What can you do to control rising medical costs in Workers’ Compensation claims? Bring your injured employees back to work.

Recently, the National Council on Compensation Insurance, Inc. (NCCI), reported on some of the trends impacting workers’ compensation across various states.  Some of the items the report covers include employment growth, information on the construction industry, and medical inflation (rising medical costs).

The workers’ compensation industry has a tendency to separate indemnity (wage) and medical costs.  Nothing exists in a vacuum, certainly not in workers’ compensation claims. 

Maybe you think I’ve oversold you with the title of this blog post. Consider the following questions.

What happens when an injured worker is injured and their employer cannot return them to work?

·     They are left to sit at home in their recovery.  Anyone who has spent time at home for a period exceeding one work week as the result of a medical issue or surgery can attest to the impact that being out of work has on you.  You may start to wonder what your co-workers are up to.  Maybe you try to stay connected by checking in or reading some emails from home, but it’s not the same.  You don’t have the context and the opportunity to ask questions – getting second hand information about the goings on at work can actually make you feel even more isolated.

·     The injured worker may begin to question if they’ll ever be able to get back to work.  What will happen if they have permanent restrictions?  Like reading hotel rating reviews, our minds tend to go to the most negative example possible.  The story of the neighbor who had to file bankruptcy because he lost his job after his work injury.  They’ve probably memorized the phone numbers for the attorneys who promise to get them huge sums of money.

·     The injured worker may become deconditioned from lack of activity.  If you’re a mason who’s used to lifting block every day for the past 15 years and now you haven’t lifted anything more than five pounds since your injury, you may have lost some of your strength and stamina.

 

What do these consequences have to do with medical inflation?

·     Isolation may have negative consequences on an injured worker’s motivation to get better.  It may also deplete their ability to cope with the aspects of managing their claim and their recovery.  For those of us who need people around us to support us, to guide us and to motivate us – when you take that away it can leave one feeling alone and without the wherewithal to get up and push through challenging physical therapy sessions or perform the home exercises that help in recuperation.

·     They may have an increased need for prescription pain medications or other medications.  These prescriptions may have negative side effects (and may require additional medications to treat the side effects).

·     Deconditioning may require additional physical therapy or work hardening.  It may also lead a physician to extend the time period between improved work status notes, resulting in increased office visits for progress checks.

Prudent, proactive employers should focus on preventing injuries in the first place.  But, when injuries do occur, a plan that focuses on the whole person (employee) and their return to wellness should be ready to go. 

 

What steps are you taking to prevent future injuries like this from happening? 

What are you doing to communicate regularly with the injured worker while they are totally disabled?

What are you able to offer based on what the anticipated restrictions? 

Are there other concerns that the injured worker has about their employment or benefits?  Address the concerns and to reassure your employees that you will work together reach the best possible outcome for them in their recovery. 

 

It’s never too early to have these discussions.  Start today.

Upset About your Workers' Compensation costs? What are you going to do about it?

There's ample research and discussion about factors that may lead to delayed recovery or poorer outcomes for workers' compensation claims.  We're all really good at pointing the finger and saying that it's because of the doctor, the unmotivated injured worker, or the employer who just doesn't get it.  I'd like to ask one simple question to those who are frustrated or angry about workers' compensation outcomes.  What are you going to do about it?

In the extreme case, an employer could shut down the business, throw in the towel.  Highly unlikely.  Realistically there are several steps employers and other stakeholders can take to GET INVOLVED in their claim management programs.  Here's just a few of my favorite.

