Guidance for Developing an Effective Injury and Illness Prevention Program

Author, Sam Brown, Account Executive, Rancho Mesa Insurance Services, Inc.

As some company leaders may recall, since 1991, all California employers are required to maintain a written Injury and Illness Prevention Program (IIPP). An IIPP is an understandable and accessible safety program tailored to a business’ operations. An effective IIPP will help an employer establish and maintain a safe workplace while setting expectations and protocols for all employees.

The information below outlines the necessary elements of a written and effective IIPP, while recommending a resource to use when creating or updating the plan.

Cal/OSHA requires all Injury and Illness Prevention Programs to contain nine critical components:

1. A person (or persons) with authority and responsibility for implementing the program is identified.

2. A system for ensuring employees comply with safe and health work practices.

3. A system for communicating with employees in a form readily understandable by all affected.

4. Procedures for identifying and evaluating work place hazards.

5. Procedures to investigate occupational injury or illness.

6. Procedures for correcting unsafe or unhealthy conditions, work practices and procedures.

7. Provide employee training and instruction.

8. Procedures to allow employee access to the Program.

9. Recordkeeping and documentation.

California employers looking for guidance on the Cal/OSHA required Injury & Illness Prevention Program can often feel overwhelmed when addressing all required elements, while also abiding by the best practices of updating the plan, annually. Fortunately, California’s State Compensation Insurance Fund offers a free IIPP builder to all employers.

The State Fund’s IIPP Builder will help an employer create an IIPP from scratch, but can also help improve an existing program to make it more effective and compliant. An employer is first asked to answer a series of questions about safety practices. The answers will help build a safety program and tailor it to the business. The IIPP builder will also guide an employer through the required elements of the written IIPP.

Once finished, an employer can save the IIPP to their computer and upload it into their SafetyOne™ mobile app. They can also print and keep a hard copy at all locations. Lastly, to make it a truly effective program, the employers should share details of the IIPP with their employees.

Rancho Mesa wants clients to feel comfortable and confident when creating, updating, and sharing details of their Injury and Illness Prevention Program. To learn more about an effective IIPP and the State Fund’s IIPP BuilderSM, please contact me at sbrown@ranchomesa.com or (619) 937-0175.

Inflation Increases Cost of Workers’ Compensation Claims

Author, Sam Brown, Account Executive, Rancho Mesa Insurance Services, Inc.

As non-profits and leaders of human service organizations navigate important business decisions in the face of inflation, it’s important to consider measures that can reduce inflation’s impact to an organization’s operating budget. Today, we look at inflation’s effect on workers’ compensation insurance and strategies to reduce future costs.

In August 2022, the U.S. Bureau of Labor Statistics published data reflecting an 8.3% increase to the Consumer Price Index  for All Urban Consumers over the previous 12 months. If medical costs are the largest expenditure in workers’ compensation claims, how is the recent inflationary trends affecting worker’s compensation medical and claim costs?

Medical costs per workers’ compensation claim increased almost 18% between 2012 and 2021 according to a study by the National Council on Compensation Insurance (NCCI). Moving forward, the Office of the Actuary at the Centers for Medicare and Medicaid Services projects an index closely related to medical costs in worker’s compensation will increase 2.5% to 3% beyond 2022. Inflation has impacted many segments of the economy, including workers’ compensation insurance.

Strategies to reduce inflation’s impact to workers’ compensation insurance premiums, include:

• Offer modified duty to all injured workers.

Offering modified duty to employees with work restrictions is widely known to reduce the likelihood of workers’ compensation litigation and reduces the overall cost and duration of the claim. In addition, if an injured employee rejects the offer, then the individual can no longer receive temporary disability benefits. These positive outcomes may help explain why at least one insurance company offers a 10% rate discount to employers that offer modified duty to all injured workers.

• Consider on-call medical technician and telephonic nurse triage services.

Rancho Mesa has published articles about the benefits of on-site medical evaluations and nurse-triage services, but they deserve a fresh look. Both services can advise the injured workers on proper self-care, thereby providing the employee with helpful treatment options while avoiding a costly workers’ compensation claim. The employer will also avoid paying the injured worker’s wages while they travel to and wait inside a medical provider’s office.

The nurse-triage service will continue to manage the injury and help the employee determine if further medical care is necessary. Of course, employers should always report the incident to the workers’ compensation carrier.

• Consider an alternative workers’ compensation plan to gain more control over claim and insurance premiums.

It’s true that self-insured worker’s compensation plans are typically reserved for very large organizations, but options exist that replicate some of the most beneficial features. The available options depend on the size of the employer.

