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Workers’ Compensation Training

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Presentation on theme: "Workers’ Compensation Training"— Presentation transcript:

1 Workers’ Compensation Training
Synergy Coverage Solutions

2 Synergy Coverage Solutions
Overview History of Workers’ Compensation Claims Claims Reporting Accident Analysis Accident Investigation Early Return to Work Post Accident Drug Testing Hiring Practices Slips & Falls Back Safety Personal Protective Equipment Ergonomics Defensive Driving OSHA Regulations Synergy Coverage Solutions

3 History of Workers’ Compensation
Workers' Compensation in the U.S. began in 1911 during the Progressive Era when Wisconsin passed the first statutory system. Other U.S. jurisdictions followed suit. In general, statutory Workers' Compensation systems strike a compromise, guaranteeing workers medical care and payment for lost time on a no-fault basis. Prior to the enactment of Workers' Compensation laws, injured workers had to file suit against employers (usually for the tort of negligence), and such legal actions had significant drawbacks for workers. At the same time, a successful suit could impose very large and unpredictable costs on an employer. Statutory Workers' Compensation systems provide for prompt payment of medical, rehabilitation, and lost time costs to injured workers, while placing limits on the cost of the system for employers. This trade-off became known as the "workers' compensation bargain"; that is, the worker traded his/her right to bring a tort suit against their employer in exchange for prompt medical care and disability payments (indemnity payments). Thus workers compensation is the original "Tort Reform." Synergy Coverage Solutions

4 History of Workers’ Compensation
Workers' compensation provides insurance to cover medical care and Indemnity payments. While plans differ between jurisdictions, weekly payments in place of wages (functioning in this case as a form of disability insurance), compensation for economic loss (PPD, TPD and PTD), reimbursement or payment of medical and like expenses (functioning in this case as a form of health insurance), and benefits payable to the dependents of workers killed during employment (functioning in this case as a form of life insurance). General damages for pain and suffering, and punitive damages for employer negligence, are generally not available in worker compensation plans. Synergy Coverage Solutions

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Claims Injury by Accident – there must be an accident Specific Traumatic Incident – Back injuries/Hernias Occupational Disease – Asbestosis, Carpal Tunnel Claim – Accepted or Denied Denied Claim – Form 33 Request for Hearing Mediation NCIC Hearing Synergy Coverage Solutions

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Reporting Claims The Employer should file a NC Industrial Commission Form 19 with the workers compensation insurance company within 24 hours following the accident. The Employee can file a NC Industrial Commission Form 18. Synergy Coverage Solutions

7 NC Form 19 – First Report of Injury
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8 NC Form 18 – Employees Claim
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Claims Reporting According to an article published in April 1995 issue of NATIONAL UNDERWRITER, “prompt claim reporting significantly reduces the cost of a claim and likeliness of attorney involvement”. Timely reporting allows for better coordination of medical treatment and rehabilitation efforts to get the injured employee back to work. Indemnity costs make up more than 50% of the total claims cost. Synergy Coverage Solutions

10 Prompt Claims Reporting NATIONAL UNDERWRITER
Report Time Ave. Cost of Claim Increase Cost % Litigation increase % Within 10 days $12,828 0% 11 – 20 days $17,566 37% 23% 21 – 30 days $18,125 41% 36% After 30 days $18,858 47% 50% Synergy Coverage Solutions

11 Why Investigate Accidents?
To Prevent Future Accidents Synergy Coverage Solutions

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The Cost of an Accident Direct Costs Medical & Indemnity costs associated with the injury. Indirect Costs Can be at least 4 times greater than direct costs Loss of productivity Employee morale Lack of experienced employee replacing injured Time taken away to investigate accident Time taken away to deal with claims issues Cost of broken equipment Higher Workers Comp. premiums due to higher experience mod. Synergy Coverage Solutions

13 Conducting an Accident Investigation
Respond immediately. Investigate to find the facts. Analyze the facts to determine the root cause. Develop specific corrective actions. Review findings with employees (Lessons Learned from Losses). Synergy Coverage Solutions

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19 Early Return to Work Program
A formal written Plan designed to return injured employees back to work in some limited or modified duty capacity as quickly as medically feasible. Synergy Coverage Solutions

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Benefits of ERTW Reduce workers’ compensation costs Brings the injured employee back to wage earning capacity sooner Shortens length of medical treatment Lowers cost of claim (TTD) Prevents malingering and symptom magnification Gives injured worker an opportunity to contribute to the company Injured worker remains active and productive Synergy Coverage Solutions

21 The objectives of a modified duty program
Familiarize/educate each employee with the modified duty programs prior to an injury. To provide each employee with support during recuperation due to an on-the-job injury. To provide employees with a means to maintain a productive lifestyle. To control claim cost. To help reduce experience modification factor Synergy Coverage Solutions

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Early Return to Work Commitment to the program by management and supervisors Written policy in place Determine restricted duty jobs Follow Doctor’s restrictions Work closely with your W. C. claims dept. Synergy Coverage Solutions

