This Week in Comp, June 23-27

 

By David Wylie, Senior Technical Writer

By David Wylie, Senior Technical Writer

This Week in Comp provides an overview of workers’ compensation news from across the country.

TRIA reauthorization

Divided House committee advances controversial 5-year TRIA extension
A divided House Financial Services Committee advanced to the House floor legislation that sets a path to phase out, after five years, the federal backup for terrorism risk insurance for attacks except for nuclear, biological, radiological, and/or chemical (NBCR) events…MORE

Safety

Safety is paramount for Texas Mutual CEO Gergasko
When the Insurance Journal asked Richard Gergasko what is most interesting to him about workers’ comp, his response was short and definitive: “For me, it comes down to workplace safety above anything else”…MORE

Workplace violence prevention program for teens gets OSHA grant
OSHA announced it has provided a safety training grant for Teens Lead @ Work, a national network of peer education programs founded by four state occupational safety coalitions and the University of California, Berkeley. The program trains teens to educate their peers and co-workers on how to recognize and prevent workplace violence…MORE

Women and PPE: Finding the right fit
PPE cannot do its job if it doesn’t fit properly. Unfortunately, PPE designed for men may not fit women properly due to differences in body size, height and composition…MORE

Safety words to know – 2014 edition
A somewhat tongue-in-cheek review of safety buzz terms you should know, and others that have outlived their relevance…MORE

Claim management

Introducing your all-star disability management team
World Cup fever has Texas Mutual’s Bob Cogburn thinking about all-star lineups in workers’ comp. In this post, Bob explains how a solid disability management team can help employers improve productivity and reduce claims costs…MORE

 

Opioid epidemic

Better prescribing through technology
A growing number of physicians are turning to pharmacogenetics to evaluate how workers’ comp claimants will respond to prescription drugs based on a patient’s genetic makeup. Advocates say pharmacogenetics could shorten injury and disability durations among workers’ comp claimants by eliminating common trial-and-error doctor attempts to find which prescriptions will benefit patients most…MORE

Prescribed drugs increasing in fatal crashes involving drugged drivers
A study released in Public Health Reports shows that more drivers are now testing positive for prescription drugs, cannabis, and multiple drugs, and they are more likely to be older than 50…MORE

Texas-like drug formulary has potential to reduce costs in other states
The study suggests that if physicians in the 23 other study states changed their prescribing patterns like physicians in Texas, they could reduce their total prescription costs by an estimated 14–29 percent…MORE

Legislative

Report card on OK
The Oklahoma non-subscription option is alive and moving forward. The state’s Department of Insurance recently approved four employers to provide benefits for injured workers outside the traditional workers’ compensation system…MORE

Fraud

15 medical workers indicted in $25 million scheme
Southern California doctors were bribed to prescribe a pain-relief concoction as part of a $25 million workers’ compensation scam that inadvertently caused a baby’s death, according to indictments…MORE

About the author
David Wylie is the senior technical writer at Texas Mutual Insurance Company. He works closely with Texas Mutual’s safety professionals to teach employers and their employees how to prevent workplace accidents and their associated costs. David holds the OSHA 10-hour general safety certification and a degree in journalism from Southwest Texas State University.

Links to and from this blog do not reflect any affiliation between Texas Mutual Insurance Company and third parties, and are not an endorsement by Texas Mutual Insurance Company of the linked sites (or their owners or operators) or of any content located there. Texas Mutual Insurance Company does not vouch for the availability or accuracy of any information contained on linked sites. Read more of this post

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Introducing Your All-Star Disability Management Team

By Bob Cogburn, Vocational Rehabilitation Specialist

By Bob Cogburn,
Vocational Rehabilitation Specialist

I’m not much for soccer, but I’ve been loosely following the World Cup. I heard something about a popular American player who was left off the team, and it got me thinking: Lineups are as important in workers’ comp as they are in futbol. (Bear with me; the World Cup only comes around every four years.) With that in mind, here are the key players on any solid disability management team.

Safety professional
If you have made the commitment to hire a full-time safety pro, congratulations. If not, your insurance carrier can provide one. Their primary responsibility is preventing workplace accidents. But they may also be able to help you analyze job tasks and identify modified duty that injured employees can do while they recover.

