Workplace Safety

Doctors to a certain extent run their practice they way they want to, as they can choose the types of cases they take and use different methods for different patients. However, they also have to play ball, so to speak, with a number of different regulators.

From being approved to working with a certain insurer to keeping their medical license, they have a lot to consider. We’ll look at how workers compensation plays out for them.

State to State 

There is a lot of misinformation out there about how doctors treat workers compensation patients, and much of it has to do with the fact that each state has their own rules. For example, in California a worker can have their regular doctor treat their injury if they had their own health insurance at the time they were hired and if they had already told their employer about their doctor before being injured.

In other states, the employer may choose the doctor as a way to ensure there is no fraud or the worker may be able to choose any doctor that’s in their network.

Insurance and Billing

A doctor has to follow a very complex set of rules should you go to him or her with a work-related injury, and the billing gets confusing quickly. Though a patient can typically go to any doctor as the very first consultation (or the ER should it be deemed necessary), a doctor may refer them to someone else for additional treatment.

Also, in certain states it may be possible to receive care from a PA or an RN for treatment while in other states one may be required to see an MD or DO, and the care may be limited. Say a worker has chronic back pain (to take one of the most common scenarios of injury), and they want to see a specialist like a chiropractor or massage therapist for relief. The insurance may cover only a few sessions at most.

Finding a Doctor 

As an employer, it’s easy to want to use all the power that you have available to you. In many cases if you live in a state that allows you to make the decision, it makes sense to find a doctor that will be fair to your employees, but who will never recommend treatments they don’t need. Ultimately this should lower your insurance and make you less of a risk.

However, it’s also worth noting that when a doctor doesn’t have a history with a patient, they’re liable to make mistakes. Those mistakes could very well leave you liable to additional compensation if something goes wrong and the worker never fully recovers.

When you only hear about fraud and rising insurance rates, then it can be easy to assume that those are the trends that are here to stay. We encourage you to remember that there is change happening out there though for certain states. Concerned residents in Florida have already started a new task force, and people around the country are fighting their own battles for what they feel is best for their employees and their customers. We’ll show you what’s happening in Illinois and West Virginia today, so you can see workers comp is functioning in other areas of the US.

West Virginia

After seeing a reduction in workers compensation for the past 11 years, West Virginia continues their streak for another round of cutting costs in 2016 at almost 15%. This time around, employers in the state can expect to save about $36 million, which has made business owners a little happier and wondering what to do with the extra cash. While it’s not been reported as to why exactly West Virginia has had such a good run regarding their workers compensation premiums, it is clear that the reduction gives businesses a sense of stability which can help relationships and growth flourish. The new change will take place the first day of November this year.

Illinois

Illinois is not quite doing as well as West Virginia but their claims will fall by 12% this year, which is still a significant drop. While they still pay more than neighboring states, it’s important to note that they do have one of the biggest cities in the country which is a clear indicator of why they would have higher rates. This fall is a good step in the right direction, but it may be for some disappointing reasons. Some of the jobs that used to be causes for injuries, like construction or manufacturing, have seen a decline in demand in the state. People claim that the high rates and special interest groups have stunted contract and projects moving forward due to the liability and cost concerns. As this year goes by, Illinois will be able to see if the reduction was the boost it needed to kickstart growth again or if it is still under too much strain by the debilitating cost of premiums.

No matter how you feel about either state, this is a good lesson that there can be change on the horizon for you. Illinois in particular will be getting an on-the-job lesson this year, so to speak. When insurance companies have the reason to do so though, they absolutely can work with state officials and businesses to start lowering the cost of workers compensation.

With all the problems and injustices in the world, it can be difficult to know exactly where you should pick your battles. This is especially true for your professional world, because you may not get much leeway if you choose the wrong issues to focus on. However, when one group of people shows their passion through both talk and action, it can be one of the most powerful forces on the planet. That’s what the Florida Workers’ Compensation Strategic Task Force is hoping to do: effect change through systematic effort to help save businesses on potentially unnecessary costs of workers comp.

After town halls across Florida, the group said there needed to be more effort devoted to creating initiatives to improve the system. The call to action was brought upon due to the recent rulings in the state Supreme Court. One of those rulings denied a law that would place an expiration date on payments at more than two years after the worker was injured, and another denied the limitation of attorney fees for workers compensation. These two measures were meant to strip down some of the incentives that has made employee, legal and medical fraud as prevalent as it has been while creating a more sustainable plan for businesses who are trying to balance their expenses.

