Employer's School - Take Control Part 3

Saturday, June 19, 2004 | 0

The following is the third in a lengthy series of articles that, when pieced together, comprise the "Employer's School" developed by Brent Heurter, Founder and Chief Solutions Officer of ClearComp. The first article presented a list of topics that will be discussed in this series, as well as the introduction. The article reviewed the first three of the strategies in detail: Create a Culture of Vigilance and Determination, Find Religion and Know Your Workers' Compensation Facts. This article continues the "school."

4. Educate Your Employees to Prevent Injuries Before They Happen
Create a culture in which safety comes first.

If you investigate your accidents and near misses, you're likely to find that 20% of unsafe behaviors cause 80% of your accidents.

You want to establish a workplace in which scrupulous safety training is a matter of course. Employees are well schooled on the proper procedures to follow in the execution of their jobs, and they know precisely what to do event of an accident. In addition to keeping your workforce safe and healthy, establishing a safe environment will secure a more favorable rating from your insurer.

Ask Yourself: How do you achieve a safer environment? Here are a few highlights:

* Establish a comprehensive employee safety program built around employee involvement and management support. If vehicular accidents are a problem, focus on driver training, if back injuries are significant, teach and train techniques for lifting.
* Use bulletin board postings, seminars, driver safety clinics, safety awareness days, articles in your company newsletter, monthly mailings, safety incentive programs, recognition awards, and other programs to get your safety messages across.
* Create a drug free workplace. Drug free employees have dramatically fewer accidents and file far fewer workers' compensation claims.
* Proactively institute programs for reporting and correcting potential workplace hazards. Recognize and publicize employee contributions toward a safer workplace.
You can develop your program in-house, or outsource it to a third party provider. In any event, it is critical that you correct any safety problems before they become liabilities-and more important, before an employee is injured.

* Perform a thorough safety audit of your facilities.
* Uncover strengths, weaknesses, challenges, and opportunities.
* Produce a Gap Analysis.
* Define your corporate safety goals.
* Conduct a workers' compensation risk management analysis.
* Interview your supervisors and employees to determine how to include them in your risk management plans.
* Create a management action plan.

If you have a clear road map of actions, you will bring your safety program where you want it to be. You'll hold the key to turning your corporate safety philosophy into an action plan that meets your risk-management goals.

5. Establish a System for the Appropriate Medical Care for Injured Employees
Channel medical treatment for injured employees.

Establishing appropriate medical care for injured employees is the most critical part of any WC claim-without question.

Supposedly, medical providers-particularly the treating physician-are the only impartial parties in the entire chain of the workers' compensation claim process.

Yet how impartial are they, really?

A 1990 study by the State of Minnesota concluded that, on average, doctors and hospitals charged almost twice as much for workers' compensation cases as they did for injuries covered by Blue Cross.

This study compared more than 75,000 medical workers' compensation cases with about 8,000 Blue Cross claims. Here are some highlights:

* Back injuries on WC claims cost 230% more than non-WC back injuries paid by Blue Cross.
* Different fees were charged where treatment was not standardized. In other words, where there was discretion, more was charged.
* Cuts and wounds cost 155% more for workers' compensation cases than for Blue Cross.
* Strains and sprains were 195% higher in workers' compensation cases.

The treating physician determines what the medical costs, the length of time the employee is off work, and the extent of disability-including permanent disability.

In Colorado, workers' compensation officials found that medical costs and lost wage costs plummeted 29% when the injured employee saw a physician chosen by the employer. It isn't much different in California.

Ask Yourself:The right doctors and clinics are critical to an effective workers' compensation process. Implementing and enforcing a protocol with your medical clinic is paramount to success in any workers' comp program.

The goal should always be to get your employees healthy again.

There should always be an agreement-or protocol-established between the employer, the medical clinic, and the insurer. Each party has certain responsibilities and should be monitored for adherence to the agreement. Under the protocol, the doctor ...

