Last week we discussed the magnitude and seriousness of workers compensation premium cost containment.  This week we continue by offering tips on developing strategies to contain those costs, and offer practical tips on how to do so.

I want to again remind you that this is a literal excerpt from our Workers Compensation chapter of our Safety Manual, if you would like more information on purchasing the full custom assembled manual, please visit our company website by clicking here.

Developing a strategy to effectively manage and contain Workers’ Compensation claim costs requires an integrated, holistic approach.  This approach should include cost containment strategies applied before an incident occurs, during disability, and when the worker returns to work.  These strategies offer solutions to help implement and strengthen your programs.

Accident Prevention

If your cost containment efforts focus only on medical and indemnity expenses after an accident, you will be missing a great opportunity to substantially reduce your costs through accident prevention.  As its name implies, an effective accident prevention program avoids accidents thus eliminating claims and their related costs.  An effective program should include:

• Top Management Commitment
• Accountabilities and responsibilities throughout an organization
• Safety/Accident Prevention Coordinator
• Safety Committee
• Safety Procedures such as Worker and Management Training; Safety Rules; Job Hazard Analysis; Accident Investigation and Analysis; Employee and Management Motivation; Safety Inspections and Program Audits

Photo by Derek Benjamin Lilly

As you develop and strengthen your accident prevention program, focus on areas that produced past accidents and operations that have a high potential to cause injury.

Claims Cost Containment Strategies

Should an accident occur, the next best strategy is to contain the costs of this loss. Effective claims cost containment practices begin before the accident occurs.

Claims handling procedures:  These procedures should specifically outline the steps injured workers and their supervisors should take in the event of an accident.  Your procedures should include the following:

For the Employee:

• Immediate reporting of all injuries to the applicable supervisor
• Use of designated medical care providers
• Follow-through on prescribed treatments and medications
• Maintain regular contact with your employer

For the Supervisor:

• Render immediate care to the injured worker.
• Immediately report, within 24 hours, all claims to your insurance carrier.
• Immediately investigate all accidents.
• Maintain communication with the injured worker.
• Immediately report any suspicious events, statements, or observations to the insurance carrier.

For the Employer:

• Obtain a list of qualified medical providers from your managed care provider.
• Post your list of preferred medical providers and employee accident handling procedures in common areas.
• Train and educate all workers and management throughout your Company as to their claim handling responsibilities.
• Regularly remind workers and management of your claims handling procedures through communications such as envelope stuffers, memos, and letters.
• Identify jobs that can be modified to permit an early return to work by the injured worker.
• Maintain communications with the managed care provider and claim adjuster.
• Review your procedures with your insurance carrier.  Your insurance carrier may have suggestions to enhance them.

Photo by Eberhard Rabich

Return to Work Program:

A “Return to Work Program” is designed to accommodate injured workers, modifying jobs to meet their capabilities, returning them to productive assets as quickly as possible.  The goal of a return to work program is to accelerate an employee’s return to work by addressing the physical, emotional, attitudinal, and
environmental factors that otherwise inhibit a prompt return.

Elements of a “Return to Work Program” include:

1. Management Commitment — Management must be committed to returning injured workers to productive roles. This commitment must be translated into specific responsibilities and accountabilities. Performance measures should be established to track the effectiveness of the program.
2. Job Profiles — Profiles of existing jobs considered suitable for early return to work should be developed. A profile should define the job in terms of overall physical demands, motions required, environmental conditions, the number of times the job is performed per week, and its duration.
3. Job Modification — Systematic analysis of specific jobs for the purpose of modifying them to accommodate the unique needs of the injured worker. Job modifications should be performed by individuals trained and skilled in ergonomic task analysis, engineering, safety and biomechanics.  In most cases your managed care provider can assist in your job modification needs.
4. Communication of Return to Work Opportunities — The presence of jobs that can accommodate injured workers and your return to work program should be communicated to your managed care provider, claims adjuster, and injured worker. In addition, regular contact with the injured worker, claims adjuster, and managed care provider should occur.
5. Changing Needs — Following the successful early return of an injured worker, review the job modifications with the worker to assure they meet his/her needs. Communicate any problems with your job modification team and insurance carrier. Work with your managed care provider and worker to move them to full production status in their assigned jobs as quickly as possible.

Injury Handling Practices:

At the time of injury, employers should concentrate on medical management and claim processes.  Managers must act quickly to ensure that injured workers receive appropriate medical treatment from the start.  Employers must effectively communicate their concern for the injured worker and their commitment to fulfill their obligations.  Ultimately, the employer must control the process and not let its role be usurped by medical providers or a claimant’s attorney.

Your injury handling practices should include:

Immediate handling of worker injuries:  Render first aid as available or needed.  Direct workers to one of the preferred medical providers.  Based on the nature of the injury, arrange for worker transportation or transport the worker to the medical provider.

Immediate reporting of all injuries:

Report all injuries to the insurance carrier within 24 hours of occurrence.

Accident Investigation:

After medical care has been rendered, interview the injured worker as soon as possible.  Interview any witnesses.  Investigate the injury site and review the actions leading up to the injury.  Gather the facts and look for possible causal factors.  Implement corrective action following your investigation to prevent a recurrence.  Report any suspicious findings to your insurance carrier.

During Disability:

As the worker is recovering, employers need to maintain continued communications with the injured worker, managed care provider, and the insurance carrier.  It is important that this communication take place on a regular and continued basis.  Workers need to be re-assured that their needs and concerns are being addressed, that they are important to your organization, and that their early return to work is desired.

Regular communication with your managed care provider and claims adjuster needs to occur.  Inform them of early return to work opportunities and update their information of worker status.

Employers should analyze their jobs, identifying those that can accommodate the needs of the injured worker, as well as those that can be modified to fit these needs.

Photo by Andrea Church

After returning to work from an injury:

A good opportunity to review and enhance your claims cost containment efforts is to review them following the return of injured workers.  Audit your procedures and obtain input from recovered workers regarding their satisfaction with provider services.  Communicate provider satisfaction information to your managed care provider.

It is your responsibility to contain the operating costs of your organization.  Insurance claim costs can represent a sizeable portion of these costs.  Exercising good claims cost containment strategies will help to contain overall operating costs, enhance worker morale, and increase profits.