Benefits specialist
Some employers hire benefits specialists to streamline the claims process. Their responsibilities can include explaining workers’ comp to injured workers, making sure they get the benefits they are entitled to and, most importantly, ensuring they have everything they need to get back to work as soon as medically reasonable.

Nurse case manager
Your insurance carrier likely employs nurse case managers who can facilitate cooperation with health care providers. After all, doctors frequently say things to other medical pros they won’t say to you or me.

Adjuster
When in doubt, call your adjuster. They know the in’s and out’s of your claims, and they can be a valuable resource. Work with them to achieve the best outcome on each claim.

There you go! Those are the key players on any solid disability management team. They’ll never be internationally known like their World Cup counterparts. They will, however, help you resolve your claims effectively. Along the way, they will help you improve your productivity and reduce your workers’ comp costs.

About the author

Bob Cogburn has nearly 25 years’ experience in vocational case management. Since 1997, he has been helping injured workers covered by a Texas Mutual policy rehabilitate and return to productive employment. Prior to joining Texas Mutual, Bob served as a vocational rehabilitation counselor for the Department of Assistive Rehabilitation Services. He also spent time as a job placement counselor for Goodwill Industries and El Centro College. At El Centro, he managed a job club specializing in placing students with disabilities back into the workplace. Bob holds a bachelor’s in rehabilitation science from the University of Texas Health Science Center and a master’s in counseling from Amberton University.

This Week in Comp, June 16-20

By David Wylie, Senior Technical Writer

By David Wylie, Senior Technical Writer

This Week in Comp provides an overview of workers’ compensation news from across the country.

TRIA reauthorization

Is Hensarling betting on more conservative 2015 Congress?
Rep. Jeb Hensarling, R-Texas, today proposed a “clean” seven-month extension of the current program, until Aug. 1, 2015, in case Congress is unable to come to terms on longer-term reauthorization legislation…MORE

AIA calls for swift action on House TRIA reauthorization bill
Leigh Ann Pusey, president and CEO of the American Insurance Association (AIA), stressed that AIA is concerned with certain provisions of the bill that could lead to decreased market capacity…MORE

Claims

History shows spike in comp claims during the summer
Increased construction activity, soaring temperatures and an influx of young workers are among the reasons workers’ comp claims increase in the summer…MORE

Firing fear among new predictors of workers’ comp outcomes
Workers who are concerned about being fired after their injuries experience poorer return-to-work outcomes than workers without those concerns, according to a study by the Workers Compensation Research Institute…MORE

Safety

Hydraulic fracturing: Growing industry, increasing fatalities
Hydraulic fracturing is powering economic engines in Texas, North Dakota and other oil-rich states. It is also contributing to an increase in on-the-job accidents. In fact, fatality rates in the booming oil and gas industry are seven times higher than other industries…MORE

Chemical safety report “is a milestone, not an endpoint”
Improvements were made in U.S. chemical safety and security following the devastating 2013 West, Texas fertilizer plant explosion, but a report issued earlier this month makes it clear how much more remains to be done…MORE

4 ways the workplace has become more dangerous
This article offers strategies for keeping violence out of your workplace…MORE

Opioid epidemic

TN announces strategic plan to tackle prescription drug abuse epidemic
Of the 4,850,000 adults in Tennessee, it is estimated that nearly 5 percent (about 221,000) have used pain relievers, also known as prescription opioids, in the past year for non-medical purposes. Of those, it is estimated that 69,100 are addicted to prescription opioids and require treatment for prescription opioid abuse…MORE

Fraud

Five charged in multimillion dollar workers’ comp and payroll fraud case
The Riverside County District Attorney’s Office has charged five owners, operators, and employees of a Corona-based paving company in a case involving wage theft, premium fraud, workers’ compensation fraud, and payroll fraud…MORE

About the author
David Wylie is the senior technical writer at Texas Mutual Insurance Company. He works closely with Texas Mutual’s safety professionals to teach employers and their employees how to prevent workplace accidents and their associated costs. David holds the OSHA 10-hour general safety certification and a degree in journalism from Southwest Texas State University.

