Employer's School - Take Control Part 7

Sunday, August 15, 2004 | 0

The following is the final in a seven part series of articles that, when pieced together, comprise the "Employer's School" developed by Brent Heurter, Founder and Chief Solutions Officer of ClearComp. The article series presents an "employer's school" on workers' compensation, how to examine your work injury strategy and ensure a "best practices" environment designed to lower your workers' compensation expenses. This article continues the "school" and includes a checklist and work sheet to complete the "course". Earlier articles can be accessed by clicking on a title in the right side bar.

15. Hire the Best Insurance Broker You Can Find
Your insurance broker is the one person who can make or break your long-term success.

Other than your insurance broker, no one provides support to assist employers control workers' compensation costs.

Ask Yourself:At a minimum you should expect the following from your broker:

* Quarterly or semi-annual claims review meetings
* Claims management services on all open claims affecting your ex-mod, even if your broker wasn't your broker at the time
* An analysis of your annual ex-mod, an estimation of your mod six months before your renewal to assist with budgeting for workers' comp costs, and an annual audit to catch and correct errors
* Safety and risk management services provided on request or on a pre-set scheduled time
* A team of workers' compensation vendors and professionals at your fingertips, including fraud investigators, return to work coordinators, nurse case managers, bill review services, premium auditors, workers' compensation defense attorneys, and employment law attorneys
* Benchmarking and loss analysis to clearly show previous experience and to forecast future experience
* Return-to-work programs, safety programs, injury care guides
* Assistance with your annual premium audit and coaching on how to prepare for the audit
* Assistance with development of best hiring practices and guidance for the human resource staff
* Employer advocate services (assistance when your carrier fails to handle a claim properly)
* Annual marketing of your workers' compensation program and a full explanation of all options and costs available in the marketplace
* Assistance with management and supervisory training, as well as leadership programs

Your broker should also examine all legal options or assume more risk to obtain lower costs with alternative funding arrangements. Some of the alternatives your brokers should consider and discuss with you include&
* PEOs
* Self insurance
* Group self insurance
* Retro plans
* Large deductible plans
* Small deductible plans
* Captives/pools

If your broker doesn't offer these types of solutions - without you having to ask-it's time to look for a new broker.

Conclusion Make these best practices a reality in your business and you will save 30% on your workers' compensation payments. This money will drop straight to your bottom line.[

Ask Yourself:Let's review the best practices once again to see what we've learned and to answer any questions that you may have. How does your knowledge compare with what you knew before this session? What action steps do you plan to take? In the checklist we've distributed, note two action steps you will take under each item. This will get you on your way to becoming a leader in workers' compensation cost control.



Handout 1: Best Practice Assessment

How many of the following practices exist in your workplace?

~ I have created a culture of vigilance and determination in my organization. Leaders who gain control of unwieldy, inconsistent, and ineffective workers' compensation procedures inevitably achieve cost cutting solutions. If you don't take part in finding solutions, you may just become part of the problem!

~ I have "found religion." It's the momentum you'll need to better manage and control your claims. Throughout the company, there must be a complete culture change in which there is a heightened sense of urgency about trimming costs and turning an inefficient workers' comp system around. In order to make this happen, the person at the top has to "find religion," and become zealous about taking an active-rather than a passive-role in managing workers' compensation claims.

~ I know my workers' compensation facts. Knowledge is power. Have you tapped into the best research available and studied the successes that other companies have attained?

~ I educate my employees to prevent injuries before they happen. Employees should receive safety training and should be briefed on the procedures to follow in the event of an accident. Employees should also be informed about how the workers' compensation system functions. They need to know that the system will help them in the event of an injury.

~ I've established a system for the appropriate medical care for injured employees. Your system should provide optimal care for workers' injuries, but it should also closely monitor the program of care and coordinate that care with medical practitioners. This establishes the best treatment-with the best prospects for returning an employee to work.

~ When injuries occur, my organization acts with urgency to investigate. The first day is the best time to conduct an investigation to determine how to proceed with a claim.

~ I show genuine care for my injured employees. Your employees need to know that they will be provided the best in quality care, and that you are on their side in getting them well again so that they can return to work.

~ I have a tightly managed system in place for managing minor accidents. Do not allow a minor injury to become a major claim. Many employers are under the false impression that they cannot pay for their own first aid claims. Companies can. And by doing so, they save money.

~ I always provide transitional duty. The key to any effective workers' compensation system is to get injured workers back on the job as soon as they are ready to return to work. Having meaningful work assignments for these workers is critical.

~ I have implemented world-class hiring procedures. At the very root of any workers' comp cost control effort is a focus on improving hiring practices. By hiring smart today, you'll alleviate the need to manage tough later. It's far better to conduct a thorough background check of a potential employee before hiring than to discover-too late-that you have a "professional victim" on your staff.

~ I have extinguished fraud in my organization. To minimize the opportunity for fraud, you'll need to create a tight, seamless workers' compensation system in which roles and responsibilities are clear, claims are handled efficiently, and medical treatment is monitored. When fraud is suspected, you'll have the tools available to fight it and win!

~ I hold my carrier accountable. Most employers don't realize their rights when it comes to working with insurance carriers. Your insurer must be willing to discuss with you all the elements of your claim files that affect your premium.

~ I attend unit stat claims review meetings and analyze my experience modification. Mistakes are often made when carriers file their unit stat filing reports. And those mistakes can be very costly. Errors in your experience modification can have an adverse effect on your premium rates for three years. Make sure that you're not paying anymore than you're legally required to.