With another hearing coming up this month, insurance companies want to increase the rates for workers comp at close to 20%, a change that would take place on October 1. The looming court data spurred people into action to see if they couldn’t get together to come up with other ways to curb the amount they’re paying from month to month. Their platform is that businesses saddled with workers comp costs cannot grow, which cuts jobs for the people of the community. Without a stable means to support the community, it spells trouble for the economy at large. Their goal is to continue to come up with ideas until the best solutions are implemented to give Floridians a fairer outcome for both employees and company owners alike. This is about continued talks, not necessarily a one-off committee.

Whether you agree with the methods of the task force or not, this is a powerful lesson for those who do not agree with your own court rulings. It is always an option to increase your involvement in order to bring to light some of the more immediate potential dangers of paying too much for workers comp. Whether you’ve even been involved with an injured employee or not, precedents set in cases in your state can have a bigger influence on your bottom line than you think.

Workers compensation can feel like a minefield, especially when it seems like all the power rests with your employees. When people who don’t follow directions or are goofing around during their breaks can be injured and then sue you for damages, you might feel helpless to safeguard yourself. The power you’re looking for comes from being prepared when you walk into work in the morning, when you hire someone and how you interact with your employees. And you should be aware that mental health may play a significant role in workers comp. Even though it can feel like a subjective matter at times, it’s good to know how it fits into the larger framework of taking care of your staff.

A Matter of Proof

There is a possibility you’ll be held responsible for a person’s mental health damages, but it will be up to the employee to prove that this mental illness would not have developed had they not been under a specific amount of stress at work. It would have to be classified as an abnormal working environment, which again, leaves a lot open for interpretation. When people attempt to prove this on their own without having hired a lawyer, the judge tends to err on the side of employers. Many lawyers won’t actually touch these cases due to the fact that without any type of permanent physical injury, it can be difficult to show that a person is suffering from a sustained psychiatric state that is more or less expected to resolve itself once the stress of the job has gone away. They’re likely only to be paid when they win, so it’s just risky for the lawyers.

The Warning

Despite your odds, that doesn’t mean you should dismiss a mental health request, especially considering that mental health problems are increasingly more accepted as a reason for disability insurance by the federal government. With this type of validation, judges may start to give a bit more weight to these cases based on the right evidence. If you are approached by an employee for being under a great amount of stress, say if they have to work with unfriendly coworkers or are expected to deal with crises on a regular basis, then you may want to see if it’s possible to lighten the load. Hopefully you’ve already implemented hiring practices that might weed out someone who would try to get out of doing his or her job at this point. Also, people are likely to win their case claiming mental health problems if they’ve also been physically injured as well – another warning for you to be as cautious as possible when dealing with workers comp issues.

When you think of fraud in workers comp, it’s common to think about employee fraudsters who are looking to cheat the company out of as much as possible. You might then extend that thought to the doctors who may be convinced to say the employee does indeed need continued treatment and cannot return to work. However, there’s another side too that you may discount – the lawyers who handle these cases. They do not quite stand to benefit quite as much as those performing the long-term medical ‘care,’ but they can certainly be tempted into turning this into a business where the specialize in getting as many clients as possible who are willing to lie a little. We’ll look at the case of Sean O’Keefe from San Diego who did just that.

Paying to Play

O’Keefe took on 9,000 cases, and he got many of those by paying a firm upfront for those who were sent his way. The firm he worked with needed his word that he would rack up a certain amount of expenses at the medical offices where his clients would go for treatment (e.g., MRIs, meds, etc.) This was a business that stood to benefit from clients being treated as dollar signs, and he’s not the only running this scam. There are currently about a 100 people in San Diego who are looking at similar charges, and those are just the people who have been caught. It causes major concerns for just how easy it is was for them to set up an operation that functioned for years entirely under the radar.

Tightening Everything Up

Despite the fact that it doesn’t look great that this happened at all, it is showing more interest in fraud than may have been shown in the past. This should cause a reevaluation of how claims are processed, how medical providers are reimbursed and how they submit their proof. This new information being brought to light should create more oversight which will bring the overall cost of workers compensation down. For O’Keefe’s part, he was paid over a million for doing what he did, and he’s agreed to cooperate in telling officials everything about the operation that they would want to know. In return for bringing down the people who were involved, he’s hoping that his sentence will be deceased.

Fraud and You

This should concern you no matter where you live, and while you might feel helpless to stop it, it’s not impossible to recognize signs of fraud. If you have a chance to check out the lawyers your employee uses, then it may not be a waste of your time either.

Even though women have been in the workforce for many years, there are many that claim the workers comp system is biased against them. There’s a lawsuit happening in California right now that states women’s rights are not being properly acknowledged as defined by the Equal Opportunity Employment Act, and we’ll look at some of the claims so you have a better idea of how gender works in the world of workers comp.

