Benefits of Offering Modified Work to Injured Workers

Author, Jim Malone, Workers’ Compensation Claims Advocate, Rancho Mesa Insurance Services, Inc.

There are many things the employer is required to do after a work related injury occurs. There are also additional things an employer can and should do after an employee is injured, though not required by any regulatory agency, like offering modified work. 

Obviously, there is the immediate need to address the injury itself. This is usually done by the lead, foreman, or supervisor and would include stopping the bleeding, placing ice on the injured area, etc. The injured worker’s injury then needs to be assessed by a medical professional. There are options for having the injury medically assessed. For minor injuries, it may be by calling a triage service or having a medical triage specialist (nurse or paramedic) go to the injured worker to determine if this minor injury can be taken care of with self-care or if the injured worker needs to be seen at an occupational medicine clinic. With referring your injured worker to a clinic, you should determine if the injured worker can drive themselves or if they need a company representative to drive them.

After the injury is properly addressed, focus on the reporting of the claim. Gather the forms and reports that need to be completed or obtained to provide to the insurance adjuster. Your next decision comes after the treating physician completes their initial evaluation. The physician should provide doctor notes, the mechanism of injury, how the injury occurred, and any other additional information. The physician may also provide wound care, sutures, x-rays, ace wraps, medications, ointments and make referrals for physical therapy, acupuncture and/or chiropractic treatment, etc.

The treating physician then provides their recommendations on the injured worker’s ability to return to work. For more severe injuries, the treating physician may want the injured worker to remain off work completely and could recommend temporary total disability. After some time off work and with some provided treatment, the doctor usually recommends that the injured worker return to work, but with some restrictions, such as not lifting over a certain amount of weight, not exceeding so many hours of weight bearing, etc. The restrictions provided are usually consistent with the body part(s) that were injured.  

So, the treating physician is releasing the injured worker to return to work but not to full, physical capacity. This is called a release to modified work, restricted duties, or light duties. From the insurance claims perspective, this is referred to as temporary partial disability. The modified work restrictions are usually slowly decreased while the injured worker continues the treatments and recovers from the work injury. This gradual recovery continues until the injured worker is able to resume all their physical work activities. This is called being released to full work activities, unrestricted duties, or to their usual and customary duties.

When the injured worker is released to modified work (i.e., restricted, light) duties, the employer decides if they can provide the injured employee duties that allows them to work while avoiding certain physical activities consistent with the doctor’s return to work recommendations.  

Benefits to the Employee

Providing modified, restricted, light duty work serves many purposes. First and foremost, providing modified work can reassure an injured worker that their employer cares for them personally, professionally, and psychologically. A work injury can be a very traumatic event, and returning to work as soon as possible after a work injury can help the injured worker feel confident their employer will be there for them and their family as they recover from the accident. This is one of the ways the employer can show their support of, and gratitude for, their employees and all the hard work they provide.  

Many studies have shown that providing modified work results in injured workers recovering quicker and more completely. It allows the injured worker to maintain their earnings and usual working schedule, while maintaining their relationships with the foreman, supervisors, and co-workers. Modified work also allows the injured employee to remain physically and mentally active while also allowing them to focus on their treatment and recovery.

Effect on the Business

For a business, a work injury can be very disruptive. The disruption of a work injury usually causes employers to move employees around to compensate for a lost employee. Employees working together as a team would see a change in work partners. Crews would be short a person who would be responsible for a certain part of an assignment resulting in changes in each crew member’s responsibilities. A work injury may affect how quickly the team can complete a job or project, how quickly the crew completes their daily tasks, and even how the employer is able to bid on future jobs or projects. 

Work injuries are stressful for an employer and the remaining employees. Besides the lost productivity from an injured worker, there may also be an emotional strain to other employees, or concerns about their own safety, about how they would be able to handle such an injury or how they would be treated if they were injured. 

