Choosing Medical Providers for Workers Comp


How you choose and work with Medical Providers is a key component in reducing your Workers Compensation costs when an employee is injured on the job.  This should be a process similar to hiring a good employee who will become a crucial part of your team.  I recommend the following: 

  • Be sure you understand your state law concerning Work Comp
  • Most states allow you to choose the medical providers for Workers Comp injuries.
  • If possible, choose a Medical network of doctors after your policy is written.  Many insurance companies offer networks of Occupational doctors who are very accustomed to dealing with workers compensation claims and insurance companies.  Work Comp is much different than health insurance, so it’s important to work with the appropriate doctor or clinic.  Usually, there are Occupational Medical Clinics in larger cities.  In smaller towns, employers may send employees to a local physician when they are injured. 
  • Each of your locations should know which physician or clinic an injured worker should go to, their phone number, and address.  I recommend posting this somewhere employees can easily see it, such as a bulletin board or in the break room. 
  • Each location should also have the nearest hospital and emergency number (if not 911) readily available for injured employees.  This should also be posted. 
  • Set up a meeting with the physician’s office or clinic in advance and let them go through their procedures with you.  Tell them what you expect, and find out what they expect.
  • Get a list of the provider’s staff who handles work-related injuries, as well as their contact information.
  • Let the provider know if you have an Early Return to Work Policy (ERTW) or Alcohol and Drug Testing Policy.  Give them job descriptions of your most common worker classifications. 
  • If you don’t have frequent work-related injuries, schedule annual meetings to keep your medical provider up to date with your procedures.
  • If you have certain specialist(s) in the area you prefer to use, make sure your provider knows your preferences.  If not, ask the provider who they use.  This also applies to Physical Therapists.  Ask if they own their own PT practice, MRI facility, etc.  This lets you know of any possible conflicts. 
  • Communicate to your employees who your local clinic or physician is and remind them of your ERTW Policy (if you have one).  This should be done on an annual basis and for all new hires. 
  • If you are having trouble finding a provider, ask a medium-to-large company (50+ employees) in the area who they recommend. 
  • Do not allow employees to choose their own provider unless you have approved them in advance. 
  • Find out the provider’s policies on using pain killers. You want to keep this at a minimum. 
Comment

Chris Moxley

Chris began his career at a Norman insurance agency in 1988 serving as a Branch Manager for 3 years. He joined Professional Insurors in 1995 as a Producer and became Vice-President in 2004, where he overseas human resources and agency operations & technology as well as continuing to manage his client accounts and grow the business. The Agency works with a variety of accounts and Chris specializes in Workers Compensation Risk Management and Insurance. He has worked in Insurance for over 20 years and besides Workers Compensation he has specialized training and experience in the fields of Construction Risk Management and Risk Transfer, Property Management, & Manufacturing.

Oklahoma Option Savings? - Reduction in Fraud

If you are an employer that has had several claims, it's likely that you have seen multiple cases of what you might consider fraud. Some reasons employees do this include:

  • To get an off the job injury covered under workers compensation.  Workers with no medical coverage are prime for this and also workers comp has no deductible. 
  • To obtain a lump sum settlement.  We have seen some employees with over 10 workers comp claims all involving settlements and all involving the same attorney.
  • To obtain pills - Opioid abuse is at an all time high and Oklahoma is one of the worst states for this.  Many work comp doctors will prescribe a complete battery of pain killers which the injured employee may either sell on the black market or take themselves.

I break this down into complete fraud, in which the employee fabricates the entire injury, or modified fraud in which the employee gets legitimately injured and is then swayed by an attorney, friend, or coworker to modify their symptoms to obtain one or more of the above.  

The Oklahoma Option makes attorney involvement much harder for the average attorney who is used to dealing with the workers comp system because most claims will routinely be referred to Federal Court due to ERISA (Employee Retirement Income Security Act), which regulates these types of workers comp plans.  This can actually benefit the employer.  

The Oklahoma Option also greatly reduces the time for reporting a claim because employers can choose reporting requirements under this type of benefit plan. This will curtail the past practice of reporting claims months or often years after the claim allegedly happened.

Chris Moxley

Comment

Chris Moxley

Chris began his career at a Norman insurance agency in 1988 serving as a Branch Manager for 3 years. He joined Professional Insurors in 1995 as a Producer and became Vice-President in 2004, where he overseas human resources and agency operations & technology as well as continuing to manage his client accounts and grow the business. The Agency works with a variety of accounts and Chris specializes in Workers Compensation Risk Management and Insurance. He has worked in Insurance for over 20 years and besides Workers Compensation he has specialized training and experience in the fields of Construction Risk Management and Risk Transfer, Property Management, & Manufacturing.

