You've hear of Undercover Boss, what about Undercover Injured Worker?

Most of us are probably familiar with the concept behind the show, "Undercover Boss."  The removed CEO or owner of a large corporation changes their identity and goes "undercover" working as a new hire that needs to learn the ropes of the less than glamorous positions in the company.  They're stripped of the everyday luxuries and live in a motel room, etc. to experience what their lowest paid employees make -- all in an attempt to understand what it's like to work for their company.  The show is usually very emotionally charged, and ends with the CEO having a revelation that changes need to be implemented, improvements need to be made, and sometimes they even shell out thousands of dollars to help an employee pay for overwhelming medical bills or something of the sort. 

I propose that employers go to work as an undercover injured worker.

Before you diminish the value of a safety measure, process improvement, or a return to work (RTW) program -- put on a pair of the proverbial "someone else's shoes" or work boots and see what the experience is like to have a workers' compensation claim.

I guarantee the experience will be eye-opening.  It will open your eyes first hand to a system that is riddled with challenges, confusion, complexity and bureaucracy -- a system that was designed to be a no-fault system to promptly provide benefits to any person injured on the job.  What does your accident investigation feel like?  How well does your injury reporting process work?  How does it treat injured workers?  How do our employees treat injured workers?  How does RTW impact the injured worker?

You'll learn how coworkers and supervisors treat you -- maybe with respect, maybe with pity, or maybe with anger or suspicion.  You'll learn what it's like to receive confusing forms in the mail, feel the uncertainty of whether or not you'll get a check in time to pay your bills, and realize that life does not stop simply because you got injured.  You may be limited in returning to work but your supervisor determines that there's "no light duty" in your company.  You'll feel the isolation and detachment within a few weeks of being out of work.  The attorney commercials will get old quickly; the resentment may build between you and your employer because you want to come back to work, but aren't being offered work.  You'll feel that people don't believe that you're really injured.  You might even see a weird car parked outside of your house that you soon discover is a surveillance company hired to see if you're doing anything outside of your restrictions. 

Now, in this scenario, you're not truly injured -- as an undercover injured worker, you're lucky that you don't have to go through the physical pain that results from an injury.  You won't have to worry about how you're going to button your own shirt, make yourself dinner, find a position to sleep comfortably because you can't use your arm due to a shoulder injury.  Fortunately, you won't have to feel how tiring and exhausting constant, throbbing pain can be and how it takes a toll on your ability to cope with stress.  Luckily, you also won't have to experience the strain that it puts on your relationship with your spouse and/or children now that you can't fulfill all of the requests you used to, cooking a meal, doing the laundry, driving the manual transmission car-- you won't have to experience what it's like to give up a good bit of independence nor will you realize how much that impacts your psychological state.

When someone has an injury, it doesn't stop at the physical level.  It impacts the injured worker from a financial, social, psychological and physical level.  It impacts their relationships, their confidence in their ability to provide for themselves or their family, and their place in this world.

Thankfully, I've never experienced a work injury.  How do I know to write about all of this stuff?  It's called empathy.  I took the time to imagine what it must be like to go through this process.  We all like to say that "if it were me in that position I'd do X, Y, and Z" but you never know until you've experienced it firsthand.

I encourage all employers who are in the position to make decisions related to the safety and well-being of their employees to take 10 minutes out of their day, at least once a month, to consider the "other side of the coin" when making a decision, not just the coins associated with implementing a change or offering modified duty.

Nurse Case Managers are NOT the Claims Police

This week's post comes to us from Eastern's own Director of Medical Cost Management, Nancy Crago, RN, BS, CCIM, AIC.  Nancy has over 35 years of nursing experience as well as 16 years of insurance experience.  She has had the opportunity to work directly in many areas of workers' compensation claims ranging from telephonic case management, claims adjusting, and supervision of adjusters and case management teams.  

What is a case manager?

The Case Management Society of America defines a case manager as a health care professional who is responsible for utilizing the case management process for individuals with health-related needs, with the goal of maximizing their wellness, autonomy and appropriate use of resources.  

What experience do case managers have?
Nurse Case Managers are registered nurses with at least 10 years of nursing experience.  Many nurses have advanced degrees and have specialized clinical skills and knowledge.  In addition, many nurses have national certification from organizations which focus on case management.  These include CCM, CRRN, and CDMS.  Continuing education is required to maintain professional licenses and national certifications.

Nurse Case Managers who work in the workers’ compensation environment generally have backgrounds in orthopedics, neurology, critical care, emergency trauma, general surgery, rehabilitation, or occupational health.  

Exactly what is it that nurse case managers do?
Case Managers have several roles – they are advocates, facilitators, coordinators and educators.  The foremost role is advocate.  Whenever a case manager works with an injured worker, the nurse establishes a relationship with that person.  The case manager and injured worker establish goals and plans to meet those goals.  While working as a case manager in workers’ comp it is essential that the case manager inform the injured workers that any information related to the claim and its outcome will be shared with the physician(s), claims representative, and employer.

