Unsure of all the different acronyms used in the Workers’ Compensation industry? Click here for a list of frequently used terms and their definitions.
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“My doctor’s office can only schedule appointments during my work hours.” How many times have you heard this or one of the many other issues your injured workers have declared regarding lost time and their medical appointments? Click here for tips on payment practices.
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Cal-OSHA found Home Depot’s safety policies and prohibition on open-toed or open-heeled shoes did not adequately protect employees. Result was a $11,250 citation, not including the cost of the injury and indirect costs of updating their safety program, appeal, legal fees, investigation time, etc. Click here to find out how to establish a shoe policy
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An important concept in the world of insurance is subrogation. The idea of subrogation is often confusing for even seasoned insurance professionals. It is important to understand the basics so that companies and their agents can spot the potential for subrogation, since it may mitigate the exposure of a claim, and a corresponding hike in Workers’ Compensation premiums.
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Lately, we have seen an uptick with a Compromise & Release (C&R) Workers’ Compensation Claims. With a C&R the injured employee receives a lump sum amount that includes a buyout of all future medical care. The carrier is “released” of all future exposure. However, if the employee is still employed, they can file another subsequent claim with the same employer. Even if it is to the same body part, medical care cannot be apportioned. There can only be apportionment to the Permanent Disability portion of the Award.
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When a serious injury or death occurs at work, your immediate goals are to:
Reduce the impact of a serious injury to the injured employee and co-workers/witnesses
Manage and reduce the cost of the injury
Comply with legal requirements
Recently, there seems to be an almost palpable and growing concern of violence occurring in our communities, schools and workplaces. At the same time there is a confusing dynamic. The issue of workplace violence seems to dominate our news feeds (and interest) in a very predictable manner; for a few days, or weeks after a high-profile incident occurs, then the energy fades.
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First aid is one of the most frequent topics of conversation I have with my clients. The confusion typically arises from two main issues:
The WCIRB (Workers’ Compensation Insurance Rating Bureau in California) rule changes, starting in 2019, which deducts $250 from ALL claims in the X-Mod calculation (more on this later).
The differences between a First Aid designation for Workers’ Compensation insurance purposes, and a first aid incident under the OSHA definitions (listed below).
Receiving a subpoena can be intimidating! It comes in the mail and asserts that you must respond and maybe even appear by a deadline or else…
Well, first things first. Nine times out of ten you do not need to go anywhere. You can generally fax, mail, email or even have the copy service company collect the documents requested in person.
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Cal-OSHA’s Heat Illness standard (Title 8, Chapter 4, §3395: www.dir.ca.gov/title8/3395.html) requires employers to have a Heat Illness Prevention Plan. Not having a policy, procedure and conducting the required training could result in employee illnesses, increased X-mods, higher insurance premiums and Cal-OSHA citations!
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ESM identifies errors by two carriers on incorrect Joint Coverage claims reported to the WCIRB and obtains 59-point reduction in X-Mod for the employer!
click to find out how..
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Reduce litigation. Reduce lost time. Save dollars. There are critical steps you should take at the beginning of the policy year to set yourself up for greater success if an injury occurs. Act NOW. Do your part, take charge to be more proficient and effective this year.
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It is unfortunate when an employee will not cooperate with your best intentions for job accommodation. An employee cannot be forced to accept your modified work offer, but if they refuse, they will not be paid Temporary Disability. Click for recommendations on this issue.
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An employee can retain an attorney who will file an Application of Adjudication of Claim with the Workers’ Compensation Appeals Board. If you receive a Notice of Representation or an Application for Adjudication you should follow these recommended steps.
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Lag Time, or the days from date of injury to reporting the claim to your carrier, is one metric used by your carrier to analyze your risk performance. Studies show that claims reported within 24 hours are 33% less expensive. Click to find out why prompt reporting is important.
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An injured worker sustained a back injury that resulted in a 20-day hospital stay. He obtained an attorney and filed an Application for Adjudication of Claim for this specific injury claim and a Cumulative Trauma claim. Find out how communication and teamwork resulted in a $374,409 reserve reduction.
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ESM was successful in reducing a client’s 2017 Experience Modification by 26 points and their 2018 Experience Modification by 8 points with a second 8-point reduction projected for a total reduction of 42 Mod points. Click here to find out how...
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As a claims consultant I answer employer questions daily regarding their employees, return to work and claim concerns. Here are my responses to the top 10 concerns that I hear most often.
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ESM saved a SIG’s members $21,000 by asking a simple question of the Office of Self Insured Plan’s (OSIP) chief. “WHY?” Click to read more...
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We have seen UR fees run anywhere from $98 to upwards of $9,500 per treatment.
- Routine treatment such as PT, diagnostics and consults are usually approved with an average UR fee up to $500 per review.
- The UR cost drivers are surgeries and opioids/narcotics - whether approved, modified or denied.
- We recently saw a TPA charge $9,500 in UR fees for a request for spine surgery because of the unbundling of the Utilization Review and fees.