According to a recent research study reported by the Insurance Journal, paid sick leave can actually be viewed by business owners as a robust strategy for managing work-related injuries and workers’ compensation costs. Paid sick leave reportedly has the potential to make workplaces safer, minimizing chances of work-related injuries or other costly mistakes.
Work-Related Injuries and Illness
Workers who have access to paid sick leave are 28% less likely to suffer nonfatal occupation injuries when compared to workers who don’t have the option for paid sick leave, according to a study by the National Institute for Occupational Safety and Health (NIOSH). The study was published in the American Journal of Public Health by Abay Asfaw, Regina Pana-Cryan, and Roger R. Rosa.
According to that study, when employers provide paid sick leave, workplace injuries are less likely. As a result, businesses that offer paid sick leave pay less in costly paid injured time off or paid injury leave. Factor in the potential for workers’ compensation claims and overhead costs, and paid sick leave becomes a reasonable strategy for minimizing business expenses while improving overall employee wellness and productivity.
How Paid Sick Leave Impacts Work-Related Injuries
Paid sick leave most likely keeps workers safer by minimizing the frequency of sick or injured workers who go back to work before they are ready to resume normal activities. When paid sick leave isn’t an option, workers tend to come back to work sooner, but at a fraction of their usual capacity. Impaired performance due to illness or injury increases the likelihood of a workplace injury that can keep the worker (or many workers) out of commission for much longer than the original reason for missing work.
According to the published article, “introducing or expanding paid sick leave programs might help businesses reduce the incidence of nonfatal occupational injuries, particularly in high risk sectors.” The high-risk fields cited in the study include agriculture, construction, manufacturing and healthcare.
Previous research, they write, shows that paid sick leave can reduce worker recovery times and complications that compound minor health problems. The researchers say they hope that their study, when combined with other pertinent research, will “encourage policy makers and employers to consider the overall well-being of workers when making policy or funding decisions.”
Minimizing Work-Related Injuries
Changes in policy on a business-by-business basis could raise productivity and help drive down workers’ compensation expenses, potentially creating a win-win situation for employers and employees alike.
Paradigm is always ready to assist with the successful management of complex work-related injuries. Fill out our contact form if you have a case you would like to refer to us, and be sure to join us on Facebook and Linkedin.
When the new system of Health Care Exchanges begins in 2014, healthcare systems may be substantially altered, but business owners and employees shouldn’t be anxious. Knowing what to expect and how the changes can affect you will help you take advantage of what the new Health Care Exchanges offer, particularly in light of the impact on workers’ compensation costs.
What Are Health Care Exchanges?
Health Care Exchanges, or Health Insurance Exchanges, are a central tenet of the Patient Protection and Affordable Care Act of 2010 (PPACA). The District of Columbia’s Health Reform Page compares these exchanges to travel sites like Travelocity or Orbitz. They will be specifically designed to help small businesses and individuals purchase health insurance coverage, and to encourage equitable competition in the marketplace. The exchanges will administer new health insurance subsidies, allow people to compare benefits and prices, and manage enrollment.
Workers’ Compensation and Healthcare Reform
The RAND Corporation and Willis Re recently published a report examining healthcare reform in Massachusetts as a proxy for national reform. The Massachusetts law contains provisions similar to the PPACA. Early results of this empirical study show that national healthcare reform may reduce costs to the workers’ compensation.
The American Academy of Orthopaedic Surgeons performed a similar review and concluded expanding preventive services and wellness initiatives under the PPACA could minimize comorbidities like smoking and obesity that compound the complexity and cost of workers’ compensation claims. As new reporting standards and coordination of benefits come into play with the reforms, decreases in administrative spending and overhead costs may further drive down costs.
Overall, the new system-wide reforms are likely to have some impact on the workers’ compensation sector while minimizing insurance costs across the board. For employees, this means better wellness care and streamlined processes in the event of illness or injury. For payors, this may mean lower total workers’ compensation costs due to less cost shifting and lower co-morbidities.