Assigning an injured worker to modified work allows the employer to address other items of their business that may not get addressed when all employees are working at full capacity or when there are not enough employees to address these other areas. Assigning an injured worker to modified duties can allow an employer get caught up on cleaning certain areas, re-organizing a storeroom, updating inventory, etc. 

Benefits to the Business

Providing modified work allows an employer to have a direct impact on the overall cost of a work-related injury claim. By providing modified work, the employer pays the injured worker’s wages instead of the claims adjuster paying temporary disability benefits. If the employer does not offer modified work for an injured worker, instead of being temporarily partially disabled, the injured worker is then considered temporarily totally disabled. The claims adjuster would then be required to pay the injured worker temporary disability benefits at 2/3 of the injured worker’s average weekly wage. This is calculated from the 52 weeks of previous earning information you provide the adjuster when the claim was being created. This is also a tax-free benefit. 

However, getting these temporary disability benefits can also be a disincentive for injured workers to return to their normal work duties sooner than they are required. There is an increasing trend of injured workers refusing to return to modified work offered by their employers. Whether they want to stay home and collect temporary disability benefits, complete a side job they were working on while concurrently working for the employer, or if they believe they will recover quicker by simply staying home, injured workers can make it difficult to provide modified work. They can be disruptive, argumentative and provide poor quality of work while performing modified work. They can be insubordinate while performing modified work and can arrive late, leave early, take too much time for doctor or treatment appointments, etc. They can frustrate the employer so much that the employer may want to reconsider offering modified work to this injured worker. If the employee declines the employer’s modified work offer, the injured worker would no longer receive any wages from the employer and they would not be entitled to any temporary disability benefits/payments from the adjuster.   

Injured workers retain legal counsel for work-related injuries for a wide variety of reasons. Disagreements over returning to modified work is one of the most common of these reasons. When an attorney becomes involved in a workers’ compensation claim, there are usually disagreements over a number of issues, but the modified work dispute from the attorney is usually that the employer did not properly advise or instruct the injured worker about their responsibilities related to modified work offers. 

The lost time from work issue, after modified work is declined by the injured worker, usually becomes a monetary issue that is documented at the time, then later becomes one of the issues to negotiate or resolve when the claim is being settled. Usually a dispute like this is negotiated somewhere between the full value of the time lost from work and zero. This adds to the overall cost of a workers’ compensation claim. The development of this issue, however, can be completely avoided if the employer were to document the offer of modified work in writing. The employer can draft their own offer of modified work letter. The claims adjuster, their return to work specialists, or your claims advocate can also provide assistance with drafting of this letter. 

When an injured worker declines modified work offers, they sometimes get state disability benefits from the State of California Employment Develop Department (EDD), who in turn file a lien (or bill) for the lost time benefits paid to the injured worker on the workers’ compensation claim.  If the attorney and the claims adjuster are unable to resolve this issue, the documentation obtained (The Modified Work Offer letter) when the modified work was offered will usually be sufficient evidence for not reimbursing EDD for any of their lien, and/or for the workers’ compensation judge to agree with the employer and claims adjuster on this issue. 

Offering modified work is a very good thing to do for injured workers, for their recovery, and for the employer. It is also a very effective and proven strategy for handling workers’ compensation claims. Offering modified work can speed up the injured worker’s recovery. This allows the workers’ compensation claim to move quicker through the claim process to resolution or settlement. This usually results in the injured worker’s return to their normal work activities, their continued employment with the employer, and in reducing the cost of the workers’ compensation claim.

Workers’ Compensation Claim Advocacy: Distinguishing Good from Great

Author, Jim Malone, Workers’ Compensation Claims Advocate, Rancho Mesa Insurance Services, Inc.

As the new normal continues evolving through this pandemic, advocates are needed across all industries and sectors. Businesses and their employees exposed to the risk of workers’ compensation injuries and illnesses need the highest level of advocacy now, more than ever. 

Like so much of what we experience in our daily interactions, establishing a baseline of competence in any field has varying levels of effectiveness. That is, there are good claim advocates and then there are great ones; high-level claim liaisons that can make organizations more knowledgeable and stronger. 

