Workers Compensation – Employer

During the fact-finding stage of the investigation, we will be looking to you to provide valuable insight regarding the circumstances surrounding the incident to assist us with our determination on the best course of action to proceed. In some cases, we may not have enough information from one or more sources, whether it is medically or otherwise, to make a final determination. Accordingly, we may categorize the claim as “Denied Pending Investigation” in order to secure the necessary information to arrive at the most accurate conclusions. Once a final determination is made to accept or deny a claim, the parties are notified.

… will include an exploration and determination regarding the feasibility, to pursue civil litigation or other actions of recovery against such third-party. Although a recovery from a third party will not have any impact on the workers’ compensation benefits already owed to the injured employee, it will likely impact your insurance policy favorably. As such, during our investigation and determination process, we will require your assistance in order to achieve the maximum possible recovery.

Notwithstanding, the steps you take BEFORE and AFTER an injury can be decisive factors in determining the impact of workers’ compensation costs on your business operations and bottom-line profitability.

BEFORE an accident occurs, you have a multitude of powerful, effective and proven tools, techniques and programs which you can implement to significantly limit or even avoid experiencing workplace injuries.

A few of these are:

• Safety programs
• In-service training for managers and employees
• Safety Committees
• Detailed ergonomic job analysis
• RTW (Return To Work) Program
• Employee incentive programs
• Management accountability programs

AFTER an accident occurs, how and how quickly you handle the situation can leave a lasting impression on that particular injury as well as curbing the potential for future injuries.

A few of the more significant actions include:

• Report the injury to Crum & Forster immediately.
• Investigate the “root cause” of an injury; how and why did this injury occur. Then, document your findings.
• Determine whether the accident could have been avoided and implement steps to prevent similar occurrences.
• Assess accountability; who may have been directly and indirectly responsible for ensuring the safety of the work environment. Accordingly, implementing appropriate corrective actions are often significant motivators for avoiding similar accidents.
• Exercise the role of the Safety Committee and the RTW Program.

In order to accomplish this, we continuously monitor the employee’s medical progress. At times, we may also include the services of a nurse case manager, who is a Registered Nurse (R.N.), to assist us with achieving this goal. We utilize nurses both in-house, as well as in the field depending on the specific needs of each situation.

However, not all medical providers consistently adhere to this billing regimen due to occasional system & data entry errors, accidental miscoding of medical procedures, duplicate & unrelated billing, and a number of other reasons. As such, we have partnered with medical bill review companies to ensure statutory compliance. Throughout the duration of a claim, medical bills are channeled through this process to verify that the medical costs paid on your claims are nothing in excess of what is reasonable and appropriate.

… which details the physical requirements of the employee’s regular work duties, as well as any available transitional work or modified/light duties. Upon receiving this completed form from you, the claims adjuster and/or nurse case manager will coordinate the RTW in tandem with you and the physician to return the employee to work at the most opportune moment when medically indicated. Once the employee has returned to work, medical treatments may continue until his/her condition has fully stabilized.

EMPLOYER

• Employees will tend to have a quicker return to full duty work.
• Having a productive employee assisting in another needed area of your operation.
• Significant savings in workers’ compensation costs.

EMPLOYEE

• Ability to interact socially and professionally with co-workers.
• Ability to stay active and be productive.
• Ability to return to the work site at lesser wages or hours but still earn full wages (part paid by employer, part paid by insurance carrier).
• Ability to further focus on abilities vs. disabilities.

Alternate work options come in a variety of forms. Each has its own unique effectiveness, depending on the type of physical capabilities the employee may have at a given time.

Light Duty

Welcoming the injured employee back to his/her normal position, but with restrictions assigned by a physician.

Example: A physician declares that the injured worker has a 10 pound lifting restriction. It is important to emphasize to everyone including the injured worker, their supervisor and others that compliance with these restrictions is mandatory.

Modified Work

Having an existing position or creating a new position specifically for this employee, on a temporary or permanent basis, that is physically less demanding than their normal position and meets the physical restrictions set by a physician.

Example: A delivery driver accustomed to carrying and moving boxes up to 80 pounds is temporarily assisting the office with filling invoices, due to his 5 pound lifting restriction.

Transitional Duty

Bringing the employee back to their full working capacity over a set period of time. This process may begin with 1 or 2 hours of work a day and/or 1 or 2 days a week and gradually increases as time passes.

It is not uncommon for Transitional Duty to be combined with Light or Modified Duty.

Example: A new temporary position is created specifically for this employee to sit by the door and greet customers 1 hour/day at minimum wage.

Although some companies may not be able to have or create light, modified or transitional work due to the nature of their business, size of their existing workforce, economic conditions, etc., every effort should be made to explore the feasibility for creating such work for the extensive social, emotional, and financial gains from which both you and the employee will reap.

It is primarily determined by a medical exam from an objective independent physician in accordance with set impairment rating guidelines established by the American Medical Association. Although many cases do not result in any PPD, there are some that do. For these, an employee is entitled to additional benefits. The benefit amount corresponding to the impairment rating is clearly documented in statute and regulated by the Department of Labor.

Disfigurement includes scars, deformity, and discoloration. Laceration scars and surgical scars are reviewed six months from the date of the occurrence. Burn scars are evaluated after one year.

This report will outline all the payments made to the employee, medical providers and other parties involved with the case. A similar report is sent to you at the end of each year for all open claims. You may file these reports in your records, as appropriate.

Otherwise, do not hesitate to contact your claims adjuster at 537-5221 or see the “Employer Contact Information” section for additional options