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.

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.

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 Mod Squad: RTW and Experience Modification Factors

We sat down with Karinda Greo, Eastern's Operations Analyst to discuss the intricacies of experience modification factors (herein known as EMF) to determine what impact RTW can have on an employer's EMF. 

If you're an Eastern client or agency partner who is interested in learning more about how you can control your EMF, register for our webinar, Experience Mod 101, that is set to take place on 3/27 @ 10 am!

Now, back to the interview...

What does the employer’s EMF represent?

The employer’s experience modification factor predicts, based on past experience, whether the employer is likely to develop loss experience that is better or worse than average. A period of 3 years of experience is considered, excluding the most recent policy term. For that time period, the employer’s claim data is compared to the average claim data for employers of similar operations and size. If the employer’s claim experience is worse than average, an EMF of greater than 1.0 is generated and acts as a surcharge to the workers compensation premium. If the employer’s claim experience is better than average, an EMF of less than 1.0 is applied to the premium and provides a discount. Keep in mind that since 3 years of experience is considered, each claim impacts the employer’s EMF for three consecutive years.

What impacts an employer’s EMF more: frequency or severity? 

In NCCI states, frequency definitely impacts an employer’s experience modification factor more than severity. The NCCI calculation uses a split point where all claim dollars below the split point are considered primary (frequency driven) and all claim dollars above the split point are considered excess (severity driven). The excess claim dollars are heavily discounted in the final calculation. Currently, the split point is transitioning from $5,000 to $15,000 over a 3 year period. Most states are around $10,000 today. Consider Employer A with one $40,000 claim; and Employer B with 4 claims at $10,000 each, totaling $40,000. Each has the same amount of total losses, but Employer A would have a lower EMF because the first $10,000 would be included at full weight, and the remaining $30,000 would be discounted as excess. Employer B would have a higher EMF because each claim would be counted as primary, resulting in $40,000 included at full weight in the calculation.

In PA and DE, the impact between frequency and severity is more even. Both states apply a cap instead of a split point. All claim dollars in excess of the cap are excluded entirely from the EMF calculation. The current cap for PA is $42,500, so the impact of highly severe claims is reduced. For example, if an employer has a $50,000 claim, only the first $42,500 is included in the EMF calculation. The remaining $7,500 is excluded. In the case of Employer A and Employer B described above, however, there would be no difference in the EMF as the full $40,000 would be included in the EMF calculation in both cases. The cap value for DE ranges from $31,000 to $470,000 and depends on the classification and size of the employer. The largest employers with the highest rated classifications will have the highest cap values.

How does the impact of lost time claims differ from medical only claims in the calculation of an employer's EMF?

In NCCI states, lost time claims have a much greater impact on the EMF than medical only claims. In fact, medical only claims are reduced by 70% in the NCCI calculation. For example, a $10,000 medical only claim counts as $3,000 in the EMF calculation. Lost time claims do not get discounted.

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...

Helping injured employees recover faster while helping your community!

We are pleased to announce our strategic partnership with two not-for-profit placement coordination firms.  Eastern has partnered with Re-EmployAbility, Inc. and Transitional Work Solutions to provide yet another innovative solution to RTW challenges. 

We realize that even when employers are on board with offering modified duty to their injured employees, locating suitable work can sometimes be a challenge.  We see this new tool as a temporary solution in cases where employers can accommodate medium duty (for example), but are unable to provide work that is within the proscribed sedentary restrictions.  This is where our strategic partners come in.  They help locate suitable work with a local not-for-profit organization where the recovering employee can volunteer their time, while being compensated by their pre-injury employer.  The employee receives the psycho-social and physical benefits of volunteer work, while the community benefits as well.  The injured employee recuperates while making the transition back to work with their pre-injury employer. While it is not a 'fix-all' solution, we're very excited to add this resource to our collection of RTW tools.

Interested in learning more about our not-for-profit partners?  You can learn more about Re-EmployAbility, Inc.'s Transition2Work program and Transitional Work Solutions by visiting their websites, or ask your Eastern Claim Representative about it today! 

Stay tuned for more information regarding this exciting new tool!

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.

I now know why Employers don't often have written RTW programs...

As the Return to Wellness Specialist, I am bound by professional, moral and ethical obligation to promote RTW and encourage employers to create their own RTW programs.  And then one day I took a walk in an Employer's shoes.  I sat down to create a general RTW program for employers to implement, or at the very least, use as a reference when creating their own.  This was the inspiration for the title of this post; as these were the first words out of my mouth when I sat down to write the program.

So you're probably not a Return to Wellness Specialist...