What are the characteristics that make up the great ones? And, what should you expect with their involvement in your workers’ compensation program?

The first pre-requisite for any workers’ compensation claim advocate is experience. Ideally, having multiple years working as a claim adjuster and managing a case load for an insurance company is vital. While this creates a solid base, stopping here can limit the effectiveness for employers in other critical areas. In order to begin to go from good to great you should expect your advocate to have one or more of the following experiences to offer the broadest perspective possible for your team:

• Background with return-to-work programs, in development, implementation and management.

• Experience from being a workers’ compensation administrator for a self-insured employer with the State of California and Department of Industrial Relations

• Obtaining years of training in diagnosing and treating industrial injuries from occupational medicine, orthopedic surgical, spinal surgical and pain management physicians.

• Providing years of training to workers compensation physicians on treatment and disability management of work injuries and preparing  med-legal reports and addressing permanent impairment ratings, causation, apportionment, contribution and all other issues.

• Or the very rare experience of suffering a work injury, requiring surgeries and rehab, concern for losing one career and starting over in another, and going through the entire workers compensation process through settlement

Secondly, using these technical experiences in review and oversight of claims is both tangible and measurable. That includes:

• Ensuring the accuracy of claim statuses and plan of actions.

• Recognizing when claim reserves are adequate or inflated.

• Pushing for claim closures in the most efficient and cost-effective resolutions.

• Forming a deep, consultative bond that elevates a claim advocate to that of a trusted partner.

The final component in establishing a superior workers’ compensation advocate is building strong, respectful relationships with adjusters and employers. This requires the most experienced advocate creating a “partnership environment” that allows for continual open dialogue, which very often expedites the entire claim process. The most effective of these professionals build this environment through direct communication with the adjuster(s), supervisors, and even claim department managers. That information is then thoroughly and simply shared with employers in regular intervals through formal claim reviews, safety committee meetings, and/or pre-renewal meetings involving the broker.

As a 35-year industry veteran of the claims management field, I proudly serve the Rancho Mesa team with a core commitment to providing great contributions to the claims management process. These contributions are predicated on bringing my extensive knowledge and experiences from all sides of the workers’ compensation claim process, to my advocacy role for you, my client… the employer.

What Employers Need to Know Before a Serious Injury Occurs in the Workplace

Author, Jim Malone, Workers’ Compensation Claims Advocate, Rancho Mesa Insurance Services, Inc.

Timely reporting of an employee’s work-related serious injury, illness or death can pose a challenge to the employer. As of January 1, 2020, these incidents (including any hospitalizations, unless the injured worker is admitted for medical observation or diagnostic testing) must be reported immediately to Cal/OSHA. Immediately means as soon as practically possible but not longer than 8 hours after the employer knows or, with diligent inquiry, would have known of the serious injury, illness or death.

Monitoring the employee’s status at a hospital can be difficult if the employer has not put in place procedures and policies that will authorize a healthcare provider to disclose information that is covered by the Health Insurance Portability and Accountability Act (HIPAA). For example, the employer must follow-up with the hospital providing care to the injured employee to determine if the incident must be reported to Cal/OSHA. The employer will need to know if the employee has been moved from the emergency room and admitted to the hospital for in-patient treatment. 

Ensuring policies and procedures are developed and implemented to restrict the use and disclosure of protected health information (PHI), are important elements of HIPAA compliance. If health information is used for purposes not permitted by the HIPAA Privacy Rule, or is deliberately disclosed to individuals not authorized to receive the information, there are possible penalties for the covered entity or individual responsible.

HIPAA permits PHI to be used for healthcare operations, treatment purposes, and in connection with payment for healthcare services. It can be argued that employers need this information to comply with State and Federal OSHA laws. Information may be disclosed to third parties for said purposes, provided an appropriate relationship exists between the disclosing covered entity (i.e., the hospital) and the recipient’s covered entity or business associate (i.e., the employee or employer). A covered entity can only share PHI with another covered entity if the recipient had previously or currently has a treatment relationship with the patient. The PHI has to relate to that relationship. In the case of a disclosure to a business associate, a Business Associate Agreement must have been obtained. Disclosures must be restricted to the minimum necessary information that will allow the recipient to accomplish the intended purpose of use. 