Oklahoma Option Savings? - Medical Management

Many people are wondering where the savings are in opting out of Oklahoma's Workers Comp system and managing their claims through the "Oklahoma Option" Employee Injury Benefit Plan? We will be looking at some of the areas of savings over the next few articles.  Today we will focus on medical management.

Anybody that works in workers compensation will tell you that the medical management under the Workers Compensation system is one of the biggest problems. While several factors may be to blame, many doctors will not see employees with workers comp claims, which sometimes results in a battle of dueling attorney's and physicians.  Conversely, the "Option" encourages more doctors to treat injured workers as the claims may not always be viewed as workers compensation. For example, wear and tear injuries, such as knee replacements, may often be denied as these should be covered under medical insurance. Therefore, the result is more positives outcomes for all, such as better managed claims according to best practices, reduced attorney involvement, and ultimately getting the employee back on the job as quickly as possible.  

While early reporting has historically been encouraged, under the Oklahoma Option, it is often required. Employees may be required to report an injury in as little as 24 hours. Early reporting has several advantages: it allows the employer and treating physician(s) to better assess and treat the injured worker (decreasing chances of an aggravated and/or escalated injury), it tackles any workplace safety concerns by being proactive, it prevents potential fraud, it returns the employee to work sooner, and it helps the employer with cost containment associated with claims loss ratios, insurance premiums, and safety programs; and let's not forget employee morale! 



Comment

Chris Moxley

Chris began his career at a Norman insurance agency in 1988 serving as a Branch Manager for 3 years. He joined Professional Insurors in 1995 as a Producer and became Vice-President in 2004, where he overseas human resources and agency operations & technology as well as continuing to manage his client accounts and grow the business. The Agency works with a variety of accounts and Chris specializes in Workers Compensation Risk Management and Insurance. He has worked in Insurance for over 20 years and besides Workers Compensation he has specialized training and experience in the fields of Construction Risk Management and Risk Transfer, Property Management, & Manufacturing.

Benefits of Early Return to Work (ERTW) Program

The longer an injured employee that is off work the more the claim will cost your company.  Since claims directly impact your bottom line, it's important to implement an ERTW program.  Currently 55% of employers do not have a ERTW program.  For the companies that do, they can decrease lost-time claims by 73%.  ERTW programs wil allow injured workers to work to return to full time or part time work before they are fully released to work.  Usually the physician will give restrictions for the employee that the company can work with to customize their duties.  They could work in the same position but not perform all duties or work in an transitional position within the company.  Most all employees can at least sit at a desk and do simple tasks.  Remember, it's beneficial to your company to offer this program as well as beneficial to the employee.

 Benefits of an ERTW Program:
• Lowers workers compensation costs
• Decreases employee time away from work
• Reduces turnover
• Strengthens employee relations
• Boosts employee morale
• Improves overall productivity
• Improves company image

To implement an ERTW program.   You should work with your insurance company, medical providers, Nurse case mangers, and your employee and set it up in advance of having a claim. 

 ERTW Elements

  • Write a policy statement in non-contractual terms.
  • Assign someone to run the program.
  • Publicize the policy to all employees and
  • at new employee orientation.
    Review work assignments to see which might be transitional duty possibilities. (Further review may be necessary at the time you receive a restricted work release from the doctor.)
  • Determine acceptable wage levels for transitional duty assignments.
  • Contact your medical providers to let them know ERTW is available at your company whenever possible. Contacting the providers as you set up your program will help you to set up a relationship with the providers and complete any paperwork to help the providers meet their requirements.  You should also remind them during each new claim and provide them with a Job Description that details current physical requirements along with requirements of transitional posistions available.
  • Follow up daily with the recovering employee to help determine readiness for transitional duty or full return to work.
  • Keep records to track all efforts and contacts with and on behalf of the recovering employee.
  • Review your program with your legal counsel to help ensure compliance with applicable laws.
  • Employers utilizing a ERTW return can speed recovery of injured workers as much as 3X companies that do not have a plan.  With all this in mind, why would you not implement such a plan?

    Comment

    Chris Moxley

    Chris began his career at a Norman insurance agency in 1988 serving as a Branch Manager for 3 years. He joined Professional Insurors in 1995 as a Producer and became Vice-President in 2004, where he overseas human resources and agency operations & technology as well as continuing to manage his client accounts and grow the business. The Agency works with a variety of accounts and Chris specializes in Workers Compensation Risk Management and Insurance. He has worked in Insurance for over 20 years and besides Workers Compensation he has specialized training and experience in the fields of Construction Risk Management and Risk Transfer, Property Management, & Manufacturing.

