photo: “tulalip bay” by diane l. wilson-simon. managing work injuries working toward a common...
TRANSCRIPT
Photo: “Tulalip Bay” by Diane L. Wilson-Simon
Managing Work Injuries
Working toward a common goal…
Managing Work InjuriesInstructor: Kerrie MurphyEdmonds Community College
This course is being supported under grant number SH16637SH7 from the Occupational Safety and Health Administration, U.S. Department of Labor. It does not necessarily reflect the views or policies of the U.S. Department of Labor, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.
With Thanks to & Cooperation of the Tulalip Occupational Safety & Health Administration (TOSHA)
OSHA There are two main parts to the Occupational Safety and Health Act, General Duty Clause, Section 5.1. The EMPLOYER Responsibilities2. The EMPLOYEE Responsibilities
Everyone needs to cooperate and play their part in safety awareness, prevention and compliance.The overall goal is to achieve a consistently safe workplace and never experience ANY accidents.
Accident / Injury PreventionAvoiding an accident and/or injury is, actually, the first priority in managing your claims.
Focusing on prevention can: Avert an accident or injury from happening
in the first place. Lesson the severity of an incident if it does occur. Don’t Ignore the “Little Things”!
For more detailed training on accident prevention and investigation, come to the next training session.
Look for the TOSHA training announcements.
Types of Prevention1. Focus on Behavior
Training, training, training! Evaluating policies, procedures & actions Creating a Safety Culture
2. Focus on Protection PPE – Personal Protective Equipment Safe-Guards on facilities, machines, equipment,
etc.
These need to work together.These need to work together.
EXAMPLEEvaluating a worksite:
What types of injuries could happen here?
But, Accidents Happen1. Immediate Response:
A. DON’T PANIC
B. Quickly Assess the situation.
C. If needed, call 911 BEFORE you start first aid.
D. Do you know:• Where the first aid kit/equipment is?
• Who knows First Aid/CPR?
• Where fire extinguishers, spill kits, and other emergency equipment is located?
• Where the MSDS is filed?
• Who to call internally?
But, Accidents HappenDepending on where an accident happens, there will be unique challenges in reacting to it.Examples:
1. Indoors vs. OutdoorsA. Environmental FactorsB. Access to Phones, Running Water, Etc.
2. Public vs. Private areasA. Securing the SceneB. Getting Assistance
But, Accidents Happen2. The top priority should always be attending to
the needs of the injured worker(s).
However, simultaneously you need to make sure the area is secure and that no further injuries will occur, also that the area is left untainted for the investigation.
But, Accidents HappenPointers for dealing with the injured person:
Communicate, offer Empathy & Keep them Engaged.A. Let them know what is happening.
For example, let them know that you have called for help. If you are administering any first aid, let them know what you
are going to do before you do it.
B. Ask them questions about how they feel. This will let you know early if they are
staying coherent or not.
C. If you need to ask questions aboutthe accident, avoid assigning guilt.
D. By preparing in advance, you canreassure them with accurate answersto questions and concerns.
Band-Aid PracticeAs obvious as this may seem, it is not second nature to most of us. It helps to have actually done it.
So, pick a partner…
But, Accidents Happen3. The next priority is investigate.
A. To prevent additional injuries.
B. To preserve the scene until an investigation can be completed.
But, Accidents Happen4. Have an accident response checklists.
Assign different tasks to different individuals.A. One person should always be assigned to attend to
the injured person.B. Another person can be assigned to secure the area.
Everyone will want to come see what happened but
that can create additional problems.If there is a hazard or danger, you don’t
wantanother accident.Also, the injured person needs privacy.
C. Others can be assigned to clean up, repair or to place warnings, whatever is needed to prevent further harm.D. The investigation should begin as soon as possible.
But, Accidents Happen5. Prepare packets in advance:
A. Information & Forms for the Accident
Investigation & Report
B. Information & Forms for Injured Worker
C. Information & Forms for Physician
The last thing you want to do when someone is injured is to be looking around for forms or information that is needed. Prepare in advance!
BREAK
The next TOSHA Training Sessions will be announced in the next week.