How can employers maximize the benefits of case managers?
Collaboration is the key to a successful outcome with a case manager.  Case managers are looking for a win-win situation – the injured workers returns to wellness and the employer regains a productive employee.  Although the case manager will be an expert about the injury and treatment, he or she may not be an expert about the injured worker’s job and specific requirements.  Share a detailed job description with the case manager.  This will foster understanding about your business.  This knowledge and a written job description helps the case manager to clearly discuss how the injured worker can safely return to work during recovery from the work injury.   Use the case manager’s medical knowledge to help design a job around any restrictions the physician may order.  Ask questions about the treatment plan – how long will treatment last, are there other effective treatments. 

Case managers are NOT the "claims police"
Injured workers (and some mistaken employers) may think that the case manager is assigned as a policeman.  Nothing can be further from the truth.  Medical care is becoming more and more complex.  The case manager will assist the injured worker to understand the treatment plan, medications, and why early return to work is essential for a full recovery. 

Because the case manager brings medical expertise to the claim, he or she will always be pushing toward the next outcome and goal.  Expect the case manager to provide suggestions and recommendations for next steps.

Through education and experience, a case manager brings medical expertise to the claim.  A case manager also helps to coordinate care with a variety of healthcare providers—physicians, therapists, pharmacists, etc.   Case Managers are not “claims police”.  Their only focus is on returning injured workers to wellness through appropriate medical care.  As nurses, case managers are advocates for the injured worker, which benefits the injured worker and the employer. 

Thank you to Nancy for sharing her experience and insight on some of the many aspects of case management!

 

Concurrent employment conundrum: Return to Work for those who work more than one job

Some states provide benefits for concurrent employment if the injured worker is unable to work one or both (or more, I suppose) of their pre-injury jobs.  The workers' compensation policy covering the injury pays for the lost wages the injured worker sustains due to the work injury, which includes wages lost at another job.

Here's the scenario:

Steve works for No Leaks Plumbing as a plumber.  He also works part time as a bartender at Ps and Qs,Pub on the weekends.  While Steve is working to loosen a pipe under a sink at a customer's home (working for No Leaks Plumbing), he injures his right shoulder.  After going for treatment, he is given one-handed restrictions.  The good news is, No Leaks Plumbing is insured with Eastern Alliance and has a solid return to wellness program.  No Leaks Plumbing can bring Steve back the following day to work within his restrictions.  Unfortunately, Ps and Qs Pub cannot. 

What's the big deal, right?

Well, if the state that Steve files a claim in considers concurrent employment wages as part of the claim, then it can have implications for No Leaks Plumbing.

When calculating the compensation Steve is due as part of his injury, the claim representative would obtain wage information from No Leaks Plumbing and Ps and Qs Pub.  These wages would be combined to determine Steve's pre-injury average weekly wage (AWW).  Based upon the AWW, Steve's compensation rate, or temporary total disability rate, would be roughly 66 2/3% of the average weekly wage.

Let's say Steve makes $1000 per week at No Leaks.  He makes $200 working at Ps and Qs Pub.  One may think that since Steve is working for No Leaks without a loss of earnings, his wages from Ps and Qs Pub wouldn't matter. That is incorrect.

Steve's AWW would be $1200.  If Steve is able to earn his pre-injury hours, earning his pre-injury wages on modified duty, the compensation carrier would still owe Steve 2/3s of the difference between his post-injury earnings and his pre-injury average weekly wage.  In this example, it would be $1200 (AWW) - $1000 (wages working modified duty) = $200.  66 2/3% of $200 = $133.33.  Steve would receive a paycheck from No Leaks, and a temporary partial disability (TPD) check for a percentage of his lost wages from Ps and Qs Pub, in the amount of $133.33.

This puts No Leaks in a difficult position.  They support modified duty but Ps and Qs Pub does not.  The claim representative can attempt to work with Ps and Qs to bring the injured worker back to modified duty, but the pub really has no reason to, other than to have an employee performing some type of work. 

Keep in mind, as long as an injured worker's earning capacity is reduced, due to the work injury, then there is likely going to be benefits due to that worker.

What can be done in this situation?

• The claim representative can encourage the injured worker to discuss modified duty with their concurrent employer
• Obtain a job description from the other employer to help the treating physician determine what the injured worker can safely do at the pub.
• The primary employer (No Leaks) could consider placing the injured worker at a local not-for-profit organization through transitional duty to reduce exposure under the claim, rather than simply paying the injured worker their pre-injury wages.
• If all attempts fail to bring the injured worker back to work at the other employer, the primary employer (No Leaks) may be forced to cover the secondary employer's wages until the injured worker is recovered to perform the work at the pub.

Concurrent employment creates a unique challenge for employers and insurance carriers.  An effective RTW program can help control workers' compensation costs, and can help employers control the aspects of their claims that are within their control.  Sharing expertise and experience with the secondary employer may help them understand why it is a good idea to bring an injured worker back to modified duty.

Complimentary Webinar: Using Not-for-Profit Organizations as a RTW option

Are you or your clients interested in learning about a new and innovative RTW solution?  Sign up for a complimentary webinar being offered by Eastern Alliance Insurance Group's Return to Wellness Specialist, Sarah Tayts. 

WHO:     This presentation is open to all EAIG agency partners and EAIG clients.  Please feel free to forward this post via email to anyone you believe would benefit from attending this presentation.  You can do this by clicking on the envelope icon located at the bottom of this post, or simply copy/paste the URL to this post into a separate email.


