COMPClub is a member dedicated organization. Our training is designed to answer the questions YOU want to know. We sent out a survey recently asking the question:
What is Your Single Greatest Challenge In Workers' Compensation?
Here are the individual responses that we will be incorporating into our training:
Return To Work
- Having employers understand the value of transitional work and how to get more initiation
- Return to work modified duty and compliance with laws specifically in Colorado with rtw with restrictions. OSHA recording;
- Coming up with creative and valued transitional work duties for some of our small clients to avoid a lot time claim and promote an effective return to work program.
- Return to work with a psychological allowance in the claim. Depression never seems to get better if they are getting paid to be depressed.
- Having Foremen putting their employees back to work on restricted duty.
- Coordination of Transitional Duty within the business. Talk is cheap, but putting plans into action is the challenge
- Employee feeling of entitlement vs RTW
- Getting light or modified duty ordered by treating physicians
- We do not have an effective return to work after injury program---supervisors do not want to take time to deal with someone with restrictions and would rather they not come back until full duty.
- Doctors not releasing the employee to light duty or returning them when appropiate
- Lack of a formalized back to work, light duty program.
- getting carrier buy in to our risk management approach. If i'm able to create an active safety committee and have support from top management, i'm confident a carrier is more than likely to make good money even if the EMR is high...
- Carriers that are not open to working with employers and Brokers to manage claims
- A lack of understanding by senior management that this is a cost that can be controlled with an investment of some time and money.
- Employer control over claims.
- Coordination of efforts between location staff, management, injured worker and all "key" players.
- Gaining employers cooperation in having a transitional duty RTW program as a part of the WC program. This is a huge saving opportunity for the employer's WC program cost but they won't put a program in place!
- Employers refusing to accept responsibility for claim costs, ie. offering no light/modified duty RTW programs or not providing health insurance for their employees, thus shifting non-related injuries on WC.
- Getting upper management to understand the importance of safety in the work place and putting training programs in place to prevent safety.
Medical / Medical Costs:
- Juris - LA Because of lack of specificity and multiple interpretations of medical guidelines along with codes not having a set fee, medical providers can be very creative when trying to maximize their reimbursement. It is a challenge to reduce payments to a reasonable and fair amount in these areas without taking a huge risk of having to pay penalties and attorney's fees. For example, surgical implants - according to fee schedule guidelines, payment should be 120% of facility's cost for implants. With guidelines specifying 'facility's cost' rather than 'manufacturer's invoice', invoices from 3rd party suppliers (which are most likely partly owned by surgeon and/or facility), are being submitted with so-said facility's cost being listed.
- The large impairment rating given on cardiac claims based on a 1996 guide.
- Finding doctors in MPN's established by carriers who utilize best practice treatment protocols; i.e. properly diagnose the injury and provide appropriate treatment to bring the IW to MMI status.
- Rising medical costs
- IW care providers.
- Employers who are being left out in the cold in regards to getting cost effective and timely medical treatment for their valued employees with prompt and reasonable medical treatment by appropriate providers despite negotiated discounts and return of those valued employees to the workforce where they are productive and making a good living at the highest level of functioning possible.
- Getting timely medical treatments and tests with reasonable work restrictions and time off work.
- Doctors being VERY cautious in their care
- Medical cost containment and Liberal states such as California and the cost of drugs in others.
- Drug Screen billing (seeing large bills with more than 30 codes) 2. Implants (determining the true cost) 3. Outpatient pricing (the rules in LA do not favor the payor)
- Getting doctors to place injured workers at MMI when there is obvious IW delays
- Network reimbursement rates
- Illustrating the importance of utilizing best doctors instead of cheapest doctor.
Causality / Fraud:
- Work-relatedness of a reported injury. Although our investigations may find no work relatedness, or definite contributions of outside work activities, NYS always sides with the subjective report of the employee. We feel helpless.
- Questionable incidents
- The abuses experienced on the TPA side with the attempt to build networks. The self-dealing and fees mirror those we see on the Health Benefits side of the business.
- Cost containment on open claims of employees that are no longer with the company (either employee was terminated for cause, like positive result of post accident drug testing, or closing of division or plant).
- Following a call for voluntary layoffs, a large number of employees took a retirement package. Approximately 25% of those have had workers' compensation claims. A few are active. I'm concerned that some of them may try to get permanency awards when they have removed themselves from the workforce. There is already precedent for this in New York.
- MVA with injury that our drivers are not at fault for. They cost a fortune.
- Medical Provider Fraud
- The biggest challenge are the ongoing claims that linger on and how to aggressively manage them to closure. The next would be battling those claims that are questionable. With a rise in healthcare costs there is a rise in questionable claims.
- Pro employee bias. Employees who are capable of working are instead receiving $808 tax free to stay home. Where is the incentive?
- Finding the truth is the hardest part of workers' compensation for me. Unbiased truth would be the most helpful tool in containing w.c. costs.
- Each state law is different and most all things are compensable and physicians in most states do not need to follow evidence based guidelines
- Variability in regulations between jurisdiction - we work in all 50 states and it is increasingly difficult to manage a consistent program
- Adverse state laws. Laws and rules changing - keeping knowledgeable as it affects the companies ways to handle each case.