~ I catch errors and know the rules. Aggressive approaches to workers' compensation charges and calculations for temporary workers and subcontractors will pay dividends. There are simple ways to ensure that your firm does not end up paying for unwarranted workers' comp claims.

~ I've hired the best insurance broker I could find. Your insurance broker is the one person who can make or break your long-term success. Other than your insurance broker, no one provides support to assist employers control workers' compensation costs.

What are your weakest areas? Can you see where you need to improve your practices? What challenges have you faced, and what have you learned from them?



Handout 2: Post-Workshop Assessment And Action Plan

Now that you have had an overview of the best practices that companies must employ in order to cut workers' compensation costs, take another look at the list of best practices that we've discussed. Under each one, list two action steps that you will take.

I will create a culture of vigilance and determination in my organization.

1.
2.

I will "find religion" and create a culture change.

1.
2.

I will continue to gather workers' compensation facts.

1.
2.

I will educate my employees to prevent injuries before they happen.

1.
2.

I will establish a system for the appropriate medical care for injured employees.

1.
2.

When injuries occur, my organization will act with urgency to investigate.

1.
2.

I will show genuine care for my injured employees.

1.
2.

I will institute a tightly managed system for managing minor accidents.

1.
2.

I will always provide transitional duty.

1.
2.

I will implement world-class hiring procedures.

1.
2.

I will extinguish fraud in my organization.

1.
2.

I will hold my carrier accountable.

1.
2.

I will attend unit stat claims review meetings and analyze my experience modification.

1.
2.

I will catch errors and know the rules.

1.
2.

I will find the best insurance broker for my needs.

1.
2.

Where are your greatest challenges, and how will you meet them? Now that you have an action plan, you are on your way to creating a best-practice workers' compensation system within your organization. You are also on your way to cutting your workers' compensation costs. Congratulations, and thank you for joining us at this workshop!



Handout 3: Fraud Warning Signs

Warning signs in the worker
* Unstable work history
* History of reporting subjective injuries
* Consistently uncooperative
* Recently terminated, demoted, or passed over for promotion
* In line for early retirement
* Making excessive demands
* Calls soon after the injury and presses for a quick settlement
* Moves out of state soon after the injury
* Changes address to a post office box, or receives mail via a friend or relative

Warning signs regarding the injury
* The injured worker was not injured in the presence of witnesses.
* The injury is a subjective one, like stress or emotional trauma-or it is hard to prove, like back pain, headache, or insomnia.
* The accident is not promptly reported by the employee to the employer.
* The employer's first notice of the injury is from an attorney or a medical clinic and not from the injured worker.
* Physicians who have examined the injured worker have vastly differing opinions regarding the injured worker's disability.
* There is no sound medical basis for the disability; all physicians' reports indicate a full recovery.
* The injured worker is claiming disability exceeding that which is normally consistent with such an injury.
* The accident occurs late Friday afternoon or shortly after the employee reports to work on Monday.
* The claimant has the accident at an odd time, such as at lunch hour.
* The accident occurs in an area where the injured employee would not normally be.
* The task that caused the accident is not the type that the employee should be involved in-for example, an office worker who is lifting heavy objects on a loading dock.
* The details of the accident are vague or contradictory.

Warning signs about the medical relationship
* The claimant frequently changes physicians or medical providers.
* The claimant changes physicians when a release for work has been issued.
* A review of medical reports provides information that is inconsistent with the appearance or behavior of an injured person; i.e., a rehabilitation report describes the claimant as being muscular, with callused hands and grease under the fingernails.
* The employer's first report of injury contrasts with the description of the accident set forth in the medical history.
* The injured worker develops a pattern of missing physician's appointments.

Warning signs about the claim itself or the claimant's attorney
* The injured worker's attorney requests that all checks and correspondence be sent to the attorney's office.
* The claimant's attorney is known for handling suspicious claims.
* The attorney lien or representation letter is dated the day of the reported accident.
* The same doctor /lawyer combination previously known to handle the same kind of injury is handling this claim.
* The claimant is unusually familiar with workers' compensation claims-handling procedures and laws.
* The claimant's attorney complains to the carrier's CEO at the home office to press for payment.
* The claimant initially wants to settle with the insurer but later retains an attorney and files increasingly subjective complaints.
* The claimant's attorney threatens further legal action unless a quick settlement is made.
* There is a high number of applications from a specific firm.
* The claimant's attorney inquires about a settlement or buyout early in the life of the claim.
* The claimant writes unsolicited statements about how much better he or she is, but treatment continues and the claimant doesn't return to work.

Warning signs about outside activities
* There are tips from fellow employees, friends, or relatives suggesting that the injured worker is either working or is active in sports.
* The injured worker's rehabilitation report shows evidence of other activity.
* The injured worker is in a trade that would make it possible to otherwise work while collecting compensation.
* The injured worker is exaggerating an injury in order to get time off to work on personal interests; i.e., the injured worker is remodeling or building a home concurrently with the injury.
* The injured worker is in a seasonal business that would make it attractive to be "injured" during the off-season; i.e., occupations in fields such as roofing, landscaping, plumbing, farming, masonry, etc.
* The injured worker leaves different daytime and evening telephone numbers.

Fraud prevention starts with education and awareness. Educate your employees and enlist your honest employees in the fight against fraud and abuse. In addition, deliver the message that workers' comp fraud hurts everyone and that it undermines morale and productivity.

Article series by Brent Heurter.
Brent Heurter is the Founder and Chief Solutions Officer of ClearComp, a workers' compensation alternative for companies that desire to control and reduce their workers' compensation costs. Brent can be reached at 888-CLEAR-89 or email brent@clearcomp.com.

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