How to Improve Your Workers’ Compensation Program

BY PETER BRYAN

Workers’ Compensation (WC) programs are designed to treat injured employees and return them to their preinjury working status. This is not always possible, for a variety of reasons. Very few agencies have or take the time to develop their WC programs to be as successful as they could be, not because of a lack of desire but rather the lack of the execution of some well-known components. Each component will take effort and, in many cases, dialogue/agreement with interested stakeholders. Following some “secrets” can help you ensure your WC program is successful.

1 Review active litigated claims regularly.

It is imperative that you assign someone to review WC cases and claims regularly, at least every two weeks. One of the most frequent complaints employees make is, “I never hear anything.” Delays are among one of the most “preventable” costs to agencies. The reviewer should have the authority to “move the claim along” or get some attention to the claim. This important component does not mean changing or adjusting the claim but keeping track and ensuring that the claim does not stall.

Litigated claims are no different from nonlitigated claims in respect to monitoring and getting attention to the claim. The difference is that there the law imposes limits as to what can be done and what communication can occur, but not the level of attention that can be paid to those claims. Work with all the appropriate employer stakeholders to get this done when it involves litigated claims.

2 Demonstrate to employees a true desire to improve wellness and fitness while administering the WC program.

Wellness, fitness, and WC can be synonymous and concurrent, just as counseling and discipline can occur at the same time. It can be of great benefit to get employees engaged and involved in various appropriate aspects to gain a better understanding and acceptance of the WC process. Nothing of the overall WC program has to be a secret. In fact, the more engaged an employee is in his health and wellness, the more he can take a role in the responsibilities.

Implementing wellness and fitness programs can and does have a tremendous effect on the overall health and well-being of employees. Professional sports programs would not engage in competitive games without having workout programs and medically monitored treatment. Why should employers not consider, develop, and implement feasible and applicable components of “sports” programs, especially for their physically demanding job classifications? Mandatory wellness and fitness programs have tremendous benefits for those agencies that can and have done so.

Another administration method that can have significant benefits is to “regularly check in” with the medical providers, treatment providers, and physical therapy (within the allowable provisions of WC laws and in conjunction with risk management and WC administrators) to see how employees are doing, if there are any issues, and to ensure that all “interested parties” are doing their part and what is expected to get the employee fully recovered. There is no doubt that some agencies and employee organizations will feel this is a privacy and confidentiality issue; this will take trust on all sides and open dialogue to implement.

3 Treat WC injuries similarly to “high-priced” sports and wartime/combat injuries.

Rapid triage and appropriate treatment are key to sports injuries and the combat injuries encountered during wartime. M.A.S.H. treatment, made famous during the Korean Conflict and by injured professional athletes seen on television, involves rapid assessment and diagnostic testing. These two components set the stage for all future treatment programs. The U.S. Army has been conducting some studies on injured soldiers; the emphasis was on getting surgery and rehabilitation started within 30 days of the incurring of the injuries. These soldiers were able to return to combat duty more quickly.

Sports programs often use diagnostic testing at the venue; they often have X-ray and MRI capabilities on site. Off-site and “outsourced” MRI services are common in many urban areas; their costs can be negotiated under some contract provisions. The readily availability of these diagnostic tests can increase the “speed” with which treatment can begin for some injuries, especially the musculoskeletal ones. For some public safety jobs, getting an employee back to work months earlier effects a significant savings in lost time and productivity.

Quality physical therapy (PT) may be as important as getting “quality” surgery, perhaps even more so. Employers often look at physical therapy as a waste of money. That may be because of the PT not being a well-designed and injury-specific program. One-size-fits-all and cookie-cutter programs are not appropriate. Everyone’s body is just a little different from the next, and thus the PT program should be tailored for the injury and the individual. Not all athletes train in the same exact way, and an injury rehabilitation program should not be the same just because the injury affects the same body part. Check out the credentials of the PT company/organization and the physical therapist. Not all are equally trained and qualified. Review their “success stories” and letters of reference; the PT firm should be able to demonstrate that the PT programs are specifically designed. The quality of PT programs ranges from A to Z; selecting the most appropriate program is of critical importance. The PT firm’s Web site should detail the company’s programs, indicate the credentials of the therapists, and have photos of a wide range of equipment. Our objective should be to treat our employees with the goal of getting them back to 100 percent and helping them to make it to a healthy and long retirement.

