November 2016

Between the Affordable Care Act, new healthcare treatments, and the amount of older workers, workers compensation has a number of issues facing it. Find out more about the trends today, so you can better prepare for the future.

Medical Care

Technology continues to sweep across states, cities and towns, with medical advancements becoming more and more effective. Communication and flexibility has also improved considerably. Injuries and illness are more likely than ever to be treated over a Skype video rather than an in-person consultation. It gives people who may have been averse to visiting a doctor more control over how they obtain their information and treatment recommendations. It generally means better long-term care as well. The more health tools available, the better it is for workers. These advances are obviously great, but in general, it raises the costs for everyone. A $10 million used to be incredibly rare, but this is now becoming extremely common. Even accounting for inflation, costs continue to rise.

Risks Today 

Different doctors have very different opinions about what constitutes the right treatment, and many have underlying agendas that have nothing to do with health. Workers compensation needs to become more conscious of the fact that dollars are being lost in a system that is largely unable to regulate the doctors within. This is why the industry is seeing states looking at their guidelines to see how they can improve consistency, and potentially implementing fee schedules that involve the insurance carriers, so there is more focus and visibility in terms of who is paying for what. There needs to be more thought and oversight given to the care of the patients who have dramatic conditions. The decision to use addictive prescriptions, surgeries, tests and more all need to be carefully weighed for the benefit of employee, employer, provider and insurance provider.

Forecasts 

States will continue to reduce the costs paid for workers compensation claims by implementing smarter guidelines for care. There may be more investigations into companies after injuries occur, ensuring that the conditions have improved as much as possible to further eliminate costs. However, some experts think that the ramping up of costs may be a systemic issue, meaning that these efforts may do little to truly bring the costs down. Again, this is mainly due to the fact that technology has simply made it more expensive to treat patients with the best possible care. The experts also state that you will likely see more claims involving mental health down the line. This is a new issue that employers are starting to give more consideration to, especially because mental health is linked to common serious conditions like heart disease.

Pain is subjective, and this fact can make management extremely difficult. Even though medical treatments continue to advance, the access to new and better methods remains widely unavailable for many. When one worker can rate the pain of a paper cut at a 10 and the other at a 1, you know that doctors have their work cut out for them in terms of treating people with major injuries. We’ll look at how it all functions in the real world.

Prescription Management, or Lack Thereof 

When a doctor gives an employee a treatment plan, they do so for several reasons. They obviously want the best possible recovery time for the patient but they also do it cover themselves. They can’t make a patient complete the plan, and often don’t understand what it will really mean for a patient to attempt to complete it. At a recent Workers Compensation conference, experts let the group know that up to 30% of prescription are never actually filled, and up to half aren’t taken as directed. If the worker has other pre-existing conditions, they may be aggravated by a workplace injury, making one small incident have lasting repercussions.

Too Much, Too Fast 

Depending on the type of care a worker receives, they may end up being prescribed multiple medications that only end up confusing the worker and potentially creating adverse reactions to a combination of medications. Also certain medications can cause muscle pain that has nothing to do with the original injury. Workers who see multiple doctors (as can be common in workers compensation) have the highest risk of this occurring. Injured parties may forget or be unaware that they have common medical problems, such as high blood pressure. The wrong medications after an injury may cause a life-threatening condition.

What to Remember 

Even if you’re not a doctor, it’s important to encourage the employee to do the right thing. Claiming ignorance may only go so far if the worker develops a more serious condition after a minor industry. Just one fallen box can result in a lifetime of chronic back pain for the worker, but proper initial care may be the answer to this. Doctors need to pay closer attention to how pain is improving, and what the effect of that pain has on the employee in terms of physical and emotional symptoms. The best thing to do in the case of an injury is to remember that your fate is tied with the fate of the worker. The better care the worker gets, the more likely it is you will have the best outcome. By understanding how pain is treated and the potential problems of the current strategies, you have the opportunity to lessen the severity of the final claim.

Having a realistic plan and expectations in terms of diversity has always been important for employers, but today it seems to be an even more pressing issue. Treating people fairly is a concept that everyone sees differently, and therefore can make for a complex topic to even broach. But being honest will be the only way to really address the underlying problems with how you handle employee safety.

The March of Time 

The population is aging rapidly. With more older workers who are unable to retire due to their economic circumstances, it’s important to give consideration to their disabilities and recovery times after an injury. There needs to be quick reactions to any injuries that may occur on the job, both to prevent the injury from getting worse and to speed up the resolution of an injury claim. Most older workers are going to be interested in getting back to the job no matter what, so it’s important to urge employees to listen to their body as well as provide a program that minimizes the strain they will feel when they return to work.

Understanding the Age Gap 

When two different generations are in a workplace, they’re bound to clash in terms of ideals and work strategies. This type of conflict can either force the two groups to understand the other or it can set the company up for a disaster. When you work with the younger generation, they may feel little loyalty to the organization, while the older generation may have more specific medical considerations when it comes to their duties. To strengthen communication and therefore minimize the chances of the injury, ensure that you’re treating both groups with the respect that they deserve. This doesn’t mean giving in to every demand, but it does mean working with them as much as possible. If you can allow them to work from home following an injury, then it should certainly be considered.

The Difference in Cultures 

Every culture is different, so ensure that you know the major issues facing each group for better planning. Minorities tend to have less access to services, meaning that their care may not be as detailed or thorough following an injury. Some cultures have a difficult time admitting they need help, so you may need to mandate a doctor’s visit into their injury so that it’s not left untreated. This will save you money in the long run, and keep the employee healthier. Also, if the employee speaks English as a second language, then communication becomes a real issue. Ensure that they have access to both providers, literature and information in their own language for best results.

Every industry develops its own terminology and jargon which helps them communicate quickly and easily. Often learning it all is just a matter of putting the time into the experience, but sometimes by learning the more complex terms, you stand a better chance at feeling empowered in an unexpected situation. While set-asides are used for the injured party, it’s helpful to be informed of the process as an employer.

A set-aside refers to the amount of money that is put into a fund to help with medical services after a settlement has been reached. The settlement goes to the injured, and it’s a way to ensure that they use that money correctly. Medicare will always be the second payer in situations where insurance money runs out after a settlement, and thus created a system to determine how the money should be spent. So if you have an employee who injures themselves on the job and your insurance pays out a certain amount, the set-asides would be the funds that need to be used before Medicare kicks in to cover the rest. The actual amount of these set-asides are decided upon by Medicare after reviewing the documentation available from the claim. The specifics may differ depending on whether or not if you have a no-fault or liability settlement.

Whether or not a Workers Compensation Medicare Set-Aside Allocation is determined by the situation, and an attorney will help counsel the employee through the process. The allocation is an estimate of the total cost of treatment (including prescriptions, surgery, etc.) There will need to be extremely detailed reports for every penny on the part of the injured, and there are certain restrictions on the use of it. Much of the fraud that stems from workers compensation is often seen on the Medicare side, as there are fewer limits than an insurance company.

As you can imagine, this whole issue gets complicated fairly quickly. When an injured worker needs continued care for years after an accident, the question of who pays often becomes a question for the courts. They have to look at the way the injured party were hurt, and determine exactly how much of their injury was on the part of the employee. While you as an employer is neither Medicare nor an insurance carrier, your rates are determined by these types of questions. Therefore it is in your best interest to provide as much safety training, oversight and documentation possible about your involvement with your workers. The more you do this, the less likely it is that you will become caught up in a large settlement that ultimately cripples your business due to rising insurance rates.