Prior to any use or disclosure of health information that is not expressly permitted by the HIPAA Privacy Rule, one of two steps must be taken:

1. A HIPAA authorization must be obtained from a patient, in writing, permitting the covered entity or business associate to use the data for a specific purpose not otherwise permitted under HIPAA.

2. The health information must be stripped of all information that allows a patient to be identified.

Employers may consider obtaining signed business associate agreements or HIPAA authorizations from their employees before any injury or accident occurs. This will ensure they are able to get the appropriate protected medical information from the hospitals so they can report “serious injury or illness” accurately and timely to Cal/OSHA. 

Therefore, it is extremely important for employers to learn the existing laws and new changes to these laws and have a plan of action in place to address these concerns before the next serious injury, illness, or death occurs.

Currently, reporting to Cal/OSHA can be made by telephone or e-mail. With these reporting changes, Cal/OSHA has also been directed to establish an on-line mechanism for reporting these injuries. It is always important to document when these incidents are reported to Cal/OSHA. Until an online mechanism is established, use of e-mail would be such method for documentation. Monitoring of the Cal/OSHA website for implementation of the on-line mechanism of reporting is also suggested.

For more information on how to report serious injuries and illnesses to Cal/OSHA, please reference “Cal/OSHA Updates: AB 1804 Changes How Injuries and Illnesses Are Reported.”

For more information about what is considered a serious injury or illness under Cal/OSHA, please reference “Cal/OSHA Updates: AB 1805 Changes Definition of Serious Injury or Illness.”

Don't Let Your Communications with Employees Hurt as Much as Their Injuries

Author, Jim Malone, Workers’ Compensation Claims Advocate, Rancho Mesa Insurance Services, Inc.

A work-related injury is a traumatic event for your employee and their family. Even though your employees are trained and educated to immediately report work injuries, it is sometimes difficult for them to do so. Employees can be similar to athletes in that they do not want to do anything that might disrupt the team. There are a lot of emotions that can come into play when a work injury occurs. One of the strongest emotions may be guilt or embarrassment after sustaining an injury. There may also be misperceptions of what others are really thinking after an injury occurs. These feelings and misperceptions are usually the main reasons why communication with an injured worker can decline after an injury.

The injured worker may feel as though they have let down their employer after sustaining an injury. They may feel guilty for missing time from work, disrupting the work shifts and schedules of their co-workers, being physically challenged, putting their careers in jeopardy, being able to provide for their families and for causing the company increased premiums associated with a work related injury claim. They realize the cost of these claims are difficult for their company to absorb and may decrease funds for other employee benefits.

It is quite common for injured workers to not want to speak with their employers after an injury. They usually have misconceptions of what their supervisors and co-workers, are thinking about their injury and lost time for medical treatment. Some injured workers feel as though the employer is upset with them for filing a claim. The employer is obviously upset a claim has been reported, but is more concerned with the well-being of the employee and their recovery from the work injury. 

Workers oftentimes assume the employer won’t believe them, even thinking they are exaggerating or faking their injuries. The employee may believe the employer thinks they are trying to get away with something by getting out of work or placed on modified duties, or trying to get medical treatment for injuries or conditions that are not actually related to a work injury.  

All these beliefs, misconceptions and even paranoia usually leads to a breakdown in communication. So, what do you do if this occurs?

Keep reaching out to the employee. Inquire how they’re feeling, how much they like and trust their doctors and therapists, and communications with the claim adjuster. Continue to reinforce your concern for their injury and recovery. Remind them of how important they are to the company and how much you need/want them back. Reinforce you are not “mad at them” for getting injured, filing the workers’ compensation claim or missing work. Let them know you’re more focused on helping them get through a sometimes complicated workers’ compensation injury and understand the claim process. Promise them you will do everything you can to help them with answers to their questions. Help them express their concerns or problems with the claim adjuster and assist in their recovery and progression through the claim process. Be an advocate for your employee. Help them get the very best in medical treatment possible and assist with the claim.

