Workplace Safety

As people retire later, the workforce keeps aging. This trend has been a concern for businesses because the conventional wisdom holds that older workers are more vulnerable to costly injuries, driving up Workers Comp rates.

However, new research from the National Council on Compensation Insurance (NCCI) casts doubt on this conclusion, changing the definition of “older workers.”

After studying injury rates for different age groups, NCCI found that, while workers under 35 had substantially more cuts on their fingers and those over 35 suffered more cases of carpal tunnel and cervical injuries, the numbers are startlingly similar.

What about expense? NCCI concluded that although workers between 20 and 34 create much lower costs (and fewer days lost), once they reach 35 these costs are similar. This redefines an “older worker” as someone who grew up listening to Nirvana instead of Elvis.

Injury prevention for employees – regardless of age –should begin during the hiring process. Once you have a written job description, offer the candidate the job based on his or her ability to do the work with reasonable accommodation. Then have the candidate complete a medical questionnaire to determine if he or she “fits” position. If so, it’s time to get started. If not, to find someone else.

If you haven’t already done so, set up and monitor a comprehensive safety-training program for new hires, Make sure that they remain mindful of how they’re doing their job. Far more injuries result from unsafe acts by employees than unsafe workplace conditions Employees who feel rushed are more likely to ignore safety aside so they can meet deadlines – leading to preventable accidents.

To learn more about keeping your workers safe on the job, feel free to get in touch with us.

The conditions enumerated in a workers’ compensation policy define rights and obligations to the parties. They outline governance of the day to day relationship between a carrier and an insured.

Typical conditions include:

• Inspections. The insured must allow inspections of premises and operations so the insurance company can assess safety and loss control concerns.
• The insured cannot transfer rights or duties to a third party without written consent from the insurance provider. For example, in the case of a merger of two companies, the selling company cannot assign coverage to the buying company, or transfer a favorable experience modification.
• The first named insured is solely responsible for all insured parties concerning premium payment, communications such as cancellations, refunds, or additional audits.
• Policies are considered as one year terms for administrative purposes. Premium rates, modifications or any administrative concern is handled as though the term were one year. Three year policies are fairly rare in the modern era of workers’ compensation. Fixed rate three-year policies have a modifying clause to eliminate this condition. Three-year retrospective plans are calculated on an annual basis, and as such, have lost their appeal to potential buyers.
• Cancellation. Policies can be cancelled, for example non-payment of premium, under conditions outlined by the state authority. Usually, the cancellation condition includes a front end period, like two months, for the insurance company to decline the risk. The carrier usually must cancel at least some minimum time prior to renewal or the policy automatically renews. Of course, non-payment has a statutory warning and time to correct.

These conditions are important to understand and honor. They protect the insured and the carrier so the governance of the policy is smooth. Typically, conditions establish a mutual respect between the insured and carrier. The right to inspect but the obligation to report back, and offer advice. Mutually beneficial management.

The bad news: slips, trips, and falls are one of the nation’s leading causes of workplace injuries. The good news: working with safety professionals can help prevent these accidents – and keep your Workers Compensation costs under control.

Falls on the same level (in which workers slip and fall on the surface on which they’re standing) cost Workers Comp insurance companies a hefty $8.61 billion in 2010, accounting for 16.9% of their total claims. That’s the word from Wayne Maynard, Manager of Technical Services and Product Development for the Loss Control Advisory Services unit of Liberty Mutual, the largest Comp carrier in the nation.

According to the Liberty Mutual 2012 Workplace Safety Index, “bodily reaction” injuries – which includes those caused by slipping or tripping without falling – represented $5.78 billion of Comp costs in 2010, or 11.4% of the overall burden,. Falls to a lower level in that year accounted for another $5.12 billion, or 10% of claims.

These costs are rising, due in part to an aging workforce (older worker tend to have more balance problems). Falls on the same level increased 42.3% from 1998 to 2010, while bodily reaction injuries increased 17.6% during this period.

You can help reduce the frequency of slips, trips, and falls by taking such ergonomic enhancements in the workplace as 1) adding slip-resistant flooring; 2) eliminating raised surfaces that might cause tripping; and 3) installing handrails on stairs. Also make sure that your employees take immediate steps to clean up spills that could create slippery floors.

Our agency’s professionals would be happy to provide a complimentary “slip, trip, and fall” safety review of your premises – just give us a call.