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ERTW Process Prepare in advance written modified duty job descriptions Have these job descriptions given to the initial medical care provider selected by the employer. The adjuster or employer should have the medical doctor sign off on the modified duty job description Have these job descriptions ready to give to the claims adjuster. Offer the modified duty job to the injured employee in writing and we recommend via certified letter. Synergy Coverage Solutions

24 Post Accident Drug Test
NCGS 97-12 Law changed 2005 Burden of Proof 2005 law changed from the Employer having to prove the drug was a proximate cause to the Employee having to prove it was not a proximate cause What did this change? Synergy Coverage Solutions

25 Hiring Practices and Workers’ Compensation Claims
Typically a “bad” hiring decision results in a “Bad” workers’ compensation claim Synergy Coverage Solutions

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Hiring Application Interview Background checks Reference checks Motor Vehicle Record evaluations Criminal background checks Pre-employment drug screening Post Offer Medical Questionnaire Synergy Coverage Solutions

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Loss Prevention Slips, Trips, and Falls Back Safety Personal Protective Equipment Ergonomics Defensive Driving OSHA Regulations Synergy Coverage Solutions

28 Significance of Slips and Falls
Over 540,000 slips and falls each year requiring hospitalization Slips and falls account for over 300,000 disabling injuries each year One in three serious bone breaks for seniors result in death, within one year of the accident. It is the second leading cause of accidental death and disability after automobile accidents. Slip and fall accidents account for 30% of all reported injuries. Synergy Coverage Solutions

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Slips & Falls Periodic safety evaluations of each business location. Improve employee awareness to slips & falls at office and their client’s locations. Conduct initial and periodic employee safety training on slip & fall prevention. Require proper shoe wear. Synergy Coverage Solutions

30 Back Safety - Patient Handling
Health Care is the only profession that thinks 100 pounds is light. Employee Safety Training - Review proper lifting techniques with all employees on a regular basis. Employee Safety Training - Periodic review on how to handle patients within the home and work environment. Use mechanical lifts whenever possible. Synergy Coverage Solutions

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Back Safety - General Techniques – bend at the knees Keep load close to the body Plan the lift – synchronize Stay healthy – diet/regular exercise Stretching exercises Synergy Coverage Solutions

32 Personal Protective Equipment
Engineering Controls Protect employees from chemical and physical hazards Safety glasses, face shields, steel-toed shoes, gloves, respirators, etc. Policy development and enforcement Synergy Coverage Solutions

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Ergonomics Musculoskeletal; Repetitive Motion Engineering Controls – task redesign; fitting the task to the employee, ergonomic tools Administrative Controls – employee rotation, exercise programs Workstation evaluation Synergy Coverage Solutions

34 Vehicle Accidents are Expensive
Motor Vehicle Accidents are the No. 1 cause of workplace fatalities. According to the National Highway Traffic Safety Administration, motor vehicle crashes cost employers more than $50 billion every year in medical care, legal expenses, property damage, and lost productivity. When a worker has an on-the-job crash that results in injuries, the cost to the employer is more than $24,000. In one year, employer medical care spending on crash injuries was nearly $9 billion. Another $9 billion was spent on sick leave and life and disability insurance for crash victims. Synergy Coverage Solutions

35 Vehicle Accident Prevention
MVR review upon hire and annually thereafter. Periodic employee training on Defensive Driving is critical. Training can take 30 minutes to 1 hour in length. Defensive Driving training presentation (video or PowerPoint), and short test to validate transfer of knowledge. Do hands-on training for preventative maintenance. Written test remains in training file Synergy Coverage Solutions

36 Defensive Driving Topics Reviewed
Defensive Driving Techniques Cell phone policy and usage Preventative Maintenance Daily, Weekly, Monthly Vehicle inspection 2 and 3 second rules – Following Distance Adverse driving conditions Speed kills Seat belts Synergy Coverage Solutions

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OSHA Regulations 29 CFR Part 1910 Hazard Communication Means of Egress Powered Industrial Trucks (Forklifts) Hearing Conservation Machine Guarding Electrical Synergy Coverage Solutions

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Safety Resources Your Insurance Carrier (workers’ compensation, auto, property, liability, etc.) Federal OSHA website…..www.osha.gov Centers for Disease Control and Prevention…www.cdc.gov National Safety Council…www.nsc.org NC Occupational Safety and Health Division…www.dol.state.nc.us/osha/osh.htm North Carolina Industrial Commission…http://www.comp.state.nc.us/ncic/pages/safety.htm NC Dept. of Labor Video Library Synergy Coverage Solutions

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Summary Safety begins with upper management. To be a successful company, safety is everyone’s responsibility. Designate a person responsible for Safety. Ask for assistance. Do NOT quit on your Safety Program. Comply with OSHA (www.osha.gov). Synergy Coverage Solutions


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