Lack of communication and not addressing these misperceptions with your injured worker is one of the biggest factors leading to legal representation. They often do not know the workers’ compensation system and don’t know the questions to ask. You can maintain a dialogue with them by providing insight on what to expect next with their claim, provide options or even just listen to their concerns and decisions they may have to make during their recovery. 

Lack of communication can result in the injury not being reported timely by the employee, not reported timely to the insurance company or not responding quickly to a request for treatment, which can lead to litigation. A litigated claim increases the cost of the claim by 100, 200 or 300%! Litigation usually increases the life of the claim by several months and even years. It results in further, if not complete breakdown, of communication with the employee. Litigation can oftentimes results in the loss of your employee, possibly increasing the cost of the claim.

Injured workers retain attorneys for a wide variety of reasons. Interruption of communication with the employer is one reason. Another is they have nowhere else to turn. Occasionally, employees may retain an attorney and does not realize they actually hired them. Reassure them you will maintain your communication with them even though they’re being represented. You are still their employer and you still want to help them through the claim and return to work. Oftentimes they realize retaining an attorney was not the best avenue to take. If that is the case, you can reassure them they can terminate their relationship with the attorney with a single sheet of paper. Their representation can be undone as easy, if not easier, than their retaining of counsel. 

Maintain communications with your injured employee. Prevent or break down the barriers that can interrupt your employee’s normal recovery and return to work after an injury.

Workers’ Compensation Fraud Is Not a Victimless Crime

Author, Jim Malone, Workers’ Compensation Claims Advocate, Rancho Mesa Insurance Services, Inc.

Fraud can happen in every industry, including workers’ compensation. According to standard definitions, “in law, fraud is intentional deception to secure unfair or unlawful gain, or to deprive a victim of a legal right. Fraud can violate civil law, a criminal law, or it may cause no loss of money, property or legal right but still be an element of another civil or criminal wrong. The purpose of fraud may be monetary gain or other benefits, for example by obtaining a passport, travel document, or driver's license, or mortgage fraud, where the perpetrator may attempt to qualify for a mortgage by way of false statements.”

Within workers’ compensation claims, fraud is a term that can be overused by employers who may not agree with a claim, or a condition that has been considered work-related/work-aggravated. Many times, instead of fraud, there is simply a difference of opinion as to whether a specific work incident caused an injury. For these disputes, it usually comes down to a medical opinion addressing whether something is work-related or work-aggravated.   

Examples of Workers’ Compensation Fraud

A claim can become fraudulent when the employee lies about how the injury occurred or about their ability to work. The treating physician may be asked to provide their opinion as to whether the injured worker mislead them about how their injury occurred, and the significance of their complaints or physical capabilities. The doctor is provided records or sub rosa videotape contradicting information previously provided by the injured worker. Fraud can also occur when the injured worker lies under oath during a deposition, thus becoming a felony. 

Workers’ compensation fraud is not limited to employees, but others within the system can also knowingly participate in the fraud. Physicians can be fraudulent in their billing for services not rendered, for accepting kick-backs, or realizing financial benefit for referrals to and from other physicians, vendors or other entities. Employers can commit insurance fraud by understating their number of employees, under-reporting payroll or misclassifying employees into cheaper job/class codes in order to secure cheaper insurance policy rates and premiums. Vendors can commit fraud by billing insurance carriers for products or services never provided. Attorneys can use illegal capping schemes to retain injured workers for clients. 

Combating Workers’ Compensation Fraud

Each insurance company is now required to have a Special Investigative Unit (SIU) that provides ongoing monitoring and investigation of questionable activities related to claims. Fraud continues to cost tax-payers millions of dollars (some estimates are up to $80,000,000) per year. The money and resources the employers and insurance carriers are spending to combat fraud are also increasing each year. 