OSHA-10
OSHA 40-Hr Haz-Woper
Why All The Paper Work?
The answers are:
To kill trees?
To keep us busy?
To punish us?
1. MONEY – healthcare of any kind costs a lot.
2. THE LAW – documentation is vital to responding to inquiries. (fines also cost money!)
DocumentationAnecdotal or Subjective Evidence
Versus
Facts and Verifiable Evidence
Who is the “Law”? In the United States, it is FEDERAL law that
employers provide a safe and healthy work place.
Each STATE has additional laws that can be even more stringent but can not be less than the federal laws.
In the state of Washington, most work related injuries are administered by the WA State Department of Labor & Industry (L&I). The exceptions are Federal Federal employeesemployees and employees of Tribally owned and Tribally owned and operated businessoperated business.
Who is the “Law”? Tribes are considered a “federal” entity, so the
Occupational Safety and Health Administration (OSHA) is the regulating body for tribal businesses.
However, tribes are sovereign nations, so they really need a structure of their own, such as: TOSHATOSHA.
Discussion: What are the Pros and Cons?
Why Money?It might seem insensitive at first to think about money when someone has been injured.
The fact is, the whole reason we created worker’s compensation was so that everyone could be insured that the costs of a work related injury will be as minimal as possible. Trust me, even the injured person will start worrying about the immediate and long term costs very quickly.
Whose Money?1. The Injured Person
2. The Business &/or Tribe
3. The Physician
4. The Insurance Carrier / TPA
It helps to step back and look at all the different players/stake holders; how they are connected in this process and what each has to gain or loose.
History of Worker’s Compensation
Prior to the industrial revolution, most people lived in SUBSISTENCE economies.
People farmed or gathered food, fished, hunted and supported themselves and their communities.
As populations grew, land ownership changed, farming & fishing became about large quantity trade rather than about subsistence.
Economies became more and more about MONEYMONEY.
There was a pretty quick transition from making your own “stuff” to buying everything at a store.
History of Worker’s Compensation
The industrial revolution had an additional affect – MACHINESMACHINES.Not only cars, trucks and airplanes, but new technologies and equipment to mine, manufacture, mass produce,and distribute.There were very little laws of commerce to protect workers at that time. As the industrial revolution exploded in the early 1900s, several movements began, including labor organizing, to address the lack of rights of workers.
Worker’s RightsDept. of Labor 1913
New Deal 1933
Social Security 1935
Equal Pay & Civil Rights 1963
OSHA 1971
Migrant Worker Act 1981
Am. w/ Disabilities Act 1990
Family Medical Leave Act 1993
http://www.dol.gov/oasam/programs/history/dpt.htm
Back to the Money & Today Besides the obvious reason that it is just good
ethics to provide a safe and healthy work place, OSHA laws protect the employee (and their families) from the expenseexpense that is associated with a serious injury, illness, disability or death that is work related.
It also provides the guidelines and instructions to employers so that they can better prevent accidents and injuries.
Costs for the Injured Worker Medical Costs Loss of Pay for Missing Work Loss of the Ability to Work
Cost of Retraining for a Different Job Disability
Change in the Ability to Earn the Same $ Extended Medical Care Costs
(Beyond the Immediate)
Pain & Suffering – the Mental Cost People’s identity is often linked to their job…
Costs for the Employer Loss of the Productivity of that Worker
Pay the worker who is out with an injury their salary plus the cost of a temporary person.
Or, the rest of the team has to take on more work. Cost of Replacing that Worker Cost of Damage to
Equipment, Structures, etc. Cost of a Litigation Cost of OSHA Citation(s) Loss of Reputation
Costs for the Physician It costs the physician to provide care to the
injured person. Without worker’s compensation, the injured
worker may not be able to afford the cost of the health care.
Broken Bone: (Estimate)
Office Visit $100-300
X-Ray $75-500
Setting $200
TOTAL: $375-1000
Other Costs? Family Friends Community
How Do We Deal With These Costs?
INSURANCE!It’s called Transferring the Risk.
In many ways it is similar to car insurance.