    Effective Safety Incentives to Reduce Work Comp Claims

    safety-xs.jpg

    Over the years I have seen safety incentive plans come and go.  Some make incentive plans into games: others give away free company swag.  There are many plans that are effective.  The goal is to make employees think about safety and work safely to avoid accidents.  One of the best methods comes from peer pressure.  I remember back in high school, when there was a player that wasn't pulling his weight or giving his best effort, the coach would not punish the player, he would punish the whole team.  This made 50 people put pressure on him because if he did not perform, the entire team had to run extra laps.  This team concept is also very effective for safety incentive plans.  Safety incentive plans should include important elements:

    • Employees should be encouraged to report injuries
    • A random drawing for cash works best
    • Incentive should be based on no "lost time" injuries
    • Regular, increasing rewards should be used until a determined maximum is reached
    • If an accident happens, the clock should start over the next day and not wait until the first of the month.  It's best if the reward reverts back to a smaller amount and starts to increase again
    • Supervisors should have their own plan outside the regular plan
    • Upper management should be involved and also hand out the prizes and make a big deal about the safety success

    Contact me if you would like a sample plan to use. 

    Comment

    Chris Moxley

    Chris began his career at a Norman insurance agency in 1988 serving as a Branch Manager for 3 years. He joined Professional Insurors in 1995 as a Producer and became Vice-President in 2004, where he overseas human resources and agency operations & technology as well as continuing to manage his client accounts and grow the business. The Agency works with a variety of accounts and Chris specializes in Workers Compensation Risk Management and Insurance. He has worked in Insurance for over 20 years and besides Workers Compensation he has specialized training and experience in the fields of Construction Risk Management and Risk Transfer, Property Management, & Manufacturing.

    Which State does Workers Comp Payroll Fall Under?

    photodune-4674367-green-road-sign-audit-xs.jpg

    I once had a contractor (OKLA client) hire a TN subcontractor to do some painting work in MO. They let them start the job without WC insurance and the sub never obtained the insurance. The question was what rate will apply at audit for our client since each state has different rates. After emailing the underwriter we received this answer from their audit department:

    The WC Rules (as found in the Scopes Manual) are:

    1. The payroll of employees who are hired for a specific job project are assigned to the state in which the job is located.
    2. Payroll of employees who travel constantly across state lines but return home each night are assigned to their headquarters state
    3. If employees are assigned to a job that is located in a state other than their headquarters' state, their payroll shall be assigned to the highest rated of either the state in which the job is located or the headquarters' state.

    For Gen. Liability, they are assigned based on the location of the job

    Since these multi-state issues do come up from time to time it is good to have a good insurance company that deals in multi-state exposures to help out on these situations.


    Comment

    Chris Moxley

    Chris began his career at a Norman insurance agency in 1988 serving as a Branch Manager for 3 years. He joined Professional Insurors in 1995 as a Producer and became Vice-President in 2004, where he overseas human resources and agency operations & technology as well as continuing to manage his client accounts and grow the business. The Agency works with a variety of accounts and Chris specializes in Workers Compensation Risk Management and Insurance. He has worked in Insurance for over 20 years and besides Workers Compensation he has specialized training and experience in the fields of Construction Risk Management and Risk Transfer, Property Management, & Manufacturing.

    What makes up my Total Cost of Risk (TCOR)?

    photodune-3989410-risk-management-xs.jpg

    Your TCOR (Total Cost of Risk) includes 3 major categories of Expenses:  Preventative Cost, Direct Cost, and Indirect Cost.  Together these equal your Total Cost of Risk.  Many people just think of their insurance cost alone but this is far from your total cost.  What is interesting is the cost you spend in one area can effect the amount you spend in another.  It is a proven fact that money spent in preventing claims or losses reduces your direct costs by several times the amount you spend.  Indirect costs are usually several times what the direct cost of a claim are so if you have some basic math skills, it doesn't take long to realize you should be spending more money in prevention of claims.  Here are some costs associated with each category that make up your Total Cost of Risk (TCOR):

    Preventative - Safety & Risk Management, Pre-Employee Screening, Safety Equipment, Culture Management, Wellness, New Hire Training, salary of safety personnel & expenses, Personal Protective Equipment, Safety Meetings.

    Direct- Insurance, Managed Care, OSHA Fines, Deductibles, Legal Expenses, Loss of Productivity post accident, Management time to administer Injury or attend hearings, Staff time to administer injury.

    Indirect - Reputation with insurance carrier(s), reputation with vendors, loss of morale, loss of reputation, employee gossip, etc.

    Considering all of these expenses why would anyone not want to spend more money on Preventative costs? 

     
    Comment

    Chris Moxley

    Chris began his career at a Norman insurance agency in 1988 serving as a Branch Manager for 3 years. He joined Professional Insurors in 1995 as a Producer and became Vice-President in 2004, where he overseas human resources and agency operations & technology as well as continuing to manage his client accounts and grow the business. The Agency works with a variety of accounts and Chris specializes in Workers Compensation Risk Management and Insurance. He has worked in Insurance for over 20 years and besides Workers Compensation he has specialized training and experience in the fields of Construction Risk Management and Risk Transfer, Property Management, & Manufacturing.