WHAT:     The presentation will highlight how to strategically use NFPs to solve even your most challenging RTW situations, as well as address the most common questions regarding the process. 

WHEN:     Wednesday, December 4, 2013 @ 10 am EST

HOW:     Register for the webinar by clicking here and completing a basic registration form.  For more information on how to get the most out of the GoTo Webinar session, you can click here to view a brief PowerPoint tutorial.               

In the past, this presentation has been very well attended, so be sure to register now to reserve your spot!

The "rules" of WC aren't a secret -- really anyone can find them...

Workers’ compensation has existed in the United States for over 100 years.  Unarguably, things have changed since 1911.  One acronym says it all:  EDI.  Don’t worry, this isn’t a post about EDI at all – we’re trying to gain a following here, not see how quickly people “x” out of their browsers.

Every year we hear of a few states who are taking a crack at this reform or that amendment.  These changes are typically a fusion of neighboring states’ systems, but with a twist!  Each state’s laws address workers’ compensation it a bit differently but whether you’re in Texas or PA, there are some similarities that, amazingly, people still don’t know about. So, here are a few common things about WC that I wish more people knew.

Medical providers:  If you want to get paid you need to submit your bill with medical records.

Would you pay a bill if you had no idea what it was for?  Despite they average person's usual philanthropic tendencies, I’d bet not.  Why would you expect an insurance carrier to pay for something when they don’t know what they’re paying for? 

Here’s what happens.  The carrier gets a medical bill or invoice without records.  The carrier denies it and requests that it be resubmitted with medical records.  Maybe the billing company is a separate entity and can’t just print out the records.  The billing company then has to request the records from the provider, who then sends them to the billing company who sends them, hopefully, with the appropriate bill, back to the carrier.  This could take a few weeks.  Suppose that in the interim, the provider identifies this as an account with a balance on it and they send a second notice to the injured worker, causing all sorts of outrage and frustration, when all the while letters and requests are crossing in the mail. 

An avoidable mess is the most frustrating mess!

Modified duty reduces claim costs

It’s as if this is a big secret!?  I’ve always said that for every attorney billboard along the major highways that we see, I wish there was one explaining why modified duty makes sense – if done properly.  I bet if you asked people what happens to their rates when they file a homeowner’s or auto damage claim the overwhelming majority of people would say, “My rates go up.”  It’s so prevalent NBC’s Today Show website has an article on this topic from just 6 days ago! The more a claim costs, the more it impacts your policy (in most cases).  WC coverage is no different.  Modified duty is one of the most effective ways to reduce indemnity (wage) loss costs on your policy.  Carriers don’t make this stuff up!

The “rules” of WC aren’t a secret – really anyone can find them.

Why do some claims go sour?

No matter how you’re connected to a workers’ compensation claim, you probably share the same goal as everyone else:  to get an injured worker prompt, appropriate medical care and return them to work.  You want to get on with business and life as usual. 

Anecdotally speaking, the overwhelming majority of claims follow a fairly smooth path.  An injury occurs, it gets reported, and the injured worker seeks medical treatment.  After a few weeks of treatment, the injured worker is released to return to work without restrictions.  Any required state forms are signed and returned.  After paying any outstanding medical bills that may drift in, the adjuster reviews the file and determines it is appropriate for closure.  

I’d venture to say that this scenario is not what typically comes to mind when discussing workers’ compensation claims.  Maybe it’s the attorney commercials, maybe it’s the horror stories from your neighbor or distant relative, or maybe it’s because something simply went wrong in the course of a claim that resulted in a negative impression of the system. 

What causes some claims to go sour while others resolve without issue?

Information asymmetry due to weak communication.

Communication, by definition, is an exchange of information between people. 

In a workers’ compensation claim, there are a lot of people, all with asymmetrical quantities of knowledge, experience, and information.  Workers’ compensation is a system that has been historically filled with distrust.  Not to mention, a workers’ compensation claim impacts people on a very personal level.  When you combine the number of people involved with the emotional impact a work injury can have, it’s almost like a keg of gun powder and it must be handled with care and respect. 

Throughout the claim process, there are numerous potential “breaking points.”   I’d be willing to bet most of them revolve around communication.  Appropriate communication can quell the symptoms of information asymmetry and has great potential to prevent claims from going sour.

Some of these breaking points are provided below, with a simplified version of a solution, focused on communication and empathy.

Problem:  The injured worker receives a collection agency notice because of an unpaid bill.  I put this one at the top of the list, as it is one of the simplest problems to prevent.

Solution:  Injured workers should not ignore a bill or invoice.  If an injured worker receives a bill it does NOT always mean the insurance carrier denied it.  It may be that they didn’t have the correct billing information, it got submitted to personal health insurance, or to the wrong insurance carrier.  A simple fix is to call the billing number on the invoice, and update them with the correct insurance information.  Waiting until a collection notice is received makes it more difficult for the workers’ compensation carrier to get an appropriate bill and medical records to make sure it is related to the accepted injury to review it for payment.

Problem:  The injured worker doesn’t receive their wage replacement check on time.

Solution:  Someone can contact the injured worker to let them know it will be late.

Problem:  The injured worker hasn’t heard from their employer for weeks.  They’re starting to wonder if they still have a job.