Small to medium sized employers can explore self-insured groups (SIG) to potentially split payroll between class codes and receive dividends. SIGs are very motivated to help members avoid workers’ compensation claims, but also closely manage open claims. A member vote is typically required after a review of an applicant’s safety plan, safety record, and operations.

Medium to large organizations may consider loss-sensitive plans. The policy will typically offer reduced annual premium if the employer can control claim frequency and claim costs. There may also be an opportunity to share in the underwriting profit following a plan year. Of course, the insured may also need to share in the claim costs in a poor performing year.

Another alternative, workers’ compensation deductible plans, can also offer a premium savings if the employer is willing to pay a deductible on each claim. Deductibles can range from $10,000 to $100,000 or more, depending on the employer’s risk tolerance.

Looking at alternative workers’ compensation strategies and plans can help employers navigate the current pattern of inflation. The information above can reduce claim frequency, claim cost, and also inform nonprofit and human service leaders about potential insurance premium savings available.

To discuss your organization’s options, contact me at (619) 937-0175 or sbrown@ranchomesa.com.

Training Supervisors on Workplace Injury Protocol Can Improve Claim Outcomes

Author, Sam Brown, Account Executive, Rancho Mesa Insurance Services, Inc.

California employers work hard to maintain a safe workplace, but accidents and injuries can occur. While human resources professionals typically have an excellent understanding of the workers’ compensation claim process, proper supervisor training can improve workers’ compensation outcomes for employers and their injured workers.

Supervisors are often the first to become aware of a workplace injury. Without proper training a supervisor may have the best of intentions, but can create problems by not following company protocols. Sound supervisor training may include:

• How to Get the Injured Worker Medical Attention
  Supervisors should know the designated medical provider or understand how and when to direct an employee to use telephonic nurse triage services. The supervisor should know what information the provider will need and, if necessary, how the injured worker should be transported to the medical provider’s physical location.

• Internal Communication
  Supervisors must know how to initiate documenting a workplace injury and how to notify the proper parties of the incident. What incident report should be used? Are witness statements important? Who needs to know of the incident as soon as possible? Whose responsibility is it to report the claim to the insurance company?

• Effective Communication
  A supervisor setting a tone of empathy immediately following a workplace injury can lead to positive outcomes and reduce the likelihood of litigation. Effective communication can even reduce claim frequency. A study by Shaw, et al., shows how four hours of supervisor training on communication skills and accommodation for workers reporting health concerns produced “a 47% reduction in new claims and an 18% reduction in active lost-time claims.”

Well-designed training can greatly improve workers’ compensation claim outcomes when supervisors follow company protocols, get injured workers medical care, and practice effective communication in the workplace.

Rancho Mesa has developed downloadable forms for the Supervisor’s Report of Employee Accident or Near Miss, and Witness’ Statement to help collect important information about an accident.

For more information on effective workers’ compensation programs, please contact me at sbrown@ranchomesa.com or (619) 937-0175.

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.

Employers Embrace Benefits of Telemedicine to Treat Work-Place Injuries

Author, Jeremy Hoolihan, Account Executive, Rancho Mesa Insurance Services, Inc.

Telemedicine is becoming prevalent in the workplace as a more efficient way to treat non-emergency type injuries. Employers, employees, and insurance companies alike are seeing the benefits of telemedicine from a convenience and efficiency standpoint. 

Telemedicine is defined as the practice of caring for patients remotely when the provider and patient are not physically present with each other. Modern technology has enabled doctors and nurses to consult patients by using HIPAA compliant audio and video conferencing tools.

Benefits of Telemedicine

• Immediate access to medical professionals is provided to injured employees and their supervisors; 24 hours a day, seven days a week. This often eliminates the need for scheduling and attending an in-person appointment and waiting room delays.

• The injured workers and supervisors avoid lost time from work driving to and from appointments.

• Employees who work remotely can quickly gain access to medical assistance.

• Minor injuries such as strains and sprains can respond favorably to appropriate on-site first aid. Often times, these types of injuries are referred to off-site clinics for care that is more expensive and more time consuming, but no more effective.

• Sound clinical decisions can be made about when first aid is appropriate and when referrals are necessary.

• When off-site referrals are necessary, doctors and nurses can direct the injured worker to pre-selected clinics within the insurance companies Medical Provider Network (MPN).

• Many telemedicine providers work directly with the employer’s insurance company to provide the first report of injury and create the claim in their system. This eliminates the need for policyholders to report the claim. This also ensures that claims are reported immediately and without delay.

• Telemedicine calls are typically recorded for future reference. The recordings are a useful tool in documenting the symptoms and injuries that are initially reported. 