Links to and from this blog do not reflect any affiliation between Texas Mutual Insurance Company and third parties, and are not an endorsement by Texas Mutual Insurance Company of the linked sites (or their owners or operators) or of any content located there. Texas Mutual Insurance Company does not vouch for the availability or accuracy of any information contained on linked sites. Read more of this post

On the Road with Texas Mutual Recruiting

By Stephanie Schumacher, Recruiting Consultant

By Stephanie Schumacher, Recruiting Consultant

We spent the last two HR blogs detailing a day in the life of an underwriter. The overviews were timely as we were actively engaging with underwriter candidates from our college recruiting efforts to fill 6 positions. The outcome? We hired seven underwriter trainees that will attend a 13-week training program at the corporate office. This effort will set the pace for future training class opportunities in other divisions.

Thinking ahead to how those future programs will develop takes me to the claims department. An insurance company thrives on its integrity, and how claims are handled is a key component of that message.

I had the chance to spend the morning with Sr. Claims Adjuster Moriah Wilson when I was hired. I wanted to find out more about her role here and the impact it has on Texas’ workers. Moriah explained, “Texas Mutual strives to look at the big picture. It’s not just about the claim. Our safety services department provides education on preventing accidents and reducing the number of overall claims. We make sure that if an injury does happen, we have quality medical professionals within the health care network to assist the injured worker. We’re really concerned with the workers of Texas not only if they’ve had an injury, but even if they’ve never had a claim at all.”

Here’s a look at Moriah’s typical day.

7:30 – 7:45 AM: As I arrive, I log in to email and review any new emails. One thing I get every morning is an email from my supervisor with the “daily counts” of the team’s individual desktops. This gives me a good gauge of where everyone is, the kind of workload we’re seeing, etc.

7:45 – 8:00 AM: I then log in to the claims system and pull up my own desktop, as well as my supervisor’s. As a senior adjuster, I assist in managing some of the requests that come to the supervisor’s desktop, such as claim reassignments and file reviews. Looking at both in the morning helps me prioritize my day.

8:00 – 8:15 AM: While assisting with the supervisor tasks, I review claims that no longer meet the criteria of the current handling adjuster to determine whether reassignment of the claim is appropriate. Typically, this occurs due to a change in their work status or new information regarding the severity of the injury. I usually complete these first to ensure they’re getting to the new adjuster quickly. We continue to monitor any new requests throughout the day.

8:15 – 8:45 AM: As I work through my own desktop today, I make contacts on new claims to confirm injury details, disability and treatment status, offer assistance, etc. I review incoming documents for my claims. I also complete follow-up activity on my own claims. I receive a reduced claim load as a senior to allot time to assist on the supervisor desktop and to work on other tasks as assigned.

8:45 – 9:30 AM: File reviews for the team will be reviewed on or by the 15th day from our first notice of loss by the supervisor or senior.   I look to confirm that the criteria for quality claims handling has been met and that we haven’t overlooked anything. I document my review and provide feedback to the adjuster as necessary. These reviews take the largest portion of my day.

9:30 – 11:30 AM: In the morning, my supervisor and I meet with another department to discuss the claims handling process across departments.  I sometimes sit in on meetings to provide input but also for development purposes. Our team meeting follows.

11:30 AM – 12:30 PM: At lunch, I participate in yoga. We have a yoga instructor that comes to the office every Wednesday and sets up in our large conference room with the tables and chairs moved to the side and the lights dimmed. This is a nice break from the workday and is one of many things our company does to encourage employees to lead a healthy lifestyle.

12:30 – 4:30 P.M.: I have no meetings this afternoon, so I get back to my desk and continue to work on reviews. I am available throughout the day to provide guidance and feedback to the team on any questions they may have. Part of my role is to provide the training for any new adjusters on our team. I also field calls throughout the day and answer our “zoom line.” The team shares the responsibility of answering that line which increases our customer service quality.

Moriah went on to describe the different types of adjusters that work within claims. “Medical only adjusters, like me, handle claims for workers that are not anticipated to have lost time from work and need medical benefits only. We also have indemnity adjusters who handle claims where the workers need income and medical benefits. Lastly, we have catastrophic adjusters who assist workers and employers when severe injuries or fatalities occur.”

What does Moriah find most rewarding? “The most rewarding part of my job is receiving recognition and thanks for work that I’ve done. Sometimes, this is from co-workers or supervisors for my contributions to our work product. I also really appreciate it when I get thanks from our external customers because I know that dealing with work comp isn’t easy. I like being able to use the knowledge I have to make their lives easier. I am thankful for the gratitude they show when they realize the impact I’ve had on the process for them.”

