April 2013

By decreasing work time lost from to job-related injuries and illnesses, Return-to-Work (RTW) programs can reduce your insurance costs (Workers Compensation, Disability, and Medical insurance), strengthen workplace morale, boost productivity – and help protect you against ADAAA litigation.

Here are ten common mistakes by businesses when using RTW:

1. Failure to manage the higher number of employees covered by the ADAAA. An expanded definition of disability has increased the number of employees under the ADA to the point that some attorneys advise against fighting disability claims.
2. Insisting on employee release to “full duty” before returning to work. This raises Workers Comp costs and the possibility of the employee not returning to work when medically possible.
3. Ignoring co-morbidities. Health issues that complicate or delay an employee’s recovery (such as diabetes, obesity, and hypertension) can increase Comp claims.
4. Failure to commit the necessary budget or resources. The costs of absences and non-compliance with government rules is usually far higher than that of implementing an RTW.
5. Reluctance to set transitional assignments because employees “might get reinjured.” It’s even riskier to have them stay at home and develop a “disability attitude” that extends the absence and boosts costs.
6. Failure to distinguish “light duty” from “transitional work.” The ADAAA permits employers to reserve less physically demanding or “light-duty” jobs for those with work-related disabilities – and these jobs should be distinct from transitional tasks.
7. Relying on physicians to guide the RTW process. Although physicians are medical experts, they’re not familiar with workplace policies, job demands, and the availability of transitional work.
8. Failure to understand overlapping and conflicting laws. The clashing requirements of insurance companies and state and local governments can be a nightmare.
9. Inability to focus on the goal. An Integrated Benefits Institute study ranked a focus on the employee’s job as the major success factor in successful RTW programs.
10. Believing that Workers Comp settlements resolve other liabilities. One size does not fit all.

Basic health interventions can help your business lower short-term disability rates, while reducing your employees’ time away from work. That’s the bottom line of a nationwide study of 118,000 employees by CIGNA, a major health services company.

CIGNA found that these measures, combined with predictive analytics, cut disability rates by 15% among employees at high risk of suffering disability within in the next 12 months. (The study defined “high risk” as a 10% or greater probability of becoming disabled during this period).

“By identifying workers at high risk of future short-term disability and providing individualized intervention that includes coaching, incentives, and other outreach, our study shows that the onset of disability absence can be reduced measurably, benefiting employers and employees alike,” says Dr. Robert N. Anfield, chief medical officer for CIGNA’s Disability business. Future studies will deal with the impact of intervention on the length of short-term disability, return-to-work rates, and total medical costs.

The company’s Absence Prediction and Prevention program establishes an intervention, led by a nurse/health advocate, that provides:

• Early identification of workers at high risk for future short-term disability.
• Proactive outreach to these employees.
• Clinical Assessment.
• A range of disability absence prevention strategies.

By proactively identifying employees who might be having health problems before their condition worsens and they need to leave work, you can help workers stay healthy and potentially prevent or lessen the impact of injuries or illness – which translates into lower absenteeism, higher productivity, and a healthier bottom line.

It makes sense to develop an absence prevention program that emphasizes preventive health safety training. As always, we stand ready to offer our advice.

Some companies employ workers who work alone or in remote areas where injuries and illnesses can occur, resulting in delays in emergency response or medical assistance. They include people who work outside normal business hours, such as janitors, security guards, special production, plant maintenance or repair staff, delivery truck drivers, and others. Protecting the safety of these lone or remote workers isn’t always easy – but it’s your responsibility.

In some cases, you must monitor the exposure of these workers to identify potential hazards, assess the risks of injury or illness, and take steps to eliminate or control them. Bear in mind that some high-risk activities have safety regulations which require at least one other person to do the job, such as confined space work (defined by OSHA regulations) or electrical work at or near exposed live conductors.

If you have any employees out in the field or working alone, consider what safety measures to take to protect their well-being and security. A well-thought-out safety program for these employees is an essential first step. Hazard control measures might include:

• Safety Awareness information.
• Training.
• Supervision.
• Protective Equipment.
• Communication and Monitoring devices.

Take steps to make sure that these safety control measures remain in effect – and review your plan at regular intervals by doing a risk assessment in areas where employees work alone.

As your professional insurance agents, it’s our responsibility to help you keep all of your workers safe at all times. Give us a call at any time to discuss how we can help.

Third-Party Administrator (TPA) adjusters form the front line of defense against unnecessary claims expenses, including such traditional cost drivers as fraud or opioid pain medication addiction. They’re the ones who determine how soon employees will mend and return to the job, the length of claims, and whether closing a claim will require additional resources, such as attorney involvement. It makes sense that the more closely you monitor the adjusters of your company’s TPA, the lower your Workers Comp claims costs – and premiums.

However, adjusters today are running on overload more than ever. In addition to managing larger caseloads, they face growing real-time information demands, increasing communication speed, and expanding regulations – which distract them from such cost-control practices as staying in contact with injured workers. Says one claims adjustment expert, “The fastest way of getting an injured employee to hire an attorney is making them feel like you don’t really care about their injury. So you end up with a lot more claims than necessary going to attorneys, which leads to higher claim costs.”

It makes sense to work closely with your TPA adjuster by following these guidelines:

1. Interview adjusters before they’re assigned to your company.
2. Review the adjuster’s claims notes on a regular basis.
3. Audit the TPA’s services periodically to make sure that the adjuster is meeting your expectations.
4. Develop close relationships with claims examiners and their supervisors.

We’d be happy to work with you and your TPA adjuster on keeping tabs on your Workers Comp claims costs. Please feel free to get in touch with us.