Male Doctors, Male Opinions

When the vast majority of practitioners determining a woman’s condition are male, people claim that women can’t receive fair treatment when it comes to truly diagnosing their level of disability. This is a class-action suit which includes a woman who has breast cancer which she was found to be caused by her two and a half decades serving in law enforcement. During that time, she came up against hazards like narcotics and other toxins while on the job. After she had her breast removed, she had applied to be put on permanent disability but her claim was denied. Her doctor had verified her breast cancer was caused by unsafe working conditions, but through a guide used by the AMA in California, it was determined that this did not qualify for permanent disability. She continues to work in her job, but her lawyer states that she has multiple physical and emotional problems due to her cancer. Her duties remain essentially unchanged after undergoing surgery. In contrast, if a man has his prostate removed, then they could be classified as being up to 20% impaired (meaning that they would at least have accommodation made for them, if not placed on perm disability.) The AMA guide also diverges from the VA, which classifies someone who has had a mastectomy at up to 80% impaired.

Tips for You

If you’ve followed workers comp (or the world) at all, you already know that inconsistencies are part of the deal. People view situations very differently, which leaves the law wide open. In this case, it’s clear that those who have filed against the policies want a reevaluation of how women are treated so that they may work safely and be compensated fairly should something happen. If you employ women, it’s helpful to be aware of gender difference, but that doesn’t mean you have to obsess about them. If you’re using your own sound sense of judgment, you’ll likely be fine, but we caution you against stereotypes. No matter what state you live in, this California suit will likely affect you as more people may start to see cases of discrimination in front of them. Whether that’s based in fact or not will be determined by the courts.

Any kind of insurance is a double-edged sword, and it often feels like each party is on the wrong side of the deal. Those who have insurance feel like they can’t get a break when they need help, and those providing the insurance often feel like everyone has their hand out for everything under the sun. Add into this that there are a select subset of the population taking up most of the available healthcare resources and the insurance fraud that occurs on a regular basis, and you can see why it can make the case of pre-existing conditions even trickier. We’ll look at what you need to know in the case of workers comp.

The Straight Facts

Obviously, you do not want to preclude a perfectly capable employee just because they have typical problems like a heart condition or knee problems. However, there have been cases where this has been known to cause disputes. Employees may blame something related to their condition by something that happened at work, and while you aren’t required to pay out for this, the burden of proof will now be put upon you to come up with evidence that their working was not responsible and that their pre-existing condition was. You are only held responsible if their condition worsens due to being on the job. For example, if someone has a back condition and there is no reasonable accommodation to get them ergonomic equipment, then you may be found at fault.

What You Can Do

Documentation is highly encouraged for all employees, but be extra careful for those with pre-existing conditions. Have employees sign off on forms that acknowledge the steps you’ve taken to reduce the likelihood that they will be injured on the job. Also, try not to take any chances. If you have someone with a knee injury who really shouldn’t be lifting heavy objects, then don’t ask them to fill in if that’s not within their job description. Too often the needs of the moment outweigh the needs of the future. If you make too many risky moves though, then chances are you’re going to land yourself in some type of hot water. Especially considering that back pain is extraordinarily common, it’s a pre-existing condition that simply can’t be taken lightly.

Additional Considerations

Each state has their own specifications regarding pre-existing conditions. For example, if the original injury was not from on the job, then insurance may deny the claim. The same goes if it can be proven that a worker operated outside their doctors orders. Any type of lie made by the employee is the best way to build a case that their claim is fraudulent.

With change in the air and the politics of the 2016 election polarizing people to extreme views, it’s helpful to understand that radical opinions about anything often have a ripple effect. The Republican party was galvanized by the ideas that liberals have simply failed to step up to the plate, that hand-outs have become too prevalent and that the common person has lost their sense of trust for the government. Now, you’ve likely already noticed that they’re not screaming about workers compensation, but the active people who want change in this sphere take it upon themselves to start using the discussion to their advantage. We’ll show you some recent events that have happened so you can get a sense of the underlying principles of what’s happening within the charged conversations.

From Michigan to California

Disability leave, workers comp, pensions: they may all be covered by an employer. It stands to reason that this could cause some overlap, but how exactly it is meant to overlap can feel a bit murky to decision makers. A Michigan judge recently ruled that it was possible for GM to use disability pensions as a supplement to workers comp costs to help cover the cost of injured workers. This decision was challenged because, while it’s legal for GM to do this, they had previously agreed not to when it came to union workers. While this case may seem specific to GM, it does signify a change and a precedent when it comes to coordinating the two measures, and of course shifts the burden of payment around to different budget lines within the company. In California, comp cases are being decided based on subtle language, which increases the fears of both lawyers, insurance companies and employers. Simply not having the correct contract language could spell big trouble for everyone.

