More Money-Saving Workers' Compensation Tips

Reduce Your Workers’ Compensation Costs

Last week, we talked about what a mod is and how it impacts your workers’ compensation costs. This week, we have some additional money-saving tips to lower your mod and reduce your workers’ compensation costs – with the obvious benefit of creating a safer environment for your employees. In this post, we’ll talk about claims management, claims investigation, medical considerations, and legal considerations.

Claims Management

Contact your injured workers early and often. This will let them know that you care about them, which can help keep morale up and encourage their return to full, regular duty.
Consider unconventional or outside-the-box treatment if it will help an employee recover and return faster.
If your state allows you to direct or encourage employees to use certain doctors, use doctors who understand your business whenever possible. This will help ensure the best treatment for your employees and hopefully aid in return to work scenarios, keeping claims costs down.
Integrate strategic wellness programs into your company to help reduce injuries. Understand how chronic conditions, like obesity and diabetes, can affect or cause other injuries. Managing such diseases properly can reduce workers’ compensation claims costs.
Explain workers’ compensation benefits, programs and expectations during new employee orientation to keep future claims costs down. Make sure employees understand that they will not be punished in any way for making a claim or reporting an injury, and explain the importance of promptly reporting any injury or incident.
Make return to work a priority across your entire organization – every job should have a return to work provision, and every employee should know about it. Return to work program awareness should not just be the job of human resources or your claims adjuster.
Keep up to date on laws that impact your workers’ compensation claims. Be sure to know your requirements and responsibilities as an employer and how to address any possible or suspected fraud.
Keep tabs on what your claims administrator is doing; you should always know what is happening with a claim.

Claims Investigation

Exercise due diligence when investigating a claim. Beyond speaking to the direct supervisor and the injured employee, interview other witnesses or co-workers who could shed light on the situation.
After an incident or claim, be sure to investigate early and keep all the information organized. Make sure you gather all appropriate evidence and information so it can be verified later.
Determine whether the employee was actually working on the date that they claim to have been injured. Discrepancies or falsities happen often, particularly with late claims.

Medical Considerations

Make sure that your occupational medical practitioner does a thorough and proper examination when an employee first goes to see them; this way, you will not be surprised when the independent medical examiner (IME) tells you that you have a problem claimant. This includes performing Waddell’s tests when there is a lower back injury involved.
A diagnosis should be supported by the conditions of the accident. If the two don’t match up, then the diagnosed injury could be a result of something not directly related to work functions. In these situations, be very careful of what you pay for.
Don’t pay a bill for a surgery or procedure without reading the operative report. Sometimes it can contain things that had nothing to do with the incident that should not be your financial responsibility.
Don’t let diagnostic tests dictate your case management; tests only prove that there is an injury, not whether it happened at your workplace.
For a quick and easy way to save money, refer employees to physicians that you trust to provide legitimate findings and diagnoses.
Before a surgery takes place, establish whether it was caused by a work-related condition. Doctors may suggest surgery a bit more readily when they know it is a workers’ compensation claim.
Make sure that diagnoses are legitimate and universally accepted before you pay a claim. For instance, don’t list “pain” as your work-related diagnosis. Pain is a subjective finding—you cannot qualify it or quantify it.
Know the basics about common medical terms that you may encounter. For example, fibromyalgia is not a diagnosis; it is a symptom. The word itself means “pain in the fibrous tissue” (the suffix “algia” always indicates a symptom).
Be wary of paying for surgeries or operations caused by arthritis. Arthritis is not caused by trauma and thus cannot result from an on-the-job injury; therefore, in most cases, it should not be considered a workers’ compensation claim. The only exception is arthritis caused by repetitive trauma, found in employees who do a lot of squatting, kneeling or repetitive hand and finger movements.
Be wary of other common claims that may be masked as workers’ compensation injuries. For example, in general, trauma does not affect an existing replaced knee, making it rare for necessary loose knee replacement to be work-related.

Legal Considerations

Know and understand the interplay between your state workers’ compensation laws, the American with Disabilities Act (ADA) and the Family and Medical Leave Act (FMLA).
Keep your legal counsel in the loop on workplace injuries right from the beginning. The first 24 hours after an incident are crucial, and your lawyer needs to be informed about conditions, investigations and any updates.
When hiring, provide detailed job descriptions that include an accurate percentage of the amount of work that is physical. This may prevent later legal disputes.
Document and file everything throughout the workers’ compensation and return to work processes, as it may become relevant information if there is a claim or later dispute.
After an incident, review the employee’s personnel file. This will help you understand the employee better, and it may offer clues or tendencies for potential fraud or a vendetta against a co-worker or manager.
After an incident, your legal team or representative should do an on-site inspection where the injury occurred. Be sure that they interview others who do a similar job in addition to any witnesses.
If there are changes in the diagnosis, the accident needs to be re-evaluated. It may not have happened as reported.
Keep an organized case chronology, documenting everything from initial claim to the close of a case. This includes previous history of the employee that may be relevant (past disputes with co-workers, claims history, problems at home, etc).
Make sure to provide the IME with everything you have, including your chronology.
Before a trial, make sure your witnesses are prepared. Someone from the company should be present at every hearing; it’s important to make sure that everyone is always on the same page.