Between the Affordable Care Act, new healthcare treatments, and the amount of older workers, workers compensation has a number of issues facing it. Find out more about the trends today, so you can better prepare for the future.

Medical Care

Technology continues to sweep across states, cities and towns, with medical advancements becoming more and more effective. Communication and flexibility has also improved considerably. Injuries and illness are more likely than ever to be treated over a Skype video rather than an in-person consultation. It gives people who may have been averse to visiting a doctor more control over how they obtain their information and treatment recommendations. It generally means better long-term care as well. The more health tools available, the better it is for workers. These advances are obviously great, but in general, it raises the costs for everyone. A $10 million used to be incredibly rare, but this is now becoming extremely common. Even accounting for inflation, costs continue to rise.

Risks Today 

Different doctors have very different opinions about what constitutes the right treatment, and many have underlying agendas that have nothing to do with health. Workers compensation needs to become more conscious of the fact that dollars are being lost in a system that is largely unable to regulate the doctors within. This is why the industry is seeing states looking at their guidelines to see how they can improve consistency, and potentially implementing fee schedules that involve the insurance carriers, so there is more focus and visibility in terms of who is paying for what. There needs to be more thought and oversight given to the care of the patients who have dramatic conditions. The decision to use addictive prescriptions, surgeries, tests and more all need to be carefully weighed for the benefit of employee, employer, provider and insurance provider.

Forecasts 

States will continue to reduce the costs paid for workers compensation claims by implementing smarter guidelines for care. There may be more investigations into companies after injuries occur, ensuring that the conditions have improved as much as possible to further eliminate costs. However, some experts think that the ramping up of costs may be a systemic issue, meaning that these efforts may do little to truly bring the costs down. Again, this is mainly due to the fact that technology has simply made it more expensive to treat patients with the best possible care. The experts also state that you will likely see more claims involving mental health down the line. This is a new issue that employers are starting to give more consideration to, especially because mental health is linked to common serious conditions like heart disease.

Pain is subjective, and this fact can make management extremely difficult. Even though medical treatments continue to advance, the access to new and better methods remains widely unavailable for many. When one worker can rate the pain of a paper cut at a 10 and the other at a 1, you know that doctors have their work cut out for them in terms of treating people with major injuries. We’ll look at how it all functions in the real world.

Prescription Management, or Lack Thereof 

When a doctor gives an employee a treatment plan, they do so for several reasons. They obviously want the best possible recovery time for the patient but they also do it cover themselves. They can’t make a patient complete the plan, and often don’t understand what it will really mean for a patient to attempt to complete it. At a recent Workers Compensation conference, experts let the group know that up to 30% of prescription are never actually filled, and up to half aren’t taken as directed. If the worker has other pre-existing conditions, they may be aggravated by a workplace injury, making one small incident have lasting repercussions.

Too Much, Too Fast 

Depending on the type of care a worker receives, they may end up being prescribed multiple medications that only end up confusing the worker and potentially creating adverse reactions to a combination of medications. Also certain medications can cause muscle pain that has nothing to do with the original injury. Workers who see multiple doctors (as can be common in workers compensation) have the highest risk of this occurring. Injured parties may forget or be unaware that they have common medical problems, such as high blood pressure. The wrong medications after an injury may cause a life-threatening condition.

What to Remember 

Even if you’re not a doctor, it’s important to encourage the employee to do the right thing. Claiming ignorance may only go so far if the worker develops a more serious condition after a minor industry. Just one fallen box can result in a lifetime of chronic back pain for the worker, but proper initial care may be the answer to this. Doctors need to pay closer attention to how pain is improving, and what the effect of that pain has on the employee in terms of physical and emotional symptoms. The best thing to do in the case of an injury is to remember that your fate is tied with the fate of the worker. The better care the worker gets, the more likely it is you will have the best outcome. By understanding how pain is treated and the potential problems of the current strategies, you have the opportunity to lessen the severity of the final claim.

Having a realistic plan and expectations in terms of diversity has always been important for employers, but today it seems to be an even more pressing issue. Treating people fairly is a concept that everyone sees differently, and therefore can make for a complex topic to even broach. But being honest will be the only way to really address the underlying problems with how you handle employee safety.

The March of Time 

The population is aging rapidly. With more older workers who are unable to retire due to their economic circumstances, it’s important to give consideration to their disabilities and recovery times after an injury. There needs to be quick reactions to any injuries that may occur on the job, both to prevent the injury from getting worse and to speed up the resolution of an injury claim. Most older workers are going to be interested in getting back to the job no matter what, so it’s important to urge employees to listen to their body as well as provide a program that minimizes the strain they will feel when they return to work.