* Should contact you before the employee leaves the clinic.
* Be the bridge to your stay-at-work program.
* Bill you directly for first aid claims.

If you wish to start monitoring medical care for your workers' compensation cases, one solution is to partner with an outside provider.

They can meet with your current medical providers and assess their strengths and weaknesses. You'll want to work with medical personnel who understand your need to get employees productive and safely back to work.

6. When Injuries Occur, Act with Urgency to Investigate
The first 24 hours are critical.

The first day after an injury is the most critical time. That is when you must conduct an investigation to determine how to proceed with a claim.

During this period, the injured employee should be given reassurance, directed to your choice of proper medical care, and encouraged to immediately return to work in an alternative function.

There are very few cost saving measures available anywhere within your organization more profitable than the efforts taken within the first 24 hours after a workplace injury.

Ask Yourself: Think about your existing system for handling injuries.

* Are your claims handled with a sense of urgency?
* Are claims reported within 24 hours?
* Are hazards removed immediately upon reporting?
* Do you have well-established protocols and procedures for immediate, sustained after-injury support for your employees?
* Where can you add urgency and action-orientation in your system of reporting claims?

Here is what you should be doing in the first 24 hours after an injury.

1. Provide immediate medical attention. Have the employee taken to your provider or clinic to receive proper medical care. It is better to drive the employee than to allow him or her to travel alone. If you have planned ahead, your firm has an advance arrangements with a medical provider who is familiar with and responsive to your return-to-work program and is knowledgeable about the type of work performed in your facility.

2. Immediately obtain an employee statement. Have witnesses on hand. Important details will be fresh in everyone's mind and this is the best time to record the facts. In addition, corrective actions can be taken to ensure the safety of other workers. This is your best opportunity to document the extent of the injury and to record the employee's description. If the claim later proves to be fraudulent, you'll have valuable documentation on hand. It's more difficult for the employee to later change his or her account of the incident in order to improve the chances of receiving undeserved benefits. Whenever possible, use diagrams or stick figures to illustrate the client's descriptions. Photograph the accident site exhaustively.

3. Alert the physician to suspicious claims. If there is anything suspicious about the reported incident, call the physician before the patient arrives. (It's necessary for you to alert the doctor because your employee will not!) Most diagnoses are not based on objective medical testing. The patient's report is paramount unless you take action. By alerting the doctor to suspicious circumstances, you will lessen the probability of the first physician reaching the wrong conclusions.

4. Receive precise work restrictions. When the treating physician is familiar with your firm, you have the best chance to receive specific information on any work restrictions. Beware of vague statements about disability. The physician's role is to determine physical limitations on bending, lifting, standing, etc.

5. Decide whether to contest the claim. All the facts necessary are usually available in the first 24 hours. If you act slowly, the employee may develop a negative attitude or obtain an attorney. Foster a positive partnership with the employee right away. Never lose the opportunity to gather critical evidence.

6. Get the employee back to work. Review the physician's restrictions. Without question, returning the employee back to work to complete his or her scheduled hours is the single most positive action you can take to minimize the cost of a claim. A quick return reassures the employee that he or she will return to a secure position. You also want to demonstrate that an incident is not a way to get out of work.

7. Explain the workers' compensation system. Lay out the rights and responsibilities of all parties under workers' compensation law. Let the employee know that the company wants him or her to recover and to get back to work as soon as possible. Provide contact information so that the employee can call with questions.

8. Submit an injury report. Prepare and submit the initial injury report at the first possible opportunity. Have the claims manager alerted so the employee's first check is delivered on time. It's a commonly overlooked detail, yet a delayed benefit check can turn a compliant employee into a confrontational challenger.

9. Manage the employee-adjuster relationship. An employee who is positive and confident will recover sooner, and remain on "your side." Make sure your process facilitates a positive relationship.

These steps are a tall order for a 24-hour period, yet they are essential to controlling costs. Think of this time as an investment, and consider a smooth claims process as your return on investment. Anything that saves you money and helps your employees should be embraced.

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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