Modified duty job offer letters communicate more than just RTW details

Return to work date, restrictions, hours, wages…

These are important elements of a modified duty job offer letter.  A modified duty job offer represents much more than a letter – it sends long lasting messages about an employer’s relationship with their employees, particularly in a time of stress or uncertainty.

If I get hurt, my employer will work with me to bring me back to work.

When employers offer modified duty, it demonstrates that they are willing to make some accommodations for someone who wants to work.  Involving the injured worker in the return to work (RTW) conversation is an important step – after all, they are the ones who are doing the work.  Listen to the injured worker’s complaints.  Consider altering their assignments or scaling back their hours if indicated.  Not every RTW will be a success the first time around.  Instead of throwing in the towel, talk to the claim representative, nurse case manager, and ask them to address this with the treating physician. 

My employer offers modified duty, so getting injured at work does not equate to sitting at home.

This is an incredibly important message.  Employees learn from what they see happen with other injured workers.  While the overwhelming majority of claims are legitimate, there are a sometimes people who wish to file an illegitimate claim or “build” their legitimate claim.  Having a strong RTW program that consistently gets injured workers back to work can help eliminate the motivation for filing illegitimate claims or exaggeration of existing claims.  Modified duty job offers shorten the time and injured worker will be out of work.

What happens after RTW?

If you’ve been following this blog, you’ll realize many of our posts focus on the process of identifying modified duty, the benefits of RTW, and developing RTW programs.  Getting someone back to work is important, but it doesn’t stop at the RTW date.  It’s a phase of the return to wellness process that must be managed.

What happens after an injured worker returns to work?
I’m sure one could find bits and pieces of answers to this question in books, and there are plenty of scholarly journal articles on this topic, trust me.  Personal experience will teach employers the most in this regard.  Not the answer you were looking for?  What follows is an attempt to summarize the most frequently learned lessons.

Communicate the return to work date to your claim representative immediately!
There simply aren’t enough font embellishments with which one can emphasize this point!  Prompt communication of the injured worker’s return to work will prevent plenty a problem:  over payments, taking credits against future benefits, getting the appropriate forms filed with the state’s workers’ compensation authority…  It’s also a great feeling for the claim representative to know that we’re returning someone to modified duty.  So it not for any other reason, notify your claim representative to provide them with the good news.

Medical treatment
Just because an injured worker returns to modified duty, doesn’t mean that they are no longer entitled to medical benefits.  This is a concern of injured workers when they contemplate RTW.  Returning to modified duty is part of an injured worker’s recovery.  As one person put it, you don’t get better and go back to work, you go back to work to get better.  It is common for an injured worker to continue physical therapy or use of prescription medications after RTW.

Employers should encourage injured workers to schedule their physical therapy and doctor’s appointments outside of the work day.  Check with your claim representative, as it depends on the state and the type of appointment (IME, etc.).  It may also be a good idea to locate a physical therapy location that is on the injured worker’s way home.

Wages
What happens if the injured worker receives less in wages than they previously earned?  As with all answers to WC claim questions…it depends.  In most states, there are temporary partial disability benefits.  These are paid as a percentage of the difference, or gap, in post-injury wages compared to pre-injury wages (calculated as the average weekly wage – AWW).  These percentages range from 50% to 90%. 

Employers process their payroll as usual and if the injured worker’s weekly earnings are less than the pre-injury average weekly wage, they should submit the payroll records to their claim representative who will review and process any TPD benefits due to the injured worker.  So, the injured worker will receive a paycheck for hours worked, and a TPD check for a percentage of the gap. 

What if the injured worker is disruptive or violates company policies?

What's the ROI on RTW?

It’s no surprise that claims-people like to use acronyms and abbreviations.  It’s as if we’ve got our own language…TTD, IME, PPD, IRE, RTW, ABC…just kidding with that last one, but it’s plausible.

The knee-jerk response of any business owner when asked to bring someone back to modified duty is typically, what’s this going to cost me?  It is important that employers understand what their potential return on investment is with a return to wellness (or, as others call it, return to work) program, but that is only part of the picture.  Examining the opportunity costs associated with modified duty will help an employer/business owner make the best decision, for their business and their employees.

What’s the return on RTW programs?
A 1993 study conducted by Crawford & Company estimated returns ranging from $8-10 for every $1 invested in a RTW program.  This same study noted an overall reduction in WC costs of 54%.

Roto Rooter Services Co. experienced a reduction in incurred WC losses from $1.4 million to $356,000 in one year, which was largely attributed to their RTW program¹. 

Gibson Greetings’ RTW program reportedly reduced their incurred WC losses from $400,000 to less than $50,000 the following year¹.

The RAND Institute (2010) published a working paper which examines the effectiveness of RTW programs.  The study suggests that for large employers, RTW programs are highly effective at reducing duration of absences due to work injuries, resulting in about a 3.6 week reduction in the median number of weeks away from work for an injured worker.²

Obviously, individual companies will experience varying results.  These statistics represent case studies that are likely not applicable to every industry nor every employer. 

What is the cost of doing nothing?
Without going into the nitty-gritty of calculating experience modification factors (if you’re a glutton for punishment, you can learn more on this by going visiting your state’s compensation rating bureau), the higher your experience mod is, the higher your premium calculation will be.  A credit score is used to assess a creditor’s risk when lending you money.  Similarly, an experience modification factor is used, among many other factors, to determine an insurer’s risk of insuring your company for workers’ compensation insurance.