New Ideas, Possible Changes

No one knows how the wind will blow exactly, but there is evidence to suggest the new ideas could weave their way into workers compensation rates. When people on one side live in fear, like currently it may seem like employers do with rates going up and major fraud cases making headlines, there may be a tide shift away from rights to employees. This will hopefully increase personal responsibility and lower rates across the board. However, workers comp, like everything in our political system, has to be all about keeping a balance. Being aware of what’s going on can help you understand where the tipping point is and when it’s crossed. The more you can deduce from national discussions (especially during these upcoming critical times), the better you can keep your wits about you when it comes to going forward.

We take our local insurance people for granted. Perhaps we think that everyone in interchangeable, or that it’s just easier to stick with what we know. These are short-cut thoughts that we often discover are all wrong after it’s too late. While there is something to be said about the grass not being greener on the other side, we’ll tell you what to look for when it comes to an insurance agent and workers comp. Whether you’re looking for a new one or evaluating your old one, keep these tips in mind.

Begin With Questions

It’s your job to ask this person lots of questions. No matter how kind-hearted an agent may be in their personal life, their professional motives are often a little different. The more coverage they sell you, the more they make. This is not to say that extra coverage won’t be handy or useful later on down the line. After all, settlements and extended medical care can get very expensive. However, when you ask questions, you get a better sense of the person’s character. It doesn’t even necessarily have to be about insurance. Chances are, you know little about insurance and have little time to study up. What you’re looking for in their answers is how extensive they are. Do they tell you the bare minimum or are they pretty open with in their conversations? Can they chat with you for 15 minutes about your children but gloss over important parts of what they’re selling? Often people are blinded by sincere attitudes, but the person will tell you a lot right off the bat both in what they say and what they don’t.

Check Their Reaction Times

Cheaper rates are appealing, but they often come with customer service that’s about as cutthroat. It’s an extremely frustrating experience to not be able to get ahold of someone. If the insurance agent lets emails go by for days, doesn’t call back when they say they’re going to, or is just plain never at their desk, these are causes for concerns. In this day and age as service falls by the wayside to save a buck, we accept these types of inconveniences as just a part of the deal. However, in the midst of an insurance claim, time can be tight. Delays can cause uncertainties for you which can eventually lead to mistakes.

Hopefully, you’ll only need to fulfill your legal obligations when it comes to your workers comp insurance. Having a rigorous hiring policy, enforcing safety tactics and ensuring that you’re watchful on the job is what will be the strongest determining factors as to whether or not you have to call your agent for anything but having to renew your policy.

There are few people out there who don’t want to be considered proactive. A proactive person isn’t taken by surprise and doesn’t feel helpless when they encounter problems. However, the definition of proactive is so different for every person that it can sometimes make the term feel meaningless. In the case of workers comp, there may be a way that you can implement a solid plan to take your claim costs down to a more reasonable level. With fees having risen steadily over the past few years, prevention programs are really one of the best ways to help yourself out.

Learning, Managing and Acting

It can’t be stated enough just how much it helps to stay on top of an employee’s progress. For example, knowing the amount of time it will take for an injured worker to heal lets you figure out how a person will fit back into your workforce, which ultimately makes for a happier environment overall. It means being able to prepare to put someone to work on transitional tasks that much sooner which can lead to more revenue being brought in for the company. It can also help facilitate better communication between you and the injured employee, which can lead to a better understanding and less chance the employee will take any type of legal action against you.

Safely Getting Everything Back Together

While it’s important to get someone back to work as quickly as possible for the benefit of their routine and your business, there still has to be major emphasis placed on the safety and welfare of the employee. The last thing you need is to aggravate them or their injury by rushing anything. Creating an effective dialog with their medical practitioner means you’re that much more likely to be making your decisions proactively rather than waiting for someone to update you and then feeling put on the spot. The more information you have, the more you can plan for what it means to have someone come back to the office or facility.

Documentation Reviews

Your employees act on a variety of self-interests, as do you. Some people avoid learning more about what happened with their employees, partially because they may not think it’s necessary to devote time to but partially because they’re afraid of what they’ll find. To be proactive though, you may need to discover a problem that will ultimately just make more work for you and potentially get the employee in trouble. An employee who has done something dishonest will raise policies for everyone. It’s also recommended that you learn more about workers comp in general for more information about trends and potential popular scams around your area.