PROVEN STRATEGIES TO CONTROL WORK COMP COSTS

HOUSEKEEPING

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INTRODUCTIONS

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Jodi MathySenior Claims Consultantjmathy@hni.com262.641.5804

Andrea TarrellMarketing Director atarrell@hni.com262.641.5813

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KEY COMPONENTS

• SET THE SCENE FOR SAFETY

• DON’T HIRE YOUR NEXT CLAIM

• PROMPT REPORTING AND MEDICAL CARE

• RED FLAGS

• INJURY MANAGEMENT COORDINATOR

• COMMUNICATION

• MODIFIED WORK PROGRAM

• EXPERIENCE MODIFICATION RATE (MOD)

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SET THE SCENE FOR SAFETY

CULTURE OF SAFETY

• You must make safety a priority from the top down.

• Make sure that you have the proper policies and training in place.

• Educate employees about their rights as well as roles and responsibilities in the event of an injury.

• Find ways to incentivize a safe workplace.

• Review all accidents and injuries to identify the root cause and put proper controls in place.

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REENERGIZE YOUR SAFETY PROGRAM

• You can’t change your past experience but you can change your future!

• Review your safety program or start one! Work with your agent if you need assistance and resources to help you achieve this.

• Safety culture in your organization needs to become a top down priority!

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DON’T HIRE YOUR NEXT CLAIM

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THE RIGHT FIT

• Put in place post-offer enhanced physicals.

• These types of tests objectively measure whether a candidate can perform the essential functions of a position.

• This step requires updated job descriptions with specific physical requirements.

• Go beyond drug testing!

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START AT THE BEGINNING

• ADA compliant job analysis details essential job functions.

• Highly detailed measurement of lifting/carrying/push/pull, positional demands, etc.

• 3rd party objective documentation of tasks verified by management and labor (both groups accept the validity of the description).

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GET TO WORK

• PT develops EPT protocol based upon physical demands documentation and client input.

• Validity testing

– Client sends in an employee to go through the EPT to validate the specifics of the protocol

• Revisions made as necessary.

• EPT becomes part of the client’s Post Offer Physical process.

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BENEFITS OF EPT

• Provides a snapshot view of the workers ability to perform the critical physical demands of the position.

• Highly individualized and specific to the job.

• Useful on a post offer/pre-employment and post accident fitness for duty examination.

• Useful in Physical Therapy treatment to identify crucial physical task goals for case closure and RTW.

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PROMPT REPORTING AND MEDICAL CARE

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TIMELY REPORTING

• Allows claim representative to make contact to explain benefits.

• Allows for proper medical attention.

• Reduces overall costs.

• Reduces litigation.

• Allows early utilization of Fraud Investigation Unit.

• Allows timely investigation.

– when facts are known and fresh

– potential subrogation

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ACCIDENT INVESTIGATION

• Interview the injured worker as soon as possible, after medical care has been rendered.

• Interview any witnesses.

• Investigate the injury site and review the actions leading up to the injury.

– Prevent others from encountering the same hazard

• Gather the facts and look for possible causal factors.

• Review findings with your safety committee

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MEDICAL TREATMENT

• Who is making the call at your organization?

• Are you utilizing the jurisdictional controls available?

• Establish relationships with local occupational health facilities.

• Consider utilizing a 24/7 nurse triage service to help refer your employees to the appropriate level of care. There are multiple options out there for this type of service.

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RED FLAGS

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WHAT SHOULD I LOOK FOR?

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• The alleged injury occurred on Monday morning or on a Friday afternoon but was not reported until the following Monday.

• The accident occurs just prior to or after a strike, job termination, layoff, end of a project or at the end of seasonal work.

• The accident was unwitnessed by any fellow employees.

MORE TO LOOK FOR…

• Claimant has a history of prior claims.

• A substantial delay occurred in reporting the incident or in the filing of the First Report of Injury.

• There are different descriptions of the accident as set forth in the medical history and the Employer’s First Report of Injury.

• There are frequent difficulties in contacting the claimant at home when he/she is allegedly disabled.

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OH THERE’S MORE!

• The lawyer and/or treating physician are known for being involved in suspect claims.

• The claimant frequently changes physicians or medical providers.

• The claimant has received a release for work which is followed by the claimant changing physicians or medical provider.

• A third party is involved in the incident under investigation. Be alert to the possibility of subrogation in any claim.

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INURY MANAGEMENT COORDINATOR

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WHO ARE THEY?

• The individual who you have empowered to be the point of contact for your injured employees and the adjusters.

• They maintain communication and help to relay red flags and other information to involved parties.

• They work to help place injured employees in modified work positions.

• Could be your safety manager, risk manager, HR manager or a separate role.

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WHY IS THIS IMPORTANT?

• Your injured employees need direction.

• One point of contact keeps the confusion to a minimum.

• They become stewards of the company to help employees in

their recovery.

• It shows your commitment to a culture of safety.

• Communication is key!

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COMMUNICATION

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DON’T LOSE TOUCH

• The adjuster shouldn’t be the representative for your company.

• Your employee should know that you care about their recovery.

• Lack of communication often leads to confusion and ATTORNEYS!

• An injured employee is STILL an employee.

• Outline roles and responsibilities.

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PICK UP THAT PHONE

• Make periodic inquiries of the employees condition.

• Help them get answers to their benefit questions – be their advocate.

• Discuss use of FMLA and how their benefits may be impacted by their disability.

• If they need corrective action, handle it swiftly.

• Welcome them back to work modified if possible.

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MODIFIED WORK PROGRAM

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AND THE SURVEY SAYS

Why are these programs important?

• When an employee returns to work in a modified position that employee is more likely to have better healing and a higher likelihood to get back to 100% pre-injury activity

• By having a dedicated modified work program the company wants to show all employees that they are valued members of the team.

• It feels good to contribute to the team’s success.

• Not all restrictions can be accommodated but the company and the employee should have good open communication for when the time is right to return to work.

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“don’t let TIME get away from you!

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% incre

ase

0%

25%

50%

75%

100%

6 months 12 months 24 Months

Time Away From Work

Ch

an

ce

of

Re

turn

ing

to

An

y W

ork

Source: New York State Workers’ Compensation Board, 2011

BEST PRACTICES

• Create a written program that outlines the responsibilities of the employee and management

• Identify light duty positions across the organization to utilize when the need arises – Job Bank

• Establish guidelines and length of time the modified duty program is available

• Have an Employee Commitment Review Form (requires employee’s signature)

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EXPERIENCE MODIFICATION RATE (MOD)

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YOUR MOD

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CONTROL YOUR EXPERIENCE

• Review all reserves and payroll data prior to unit stat filing.

• Project what your future rating will be.

• Audit your published rating at time of release for errors.

• Take advantage of state specific rules that allow for mod corrections to be made in your favor.

• Medical-only claims receive a 70% discount when their primary actual dollars go into your mod calculation.

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Workers compensation claims are costly and frustrating.GIVE SOME OR ALL OF THESE STRAGEIES A CHANCE.

WHAT’S NEXT AT HNI U

NEW Chiropractors & Work Comp: Aligning Treatment and Expectations to Handle Claims Effectively

10-11 a.m. December 18 | Webinar

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