The impact of a RTW program, or not having one, will depend on what type of policy you have.  If you’re an employer with a large deductible, you will see more “immediate” savings than someone on a guaranteed cost policy.  If you’re an employer who has a retrospective rating plan, then you have an incentive to lower your claims – a dividend! 

These are the direct costs associated with insurance premiums.  Consider your profit margin.  Think about how much more you would have to sell to offset a WC premium increase of $10,000.  Now, reconsider the cost of offering a few hours of modified work per day for 6 weeks.  There’s an opportunity for even greater savings in some states when a claim remains medical only as opposed to becoming a lost-time claim in regards to your experience modification factor.

We haven’t even discussed the indirect costs associated with having an injured worker out of work…lost productivity, decreased employee morale, increased potential of illegitimate claims, increased turnover, increased injury rates, increased costs of overtime, increased health insurance costs…  We’ll save that for another post.     

References:
1.   Friedman, S. (May 8, 1995).  Back-to-work WC programs pay big dividends.  National Underwriter, 99(19), 3;26.
2.   McLaren, C., Reville, & Seabury, S. A. (March, 2010). How effective are employer return to work programs? (Working Paper No. WC-745-CHSWC).  Retrieved from RAND http://www.rand.org/content/dam/rand/pubs/working_papers/2010/RAND_WR745.pdf.

Have an injured worker out of work? The meter is running.

If you're an employer with an injured worker who is currently out of work, the temporary total disability (TTD) meter is running!  Whether it's staring at the meter at the gas pump, silently praying that it will soon stop, or imagining dollars going out the door everytime the air conditioning kicks on and you see your electric meter hypnotically spinning in circles...cha-ching, cha-ching, cha-ching, most of us have at least felt the pain at the pump or cringed when reviewing your summer-time electric bills.

We can blame the meteorologists and global warming, or grumble about the price of oil, but it's unlikely that we're going to stop using gasoline or electricity.  The same goes for workers' compensation (WC) insurance.  It's a requirement for the overwhelming majority of employers, and while there's little you can (legally) do to avoid having WC coverage, there are many ways to avoid overpaying.  Don't worry, you won't have to start biking to work or start adopting the ways of the Amish life.

One of the most influential ways to reduce workers' compensation claim costs (and resulting impact on premium calculations) is to offer modified duty.  If you have an injured worker who has restrictions that you [think] you cannot accommodate, the TTD meter is running.  As a claim representative I was often outraged at the number of employers who didn't seem to be alarmed by this statement:  "Each week that you do not offer modified duty, your policy is paying out $422 per week!  Over the course of 12 weeks, that is $5,064!"  It's not Monopoly™ money, it's real claims dollars.  Dollars paid to an injured worker, who is capable of performing productive work. 

Out of sight, out of mind? 

5 Tips for identifying modified duty RTW options

1.  Review job descriptions of other positions. 
If you don't have job descriptions (tisk! tisk!) then think about the less physically demanding elements of each position within your company.  Make a list of these tasks.  Ask other managers or supervisors if they have any "extra" work that needs to be done.  Most people have a name for this type of list...we'll call it the never-ending, ever-expanding to-do list.  Sure, re-organizing the toolboxes on the trucks would help, but who has the time?  Answer:  Your injured employee!  Yes, having well-stocked first aid kits in every vehicle would be a nicety, but who has the time?  Answer:  Your injured employee!  Bonus tip:  Keep this list in the same place you keep your WC insurance information -- there's no need to reinvent the wheel the next time you experience a lost time claim.

2.  Ask the injured worker
It is astonishing how many employers don't involve the injured worker in the RTW conversation.  I bet there are at least 10 things that you do, weekly, if not daily, that fall into the "other duties as assigned" category of your job description.  Most likely, your boss doesn't even realize they're being done, but would sure notice if they weren't.  The point is, the injured worker knows their job better than anyone else and if asked, they could probably identify at least a handful of things they could do.  Offer a bit of cross-training and voila!  That brings us to our next tip...

3.  Offer a few hours of cross-training
The payoff for this tip can be extensive.  There's nothing more frustrating than having one of your team members taken out of work when you need them.  Consider any type of cross-training opportunities.  Could they learn to answer the phones?  Make follow up customer satisfaction calls?  Could the injured worker learn to write estimates or coordinate deliveries?  Even if it takes 10 hours to train someone, it could yield weeks of valuable, meaningful, productive modified duty.  This could also free up some of your other team members to get to more pressing issues.

4.  Add value to your organization with RTW
What if you could use a challenging situation (such as a WC claim) to increase sales or customer satisfaction?  An example of this involves an appliance retailer.  The injured worker couldn't deliver appliances, but knew how to operate them.  Today's appliances involve many technological advances, buttons, self-cleaning, filters, etc.  I, up until a few months ago, didn't know my microwave had a "potato" button.  Apparently my mother-in-law didn't either.  I was so excited to discover this feature, but wished that someone had shown me sooner!  So, why not have the injured worker do a new customer orientation, demonstrating all of the functions of the appliance, best practices for maintaining and cleaning that tricky flat top stove... You get my point.  I'm pretty sure the big box stores aren't doing something like that...