Understanding the Age Gap 

When two different generations are in a workplace, they’re bound to clash in terms of ideals and work strategies. This type of conflict can either force the two groups to understand the other or it can set the company up for a disaster. When you work with the younger generation, they may feel little loyalty to the organization, while the older generation may have more specific medical considerations when it comes to their duties. To strengthen communication and therefore minimize the chances of the injury, ensure that you’re treating both groups with the respect that they deserve. This doesn’t mean giving in to every demand, but it does mean working with them as much as possible. If you can allow them to work from home following an injury, then it should certainly be considered.

The Difference in Cultures 

Every culture is different, so ensure that you know the major issues facing each group for better planning. Minorities tend to have less access to services, meaning that their care may not be as detailed or thorough following an injury. Some cultures have a difficult time admitting they need help, so you may need to mandate a doctor’s visit into their injury so that it’s not left untreated. This will save you money in the long run, and keep the employee healthier. Also, if the employee speaks English as a second language, then communication becomes a real issue. Ensure that they have access to both providers, literature and information in their own language for best results.

Every industry develops its own terminology and jargon which helps them communicate quickly and easily. Often learning it all is just a matter of putting the time into the experience, but sometimes by learning the more complex terms, you stand a better chance at feeling empowered in an unexpected situation. While set-asides are used for the injured party, it’s helpful to be informed of the process as an employer.

A set-aside refers to the amount of money that is put into a fund to help with medical services after a settlement has been reached. The settlement goes to the injured, and it’s a way to ensure that they use that money correctly. Medicare will always be the second payer in situations where insurance money runs out after a settlement, and thus created a system to determine how the money should be spent. So if you have an employee who injures themselves on the job and your insurance pays out a certain amount, the set-asides would be the funds that need to be used before Medicare kicks in to cover the rest. The actual amount of these set-asides are decided upon by Medicare after reviewing the documentation available from the claim. The specifics may differ depending on whether or not if you have a no-fault or liability settlement.

Whether or not a Workers Compensation Medicare Set-Aside Allocation is determined by the situation, and an attorney will help counsel the employee through the process. The allocation is an estimate of the total cost of treatment (including prescriptions, surgery, etc.) There will need to be extremely detailed reports for every penny on the part of the injured, and there are certain restrictions on the use of it. Much of the fraud that stems from workers compensation is often seen on the Medicare side, as there are fewer limits than an insurance company.

As you can imagine, this whole issue gets complicated fairly quickly. When an injured worker needs continued care for years after an accident, the question of who pays often becomes a question for the courts. They have to look at the way the injured party were hurt, and determine exactly how much of their injury was on the part of the employee. While you as an employer is neither Medicare nor an insurance carrier, your rates are determined by these types of questions. Therefore it is in your best interest to provide as much safety training, oversight and documentation possible about your involvement with your workers. The more you do this, the less likely it is that you will become caught up in a large settlement that ultimately cripples your business due to rising insurance rates.

With every state having their own workers’ compensation rules, it has meant that incentives have varied widely throughout the nation. The majority of doctors, lawyers, insurance carriers, employers and employees are all either inadvertently or consciously trying to avoid their losses at every level.

When a report came out about surgery and Medicare in the nation, it was found that New York was performing vastly below the average while Alabama and Louisiana were operating at far higher rates. Is it that because people in Alabama are more likely to become severely injured? It is a better bet to say that there are other forces at work here. We’ll look at the numbers from the 33 states that were included in this study, and talk about the implications of it for you.

Averages and Rates 

As you might expect, states without fee schedules had much higher utilization rates than those who did (up to 150% over the average amount.) This means that if there was a limit on how much could be spent, somehow that limit was magically reached in the majority of cases. Surgery and other costly procedures were performed sparingly.

If there was no limit, there seemed to be more care that was necessary to complete the treatment. The same trend was shown whenever there were states that had some type of limits imposed, whether it was percent-of-charge or cost-to-charge.

What Does This Mean for You?

There are several ways you can look at this study. One is that you could assume those who did receive more care got the additional consideration because there were no limits in their state. A doctor had every measure to complete a full plan for their patients without having to worry about costs thus achieving a better state of wellness for the patient. This is certainly one reason why no limits might be imposed in a state. However, the less optimistic viewpoint would be that people are flat-out exploiting the system.

