fortunately not extremely common, and the number of cases filed is down. Most people don’t know anyone who has ever filed, and you may have very limited exposure to it aside from forms full of words you’re likely never going to read. However, the most important factor here is that workers comp involves money which is a powerful incentive for people. Recently in California, there were doctors and providers who were uncovered in a large-scale fraud operation that involved receiving kickbacks for the treatments and prescriptions given to mainly Latino workers. This was all done via a highly advanced organization with employees all the way down the chain of command placing flyers in trucks to call a number if they’d been injured. There is also interpretation fraud discovered at the end of December with people billing for services that weren’t necessary for injured parties. And of course there’s fraud of employees faking an illness.

Obviously you can’t stop these types of things from happening, but if you think you’re not affected by all of this, then you’re mistaken. Fraud pushes everyone’s rates up and knowledge really can be the key to stopping it from happening at all. Understanding your policies can prevent fraud before it happens. When you keep up with new laws, reforms and the current political landscape, you increase the chance that you’re doing what you can do in terms of taking responsibilities for your employee’s welfare. It can also make you more likely to detect patterns that may signify something fishy going on.

In the case of the fraud operation, it was very well planned and everyone knew what was expected of them. However, the way they were caught is because they wanted to expand. Criminals are not above making a mistake, and your mindfulness can be just the key to noticing an anomaly in an employee. Also, you have rights guaranteed by your particular coverage which can also be your saving grace. You do not have to be a victim of fraud when you know your coverage and who your employees are.

Employees who don’t have a lot to do will inevitably become bored which can then lead to frustration. It might cause them to make careless actions or resent the few tasks that they do need to do. The law is not entirely clear on what will happen if an employee injured themselves if they were goofing off or playing a game when there was nothing else to do, but it is best practice to keep them as engaged as possible. If not you could be in a war with a situation you don’t have time for.

Consider a case where laborers were on the job and found an old bowling bowl in Pennsylvania. One thing led to another when the bowling ball smashed and the shard hit someone’s eye. Or consider an employee who wanted to chill out in an air conditioned truck in South Dakota and convinced his co-worker to leave the vehicle for a while. Once the co-worker came back, the sufficiently chilled man decided to dodge his co-workers potential physical punishments by running away. When he tripped, he claimed workers comp for this.

Judges both awarded people compensation in these cases, though the bowling ball case was overturned by the workers compensation board. The bowling ball case had a mitigating factor of a supervisor who did tell the employees to stop messing around with the bowl before the injury had occurred. Had that supervisor not been there, the courts generally do not see a momentary mistake as a means to deny care for the employee.

Whether or not you agree with these decisions isn’t really the point. You need to ensure that employees do have productive tasks and that there are specific rules on horseplay. Busy employees not only are less likely to find trouble, but are also more likely to take pride in what they’re doing. This is not to say that people can’t blow off steam and have fun because sometimes that’s necessary in the workplace too. However, there needs to be guidelines in place as to what is and isn’t acceptable. If you witness employees being just a little careless on the job, then it can’t be ignored.

The bottom line here is that even you dispute and win a case over an idle employees hijinks, it can eat up a lot of time and money. Days should be structured with deadlines when necessary. When employees are waiting for machinery or certain processes to be complete, there should be a list of approved activities that they can do. Don’t try to limit their freedom entirely though as this will cause further annoyance and resentment.

If you’re familiar with the Affordable Care Act (aka ACA or Obamacare) at all, then you may know just how difficult it was to come to fruition. There was untold amounts of opposition, and then when it finally did roll out, it frustrated and upset a lot of people with a clogged website that failed to keep up with the growing demand, complicated rules and extremely resistant doctors.

Here’s what you need to keep in mind for the new year in health insurance for this controversial bill and beyond:

The ACA is still in effect right now, but Republicans recently pushed a bill through Congress to the president for approval. Obviously, the bill wasn’t approved by Obama, but Republicans did all of this to prove a point. Their goal was to show that they had the ability to get this petition up through the Senate and to the president. Should the president change this year to a Republican candidate, then the outcome would likely be very different. While it will undoubtedly make a lot of people angry to have the ACA repealed, as an employer, you must accept it as a potential reality.

Other potential changes for this year include the introduction of more virtual visits to the doctor. Health insurance works to provide options, convenience and overall cost savings to their program participants. While that may save a little money, the rising costs of health care could cause your premiums to go up.

There may also be more restrictions on higher priced drugs. There are ways for name brand drug companies to skirt around patients ordering generics, which are almost always just as effective. This pushes everyone’s costs up, so there are more steps that doctors will need to go through to justify ordering the expensive drugs. Lipitor, for example, does have a generic version, but there is a small portion of the population that will only respond to Lipitor. If your workers happen to be in a similar situation, then that’s something for them to be aware of.

Depending on your costs this year, you may have wondered if you should use higher deductible plans. This may increase your budget for this year to be put toward additional measures in the business; however, you’ll need to be careful. If you’re planning to do this, you may want to consider discussing this with your employees, as they might feel blind-sided by the change. This is expected to be a major trend for this year, but there will undoubtedly be unseen costs with this type of change.

Regardless of what you choose, knowing what other companies are doing (both your direct competitors and the insurance companies) can help you understand everything in the context of your own business.