5.  Use a work injury as an opportunity to improve safety
 Consider having an injured worker review safety materials, watch safety videos for your industry, or even conduct a "tool box talk" that will help prevent future injuries.  When the message is coming from an injured worker, it carries greater weight.  This shouldn't be punitive, but it should be viewed as an opportunity to increase safety culture, to learn from a negative event, and to accommodate restrictions.

RTW: Everybody’s doing it

…or at least for the majority of cases.

According to the Bureau of Labor Statistics (BLS), nearly "60% of the most severe cases in private industry include at least some days of job transfer or restricted work, with the remainder resulting exclusively in days away from work." (2013, p. 31). So what's the big deal? Well, in 1970, less than 5% of severe cases involved job transfer. We've come a long way, baby.

In 1985, only 8.6% of all lost-workday cases involved restricted work (2013, p. 32). In 2001, this number rose to 39.9% (2013, p.32). That is good news! BLS classifies restricted work cases as cases where the injured worker returns to work with restrictions, without losing time from work. In other words, injured workers return to modified duty without losing more than a day of work. 

Does business size matter?
According to the BLS: somewhat. Their research has found that establishments increased in size, the proportion of restricted work days also increased, measured at years 1985, 2001, and 2009, until employer size reaches about 1,000 or more employees where it levels out and drops off slightly.
While peer pressure is typically not a good basis for doing something, particularly when it involves important business decisions and employees, it's clearly not just us who believe RTW is beneficial.

Exciting news!
Well, I find it exciting. In their future surveys, the BLS plans to capture more worker characteristics such as:

• Occupation
• Age
• Race or ethnic origin
• Gender
• Event or exposure leading to injury or illness
• Nature of injury or illness
• Part of body affected
• Source of injury
• Number of days of job transfer or restricted work
• Number of days away from work
• Length of service with employer
• Day and time of event or exposure
• Amount of time on shift when event or exposure occurred

It is expected that the BLS will release the results of their most recent survey sometime in 2013.

For more information, you can access the original article here, or visit www.bls.gov
 
Reference:
Ruser, J. W. & Wiatrowski, W. J. (2013). Restricted work due to workplace injuries: a historical perspective. Monthly Labor Review, 136(3), 31-43.

What's the deal with blame in a 'no-fault' system?

Although this may sound like the intro to an episode of Seinfeld...it's not. No bulky white sneakers, classic cut jeans, or improv-funk music playing in the background here...

There's a lot of information about social support for people suffering from non-occupational illnesses, but it is less common to hear about the role that social support plays in an injured worker's recovery from a work injury. 

Why??
As humans, we tend to seek out the "why" and a justification to events that we can't explain -- some may refer to this as fault finding, or the blame game.  Maybe it's easier for us to give sympathy to people who are diagnosed with a non-work related illness because "it isn't their fault."  Despite work accidents being just that, accidents, it is human nature to attribute some individual responsibility for what happened.  However, come to think of it, I've never met anyone with a back injury or an amputated finger who wanted to experience the pain or fear associated with these injuries -- very few people ever intentionally cause themselves harm in an attempt to "get workers' compensation benefits."  We could just as easily say to ill individuals -- well, you really should have done a better job washing your hands, or perhaps done more exercise or improved your diet.  Either way, how we got here doesn't really matter (except for future injury prevention, and maybe subrogation potential -- but that's for another blog). 

So, you've experienced a work related injury -- what are you going to do about it?  

The goal of any workers' compensation program is to restore an injured worker to their greatest level of function and earning capacity by providing appropriate, prompt medical attention.  Early, suitable, return to modified duties is one of the best ways to assist in an injured worker's recovery. 

Instead of pointing a finger at an injured worker, point them in the right direction for recovery.
Numerous studies have shown that an employer's initial response to a work injury and continued follow-up can have a significant impact on the outcome of the claim - including when an injured worker returns to work, the amount of treatment they require, and their eventual return to full duties after a work injury. 

Sure, if there's a safety violation or concern, they should be investigated and addressed.  But focus on the processes your employees are completing and the environment in which they are completing them. Yes, we should be concerned if the individual is acting in unsafe ways, but don't be afraid to look at the big picture (or in the mirror) to determine if the structure and company culture "allow" it or make it the norm.  We all have a role to play in injury prevention...just don't forget about the role each of us play in an injured worker's recovery.

Struggling with WC costs? -- Focus on what you CAN control!

It's easy to focus on what you can't control.  Sometimes we do this to avoid accepting responsibility for our own situations or simply because we've never stepped back and taken an objective look at the situation.

As an employer there are many things that we can't control -- the weather, the laws the govern how you must conduct business, as well as the restrictions that a physician places on an injured worker as a result of a work related injury. 

So, let's take a look at what we can do to influence the outcome of a workers' compensation claim.

Offer modified duty
As written in our last post -- there's no condition so disabling that there's not someone in the US with that condition working full time today.  If you say that you don't have modified duty, you're likely not going to look for it.  Keep an open mind and use the resources available to help you identify modified duty options.

Modified duty wages
The rate at which you pay an injured worker for modified duty impacts the amount of any temporary partial disability benefits (TPD) the injured worker may be entitled to.  Obviously, the more they are paid for modified duty, the less they receive under their workers' compensation claim.  In most states, the TPD rates are 66 2/3 of the difference between the injured worker's pre-injury wages and their modified duty wages.

