RiskSolutions Newsletter Winter 2012

7/31/2019 RiskSolutions Newsletter Winter 2012

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RiskSolutions In

of doing busine

Reducing the co

Delayed Recovery,

Early Intervention& FunctionalRestorationBy Steven D. Feinberg MDand Melvin Belsky MD

Remarkably, there is an evi-

denced-based alternative to

out of control and unneces-sary medical and indemnity

costs where the injured work-

ers functional recovery is de-

layed. Its implementation on

a larger scale requires a para-

digm shift in the perspective

of all parties, but it is doable

and necessary. The alterna-

tive is identification and

multidisciplinary treatm

injured workers at risk delayed recovery. This

ability management app

to potential disability i

known as a functional re

ration (a term often mis

derstood).

Early intervention (EI) fo

on the small but signific

ten percent of injured wers with non-catastroph

juries who experience

delayed recovery (the

of anticipated functiona

covery in a medically rea

able period of time). Tho

experiencing delayed r

ery become over-utilize

medical services withou

A Message from

our Captain

CEO Ed Taylor

are often asked whats next

he horizon in the world of

rkers Compensation.

one can address everything

he field, but there are trends

ideas that can positively

act all the stakeholders in this complex system.

are addressing this newsletter to a broad range

eaders but it is our clients focus that will drive

at we put in future issues. Look for articles

ut trends as well as process improvements that

be implemented to help control the cost for

employer or improve the outcomes for injured

ployees. These are not mutually exclusive.

r field of vision is filtered by our client base,ployers, brokers, and the carrier community.

are hoping that our wide view will appeal to

audience and that you will continue to look

ward to receiving our message.

know that rates are increasing. What does this

an to employers? It is time to start looking at

r safety programs. It is time to look to their

rier relationships and gains control over costs.

s can start with picking carriers that have a

ng pharmacy benefit management program totrol medication costs. In addition, we must

k for new ways to identify the claims that do

olve in a timely manner. We must endeavor to

stantly try and control costs in the systems of

rkers Compensation.

Continued on p


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significant symptomatic/

functional benefit. In fact, costs

escalate over time while they

experience drug dependency,

debilitation and reactive

depression/anxiety. These indi-

viduals ultimately are now la-

beled chronic pain patients.

Although the process of

delayed recovery rarely be-

gins with catastrophic injury or

impairment, delayed recov-

ery /chronic pain claims con-

sume an astonishing 75% of

medical and indemnity resourc-

es. Just as amazing is the fact

that a majority of such expen-

ditures are unnecessary. Why?

Because delayed recovery,

when identified and addressed

properly at an early stage, is

largely a preventable or revers-

ible clinical phenomenon.

The earlier an injured worker is

identified as at risk for devel-

oping delayed recovery or

chronic pain along the timeline

from Date of Injury (DOI) to

claim closure, the more likely a

well-designed multidisciplinary

therapeutic effort will be effec-

tive in minimizing the other-

wise predictable consequences

of drug dependency, physical

debilitation and reactive

depression/anxiety. Effective,

efficient, and timely interven-

tion will significantly reduce

needless work disability and

associated medical and indem-

nity costs, while supporting

timely return-to-work.

The workers compensati

dustry and the medical co

munity needs to suppor

medical treatment appro

where the singular goal is

minimize needless work d

ity and drug dependency

promoting return-to-wor

maximum overall functio

through independent self

agement.

Some people do not cope

when injured and there c

a multitude of reasons fo

layed recovery, but one

great importance is adve

childhood experiences or

(physical, emotional, sex

abuse, household dysfunc

etc.) which constitute a r

tinely overlooked, second

logic factor for subseque

adult morbidity, mortality

disability.

Delayed recovery charact

tics can include the follow

Distress, depressio

anxiety

Excessive pain/disa

behaviors

High pain ratings

Fear-

avoidance/maladapbeliefs

Focus on litigation

Somatization

Job dissatisfaction

Adverse Childhood

riences (A.C.E.)

Being informed is your best de-

fense when dealing with a ques-

tionable workers comp injury.

Please keep in mind multiple

indicators may signal a fraudu-

lent claim and if you do suspect

or have doubt regarding com-

pensability, advise your carrier

and request that the claim be

on delay status and carrier will conduct aay investigation.

e are some red flag scenarios that you

uld be aware of when claim is reported :

Accident occurs immediately prior to

strike, layoff, plant closing, job termination

and/or after bad job review.