1. You purchase it with the hope you never have to use it.
2. If you have to use it, you are “penalized”.1. Your rates go up.
2. You have to pay a deductable.
Etc.
BREAK
The next TOSHA Training Sessions will be announced in the next week.
OSHA-10
OSHA 40-Hr Haz-Woper
TRIBAL FIRST INSURANCE
Claims Administrators are referred to as Third Party Administrators (TPAs)
Tribal First is also an insurance provider but not all TPAs take on this role.
Even though the employer is technically the person insured, having a different party administer claims provides for someone to attempt to balance the needs of the employee and the employer.
The THIRD PartyEXERCISE:
1. Gather in groups of 3 or 4.
2. You have 30 minutes to discuss the following questions. (Handout)
3. One person from each group will report back to the large group.
4. We will discuss everyone’s opinions as a group.
Third Party Objectivity1. What are the challenges to the employer be objective
or not?
2. What are the challenges to the third party administrator being objective or not?
3. Where does the regulating body, such as OSHA come into all this and do you think they are objective?
4. Do you feel the laws are objective?
5. What challenges are unique to tribal business?
6. Should Objectivity be a goal?
Working Toward A Common Goal1. Everyone wants to limit their individual cost
and/or loss.
2. By acknowledging the other parties similar position, we can try to work together for a common goal.
How Do We Limit the Costs?1. Make the process go as smooth as possible.
2. Limit any unnecessary costs.
The longer someone stays off work, the more cost is associated with each claim.
Return to Work Policy
Modified Duty Process
We have to be able to TRUST each other!
How Do We Make The Process Go Smoothly?
1. It ALL Comes Back to the FORMS!
A. The number one reason that a claim is delayed and/or denied:
Missing or IncorrectMissing or Incorrect
Information on theInformation on the
Initial Report.Initial Report.
SECTION ONE
Employer Section:
1. “Firm” Name
1A. Policy Number
2. Mailing Address
2A. Phone Number
3. Location Address (Why might this be important)
3A. Location Code
4. Nature of Business
Should the injured employee be expected to fill this section out?
SECTION TWO
Employee Section:
5. Employee Name
6. Social Security Number (Why might this be important?)
SECTION TWO
Employee Section:
7. Date of Birth
8. & 8A. Home Address & Phone
(What happens if you move, give the wrong address and/or don’t provide a phone #?)
SECTION TWO
Employee Section:
9. Sex
10. Occupation
(Why do they want to know this?)
SECTION TWO
Employee Section:
11. Occupation (Job Title)
12 & 12A. Usual Work Times & Employment Status
(Why is this important?)
SECTION TWO
Employee Section:
13. Gross Wages
13.A Other Payments Not Reported as Wages
14. Have you previously injured the “body part in question”?
SECTION TWO
Employee Section:
15. Do you have more than one paying job?
15A. Married?
15B. Dependents?
SECTION TWO
Employee Section:
Release Authorization
SECTION THREE
Incident Section:
BREAK
The next TOSHA Training Sessions will be:
MAY 13th Accident Prevention
MAY 20th Basic Ergonomics
Making Treatment Go Smoothly
The Physician’s Perspective:
TIMETIME
1. Can determine if a cut can be stitched or a finger reattached, etc.
2. May be critical to treatment of exposure or poisoning.
3. Will help in determining the relationship of the injury with the actual job duties.
Making Treatment Go Smoothly
The Physician’s Perspective:
EXPOSUREEXPOSURE
1. MSDS – Material Safety Data Sheets
If there has been any type of exposure to a chemical, the proper procedure is to send a copy of the MSDS for each chemical with the patient.
2. Medical Surveillance
For many jobs, a basic physical including testing of baseline, periodic and termination levels of a variety of compounds is required and is helpful for the physician, if other than the one who completed the physical.
