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 Workers Comp Commission New Web Site up

The website for the newly established Oklahoma Workers Comp Commission is up and running.  Some things to know:

  • Forms Page - This are for new forms for any claim after 2/1/14.  Some of the forms have changed very little from the workers compensation court forms.  This is only temporary until the commission has time to roll out new forms that are more "user friendly".
  • Rules Page - These are the new rules that go along with the new law.  These are emergency rules and will be changing as things develop.
  • Commissioners - In case you are wondering who the new commissioners are, their bios are here.  Only 1 is an attorney.  
  • Workers Comp Certificate of Non-Coverage/Affidavit of Independent contractor Status - This form is not been released yet.  It will be more like the latest form that the insurance commissioner was using instead of the old form of the past.  It does not look like their will be a charge for this form at this time.   

More info will follow as it is developed - 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 Workers Comp Rates to Drop 14.6% in 2014

OKLAHOMA CITY – An annual filing most insurance carriers will use to develop rates for workers’ compensation insurance shows a dramatic decrease in loss costs, Oklahoma Insurance Commissioner John D. Doak announced today. The overall loss cost decrease of 14.6 percent takes effect Jan. 1.

“This is fantastic news for Oklahoma businesses,” said Doak. “Reducing workers compensation costs by enticing new companies to come to the state and allowing current businesses to expand operations can trigger a new wave of economic prosperity. These decreases over a period of time will help to make Oklahoma much more competitive.”

The National Council on Compensation Insurance Inc. (NCCI) is an advisory organization that studies workplace injuries, collects workers’ compensation data, analyzes industry trends and prepares rate recommendations. The NCCI credits most of the decrease to the passage of SB 1062, which makes substantial changes to Oklahoma’s workers’ compensation system. The 14.6 percent projected reductions in loss costs represent the part of a workers’ compensation insurance premium for indemnity and medical payments and associated claim adjustment expenses, not reflecting overhead and profit.

“I commend Gov. Mary Fallin, Speaker of the House T.W. Shannon and Senate Pro Temp Brian Bingman for dedication to improving the state’s workers’ compensation system,” continued Doak. “With their outstanding leadership and belief in pro-growth policies, Oklahoma will continue to thrive.”

The overall average loss cost impact at an industry group level is as follows:

Industry Group Impact

Manufacturing -16.3%

Contracting -16.2%

Office and Clerical -13.4%

Goods and Services -14.1%

Miscellaneous -12.2%

TOTAL -14.6%

Other key observations from the report include lost-time claim frequency continuing to decline across the state, indemnity average cost per case increasing for latest policy year and loss adjustment expenses declining for a lower average than nationwide

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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.

    Who is NCCI and What do they do?

    NCCI does lots of things.  What they do can affect your Total Cost of Risk.  According to their website:

    spreadsheetpic.jpg

    “National Council on Compensation Insurance, Inc., based in Boca Raton, FL, manages the nation’s largest database of workers compensation insurance information. NCCI analyzes industry trends, prepares workers compensation insurance rate recommendations, determines the cost of proposed legislation, and provides a variety of services and tools to maintain a healthy workers compensation system.”

    What they do affects the workers compensation rates for all employers in your class as well as your specific experience modifier (determined by your company’s claims), and impact of any legislative changes on rates in your state.

    Rates for your business

    To determine the rates for your business NCCI uses class codes based on what your employees duties are.  More hazardous duties usually equal higher rates.  For example, steel workers have a much higher rate than salespeople.  Each business can have multiple class codes depending on the variety of duties their different employees perform.  A Manufacturer may have a different class code for clerical, sales, drivers, and 2 more for each of two products they make.  They look at the claims for all employees in that class in the entire state and compare to payroll in the class to determine a rate.  They use actuaries for this.

    Your Experience Modifier

    If your premium is over $5000 for the past few years or over $10,000 in a single year, you are subject to being “experience rated” by NCCI.  Every year you will receive a sheet from NCCI that has a bunch of numbers on it and looks similar to a spreadsheet.  There is a complicated formula involved but basically the more claims you have the higher your modifier is.  The modifier, often called “EMR” or “Mod”, is a multiplier applied to your premium.  So if your modifier is 1.25, you get surcharged 25% and if it’s .75 you get a 25% discount.  All insurance companies will apply your experience modifier to your rates.  If you are really into math here is a link that explains how they are calculated: “ABC’s of Experience Rating”, by NCCI.

    Impact of Legislative Changes or Case Law

    NCCI will also determine how any legislation that affects workers compensation will ultimately affect the rates.  These changes could result in immediate or future changes in the rates for your state.  Changes that are perceived to change rates (such as a new law extending disability time) will be calculated by an actuary based on detailed information of past claims and a rate increase or decrease will often be applied immediately or in the future.  Court cases that overturn this legislation or other court cases that are appealed above the workers comp court can also have an effect on the rates.  In Oklahoma, key legislation was passed that had an immediate rate reduction.  Over the next few months, many of these changes were challenged and defeated in appeals courts and therefore much of the rate decrease was reversed and rates were raised back up to almost where they were before.

    You can see the effect NCCI has on your rates.  It is funded by the member insurance companies that are members and through fees they charge for their data.  Understanding this helps you better control your Total Cost of Risk.

    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.