Injury is not consistent with nature of

business / job description.

Injury occurred after a day off or return-

ng from vacation. Date, time and place of accident are un-

known.

Claimant cannot recall specific details

about the injury or injury type does not

match mechanism of injury.

Report of injury is not timely and immedi-

ate.

No witnesses to the accident.

Claimant is in line for early retirement.

Tips from coworkers.

First notice of injury is through a claimsubmitted by attorney.

Unexplained or excessive time off prior to

njury, particularly where recovery time ex-

ceeds medical protocol guidelines.

Uses an alias and or refuses to give proper

dentification.

Accident occurs in an area where the

claimant should not be present.

By Melissa Rehm WCCP , CSIA.


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The current Introduction to

Chronic Pain Guideline in the

CA MTUS supports the biop-

sychosocial model and the

principles of functional resto-

ration (FR). This model recog-

nizes that the perception of

chronic pain is ultimately theresult of pathophysiology, the

psychological state, the life

experiences, culture and belief

systems, relationships with

people and interactions with

the environment.

Functional restoration is not

an expensive chronic pain pro-

gram but rather a process bywhich the injured worker ac-

quires the skills, knowledge

and behavioral change neces-

sary to assume or reassume

primary responsibility for

his/her physical and emotional

well being post illness or inju-

ry. It is a coordinated, multi-

disciplinary process,individualized for each pa-

tient. It is educational and

functionally oriented (not pain

oriented) where the injured

person rehabilitates to reen-

gage in work and every day.

The FR approach educates the

patient about the tools andresources available. The in-

jured worker learns accep-

tance of, or willingness to

experience chronic pain and

distress rather than attempt

to prevent, control or reduce

such symptoms.

This functional restoratio

early intervention appro

a win-win for all concern

parties. The injured wor

returns to life activities in

ing work, stabilizes medi

and avoids iatrogenic com

cations. The employer avunnecessary costs and

achieves an early return

work place of an able bo

employee.

Roadmap for Suc Avoid work injuries wit

ucation, health and sa

programs. Utilize tools already av

able for early identific

of individuals at risk

delayed recovery p

injury, followed by ind

alized, focused care f

rapid return to work (R

Build systems to incent

all players (payers, inju

workers, attorneys, a

physicians) to help inju

workers rebuild their l

at return to gainful em

ment.

Provide medical care a

the lines of functional

ration as supported by

MTUS Chronic Pain Me

Treatment Guidelines

Resolve cases fairly and

uitably for the injured

er and the employer/p

This approach is not theo

cal. Safeway, Inc., has im

mented a successful Ea

Claimant immediately starts asking how

much am I going to get and is overly famil-

iar with workers comp terminology.

Family members are receiving workers

comp benefits.

Claimant has high-risk hobbies such as sky-

diving or bungee jumping.

Dual employment.

member to let your carrier know upon sub-

ting the claim if you question its compensabil-

Once a claim is accepted by the carrier, it is

rly impossible to contest it regarding initialet. I appreciate the opportunity to inform

educate. I hope this information is found

ful when dealing with a questionable new

rkers comp injury. Heres to an Injury Free

2!


4/5

ow to Save on Workers Comp CostsBy Joe Stevens

After several years of declining work-ers comp rates, and a few more

where the rates were stable, there has

been a dramatic shift, with premiumsincreasing; in some cases dramatically

higher. Since every company is re-

quired to have this insurance, there isonly one way to limit what you spend

on it: minimize claims. The insurancecompanies pay the claims directly, but

the employer really pays in higher pre-

miums.

mistake that many companies make is believing they have a

g safety program if they are fully OSHA compliant, provideough job training, and hold regular safety meetings. All those

s are important, but they do not comprise a safety program.are only a beginning, a starting point.

know that almost 90% of workplace injuries are determined tovoidable. So if only 10% of workplace injuries are caused by

e conditions, doesnt it make sense to address the 90%?

k of safety like you would if you were the coach of a football. In order to win, the field must be in perfect condition

HA compliant), the uniforms and equipment must provide pro-

on (PPE), and the players must know the plays (training). Butthe game begins, and the way the players execute determines

utcome.

he same in your workplace. You can provide a perfectly safe

onment, but its the behavior of the people who work for youdetermines the outcome. Safe behavior, correct execution of

and teamwork all play a role in eliminating injuries. The more

mpany can do to motivate safe behavior, just as the more a

ball coach can do to maximize the performance of his players,etter the results.

we know that behavior is the cause of most injuries, our chal-

becomes how to affect that behavior positively. It doesnt doh good to tell employees to be safe, because every company

them that. The people who work at any company judge safety

companys actions. Here is a key point about workers in anytry that can guide your actions: Their attitude about safety is

d on what they think your attitude about safetyis. If theyt think its your highest priority, it wont be theirs, either.