Safety and Injury Prevention
While injuries may occur that are out of your control, there is much that you can do to prevent injuries from occurring, and to reduce the severity of the injuries if they do occur.  Providing a safe work environment is one element of injury prevention, enforcing safety rules, providing appropriate personal protective equipment (PPE), and appropriate training for new hires are just a few suggestions.  Injuries can still occur if we're being safe drivers, but if the employee is wearing their seatbelt at the time of injury, this safety measure can greatly reduce the severity of the injury.  Also, having employees properly trained to administer first aid can help minor injuries from developing into something worse.

Organizational Culture that Supports Safety and RTW
While this may be the most challenging aspect of safety and RTW, creating buy-in at all levels of the organization is paramount in influencing your workers' compensation program before an injury even happens.  If employees know that they will be offered modified duty, they may be less likely to file a false injury claim.  It also communicates that employers care about the wellbeing of their most valuable assets -- their employees.

Appropriate Medical Treatment
Providing prompt and appropriate medical treatment can have a significant impact on the injured worker's recovery.  If your state allows direction of medical care, having a physician panel that complies with state regulations is an important step towards helping the injured worker recover and RTW.

Maintain Contact with the Injured Worker
Too often an employer files a claim and assumes that they should let the insurance carrier maintain all contact with the injured worker -- this is incorrect (unless of course the employee retains an attorney who prohibits contact with the injured worker).  One of the best ways to keep an injured worker focused on returning to wellness is to stay in contact with them.  Send a get well card, give them a call once a week or every other week to check in, invite them in for employee meetings, and keep them in the loop so that they feel connected with the workplace.

This turned into a lengthy post, but the length (and content) hopefully communicate just how much an employer can influence the outcome of their WC claims.

RTW at a Not-for-Profit: An Injured Worker's Experience

As you may have heard, Eastern now offers another innovative RTW solution -- transitional duty at local not-for-profit organizations (NFP).  Sure, we can say it's a great idea, that it helps injured workers recover and stay connected, but what does an injured worker have to say about working at a not-for-profit as part of their recovery from a work injury?

We are fortunate to have worked with an injured worker who was willing to give us his opinion and tell us about his transitional duty experience while working at an NFP.  Joe* sustained a shoulder injury, which required surgical intervention and left him with very challenging restrictions that his employer could not accommodate.  Joe's employer agreed to pay him to volunteer at a local Goodwill store while he recovered, and eventually transitioned him back to his pre-injury job.

Without further ado, we give you Joe's story, in his own words:

What type of work did you perform as transitional duty? 

“The type of work I did was a little bit of everything, what I did most of was what Goodwill calls purging. I just went through the clothes on display the racks and pulled out the old items and took them to the back to be sent to the main distribution center in Indy. I also sorted clothes and different items as they came in and put them out on the display shelves for sale.”

As an injured worker in this program, how did it benefit you?

“My biggest benefit was making new friends and having something to keep me busy during my recovery.  My overall impression is that this is a good program for someone that will be off work for more than a couple weeks. It got me out of the house and gave me something to do besides sitting around being bored. I met a lot of good people and had fun doing it.”

RTW and Seasonal Workers: Bring them back or risk paying them all year long

It's that time of the year again...your neighbor is fertilizing and seeding their lawn to ensure that their lawn invokes feelings of grass envy throughout your neighborhood, you're waking up to the sound of birds chirping in the trees as opposed to snow plows scraping the streets, isn't Spring a wonderful time of the year?

Soon we will start to see the landscaping trucks on the streets at the crack of dawn and workers spreading shovelfuls of recycled and dyed pieces of wooden pallets, known to the consumer as mulch.  What did you think I was going to say?  College students will be returning home to look for summertime employment, hoping to secure that sought-after summertime gig that pays more than minimum wage in an attempt to offset the rising prices of bee---I mean...books.  Everywhere you look, people are starting their spring projects, building patios, planting gardens and getting those home repairs they've put off until warmer weather.

But, if you're a seasonal employer you're probably not thinking of gladiolas and grilling, you're thinking about starting up business again and getting back to work! 

Why worry about WC at a time like this?  There are several reasons.

The Dollars and Sense of RTW Programs

According to one study on worker absenteeism, the costs of a worker who is out of work for 2 weeks costs their employer 133% of his/her wages.  So, if an employee earns $500 per week, it will cost the employer $665 per week, or an extra $330 over a two week period. 

Various studies have been conducted on the cost-benefit and ROI of RTW programs.  In an article from the American Society of Safety Engineers, RTW programs can return $8 to $10 dollars for every $1 invested in a RTW program. 

In the same article, the authors cite another study which found that the direct costs associated with a WC claim (wage benefit payments, medical payments, and legal expenses) make up only 28% of the costs associated with WC claims.  The other 72% is comprised of indirect costs such as lost productivity, training, replacement worker costs, and other costs not covered by insurance.

A RTW program doesn’t have to cost you big bucks.  Many things can be done by making small changes.  When creating or identifying modified duty job opportunities, employers should look at the job tasks that other employees already perform.  This will help to ensure that the modified duty work is productive and serves a legitimate purpose, thereby helping reduce any costs associated with RTW.