Health care exchanges and other aspects of the new law are receiving serious media and business-sector scrutiny at the moment. There are reasons to be optimistic. Beyond the hype, the PPACA has the potential to be a positive game-changer for injured workers and workers’ compensation coverage.
While the average medical cost for a workers’ compensation claim is approximately $6,000, the medical cost of an individual claim can be a few hundred dollars or millions of dollars. In 2010, an NCCI study found that claims with an obesity comorbidity diagnosis incurred significantly higher medical costs than comparable claims without such a comorbidity diagnosis. Relative to that study, this study expands the number of comorbidities examined and provides additional information on both the types of claimants receiving comorbidity diagnoses and the types of providers submitting comorbidity diagnoses.
KEY FINDINGS
The share of workers’ compensation claims with a comorbidity diagnosis nearly tripled from Accident Year 2000 to Accident Year 2009, growing from a share of 2.4% to 6.6%
Claims with a comorbidity diagnosis have about twice the medical costs of otherwise comparable claims
Comorbidity diagnoses for hypertension are the most prevalent of those investigated
The initial comorbidity diagnosis tends to occur early in the life of a claim
Hospital and physician visits account for a majority of visits resulting in a recorded comorbidity diagnosis
Only a small portion of visits result in the recording of a comorbidity diagnosis
STUDY DESIGN
Data
The data set used in this study is from a nationwide sample of transactions provided by carriers. The data set includes medical services provided between 1996 and 2010 on both lost-time and medical-only claims that occurred between 1994 and 2010. The data set is evaluated as of July 1, 2011.
Identification of Comorbidities
This study identifies comorbidities by matching the International Classification of Diseases, 9th Revision, or ICD9, diagnostic codes on individual claim transactions against the table of Comorbidity and ICD9 code mappings in Appendix 1. The D’Hoore, Sicotte, and Tilquin [2] adaptation of the Charlson Comorbidity Index [3] serves as the main basis for both (1) the comorbidities included in this study and (2) the table of Comorbidity and ICD9 code mappings.
Paradigm has been the leader in complex medical management for over 20 years, thanks to experts like Julie Fawson. As a Director of Clinical Services, Julie works hard to help improve the lives of catastrophically injured people. So let’s take a look at what she does to make a difference on a daily basis.
Julie coordinates the experts that make up the unique Paradigm model. She selects the right physicians, network managers and specialists to drive the best clinical outcomes for each case. She ensures each injured person’s needs, and the client’s expectations, are met in accordance with the highest standards.
And, thanks to her years of experience assisting injured people and working directly with our clients, she’s able to align goals and achieve superior results for all.
Directors of Clinical Services like Julie benefit our customers for many reasons. They lead the management process toward Paradigm’s guaranteed outcomes, pursue necessary, high-quality and effective courses of treatment, coordinate nationwide resources, and help everyone understand and plan for future medical needs.
Thanks to people like Julie, Paradigm is able to achieve return-to-work results that are 5 times better than the industry average, and help customers save 36% over the life of the claim.
As a service provider to the nation’s largest workers’ compensation insurance carriers, state funds and employers, Paradigm has a unique perspective on the industry. So what are some of the trends they’re seeing for 2012?
First, expect workers’ compensation premiums to increase this year. The slow economic and job recovery, industry wide combined ratios greater than 110% for many insurers, continued low investment returns on reserve funds, and rising medical costs are all factors.
When hiring does increase, expect to see higher injury rates due to inexperienced and deconditioned workers rejoining the workforce.
Narcotic use and abuse remains a national epidemic, but we’re hoping to see a tipping point soon on the topic, and a concerted effort by all to find a comprehensive solution to the problem.
Companies that focus on analytics, which are now more widely available, will be able to manage their claims and overall spending in a more effective way.
And finally, companies are strengthening their reserves in order to compensate for rising medical costs. This trend should continue, especially with medical costs showing no sign of reducing.
These are just a few of the trends that Paradigm foresees in the workers’ compensation marketplace. No matter what the conditions, Paradigm’s complex care management and chronic pain solutions can provide medical and financial security for your business. For more information, visit www.paradigmcorp.com.