Creating a RTW program can be a daunting task, even if your job title is "Return to Wellness Specialist."  Let's face it, it probably doesn't fall on the top of your list of things to do...but it should be there somewhere!  I understand.  It took me quite a few hours to develop the general RTW program that is available as part of our ecovery library.  I vowed from that day forward that if you're an Eastern client, implementing a RTW program should not be difficult!  We want to help our clients easily implement a program that is efficient and effective.

We're pleased to announce our ecovery newsletter for Employers!

If you're an employer who is insured by Eastern, you now have access to another great RTW resource!  Written with employers in mind, we've developed a monthly ecovery newsletter that focuses on a variety of topics including:  RTW tools and resources, a recap of the month's blog postings, "how-to" section, helpful tips, news, and reminders. 

You can access the newsletter by visiting http://www.eains.com/work/employers/additional-resources.aspx and logging in.  Upon logging in, you will see a link to access the ecovery newsletter.

If you would like to receive the newsletter via email once a month, please send an email to ecovery@eains.com and include your name, your account/policy number and the email address to send the newsletter to.

We hope you find this resource beneficial to your organization!

To push oneself or self-protect oneself, that is the question...

...asked by many older workers.  Many of us have asked ourselves the same question, whether it's a choice between taking the stairs or the elevator, doing that extra set of reps at the gym, or getting out of bed after pulling a back muscle.  It is also likely that the decision you would have made at age 20 is not the same decision that you would make at age 45. 

What factors go into making these decisions?  More importantly, how can employers and insurers use their understanding of this decision making process to improve the outcomes of WC claims for their older employers?

Video: An introduction to ecovery

Learn how ecovery, an exclusive, value-added program from Eastern Alliance Insurance Group, helps return injured workers back to wellness and productivity by using work as a therapeutic tool.

Eastern Alliance Insurance Group Introduces ecovery Program and Return to Wellness Specialist

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LANCASTER, Pa., May 21, 2012 /PRNewswire via COMTEX/ -- Eastern Alliance Insurance Group (EAIG), a subsidiary of Eastern Insurance Holdings, Inc., announced today the launch of ecovery, a new EAIG program that returns injured workers to wellness and productivity by using work as a therapeutic tool. EAIG is a domestic casualty insurance group specializing in workers' compensation insurance products and services.
In conjunction with the launch of the ecovery program, Sarah Tayts has been appointed as EAIG's Return to Wellness Specialist, responsible for developing ecovery tools, resources and technology initiatives to assist EAIG's agency partners and policyholders with implementing modified duty programs.
"Sarah brings a unique combination of experience in the workers' compensation industry and education in industrial and organizational psychology," said Michael Boguski, President and Chief Executive Officer of EIHI. "She has already become a tremendous asset to our organization through her role in launching our ecovery program."

EAIG has a strong philosophical commitment to modified duty. EAIG's ecovery program was developed after market research indicated a need in the workers' compensation marketplace for next generation approach to modified duty featuring comprehensive, practical information and proactive education. Instead of "Return to Work," EAIG uses the phrase 'Return to Wellness' to describe its unique, holistic approach.
"We selected the name 'ecovery' to link the Eastern brand with the goal of recovery for both the injured worker and the employer," said Suzanne Emmet, Senior Vice President of Claims and Corporate Compliance for EIHI. "The phrase 'Return to Wellness' captures the intrinsic, positive spirit of ecovery, and reflects the broader scope of the program, which promotes faster healing, increased productivity, improved employee retention and workplace culture, and reduced insurance costs."

The ecovery program features an extensive online library of turnkey and customizable materials targeting employers, injured workers, agents and medical providers. In her role as EAIG's Return to Wellness Specialist, Tayts uses webinars, newsletters, blogs and social media to communicate to EAIG agents and policyholders on a wide variety of topics related to workers' compensation and modified duty.
Prior to joining EAIG, Tayts served as a Workers' Compensation Claims Team Leader for Donegal Insurance Group. She graduated from Millersville University in Millersville, Pennsylvania with a Bachelor of Arts degree in Psychology and from the Chicago School of Professional Psychology with a Master of Arts degree in Industrial/Organizational Psychology with a concentration in Organizational Effectiveness. She has also earned the Associates in Claims designation.

Employers can visit www.eains.com/ecovery to learn more about the ecovery program and find an independent insurance agent representing EAIG. Founded in 1997, EAIG specializes in providing workers' compensation products and services to businesses and self-insured clients. EAIG is a member of the publicly-held Eastern Insurance Holdings, Inc. family of companies, with offices in Lancaster and Wexford, Pennsylvania, Charlotte, North Carolina, Carmel, Indiana, Franklin, Tennessee, and Richmond, Virginia. EAIG's Web address is http://www.eains.com/.