4 Perform surgery early. Injuries heal better when surgery is not delayed too long after the injury occurred.

If surgery is necessary, generally the sooner it occurs and rehabilitation begins, the sooner and more successfully the employee heals.

5 Develop and implement programs aimed at improving the WC program.

Much has been said about empowering employees, quality circles, improving customer service, and so on. WC programs are just customer service for the internal customer. We should look for ways to improve our WC programs as we do our business programs. Medicine is improving; science is always advancing. Shouldn’t we consider doing the same for a program that has a significant effect on our employees (our most valuable asset)?

Providing standardized policies and procedures for the agency on how to access medical providers for specific injury types can speed diagnosis and treatment, and it provides consistency (something we all shout for). Examples could include shortness of breath/chest pain, burns, and musculoskeletal injuries.

Another critical aspect is providing “guidance and direction” to the treating physicians and medical practitioners. Depending on the level of the relationship that exists between the agency and its WC program administrator and the various physicians and medical practitioners, it is possible and actually very feasible to provide guidance and direction for individual claims, including diagnosis and treatment. This is not to suggest that an agency be the “medical director” but rather that the agency develop relationships that foster regular dialogue and discussion on how employees are diagnosed and treated—for example, directions that all employees with musculoskeletal injuries receive an X-ray and MRI early to speed diagnosis and treatment.

Conducting regular “roundtable” and brainstorming meetings with all the interested parties in the WC program can lead to improved, more effective, and often more cost-efficient administration. It is often beneficial to involve employees’ groups at the table during appropriate times; employees’ understanding of what to expect relative to a WC claim and their responsibilities can make the program more effective.

6 Select/implement effective “claims administration” services.

Select appropriate, knowledgeable, and effective personnel or services to manage your WC claims. The WC field is changing daily as a result of legislation or medicine. These personnel need to be very knowledgeable and effective. Not only do they manage the files, they also often are in charge of the “utilization review” (UR), which is very medical in nature and often involves fiscal management, legal issues, and claim litigation.

The WC administrators must be good communicators with everyone from employees to medical providers. What generally “spoils” a WC claim is not knowing what is going on from everyone’s perspective. Choose well.

7 Implement “modified-duty” programs.

Getting an employee back to work as soon as feasible makes good business sense. Too much of the time, there are too many delays of all kinds. One such delay occurs when an employee does not feel ready to return to work or desires not to return quickly.

Modified-duty programs can provide appropriate-level work these employees can perform. The modified-duty program will have to meet certain requirements and medical/physical limitations based on the employee’s condition.

The other big advantage of modified-duty programs is that they can also be used for nonwork-related injuries to assist employees who want to save sick-leave time or who don’t have sick leave.

8 Provide attorneys with direction on litigated claims.

WC attorneys deserve and often want direction. There may be limitations on what can be done at a particular time, but the agency and the attorney need to discuss those options. Generally, leaving a WC attorney without direction causes delays in the overall management of the claim. If nothing else, the two parties can discuss whether the claim should be fought or settled.

9 Implement quality “physician listing” services.

The list of physicians and medical practitioners, including specialists, should be as comprehensive as is feasible. Employees often live remote from work-site locations, and medical appointments are often scheduled during nonwork hours. Having a quality and extensive listing can also limit or reduce the need to “use employee-designated physicians.” Generally, anytime an employer can designate medical practitioners for its WC claims, the greater control it has. Physicians and medical practitioners need to be competent in WC paperwork requirements.

10 Develop accurate and current essential job functions.

Most job classifications have job descriptions, but few have current essential job functions. Essential job functions should describe all (or at least as completely as feasible) the physical demands and expectations of each job from sitting to highly active. For each activity, there should be an indication of how often the activity or task is performed and how important that activity is. This is often a lengthy document for each job classification. Few jobs are identical; thus, a separate essential job functions list is necessary for each job description.

•••

Most employers and employees want similar positive outcomes for WC claims. Agencies are said to be ineffective and unknowledgeable in WC programs, and employees are said “to work the system.” Regardless of whether these allegations apply, WC programs can generally be much more effective if these guidelines are followed.

PETER BRYAN, a retired chief, is a fire protection consultant; is a 37-year veteran of the fire and emergency services; and served as chief for the Norco, Monrovia, Rancho Cucamonga, and Wheatland (CA) Fire Departments. He is experienced in wellness, fitness, and workers’ compensation programs.

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