Don’t leave the management of workers’ compensation claims to chance, or to whichever employee is available to handle the paperwork at the time. Create and implement an organized system for handling workers’ compensation claims, so employees know their role.
The duties of each individual involved in the claim should be defined and provided in writing, so they know exactly what to do when a claim is activated. Assigning roles and responsibilities helps to position your business well for managing workers’ compensation claims costs.
Management Roles and Responsibilities
Consider the following roles and responsibilities when preparing to address workers’ compensation claims:
Claims coordinator responsibilities: A claims coordinator should establish a transitional duty program so that when an injury occurs, impact on productivity is minimized. He or she should be responsible for notifying all employees of accident-related procedures and arranging medical care in case of an accident. Afterward, they should act as a liaison with medical providers, interview an injured employee to understand how the injury occurred, compile all paperwork, maintain contact with the injured worker during his or her time off, arrange for possible changes in duty upon return to work, and even send get-well cards. In other words, the claims coordinator follows each claim from beginning to end.
Post-accident responsibilities of the supervisor: Field supervisors should be charged with training each employee on what to do in case of an emergency. An injured employee’s direct supervisor should accompany the injured employee to the appropriate medical provider, offer that provider a work ability form, and obtain the completed document from the medical provider’s office. After the acute phase of care, a supervisor should monitor an employee’s return to work status and ensure that modified duty or transitional duty is undertaken in accordance with any limitation ordered by the medical provider.
Management roles and responsibilities: Every level of management should be involved in organizing and implementing an annual safety program, as well as implementing risk management practices on a daily basis. Management teams should meet on a bi-annual or annual basis to assess the current plan, examine the insurance carrier, determine what medical providers should be used, and track and report lost work days. These meetings can help prepare a company for future accidents and keep costs in check.
Remember, every supervisor should be responsible for ensuring that employees are involved in a culture of safety and comply with all safety regulations. Each employee has the responsibility to work safely, be involved in their own workers’ compensation claim, and comply with doctors’ orders upon return to work.
It may even benefit managers to review the actual monthly and ongoing costs of workers’ compensation, so they understand exactly what is at stake for the company. This information should be communicated to employees in terms of what additional sales or additional production is necessary to cover the costs of workers compensation’ claims. Such concrete information can help encourage a culture of safety and minimize injuries.
Paradigm is always ready to assist with your complex medical needs. For more information on our full service offerings, contact us via our website or call 888-621-6602. We also invite you to join our social communities on LinkedIn, Twitter, Facebook and YouTube.
According to a claimsjournal.com workers’ compensation article, the 2012 P&C Workers’ Compensation and Safety Survey found that 59 percent of employers are very or somewhat concerned about managing the cost of workers’ compensation in 2012. Employers say cost containment is their biggest workers’ compensation insurance concern, along with increasing exposures, renewals and rising fraud behaviors.
Mitigating Workers’ Compensation Costs
The survey indicated that the most effective control mechanism for managing workers’ compensation costs was encouraging a culture of safety. Sixty-five percent of respondents stated that having a culture of safety was their best defense against high workers’ compensation claims costs. The survey also found that 59 percent of participants thought light-duty or return-to-work programs were effective in controlling workers’ compensation costs. Interestingly, only 45 percent of participating firms actually had a written return-to-work policy.
Other cost-control measures that were widespread and reported to be somewhat effective were:
Onsite accident evaluations
Loss prevention evaluations
Zero-accident goals
Retaining a dedicated claims manager
Safety committee organized efforts
Maintaining a relationship with a preferred occupational medicine facility
Survey Participants
Participants in the P&C Workers’ Compensation and Safety Survey represent 20 business sectors, with the highest percentages from:
Manufacturers (17%)
Health Care/Social Assistance Providers (15%)
Construction (13%)
Occupations of survey respondents included HR personnel, finance staff, CEOs/presidents, safety managers, risk managers, and operations directors. Of those surveyed, 57 percent reported that workers’ compensation premiums were under $50,000 per year.