Want to find out how our underwriter trainees are faring? Find out next time when On the Road spends a day inside our new training program.

About the author
Stephanie Schumacher is the corporate recruiter at Texas Mutual Insurance Company.  She was a founding partner and chief marketing officer at Platinum Select, LP, a medical staffing firm operating in all 50 states.  Platinum Select was recognized as the Fastest Growing Medical Staffing Company in the U.S. in 2006.  Stephanie spent five years traveling and collaborating on multiple startup concepts in Dallas.  She also served as a mentor for the City of Dallas’ Youth Today Entrepreneur Tomorrow program and was a board member for the West Dallas Chamber of Commerce.

This Week in Comp, June 9 – 13

This Week in Comp provides an overview of workers’ compensation news from across the country.

TRIA reauthorization

House committee unveils TRIA-extension bill with 5-year term
The Senate version of the bill extends the program in its current form for seven years, but it also increases industry co-shares by one-third under a five-year phase-in period…MORE

Regulatory

Texas moves forward in becoming an NCCI state
The Texas Department of Insurance has adopted the NCCI manual for workers’ compensation and authorized NCCI to assume certain functions that traditionally have been administered by TDI’s Workers’ Compensation Classification and Premium Calculation Office…MORE

Safety

Safe driving initiative launches in Victoria
Texas Mutual and its partners launched the Give Safety a Hand campaign in Victoria. The campaign promotes safe driving in the oil and gas industry…MORE

3 major occupational risk factors linked to sleep deprivation
Risk factors of fatigue may result in financial losses of more than $1,960 per employee annually in lost productivity…MORE

Tracy Morgan crash trucker was awake over 24 hours
The Walmart truck driver blamed for the highway pileup that left comedian Tracy Morgan in critical condition and killed his mentor had not slept for more than 24 hours before the crash…MORE

29 rulemakings listed on OSHA’s Spring Unified Agenda
Final rules on confined spaces in construction and slips/trips/falls prevention should debut in August and October 2014. This table provides a snapshot of other OSHA rulemaking activity…MORE

OSHA announces interactive training webtool on identifying workplace hazards
Employers and workers can virtually explore how to identify common workplace hazards in the manufacturing and construction industries. Users of the new training tool will learn not only hazard identification skills but also learn about hazard abatement and control…MORE

Opioid epidemic

Top 5% of opioid prescribers write 40% of US narcotic prescriptions
According to the analysis, high prescribers wrote an average of 3.5 times more opioid prescriptions — 4.6 prescriptions per patient compared to 1.3 in their peer group. Opioid cost per patient per day of therapy was nearly 5 times higher, on average, for patients treated by high prescribers…MORE

Claims

Step 2 in the dispute resolution process
The Texas Legislature established a formal process for resolving disputes in the workers’ compensation system. If the parties do not reach an agreement in step 1 (benefit review conference), the dispute can proceed to a contested case hearing…MORE

Fraud

Five charged in multimillion dollar workers’ comp and payroll fraud case
The Riverside County District Attorney’s Office has charged five owners, operators, and employees of a Corona-based paving company in a case involving wage theft, premium fraud, workers’ compensation fraud, and payroll fraud…MORE

About the author
David Wylie is the senior technical writer at Texas Mutual Insurance Company. He works closely with Texas Mutual’s safety professionals to teach employers and their employees how to prevent workplace accidents and their associated costs. David holds the OSHA 10-hour general safety certification and a degree in journalism from Southwest Texas State University.

Links to and from this blog do not reflect any affiliation between Texas Mutual Insurance Company and third parties, and are not an endorsement by Texas Mutual Insurance Company of the linked sites (or their owners or operators) or of any content located there. Texas Mutual Insurance Company does not vouch for the availability or accuracy of any information contained on linked sites. Read more of this post

Dispute Resolution Step II – Contest Case Hearing

By Kirk Lair, Senior Hearings Specialist

By Kirk Lair, Senior Hearings Specialist

Getting injured workers well and back on the job is the workers’ compensation system’s priority. But even with all stakeholders working toward a common goal, disagreements happen. The system’s dispute resolution process was designed to ensure all parties are treated fairly.