Making Treatment Go Smoothly
The Physician’s Perspective:
JOB DESCRIPTIONJOB DESCRIPTION
1. In order to determine potential causes of an injury but also for determining the modified duty status, the doctor needs a detailed description of the injured worker’s job. Including;
A. Different tasks from start to finish
B. Approximated time the employee does any of the following; STANDING, SITTING, LIFTING, BENDING, KNEELING, TYPING, ETC.
C. And any medical surveillance that has been done.
Making Treatment Go Smoothly
The Physician’s Perspective:
PROTECTIONPROTECTION
1. The doctor will want information on what measures are/were taken to protect the employee. Did they perform to their expectation? What will be available for the employee when they return to work? The doctor may suggest additional safeguards for the employee when they return.
Making Treatment Go Smoothly
The Physician’s Perspective:
REPORTINGREPORTING
It is important to know/remember that licensed medical practitioners are required to report certain things to the county health authority who then reports to state authorities who reports to federal authorities. There is no way to avoid it.
However, it is not a physician’s role to enforce the law and most are usually very clear that the needs and decisions of the patient are their first concern.
Physician’s Initial Report1. Section One is usually ObjectiveObjective Findings
A. Height, Weight, Temperature, etc.B. Description of injury such as:
(Lac) Laceration on Right Index Finger, 1 cm length, 1 mm depth, etc.
2. Section Two is SubjectiveSubjective FindingsA. How did the injury “appear” to the doctor.
The difference is that the objective should be measurable while the subjective is based on the physician’s opinion.
Physician’s Report3. The physician will determine, based on the
examination and sometimes by running some tests on the patient, if, when and how the injured worker can return to work.
This is supposed to be based on OBJECTIVE findings!
So what does that mean?
Physician’s Report1. Back to Work with NO RESTRICTIONS.
2. Back to Work with RESTRICTIONS or in other words, MODIFIED DUTY.
3. OFF WORKA. Plan of Treatment.
B. Disability…
So, Does that mean you are
on VACATION?!
Modified Duty1. Sitting
2. Standing
3. Bending
4. Lifting
Etc.
In a typical WORK day, how often and how much can you withstand without aggravating the injury?
Why is Return to Work Important?
1. Back to the Cost.
2. There is a psychological concern with any injury or illness.
A. The longer someone delays getting back to work the harder it is.
B. Sometimes we can actually make an injury worse by “babying” it too much.
C. Pain and Discomfort are actually part of the healing process.
Being Aware1. Anticipate that there will be a transition
period.
2. The employee may experience post traumatic stress, depending on the situation.
It is important for coworkers, supervisors, family, the physician and the injured employee not to underestimate the mental impact of a work related injury!
COMMUNICATION!Part of any smooth process is making sure all parties communicate.
1. The employer should check in with the injured employee, especially if they are off work.
2. The employee needs to let both the doctor and the employer what is going on, if they are having trouble with treatment or adjusting to a return to work plan.
COMMUNICATION!3. The doctor needs to make sure that the
insurance carrier, the patient and the employer all know what is going on with test results, treatment options and any changes to the return to work plan.
4. IMPORTANT! Once a doctor has signed the initial paperwork, they are considered the treating physician. Any treatment or care that does not have the approval of the treating physician will not be covered!
COMMUNICATION!NOTE: There is the option to request a second
opinion and/or to switch doctors.
Again, make sure that you communicate to your employer, the insurance provider and your previous doctor to make sure that the process goes smoothly.
It is best to communicate with everyone BEFORE you actually proceed with any changes or your treatment may not be approved and you will be responsible for the cost.
Getting Back on the Horse!
FALL OUTBe creative and willing to make changes.
NOTE: If we follow basic incident investigation procedures, BLAME is not the focus.
How, Why, What etc. can be achieved without focusing on the blame.
Try to turn the negative into positive.
You can’t change that the accident
happened but you can control the
result(s) of the situation.
FALL OUTIt is not uncommon that there may be adjustments that occur following an incident, both for the individual who was injured but also for the work itself.
THAT’S A GOOD THING!!
Use the situation as an
opportunity to make the
work safer for everyone.
BREAK
The next TOSHA Training Sessions will be:
MAY 13th Accident Prevention
MAY 20th Basic Ergonomics
TEST
The next TOSHA Training Sessions will be:
MAY 13th Accident Prevention
MAY 20th Basic Ergonomics