- The seemingly ceaseless re-interpretation of statutory provisions which in turn yields confusion and sometimes chaos in the application of the workers' compensation laws to the litigated issues.
- Gaining access in one place to detailed information that compares WC jurisdictions across the country. There are various locations available to seek a summary of benefits and laws about various jurisdictions but not necessarily one location to go to get this information in detail. This is helpful when having to work in multiple jurisdictions. Possibly the information would have detailed examples of benefit calculations and scenarios.
- Changing laws
- Not knowing every state's rules regarding work comp and there is not a best guide to have at fingertips that I have located.
- Lost cause being reduced over the majority of the state is putting pressure on rates
Data / Analytics
- Technology and the struggle to keep up. Now that data analysis and reporting is so prevalent it's important we are able to provide our customers with the data they want/need. It's also important from my perspective because there's so much valuable information in the data for me to use to make decisions.
Service Provider Relationships
- Reimbursement from the carriers, In Texas the carrier is penalized 3.5% for paying later than 45 days on clean claims, it takes us 60-75 days for reimbursement on clean claims, which makes us rethink even accepting comp. When the same carrier in the insurance arena pays promptly.
- Access to insurance carriers who will consider accounts with less than desirable legacy losses.
- Claims examiners with too much to do to care.
- I am Director of Audits for the Maine WC Board, and do compliance training for adjusters. Despite our efforts in education, penalty assessment, etc., compliance is still very poor. In the current audit cycle we have found only 41% of claims paid correctly.
- Timely UR or adjuster response to authorizations.
- Conflicting theories of WC claims handling amongst companies. Across the board there seems to be no clear "best practices", instead each company develops 'custom; approaches to basics from reserving to settling claims.
- TPA's and insurance companies who have no idea what they are doing. MPN'S that create higher cost than the old med/legal systems, doctor owned physical therapy etc
- Litigation is the biggest challenge facing employers in this area. Even modest claims that are litigated often balloon into much larger and more expensive claims due to the attorneys adding body parts to the claim and or alleging a CT claim.
- Establishing trust between the company and injured workers from various ethnic backgrounds in order to reduce litigation.
- Ongoing changes in regulations and inconsistent application/interpretation by Judges.
- Reducing litigation in Southern California
WC Cost Containment Education & Employer Best Practices
- Educating managers about avoiding cases that will turn into a claim
- We own a temp staffing agency that operates in several states. I am one person doing the entire WC for our Corporation. Our employees are paid hourly and mostly consist of security guards and janitorial workers. We staff many warehouse with temp labor. Our clients consist of Amazon and Genco,etc... My challenge is keeping up with the injuries, follow-up doctor visits, tracking down the adjusters, faulty in house drug screens, discouraging ER visits, over use of unprofessional doctors prescribing narcotics, over-seeing the EE's, and recommending PT when not needed. I have campaigned to remove our current clinics off all of our panels of doctors in every state we operate. They over-see and give ridiculous light duty restrictions while prescribing pain medication and in house therapy using third party doctors. The prescriptions become OSHA recordable FYI that way.
- My concern and challenges, get to both parties, a accurate report of what happened and work with the company investigator to file the reports in a timely manor while keeping the parties informed as to what is happening.
- I am new to the workers comp rules and regulations therefore my knowledge base is small. The amount of knowledge and time needed to effectively monitor and control a Workers Comp. program is enormous.
- Employer lack of knowledge regarding how culture impacts workers comp losses more that safety programs.
- Conveying to the customer a ROI that is realistic and believable.
- Explaining to the client how he will get $ for lost work as his case progresses
- Keep costs contained while delivering the best possible service for my employees.
- Communication between case/claim manager and employer.
- We are very strong in Work Comp as an agency but always looking for tools etc. for our young producers and AEs.
- Training options for our 'store level' leaders and associates.
- Getting rid of claims and dealing with lagging cases
Pharmacy / Pharmacy Costs:
- long-term pain management/pharmacy costs
- Pharmacy costs and utilization -- compounds, opioids.
- Over prescribing narcotics; health care providers enabling injured workers to not return to work
- prescription drugs and compound creams
- Pharmacy spend continue to be a challenge to control and prescribing physicians have still not taken a collective stand against the prolonged use of opioids within workers' comp claims.
- Mental health injuries
- Managing Future Medical claims from medical management standpoint and use of PMR specialty and opioids, claim settlement as the majority of our population are Medicare eligible and pro's and con's of settling these claims.
- Claim settlement with the State of Illinois IWCC
- It would say liens. The whole process of handling liens and the WCABs views and handling of liens and lien conferences. Judges are forcing payers to pay for liens that have been properly disputed just to free up their dockets.
- I need to better understand how to accommodate an employee with a permanent partial impairment rating as a result of a WC claim with our company. I want to be sure he is properly placed back in our work force while taking his PPI rating into consideration
- Calculating net rates for all the different carriers and finding cost effective carriers for every single type of class code.
- Getting Illinois governments to start using light work to bring government workers back to work.
- Talent replacement - the limited number of people interested in entering the industry is not enough to make up for people who are being promoted, retiring, or changing jobs.
These responses were instrumental in creating the COMPClub training program. Registration is open through Friday, February 5, 2016 at 5:00 pm EST.