In a previous post, we covered the first step in the dispute resolution process: the benefit review conference (BRC). The law allows two BRCs per disputed issue(s). If the parties do not reach an agreement, the dispute can take one of two paths.

The Texas Department of Insurance, Division of Workers’ Compensation (DWC) can appoint an independent arbitrator to resolve the dispute if both parties agree. Because the arbitrator’s decision is final and cannot be appealed, however, most disputes proceed to the contested case hearing (CCH) stage instead.

A CCH is similar to a jury trial. An administrative judge hears testimony, reviews evidence and issues a binding decision. Unlike decisions issued during arbitration, the administrative judge’s ruling is not final. If any of the parties disagree with the CCH decision and order, they can request a review by an appeals panel.

The appeals panel includes three judges who review the evidence, the CCH judge’s opinion and the written appeal filed by the parties to the BRC. The appeals panel may overturn the decision, concur or return the issues to the judge to review and apply the law correctly based on their findings. If there is still no resolution, the parties can file a lawsuit at the district court level. Due to the significant expense and time involved in litigation, however, parties must carefully consider whether to proceed.

The dispute resolution process is a necessary component of the workers’ compensation system. I believe, however, that we sometimes lose sight of our priorities when we rely on the process too much. We tend to stop working proactively to resolve disputes prior to going through the dispute resolution process. The result can be unnecessary delays in income benefits and medical treatment delivery.

The workers’ compensation system exists to help carry injured workers through difficult economic situations, and get them well and back on the job. That is what the Legislature envisioned when it created the system 100 years ago, and that is what we should all be working toward. It takes all parties (employees, employers, medical providers and insurance carriers) working together to accomplish our common goal as fairly and efficiently as possible.

About the author
Kirk Lair has nearly 30 years’ experience in workers’ compensation insurance. He started his career with Travelers Insurance in 1986 and joined Texas Mutual Insurance Company in 1993. Kirk currently serves as a senior hearings specialist. He holds a bachelor’s in business from Texas Tech University.

This Week in Comp

This Week in Comp provides an overview of workers’ compensation news from across the country.

Safety

Stand down for safety – But then what?
Falls are the leading cause of workplace fatalities in the construction industry. Last week, OSHA encouraged employers to pause from their busy day and participate in safety stand-downs. Texas Mutual hopes employers participated in this worthy initiative. We encourage you, however, to continue the conversation and make safety a permanent part of your company culture…MORE

Only half of employees feel their companies are prepared for a severe emergency
Nearly half of businesses have closed temporarily due to weather in the past six months, but majority have not reassessed safety plans as a result of natural disasters…MORE

Some trucking firms want congress to ease safety limit on truckers’ hours
The 70-hour cap on a U.S. trucker’s workweek has a chance of being eased by Congress, undoing the result of a 15-year effort to reduce highway fatalities caused by drowsy long-haul drivers…MORE

Opioid epidemic

National Safety Council offers 5 tips for using opioid painkillers safely
These tips can help reduce the risk of developing an addiction to, or overdosing from, prescription painkillers…MORE

Fraud

Dancing Hamster Arrested On Insurance Fraud Charges
Leroy Barnes, 27, of Los Angeles, known as one of the dancing hamsters in Kia commercials, was arrested on insurance fraud charges related to his alleged fraudulent collection of state disability insurance benefits. Barnes is suspected of deceiving his doctors about his employment status while he receiving disability benefits…MORE

TRIA

Professional Sports Teams Looking for Terrorism Insurance Win in Congress
Renewal of a U.S. terrorism insurance plan is gaining momentum in Congress, thanks to some big-league backing from a coalition that includes professional football, baseball, basketball and hockey leagues. The House and Senate are poised this month to advance somewhat different bills renewing and reshaping the program…MORE

About the author
David Wylie is the senior technical writer at Texas Mutual Insurance Company. He works closely with Texas Mutual’s safety professionals to teach employers and their employees how to prevent workplace accidents and their associated costs. David holds the OSHA 10-hour general safety certification and a degree in journalism from Southwest Texas State University.

Links to and from this blog do not reflect any affiliation between Texas Mutual Insurance Company and third parties, and are not an endorsement by Texas Mutual Insurance Company of the linked sites (or their owners or operators) or of any content located there. Texas Mutual Insurance Company does not vouch for the availability or accuracy of any information contained on linked sites. Read more of this post

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