• Report all injuries as soon as possible.  It's fairly common knowledge that the sooner everyone knows about an injury, the sooner it can be managed.  This leads to the next important point.
• Get the injured worker prompt appropriate medical care.  Get them the best care a workers' compensation dollar can buy.  If you want the best outcome, why would you skimp here?  Who would you want to see if it were your injury -- the doctor who just processes injuries and prescribes anti-inflammatories, tells you to follow up with your family physician if not better in a week or the occupational health physician who understands how to approach work injuries, what is necessary to help you get better and back to work, and what the signs of trouble may be?  Do you want a physician who follows what massive amounts of research says provides the best outcome, or the doctor who disregards evidence-based medicine in exchange for their anecdotal, 30 year old medical school training.  I wouldn't want a mechanic who only worked on cars from the 1970s to work on my 21st century car that's basically a computer running on gasoline (or electric, for that matter).  Get your employees to the best providers who are on top of the most current medical practices, and follow evidence-based treatment guidelines.
• Reduce delays in care by getting treatment approved, appointments scheduled, and referrals made TIMELY.  The sooner we can help that injured worker get the care they need, the sooner everyone can learn what the true injury is, what the treatment plan will look like and assess the RTW opportunities.  Nurse case managers can help with this process.
• Communicate effectively!  Communication is often the cause and the solution to all problems in a claim.  Keep everyone in the loop -- find a way to do it. Maybe it's a list of everyone who you need to update, written down on a sheet of paper.  Maybe it's an email distribution list that you create for each employee's claim.  Whatever your strategy is, keep everyone up to date.  As the saying goes, communicate by a factor of 10, and then say it one more time.  This group includes the injured worker, the employee's supervisor, the claim representative, nurse case manager, medical providers, and whoever else may be involved in the claim.  Documentation will be key in communicating technical, detailed information.  One example of this is the injured worker's pre-injury job description.  Document it, send it around for review and approval (including the injured worker) and then send it to the treating physician, physical therapist, and nurse case manager.  After all, how can you plan to get an injured worker back to work if you don't know what they need to do?  Identify barriers to return to work early on and develop a plan to address them.

These suggestions are based upon evidence.  Researchers from the Department of Physiotherapy and the Department of Epidemiology and Preventative Medicine at Monash University in Melbourne, Australia conducted a study involving the aforementioned interventions.  The results?  In their study, their intervention reduced costs associated with RTW claims by 34% and cut the days away from work by 58% (Iles & Wyatt, 2013).

References:
Iles, R. A., & Wyatt, M. (2013). Applying the evidence: a real-world example of an intervention to reduce workers' compensation costs. Physical Therapy Reviews, 18(5), 395-402.

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.

The Snowball Effect of Employee Satisfaction

If the words “employee satisfaction” incites eye rolls from your management staff, then share this post with them next time you discuss your workers’ compensation program. 

A 2011 prospective study of work-related low back injuries indicates that what employers do after a work injury can have a significant impact on the injured worker’s recovery level.

Loss reduction efforts that improve employee satisfaction may also improve the injured worker’s outcome.  This study found that injured workers who were both satisfied with their employer’s response to the injury and their doctor’s treatment experienced better scores on leg and back pain scales, tests of function, and quality of life scales.  It’s important to point out that it wasn’t because the doctor wrote them out of work or gave them a warm and fuzzy feeling – the study indicates that satisfaction regarding the effectiveness of treatment is what contributed to the reduction in symptoms and functional limitations. 

The effect of the employer’s treatment of the claim was just as important as the medical provider’s treatment of the injured worker at 6 months post-injury.  Even more interesting is that at 1 year post-injury, the importance of employer’s treatment of the injured worker continued to grow.

In practical terms, this makes sense.  Think about an injured worker who has been disabled from working for a period of 3 months as the result of a significant injury.  If an employer responds negatively, or fails to stay in contact with the injured worker, the relationship begins to deteriorate.  How would you feel if you were out of work for a significant duration and no one seemed to care?  An understanding employer who is willing to work with an injured worker will gain the reputation of an employer who cares about the well-being of their employees.  This reputation travels faster than the speed of light.  I’m sure you could name three places right now that you swear you’d never work – and not just because of the type of work, but because of how they reportedly treat their employees.  Fact or fiction, it doesn’t matter if potential, future job applicants hear this.

Using deductive reasoning, one could conclude that what is good for the injured worker’s recovery is also good for reduction of claim costs (and good for the company).  The authors report a 30 percent reduction in claim costs attributable to higher satisfaction with claim treatment and likely due to a reduction in lost time claims.

Reference:  Butler, R. J., & Johnson, W. G. (2011).  Loss reduction through worker satisfaction:  The Case of workers' compensation. Risk Management and Insurance Review, 14(1), 1-26.  doi: 10.1111/j.1540-6296.2010.01188.x

Did this topic interest you?  Check out our related posts:

RTW and Injured Workers -- Its all in their heads!
Call me -- maybe?
Modified duty job offer letters communicate more than just RTW details

Why you should care about RTW for direct-care workers

According to US News and World Report, it is estimated that in 2013, roughly 3.3 million Americans called a nursing home their place of residence.  For these millions of residents, there must also be millions of people to care for them. 