Other Major Workers’ Compensation Concerns
Survey participants reported the five largest concerns following cost containment were:
Increasing exposures (35%)
Renewals (35%)
Rising fraud behaviors (31%)
Market availability (26%)
Carrier stability (20%)
Once Accidents Happen
Nurturing a culture of safety and other pre-incident cost control measures are very important. However, workplace injuries will still occur. When they do, Paradigm recommends ensuring high quality care possible for the injured worker. This approach may seem to conflict with cost control strategies, but receiving the right care at the right time will reduce lifetime costs of workers’ compensation claims. Not only can this approach reduce claims cost in the long run, but it also has the benefit of aiding the best possible recovery for the injured worker, including a return to work.
Paradigm was specifically designed and built to help self-insured employers and carriers manage their most catastrophic, complex and costly claims. By wrapping an expert team around the injured person, we ensure the best care by the best providers for better medical outcomes, and ultimately substantial savings for our clients. For more information, contact us via our website or call: 888-621-6602.
Workers’ Compensation Employee Injury Rates Can Be Controlled
According to a claimsjournal.com workers’ compensation article, the 2012 P&C Workers’ Compensation and Safety Survey found that 59 percent of employers are concerned about managing workers’ compensation costs in 2012. Managing workers’ compensation employee injury rates is, of course, one of the best ways to control these costs. Interestingly, recent research has identified a link between the rate of employee injury and an ineffective work/life balance.
Employee Injury and Work/Life Balance
Once upon a time, “we used to think work was one thing and family was another,” Dave DeJoy, a professor at the University of Georgia, told the Society for Human Resource Management. Now, there’s a “realization that work/life balance affects performance and productivity.”
DeJoy recently published a survey with Todd Smith, a recent graduate of the University of Georgia’s College of Public Health. The study, published in the February 2012 edition of the peer-reviewed Journal of Safety Research, is titled “Occupational Injury in America.”
Using the 2002 General Social Survey, which is a personal interview survey of households throughout the United States, the researchers found that injury risk increases by 37 percent for employees who are dealing with difficult family issues. According to the study, companies that run smoothly and effectively—and that only minimally constrain worker performance—experience 30 percent fewer injuries.
Workers’ Compensation Employee Injury Rates and Work/Life Balance
DeJoy’s study found that workers who reported the greatest amount of interference stemming from family issues tended to have the highest injury rate. Conversely, workers who reported the least interference had the lowest injury rates. In addition, employees who said they work in unsafe environments had substantially more injuries than those who reported safer work environments.
Together, these two measures of on-the-job climate are telling. Workers whose jobs interfered least with their family life and who worked in what they perceived as a safe environment with a positive culture of safety were least likely to be injured. When employees were unable to successfully balance work and home life, they were more likely to be injured—and most likely to be injured when they worked in what they perceived as an unsafe environment.
How You Can Improve Workers’ Compensation Employee Injury Rates
Building a safe on-the-job environment is still one of the best things any employer can do to protect the safety of employees. Once a safe work environment is established, continuously encourage employees to foster a culture of safety. Even workers who have problems at home had lower workers’ compensation injury rates than their counterparts who worked in perceived unsafe environments.
In addition, survey your employees to find out whether they feel their jobs interfere with their responsibilities at home, and work as a team to find ways to help employees improve their work/life balance. Employees who avoid major problems at home are statistically safer on the job, further lowering an employer’s workers’ compensation employee injury rates.
Paradigm is always ready to assist with your complex medical needs. For more information on our full service offerings, contact us via our website or call 888-621-6602. We also invite you to join our social communities on LinkedIn, Twitter, Facebook, and YouTube.
Best Practices in Workers’ Compensation Cost Control
The use of best practices can result in fewer injuries for employees and more effective workers’ compensation cost control for employers. A few basic tools combined into a solid, three-pronged approach can help employers maximize workers’ compensation cost control.