How Telemedicine Works

When a workplace injury occurs and the employee requests medical treatment, a call will be placed to the predetermined telemedicine company. The triage nurse that answers will typically speak with the supervisor first, then privately with the injured employee. During the call, the nurse will provide an initial assessment of the injured worker, determine the seriousness, and evaluate the type of medical care that is appropriate. If further medical care is deemed necessary, the nurse will refer the injured employee to a certified occupational physician who can conduct a virtual appointment online via a computer, tablet, or smartphone. If the telemedicine company is not able to conduct a virtual appointment, the injured employee will be directed to a clinic within the MPN.

Once the assessment is complete, the nurse will provide a treatment plan. If the injured employee can safety return to work, the nurse will provide first aid/self-care instructions. Self-care instructions are typically accessed online or faxed. The nurse typically completes the call by speaking once again with the supervisor to ensure they are aware of the treatment plan.

Telemedicine is recognized by many as an efficient way of treating non-emergency injuries in the workplace. In fact, many insurance companies have recently partnered with telemedicine companies to help prevent a minor injury from becoming more complicated, and help the injured employee focus on returning to wellness.

If you would like to have a discussion about telemedicine and how it could be implemented into your workers’ compensation program, please feel free to reach out to me, Jeremy Hoolihan, at (619) 937-0174.

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. 

What Does the Employer Do After a Work Injury?

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

A work related injury can be a very traumatic event for the injured worker, but also for their
co-workers, employer, family and friends. Some injuries occur from a specific event when everybody knows the injury occurred. Other times, incidents occur during the work day, or repeatedly over time, where the employee needs to report these incidents, accidents or developing symptoms to his supervisor, manager, or human resource manager according to company protocol. 

Prompt reporting of a work injury is very important for the employer and their continued responsibilities. The employee reports the injury or accident to his supervisor, manager, or appropriate employer representative. The employer than has 5 days to report the incident to the insurance carrier.

Once reported, the employer can examine the scene of the accident and verify the mechanism of injury. Witnesses can be identified and their statements can be obtained. If the cause of the accident was another person, that person can be identified and their information can be obtained. If caused by a tool or apparatus, that tool or item can be removed from the work place and kept in a secure area for future reference. If caused by a dangerous condition, the condition can be corrected or barricaded to prevent additional injury. 

Work injuries usually result in instances where the injured worker reports the injury to their employer and they are interviewed and referred to an occupational medicine facility. There are companies that provide medical professionals that triage, the injury with the employee via telephone, or a visit to the workplace. The employee may be allowed to drive themselves to this facility or may have to be driven by a supervisor or foreman. The employee is instructed to provide the employer the Work Status form from the physician immediately after each and every examination or follow up visit.  If he is released to work, his employer needs the physician’s release to allow a return to work and if they are released to modified duties, the employer then determines if modified work is available. If modified work is not available, the employer than sends the injured worker home until his next visit or until modified work becomes available. 

When the injury is addressed, there are forms that need completed for the work related injury. The most important document is the DWC 1 Claim Form. This form MUST be provided to the injured worker within 1 DAY of when the employer knows of the injury. This form starts the claims process with the insurance company. It is a two part form where the employee completes the top part and the employer completes the bottom. Upon completion, the form is submitted to the insurance company and copies are provided to the injured worker and kept by the employer. The employer is then to complete the Employer’s First Report of Occupational Illness of Injury Report (ER’s 5020 form). Then, they obtain the Supervisor’s Report of Work Injury Report and any witness statements that may have been obtained. All these forms and reports are submitted to the insurance adjuster upon receipt and/or completion.

Now that the claim has been created, the employee is obtaining medical treatment, and all the forms have been completed and submitted, the employee’s progress will be monitoring during their recovery.  Maintaining good communication with the employee and claims adjuster is very important for helping the employee get through this recovery process. 

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

Berkshire Hathaway's Steve Hamilton Discusses Workplace Injury Trends for the Landscape Industry in Recent Webinar

Author, Drew Garcia, NALP Program Director, Rancho Mesa Insurance Services, Inc.

Steve Hamilton, Senior Loss Control Specialist from Berkshire Hathaway Homestate Companies, reviews workplace injury trends for the landscape industry, along with OSHA’s most cited regulatory violations, in his Landscape Industry Injury Trends for 2017 webinar.

This information will help landscapers focus their training efforts to improve compliance and reduce the risk potential for frequency and severity.

Start the year off right with a plan to address these common injury trends!

A National Association of Landscape Professionals (NALP) login is required to view the webinar.