Productive modified duty for nursing staff

Nursing homes are rated on various aspects of their operations by Medicare.  Nursing homes are rated on health inspections, staffing, and other quality measures.  One element of staffing criteria that is measured is the number of staffing hours per resident.  A facility reports the number of hours of care on average provided to each resident, each day, by its nursing staff.  It is important that RNs and LPNs, for example, are providing care to residents as opposed to “non-care” hours.  This is important when considering modified duty opportunities for long and short term care facilities.

When considering modified duty options for health care staff, a great place to start is their job descriptions.  What aspects of their jobs fit, or can be modified to fit, within their work abilities?  Consider other areas or departments for opportunities.  While there may be some initial resistance, some of the duties that other health care employees perform may also yield modified duty opportunities.  An example of this would include having an RN perform duties that an LPN could do.  Another great source of modified duty suggestions is to ask the injured worker what they believe they could do.  This will provide suggestions, but also foster support of the return to work process.

Keeping injured workers at work doesn’t just help your workers’ compensation insurance costs

When an employee is injured, the repercussions are felt throughout an organization and the community.  Maintaining a staff of qualified and skilled employees is a challenge in any industry, but is particular evident in the health care field.  According to one study, the cost of turnover in the direct-care industry was found to be 25% of an employee’s total annual compensation.¹ The Bureau of Labor Statistics estimates in 2003 that costs associated with turnover in this industry ranged between $4,200-5,200.

            Direct costs:

·          separation

·         vacancy, replacement, training and injuries

Indirect costs:

·         lost productivity

·         reduced service quality

·         lost clients revenues due to lost existing and potential clients

·         impact on the culture, morale, facility reputation and service quality

Service delivery level costs:

·         Consumers/Clients

o   quality of care

o   quality of life

o   care hours not provided

·         Employees

o   increased work injuries (doing more with less)

o   increased physical and emotional stress

o   reduced working conditions may lead to higher turnover

Suggested resources

There are many resources available to employers who wish to offer modified duty to one of their injured workers.  The Job Accommodation Network (JAN) is a great resource for ideas and modification suggestions.  We previously wrote about it in this post.   Our website also has a variety of tools to help, in addition to lists of suggestions for health care employees who are given restrictions as the result of a work injury.

You can also check out the studies and resources referenced in this post by clicking here.

1.  Seavey, D. (Oct., 2004).  The cost of frontline turnover in long-term care. Washington, D.C.:  Better Jobs Better Care.

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!

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?

Meet JAN, your new best friend

Who is JAN?

The Job Accommodation Network (JAN) is the leading source of free, expert, and confidential guidance on workplace accommodations and disability employment issues.  Working toward practical solutions that benefit both employer and employee, JAN helps people with disabilities enhance their employability, and shows employers how to capitalize on the value and talent that people with disabilities add to the workplace.

JAN’s Workplace Accommodations:  Low Cost, High Impact  reports  the results of a recent survey of 723 employers who utilized JAN’s services.  We’ve provided some of the most relevant findings below.

An astounding 57% of accommodations didn’t cost anything.  Zilch.  They were free.  The average cost of a one-time expenditure was $500 for employers.   Do the accommodations work?  76% of employers reported they found the accommodations to be “very effective” or “extremely effective.”

What benefits have employers utilizing JAN received?

Direct Benefits
 

39% reported a savings on workers’ compensation or other insurance costs

90% reported the retention of a valued employee

71% reported increased the employee’s productivity

60% reported the elimination of costs associated with training a new employee.

Indirect Benefits

66% of employers reported improved interactions with coworkers

61% cited an increased overall company morale level

45% reported increased workplace safety

57% reported increased overall company productivity

99% of employers stated they would use JAN again.

There’s a Searchable Online Accommodation Resource (SOAR) database which provides information, suggestions, examples and resources for employers interested in implementing a job accommodation.  These suggestions are sorted by impairment or by industry.

 

References:

Job Accommodation Network (Original 2005, Updated 2007, Updated 2009, Updated 2010, Updated 2011, Updated 2012). Workplace accommodations: Low cost, high impact. Retrieved August 12, 2013, from http://AskJAN.org/media/lowcosthighimpact.html

 

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? 

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.

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.

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. 