In the event of a fraud conviction, fines or assessments, prison sentences, or restitution can be ordered. Workers’ compensation fraud is not a victimless crime; from the losses caused by fraudulent activities, to the money used to combat and prosecute fraud. The money lost to workers’ compensation fraud can never be replaced, but we are all responsible to do our part in remaining vigilant and reporting suspected fraud to the appropriate person or agency. 

Protecting Employees from Third Party Harassment

The recent changes to California’s Anti-Harassment Training Requirements have prompted employers to take a closer look at their internal operations and how they can eliminate harassment from the workplace. A question that is frequently asked is “What happens if the harassment comes from someone other than one of my employees?” This is known as Third Party Harassment.

Third Party Harassment is when someone outside the organization harasses an employee. With a heavy focus on home care/home health care, third party harassment can arise between a nurse and an elderly client. In some cases, advances are made towards a nurse - further compounded in some cases by dementia or Alzheimer’s. Restaurants and bars are another common place where this type of harassment can occur when a patron or supplier harasses an employee. However, this type of harassment can occur in any industry where employees interact with people outside the organization. Several questions arise in these instances: As the employer, am I liable for third party harassment?  What can I do to address this? Can I insure against this type of harassment?

Is the employer liable for Third Party harassment claims?

The short answer is yes. An employer is responsible for creating and maintaining a harassment-free workplace for their employees. Failure to act on a third part harassment claim is not an option.

What can an employer do to address a potential situation?

If you become aware of an alleged act of harassment, act quickly. Engage the employee with sympathy. Not only will this show them that you care, but you need their input if you are going to maintain a safe work environment. Implement corrective actions immediately and ensure the employee will not be adversely affected. Investigate the incident through interviewing and evidence collection. Document all that was discovered and determine who is involved and what occurred. Depending on the seriousness of the incident(s), legal action may be necessary. In many cases, simply removing the employee from the situation and have a conversation with the alleged harasser is all it takes. For example, with the employee’s input, you may switch their schedule to work with a different client. If your employee is a sales representative, you might try switching accounts with another employee so they no longer need to work together.

If the harassment continues or is severe, you may need to stop doing business with the alleged harasser. While this might be difficult to do, the long term effects on employee morale and decreased likelihood of a harassment suit are worth it.

Does insurance cover these suits?

An Employment Practices Liability Insurance (EPLI) policy can cover against such claims, but only if it specifically includes “Third Party” in the wording. Some EPLI policies exclude or limit coverage. It is important when working with a broker that you clarify the coverage so you aware of what you are buying. 

Rancho Mesa Insurance clients have access to free online supervisor and employee Anti-Harassment training designed to educate the entire organization on the types of harassment, remedies, and the organization’s responsibilities.

If you have any questions, or any questions regarding California’s New Anti-Harassment Laws, please contact Rancho Mesa Insurance Services, Inc. at (619) 937-0164.

Understanding Your Claims: What Do You Have To Lose?

Author, Daniel Frazee, Executive Vice President, Rancho Mesa Insurance Services, Inc.

Claims happen. They come in all shapes and sizes, from all types of parties, and can cost your company in many different ways. An important aspect of managing the costs of risk start with gaining a clear understanding of your claims. Our clients are always looking to improve their bottom line. This article focuses on just one piece of the pie chart; workers compensation claims. Understanding the nuances of these cases can create measurable plans in the future to reduce frequency and severity of claims and ultimately lower your costs.

DIG UP THE ROOTS

Perhaps the most common problem solving method for identifying causes of problems or faults is referred to as a “Root Cause Analysis.” As someone who likely manages many facets of your business, developing systems that analyze failures of a process makes complete sense. Once a claim occurs, initiate an Accident Investigation that is meant to uncover all of the small details that ultimately led to the injury or incident. In many cases, a Best Practices approach involves this same process for “near miss” incidents. That is, perform the same process despite the fact than injury did not actually result from the incident. This allows your company to refine the approach, improve the analysis, and develop training modules addressing the failure(s).