Occupational Clinics participated over 4 plus ye

Although limited in scope, the results were dra

no delayed recovery cases were created; no in

worker sought legal counsel; Modified Duty a

days were markedly reduced; and everyone re

to work. The results were so positive that Safew

and KOJ plan to expand the approach to other

clinics.

If you would like to hear more about this approach, Dr

berg can be reached via email at

[email protected] and Dr. Belsky at

[email protected].

Intervention Pilot with Kaiser-On-The-Job (KOJ). The

project was limited to Safeway, Inc., stores within a sp

KOJ catchment area in Northern California, for injured

ers presenting at those clinics with low back pain. Fiv

INJURY DOCUMENTATIONBy Linda Taylor, CSIA, WCCP, RN

One of the most confusing areas of compliance is the

vs. recordable/reportable dilemma. Many employers

what constitutes a first aid and what they must report o

their OSHA Log and to thei

ance carrier. CalOSHA and

SHA are very clear orequirements for an injury

considered first aid. The follo

a list of injuries that are con

first aid by these agencies:

Using nonprescription m

tion at nonprescription stren

T etanus immunizations

Cleaning, flushing, or soak

surface wounds


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companies with minimal claims are successful in

vincing the people who work for them that safe-

the companys highest priority. That is the key.y dont do it by putting up more signs or holding

e meetings; they do it by making safety highlye and reinforcing its importance. One great way

o that is with a safety achievement program that

enges teams and departments to be safe, thenards them when they accomplish that. By hold-

monthly awards meetings, it gives management

pportunity to provide recognition and show ap-iation, two important elements to keeping any

kforce positive, and when that recognition ised and acknowledged, it sets an example for

yone. Take pictures and post them around thepany, announce results, promote the program insletters and blogs. Make safety a Big Deal- a

re Value of the company.

ating a culture of safety where workers take re-

sibility for being safe is the only long term solu-to keeping rates down. Doing everything you

o demonstrate to the people who work for you

committed you are to their safety pays off foryone.

Wound coverings including Steri-strips and butterfly bandag

wound closures

Hot or cold therapy

Non-rigid means of support. (e.g. Ace wrap type devices)

T emporary immobilization device used to transport accident v

Drilling a fingernail or toenail or draining fluid from a blister

Eye patches

Removing foreign bodies from eye using irrigation or cotton s

Removing splinters or foreign material from areas other than tby irrigation, tweezers, cotton swabs or other simple means

Finger guards

Massages

X-rays used to determine if there is a fracture.

Drinking fluids for relief of heat stress

Caveat: a work-related case involving loss of consciousness must be

corded. Employers must report/record any change in duty other than

day of injury. If the worker comes back on modified duty then it is co

ered a recordable/reportable injury. If your industrial clinic dispense

medication, such as T ylenol #3 (prescription) whether the injured w

takes the medication or not, then it is recordable/reportable. In this

stance, schedule a meeting with the industrial clinic (first treatment fa

and discuss the companys expectations. Industrial clinics are a busine

too. They make their money from providing medications, performing

rays and prescribing physical therapy. As the employer, you have eve

right to discuss your expectations of how your injured workers will

treated. If they need medication then the clinic should prescribe it. If

are not in pain then do not give them the medication just to have a b

event. There is nothing wrong with being OSHA sensitive. When O

pays a visit they look at all the injuries your facility has had and determthe frequency. If your clinic is not a partner in helping control your fr

quency then you should look around for a new one. The clinic does s

very fine line. They are held responsible by the insurance commission

report work-related injuries in a timely manner. They would be guilty

insurance fraud if they kept a recordable/reportable as a first aid and

not report it.

Remember, February 1st is the start of the 90 day posting of your O

300A (Summary of Work-Related Injuries and Illnesses).

Risksolutions, Inc

reducing the costs of

doing business

P .O. Box 180

17602 17th St.

T ustin, CA 92780

951-943-6775 xt 151

Fax: 951-943-5221 [email protected]

RiskSolutions Newsletter Winter 2012

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