When you focus on prevention through safety, quickly responding to injuries, and effective claims management, you’re emphasizing three areas that can help mitigate the costs of workers’ compensation claims. Here’s how:
Prevent Accidents Through Safety: The best way to eliminate workers’ compensation costs is to prevent injuries from occurring. The time and resources involved in implementing a comprehensive safety program amounts to a mere fraction of the time and resources required to manage a serious injury. Safety minimizes exposure to indirect costs, too, including a drop in productivity, time spent training replacement employees, and low employee morale.
Respond to Injuries Quickly: An organized accident response protocol can help your team determine where the injured worker should be treated, get the individual to the appropriate medical provider quickly and safely, and manage paperwork to minimize errors. A quick response time can mitigate the severity of an injury and decrease recovery time. Proper handling of the Work Ability Form can help the company respond to the employee’s needs upon returning to work.
Manage the Claim Effectively: Hiring a dedicated workers’ compensation coordinator can help your business with effective workers’ compensation cost control. Upon the report of an accident, your workers’ compensation coordinator should immediately report the claim to management, ensure all appropriate accounts of the accident and other forms are filed and considered, and provide all relevant documentation to the claims office. Your coordinator should also contact the adjuster handling the claim to plan a course of action. A concerted effort to fully manage the claim can minimize the total cost to the employer and maximize the likelihood of a positive experience for the injured worker.
No matter how strong your safety plan, accidents can and do happen every day. Start by implementing a strong safety plan, but don’t stop there. Plan for responding to and managing workers’ compensation claims and you’ll maximize workers’ compensation cost control.
Paradigm is always ready to assist with your complex medical needs. For more information on our full service offerings, contact us via our website or call 888-621-6602. We also invite you to join our social communities on LinkedIn, Twitter, Facebook, and YouTube.
Obesity workers’ compensation concerns are growing in HR and C-Suite sectors, even though U.S. obesity rates have begun to level off. In 1994, 14% to 16% of American adults were obese, according to the Centers for Disease Control and Prevention (CDC). By 2010, the percentage of obese adults was between 20% and 30% by state. Obesity has been a growing problem in the United States for decades with major implications for worker health and productivity.
An Ongoing Epidemic
The National Health and Nutrition Examination Survey has shown obesity rates holding steady in the U.S. at around 35% over the last several years. Growth in obesity may have leveled off as people became more aware of the health concerns associated with obesity.
Nonetheless, at that new plateau, 1/3 of adults and nearly 17% of children are obese. Obesity has become a long-term health concern, with a new generation of children at risk for becoming obese adults and thus obese employees. Obesity workers’ compensation concerns have the potential to be a major drain on the health of individual employees and the health of your business for decades.
Obesity and Workers’ Compensation Claims
Several employers quoted in a Workforce.com article indicated that obesity is an issue that can add substantial costs to and lengthen the management of workers’ compensation claims. The publication’s “Obesity Problems Weigh on Workers’ Comp” article summarized some research on the problem:
A 2007 Duke University survey found obese workers were twice as likely to file workers’ compensation claims as their non-obese colleagues; medical costs were seven times higher for obese workers; and they missed 13 times the number of work days due to injury compared to non-obese individuals.
The National Council on Compensation Insurance (NCCI) released research in 2010 indicating medical treatments, costs and claim duration were typically greater for obese workers than their non-obese counterparts with the same types of injuries. NCCI also found that injuries were more likely to become permanent disabilities in obese workers.
Obesity and injury can create a vicious cycle. An obese individual who finds herself off the job can “decondition” over time, gaining more weight during time away from work and creating more long-term medical problems. Obese individuals are also more likely to suffer from co-morbid health problems like hypertension or diabetes, making it more difficult to attain long-term health.
The obesity problem will be a long-lived and costly concern in workers’ compensation. Part of the solution, according to the Workers Comp Insider blog, is to encourage employee engagement with his/her own health and wellness plans. Safety compliance, general awareness and individual healthy behaviors can improve a person’s well-being and reduce healthcare costs for employers.
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