MORE QUESTIONS LEAD TO ANSWERS...

When claims occur, proactive business owners build a list of specific questions that deliver uncensored facts. Those facts build a story and allow your team a clear view of what really happened. Some examples of questions that can be used by your team are listed below:

• How long had this injured worker been employed with us before the claim occurred?

• Was the employee following protocol when the injury occurred?

• Did the claim occur at the beginning or end of the day?

• How quickly did our team provide assistance and get him or her the care they needed?

• How quickly was the claim reported to our insurance company?

• Have we had incidents like this in the past?

ROLE PLAYING EXAMPLES

While role playing actual incidents and scenarios is not factual, it helps your team walk down a path to understand “what if” scenarios and forces discussion on how to address issues.

Example: Employee ‘A’ was injured when he fell from a ladder and fractured his leg. He had been employed for only two months. The injury that occurred was caused by a lack of proper training as the ladder was not properly secured. This claim occurred in the early morning and the area surrounding the ladder was wet. The team reacted quickly and was able to transfer the injured worker to an emergency room in less than an hour. The claim was reported 3 days from the incident. There have been two other similar “near misses” with ladders that did not result in injury.

Understanding your claims is a vital step in preventing future incidents. An investigation of an incident or near miss can uncover the root cause, explain the circumstances surrounding the incident, and help to identify scenarios and prevention plans. To learn more about understanding your claims, register for the Accident Investigation and Analysis training in Rancho Mesa’s Risk Management Center.

Higher Workers' Compensation Premiums Linked to New Employee Injuries

Author, Drew Garcia, Vice President, Landscape Group, Rancho Mesa Insurance Services, Inc.

Based on Rancho Mesa Insurance Services’ clients’ information, we have been able to identify that the majority of work-related injuries occur within the first year of employment. During the first year, the majority of these claims occur in the first six months. Having a system for on-boarding and training new hires is a critical component to dealing with the heightened risk of injury during this time period.                                                                                                                       

New Hires Effect Risk Exposure

During the workers’ compensation underwriting process, companies are commonly asked if their payroll will continue to grow, stabilize, or decline. Underwriters can assume that with growing payrolls, the company will be hiring new employees. New employees will likely increase the probability of work-related injuries. Underwriters must take this information into consideration when justifying a premium that will cover the company’s complete risk exposure.

Mitigating the Increase in Premium  

It is extremely beneficial for the owner and insurance broker to relay the measures that their company has committed to train, manage, and track new hires. If you are looking for a way to improve your safety efforts, consider focusing on proper new employee onboarding and training to minimize the potential impact claims can have on your company.

Please reach out to Rancho Mesa’s Client Services Coordinator Alyssa Burley at (619) 438-6869 to learn more about the Risk Management Center and how you can improve your safety training.

Reporting Serious Workers’ Compensation Injuries

Author, Jim Malone, Workers’ CompensationClaims Advocate, Rancho Mesa Insurance Services, Inc.

Workers’ Compensation injuries occur every day. The majority of these injuries are minor incidents which require no medical treatment or loss of time from work. For others, the injury is reported to the insurance carrier, the injury is addressed, forms are provided, and the recovery from the injury is monitored until the employee is released back to work and a discharge from care is provided.

However, serious injuries, illnesses or even deaths occasionally occur at work because of a work related accident. These incidents usually require 911 calls, hospitalizations, emergency surgeries, family contact, and a longer road to recovery. They may also require immediate (within 8-24 hours) reporting to the California Occupational Safety and Health Administration (Cal/OSHA), if they meet the criterion that has been established.

As defined in the California Code of Regulations Title 8 §330(h), serious injury or illness means any injury or illness occurring in a place of employment, or in connection with any employment that:

1. Requires inpatient hospitalization for a period in excess of 24 hours for other than medical observation.

2. Results in a loss of any member of the body.

3. Results in a serious degree of permanent disfigurement.

4. Results in the death of the employee.

Does not include any injury, illness, or death caused by the commission of a Penal Code violation, except the violation of Section 385 of the Penal Code, or an accident on a public street or highway.