If WC were a family, RTW would be Subrogation's long lost cousin

While RTW and subrogation are part of worker's compensation claims, it's easy to treat them like olive oil and balsamic vinegar. Two immiscible ingredients that go on the same salad.  However, just like making vinaigrette, with some work, RTW and subrogation can emulsify and yield a delightfully popular result.

Think of it as a family get-together where Subrina shows up to the [third] party, in her suit, hungry.  Some family members see Subrina as a person who only looks out for herself and is at the table to gorge upon as much as she can, and stuff her pockets with whatever else she can just because she doesn't want anyone else to have it.  The other guests fail to recall that she paid for a nice portion of the food being provided.

Meanwhile, Rhett T. Wellnest (RTW), the long lost cousin, is in the kitchen preparing the food.  He decides that he is going to help everyone with their New Year’s resolutions to get healthy by making up everyone’s plates as opposed to a buffet-style meal.  Rhett limits the amount of food on the table, thereby reducing the amount that Subrina will get.

Subrina may be upset at first, because there’s less food on the table, but realizes that she can only eat so much.  She leaves the table feeling glad that she didn’t over eat. She thanks her cousin Rhett, as it has helped her fill her up (make her whole) and not overindulge.

Who really holds the power in WC claims?

The injured worker?  The judges/commissioners?  The insurance carriers?  The employer?

Depending on which chair you're sitting in, you'll likely have a different answer.  Most times, your answer is someone other than yourself.  Stop putting the power into someone else's hands!  Whether intentionally or not, if you believe you have little or no control over the outcome of a claim (or any situation, for that matter) you relinquish your share of the “power-pie” to someone else. Stop!

Think about the ubiquitous day-time attorney commercials.  They are based upon the assumption that the insurance companies possess all of the power.  What about the employer's perception that the injured worker has all of the power?  Don't these two positions seem at odds with each other? 

Some additional thoughts on perception...

What have you got to lose?

Focusing only on what you have to gain in a situation only provides you with half of the picture.  It can be easier to consider what you will gain than to put a number on what you're going to lose.  Maybe it’s the uncertainty of the future that allows us to be more optimistic.  Maybe it's a self fulfilling prophecy.  Whatever it is, it's more pleasant to think about what we'll gain by making a decision than to think about what we'll lose.

Before you decide that you can't afford to offer modified duty, ask yourself what you're really losing...the answers may surprise you.

A chance to utilize work as therapy and assist in the injured worker's recovery.
Think about how quickly you lose any progress you've made on a diet once the holidays roll around, or after skipping the gym for a few weeks.  We quickly lose any gains (or gain back any weight losses).  The same holds true for someone who is away from work for an extended period of time.   This can extend the period of time it takes for them to return to their pre-injury job because.  When an injured worker is detached from the workplace, they also lose some of their skills, recollection of processes, and even simple everyday tasks can take longer until they are up and running again.

Experienced employees who possess valuable knowledge.
There is a lot that can be learned through books and higher education, but how do you put a price on work experience and skills that can only be gained by working.  I may be able to recite the Pythagorean Theorem, but I probably couldn't apply it to building a foundation.  Experienced employees provide an opportunity to shorten the learning curve for younger employees.  Envision an inexperienced workforce and how long it would take them to complete a project.  Without your most knowledgeable employees, the entire team suffers.

An opportunity to demonstrate what happens when a worker is injured.
Actions speak louder than words.  Co-workers will look to the treatment of the injured worker and envision themselves in that injured worker's shoes.  When an employer treats an injured worker with respect and provides them with a modified duty opportunity, it sends several key messages to their other workers.  "If I get injured, I know my employer will be bringing me back to work."  Some variations of this response may include "WC claims don't equate to paid time off" and "If I get hurt, at least I know I'll have a job to come back to."

So, ask yourself, what do I stand to gain?  But don't forget to also consider what you've got to lose?

Now, try and continue your day without humming "Judy Blue Eyes" by Crosby, Stills and Nash...

The Numbers of RTW

Decision-makers want facts.  They want numbers.  While numbers cannot tell us everything, they can certainly provide valuable information.

Here are some numbers to help put the costs and figures associated with RTW and WC claims into perspective. 