Certainly we know that fraud is real in workers compensation, and potentially difficult to reveal. Whether a doctor recommends one unnecessary treatment for one patient or 50, they’re committing an act that will raise everyone’s costs further down the line. If you’re interested in becoming an advocate in your state, you may want to lobby your local lawmakers with information about recovery and relapse in patients in the states that have imposed limits. It is the best way to prove that those who have limits are both not a drain on the system while still achieving acceptable care. This is a difficult issue to talk about, but one that needs to be addressed.

The Annual Workers’ Compensation Educational Conference (WCI) is just one example of how complex this topic is to everyone involved, from doctors to employers. Many of the sessions are made solely for those in specific industries (e.g., only for judges or attorneys.)

With a variety of laws from state to state and interpretations of those laws from state to state, this conference has to address a lot of questions and confusions. We’ll give you an idea of what it was like to attend, though it should be noted that it’s impossible to cover it all here.

All Eyes on Florida

The Florida Supreme Court has already ruled on several aspects of the workers’ compensation rules, as in they will not be limiting attorney fees and temporary employment benefits, in an effort to avoid needless litigation from employers. Some experts say this has worked with fewer court cases being heard, but insurance companies are claiming that they’re now subject to paying the costs and haven’t been able to set prices for their premiums based on these laws. They now want to raise their rates up to 20%.

Florida is where the event was held, so it was a topic that was especially on people’s minds. Between this and the contrasting event of falling costs of rates in Oklahoma, it was these two states that won the spotlight. Everyone at the conference wanted to fight against fraud and waste, but the best ways to regulate that is still debated by many.

Bureaucracy, Advocacy and Safety

These are typical topics when it comes to anything related to workers’ compensation, but the conference attempted to address them with a modern bent. For example, studies into the Affordable Care Act (Obamacare) have not necessarily shown the rates to have changed due to the laws, though it behooves employers to keep an eye on any overlap between provider networks and approved workers compensation professionals for additional cost savings and streamlined care. They also talked about the employees who are not covered by workers compensation (e.g., domestic or agricultural workers.)

There was more information about how employers can better develop their own safety plans, and how changes in healthcare will affect the program. The conference addressed how many larger businesses do not have effective risk management, and how accountability should be at the forefront of each business.

There was an emphasis on how data can help people make better decisions, and on how best to use that data when it comes to driving change in workers compensation. In other words, there was a lot happening at this conference, and if you want to learn more about a particular talk you can click here.

Every day you likely see people make decisions you wish they would reconsider. People make mistakes because they’re tired, bored, angry or just plain uninterested in what’s happening around them. Appeals were made for those who feel the courts were full of professionals making choices based on their own self-interests and not based on the facts.

We’ll tell you what you need to know about workers who choose to go through the appeals process.

Before You Reach the Courts 

If a doctor denies a request for treatment that an employee feels is necessary, the first step is to get a second opinion. Often this can be done through a Qualified Medical Examiner, meaning this person has undergone special training to work with injured patients on the job. However, if an employer refuses to acknowledge their part in the matter or the insurer denies their responsibility in the claim, then it may be necessary to take the matter to the courts.

How It Works 

For some cases in workers compensation, the employer is clearly at fault, they cover the employee’s injuries and insurance picks up the tab. However, other times the facts aren’t so clear and the employer goes to court. Workers compensation will typically have their own judges who work to decide fair outcomes for all employees they see.

They look at the testimonies of the employee and potentially the employer, they’ll gather the medical information and review all other evidence to determine what compensation should be given. Once the judge gives their decision, either the employee or the employer may appeal. In New York state, it’s normally 30 days after the filing, but each state will have their own specifications.

The appeals board typically will then have the power to modify the terms of the decision, or flat-out agree or disagree with the judge. If those on the Appeals panel don’t agree with each other, it will get kicked up to a higher level for a full Board review, in which case there will be another set of people who look at the facts.

Benefits and Beyond 

You are not required to pay benefits while a case is being contested, meaning that some employers have used it to tie up funds by dragging cases out through appeal after appeal. The justice system is somewhat malleable in that cases have the ability to be pushed up the ladder until they reach the very top — especially in unique cases that haven’t been tried before. If you’re at a loss of what to do, remember that there are always options. However, the legal costs and hassle may not make it worth it.