The California Code of Regulations Title 8 §342(a) states, “every employer shall report immediately by telephone or telegraph to the nearest District Office of the Division of Occupational Safety & Health any serious injury or illness, or death, of an employee occurring in a place of employment or in connection with any employment. Immediate means as soon as practically possible but not longer than 8 hours after the employer knows or with diligent inquiry would have known of the serious injury or illness. If the employer can demonstrate that exigent circumstances exist, the time frame for the report may be made no longer than 24 hours after the incident.”

The 8-24 hour time frame begins when the employer knows, or “with diligent inquiry” would have known of the serious injury, illness, or death. The “employer” means someone in a management or supervisory capacity.

As with any injury or accident, it can be a difficult and confusing time for all those involved and affected. It may seem like many things need to be done all at once. That is, of course, impossible. So, prepare yourself now. Make a list of your responsibilities and important contact numbers before a serious injury or accident occurs.

The order in which you perform each of these responsibilities may differ, according to the type of injury or accident that occurs. However, you will still have your checklist and contact numbers ready to use to ensure you do not forget any particular step or obligation. This emergency list of telephone numbers may be your broker, safety/loss control specialist, claims administrator, or workers’ compensation claims advocate. We are all available to provide you with any assistance you may need.

For those in California, the Cal/OSHA District Office contact list is below. Ask for the officer of the day.

Concord (925) 602-6517
Oakland (510) 622-2916
San Francisco (415) 972-8670

Cal/OSHA Link: www.dir.ca.gov/title8/342.html

For additional information, please contact Rancho Mesa Insurance Services, Inc. at (619) 937-0164.

3 Practical Reasons for Timely Claims Reporting

Author, Jim Malone, Claims Advocate, Rancho Mesa Insurance Services, Inc.

When a work-related accident occurs, as a business owner or manager, it is our nature to want to analyze the situation in order to learn how to avoid it in the future. However, the reporting of the incident is equally as important. With the recent requirement to report first aid claims, timely reporting for all claims is recognized as being critical for a number of reasons. 

Employee Morale

First and foremost, timely reporting allows for immediate care of any injuries that may have occurred as a result of the incident. It promotes prompt referral for medical evaluation, documentation of the bodily areas affected, and provides recommendations for treatment. 

Promptly reporting an injury shows the injured employee, and their coworkers, that the company cares about them. When an employee knows the employer cares, they are less likely to litigate the claim, which can significantly reduce the overall cost to the employer.  

Elimination of Hazards

Timely reporting can trigger the immediate assessment of the scene and cause of the accident. The initial focus is to document the area and determine if there is still an injurious exposure or condition present that may need to be addressed to prevent further incidents or injuries. Timely reporting also allows for prompt investigation of the accident and the scene of the accident, identify witnesses, secure faulty tools or equipment for safety and subrogation purposes, and to convey a sense of responsibility and concern for the employee that their safety is of extreme importance.

Prompt investigations into the cause of a near miss, accidents, and injuries can lead to an understanding of the factors that lead up to the incident. Thus, the employer has the opportunity to make changes in processes and improvements in safety in order to prevent future near miss events or accidents from occurring.

Cost Savings

Timely reporting can directly affect the overall costs of a claim. Decreased medical costs are realized when injuries are promptly assessed, allowing for treatment to start immediately. Injured employees tend to recover quickly when treatment is provided right away. Swift recoveries usually result in shorter periods of temporary total and/or temporary partial disability, fewer diagnostic studies, physical therapy visits, injections, surgeries, permanent physical limitations, work restrictions or permanent disability percentages, and lower future medical care needs. This translates into lower financial resources allocated to these claims.

The timely reporting of a claim promotes positive morale among employees; helps remove potential future hazards from the workplace and can significantly reduce overall the cost of incidents.

 
For more information about claims reporting, contact Rancho Mesa Insurance Services, Inc. at (619) 937-0164.