Reasons Injured Workers Return to Work

In a 2010 study of 168 individuals who sustained non-life-threatening orthopedic injuries, it was found that participants who reported "high social functioning" two weeks post-injury, were roughly 2 1/2 times more likely to return to work (Clay, et al., 2010).  This same study reported that financial security and perceived ability to return to work were not statistically significant. 

Clay et. al, (2010) also found that "Ninety-three percent of respondents who reported the need to use work "to fill the day" were back at work by three months, compared to 66% who indicated other reasons" (p. 7).

The psycho-social factors and environment are equally important as the physical injury in the return to work process.  While we cannot influence the injury we can influence the socialization of injured workers. 

What amount of effort does it take on behalf of an employer or coworker to make a phone call to chat with the injured worker, keep them apprised of any developments at their workplace, or even to send a "get-well" card?  Very little.  The ROI on a 99 cent get well card is potentially tremendous.

So when an employer feels as if they don't have control over the WC claim, and that all power rests in the hands of the injured employee and their treating physicians, remember this post, and it might be a good idea to reference this post as well, oh and this one is probably useful, too. 

When we discuss the concept of Return to Wellness as opposed to return to work, we’re focusing on all aspects of a workers’ compensation claim.  Not just the financial impact, but how we need to treat the injured worker as a person who has sustained an occupational injury and not as a claimant. Returning injured workers to wellness using a bio-psycho-social approach -- treating the injury, treating the individual and acknowledging the positive impact that returning to the workplace (environment) after an injury can have on recovery.

Source:  Clay, F. J., Newstead, S. V., Watson, W. L., Ozanne-Smith, J. & McClure, R. J.  Bio-Psychosocial determinants of time lost from work following non life threatening acute orthopaedic trauma, Bio Med Central Musculoskeletal Disorders 2010, 11:6. http://www.biomedcentral.com/1471-2474/11/6


 

Hold your fire!

Things to consider before you terminate an injured worker who is receiving workers' compensation benefits.

Please note, we are not employment/labor law specialists, nor do I play one on tv -- this post should not be construed or used as legal advice on how to handle employee terminations, it is simply an attempt to make employers aware of the impact a termination may have on their workers' compensation program.  Now we've got that covered...

Don't terminate an injured worker simply because you [think you] can't accommodate their restrictions

Often times an injured worker is given challenging restrictions that an employer believes they cannot accommodate.  The employer sees no possible way of bringing the injured worker back to work, but somehow temporary restrictions result in a long-term action.  The injured worker served a key role in their operations, and they need to replace him. 

I see two problems with this line of thinking.  Problem #1:  The employer has assumed that the injured worker can do nothing.  That is contradicted by their release to return to work -- the doctor is stating that they can do something, albeit not their pre-injury job.  I implore employers to take 45 minutes (not even an hour) to sit in a room and come up with 5 examples of modified duty work the injured employee could perform.  Act as if your livelihood depended on it, because in some cases it does.

Example:  The employer values the employee's contributions, but needs someone to help pick up the slack.  So, while you have Joe working to make up for Maria's work, can't you have Maria help out with some of Joe's duties?  Or, perhaps you need to bring in a temporary worker -- there is a learning curve which equates to lost production, increased hours, increased error rates or declining piece rates -- use Maria's skills and knowledge to help train her temporary replacement. 

What The Rolling Stones' "Gimme Shelter", the theme song from Cheers, and RTW have in common, Part II

Last week's post addressed Maslow's needs of Biological, Safety and Belongingness.  Picking up where we left off, here are the last two...

Esteem Needs

Esteem is the human desire to be respected, valued and accepted by others.  Independence is closely tied with self-esteem.  Not until an individual has satisfied their basic biological, safety and belongingness needs, will they be able to focus their efforts on striving for more, achieving more and gaining status among the group.

How can an employer help satisfy this need?

Employers should treat employees, injured or non-injured, with respect and provide them with the opportunity to return to modified duty.  Transitioning an injured worker from restricted to unrestricted work increases a sense of responsibility, control and independence. Without support of esteem needs, learned helplessness may develop, leading an injured worker to lose a sense of accountability, ownership and ability to influence their own situation, despite being given opportunities to do so.

Self-actualization Needs

From 1980-2001, the Army’s recruitment slogan was “Be all you can be.”   It’s about personal growth and performing at your peak.  I highly doubt that any of us will ever reach our peaks in all areas of our lives, as the bar will continuously be raised, just out of reach.  Self-actualization is reached when a person's mental and physical needs are met, enabling an individual to operate at their maximum potential.  Think of it as the best "you" that you can be.

How can an employer help satisfy this need?

Employers play a key role in providing employees with opportunities for growth, advancement, and fostering potential in their employees.  Take the skills of an injured worker and allow them to be used as a modified duty option.  Cross-train employees in various departments to help improve their skills and knowledge within the organization.  By improving an employee’s skills, you’re improving the competitiveness of your company.  After all, your employees are your most valuable asset.

While this is an extrapolated and somewhat diluted take on Maslow’s theory, there is a relationship between employee motivation and returning an injured worker to wellness after a work related injury.  There has been much debate and criticism of Maslow’s "Theory of Motivation," but it remains one of the most widely referenced theories on human motivation, from introductory psychology courses, to risk management books, to political activism.