1,191,100 the number of non-fatal occupational injuries/illnesses in the U.S. in 2010

50% the likelihood of an injured worker returning to work after 8 weeks away from work

34%  the percentage of Waste Management employees who felt that they could have returned to work sooner than their full duty release (but didn't since their doctors kept them off work)

15% the likelihood of RTW after 6 months away from work

3 the number of years a claim will impact an employer's experience modification factor (impacting the premium calculation)

I've never seen (or counted) a million of anything, but I do know what a 50% probability looks like.  Simply flip a coin (repeatedly).  Most people are familiar with the duration of three years.  Take the following numbers and ask yourself how they are impacting workers, insurance costs and the future of your business.

Return to Wellness Perspectives from a WC Underwriter

As part of our ongoing Return to Wellness Perspectives series, we're continuing to interview Eastern team members from various departments regarding to get their take on RTW and WC.  This week, Anne Gennusa draws upon nearly a decade of underwriting experience to provide us with input on the importance of RTW to an underwriter.  Anne works in Eastern's Franklin, Tennessee office and writes business for our Custom underwriting unit.

Q:  For those blog followers who aren’t in the insurance industry, briefly tell us what the primary responsibilities of an underwriter are?

A:  Underwriters review accounts submitted by agents. We work to understand the operations of every potential client and analyze the possible insurance risks. At that point, underwriters determine if we can take on the risk profitably and at what terms and conditions.  

Q:  Why is an Eastern Alliance underwriter concerned with RTW?

The 7 (RTW) Habits of Highly Effective Employers (part 2)

Last week we covered the first 3 habits of highly effective people, and highlighted how these "habits" can be utilized by Employers seeking to return their injured employees to wellness through modified duty.  This week's post will cover the remaining 4 habits (be proactive, begin with the end in mind, and put first things first) and their application to Return to Wellness.
So, without further ado...here are habits 4 through 7.

4.  Think win-win
It's self-explanatory.  You win.  I win.  We win.  It's not only about providing a solution that saves you, the employer, money on your WC insurance premiums.  It's about returning injured employees to a state of wellness after their injury.  It's about getting your business back on track after a loss.  You gain productivity while your injured worker gains the physical benefits of working.  You approach the challenge of RTW with integrity and with the end result in mind.  You do it because it's the right thing to do, not because you have to do it. 

5.  Seek first to understand, then to be understood

Have you ever had a conversation with someone who, while you were talking, was formulating their next thought, completely ignoring what you were saying?  Sometimes people do this without even thinking, particularly when the topic of discussion is something we feel very strongly about.  Before you say, "We don't have any modified duty work for Larry, he can only come back if he's 100%," listen to the options and solutions that your Eastern team can provide.  Understand the statutory provisions and the hurdles that must be overcome in any claim.  Learn what the true costs (direct and indirect) are associated with this particular claim.  Understand the potential repercussions of your decision before shutting down any options. 

It's a two-way street.  We need to listen and understand your circumstances before trying to apply a solution.  This is why we have more than one approach to resolving RTW challenges...we have a whole toolbox full!

6.  Synergize
Sounds like a pop-psychology buzz word, right?  Please refer to the old adage "two heads are better than one."  Synergy occurs when two or more people use their experience and skills to build off of each other's ideas to attain results greater than what they could've acheived alone.  This is where your Eastern team comes into play.  You have an entire team of people committed to helping you resolve your RTW issues.  Maybe the Risk Management Consultant was out for a visit last week and saw some RTW ideas that the Claim Representative didn't think of, or maybe you have some ideas but aren't quite sure if they would solve the RTW problem.  By using our combined knowledge, the possibilities are exponentially greater than leaving it to one person.

7.  Sharpen the saw
While Dr. Covey has a new book out, The 8th Habit, we're going to stop at seven.  By all means, you can keep going.  This last habit focuses on the physical, emotional/social, mental and spiritual realms of life.  How does this relate to RTW?  Well if you haven't noticed, we take a similar, holistic, approach to RTW.  Returning to wellness is about restoring physical and psychological wellness to injured employees.  Injured employees who are given modified work maintain their mental sharpness and skills required for their jobs, too.  The seventh habit is about self-renewal and keeping yourself fresh and ready to approach future challenges.  Keeping a fresh outlook will also produce a better outcome.  So, take some time to recharge your batteries and stare down your RTW challenges. 

Oh, and please be sure that all sharp saws have a proper guard in place.

While you may not embrace all of these habits, they are an excellent framework for how you approach RTW challenges. 

Please check out the author/publisher website for more information.