Workers’ Comp Loss Prevention, Going Beyond the Safety Dance

By | July 19, 2004

You work hard, yet you’re frustrated. Why is your client still suffering from employee injury problems and escalating workers’ compensation insurance cost regardless of your efforts?

So, is the solution to do like what is always done? Respond to workplace injuries by beefing up loss prevention programs? Should management finally get serious and committed about safety? Should committees be formed? Is it time for more meetings and additional training? And, is now the time to add incentive programs to the mix?

So you do all that for your clients, yet injuries continue to occur and getting your employees productive again has become more and more of a headache (and heartache, too).

Recent studies have shown that the total number of workplace injuries is trending downward. However, the total direct cost of workplace injuries is still going up. Fewer employees are getting hurt, but those getting hurt are costing much more.

Safety programs and training are necessary and vital to a healthy and productive workplace. However, safety programs alone will not get the job done in reducing workplace injuries, malingering claim problems and the overall total cost of injuries.

Employers intuitively sense there must be something more that is driving this cost and aggravation. Ask any business owner about one of their most aggravating workers’ comp claims, and it is unlikely they will talk about “how their safety program failed.” You will probably get an earful about the character of the employee, the abuse of the system, and maybe even a word or two about doctors, attorneys and insurance company personnel.

However, the solutions that keep coming their way from insurance companies and agents are often wrapped in a safety program package. Yes, it’s necessary but far from sufficient.

Graduates of the Institute of Work Comp Advisors have learned to focus on two areas in addition to safety. The first is the hiring process and the second is the steps to take before and after an injury occurs.

Many employers are confused about what they can and cannot do during the hiring process to prevent problem claims from occurring. The Americans with Disabilities Act does not allow you to ask questions about disability or use medical examinations until after you make someone a conditional job offer. However, after making a job offer, you may ask any disability-related questions and conduct medical examinations as long as you do this for everybody in the same job category.

It is critical for employers to integrate in their hiring process two powerful hiring forms: the Conditional Offer of Employment and the Post-Offer, Pre-Placement Medical History Questionnaire.

Just as the name indicates, the Conditional Offer of Employment makes the job offer conditional upon the employee being able to perform the essential functions of the job and would not pose a direct threat (i.e., a significant risk of substantial harm) to the health or safety of themselves or others. The offer may be withdrawn, if in medical opinion, the employee poses such a threat with reasonable accommodation. (E-mail Preston Diamond at pdiamond@workcompadvisors.com for a sample Conditional Offer of Employment.)

Once the Conditional Offer is in place and before work begins, the employee should complete the Medical History Questionnaire. Some employers direct the employee to their local medical clinic to have the form completed with the assistance of a doctor, nurse or physician’s assistant.

Assuming the employee is truthful, the medical history information will go a long way to determine if the employee is fit for the job. Sometimes, an additional examination may be needed.

This process is in the best interest of all concerned. The employer, employee and the employee’s family all lose if an employee is placed in a job for which they are not fit. Injury or re-injury of a pre-existing condition is likely to happen if the employee is not suited for the job.

But, what if the prospective employee lies on the Medical History Questionnaire? At least you will have a record of the misrepresentation, which may be helpful during a future claims battle.

The second area of focus, in addition to safety and the hiring process, is the pre- and post-injury process. Many employers don’t know the steps to take before and after an injury occurs. Most will just hand off the responsibility of the injured employee to the insurance company. They simply forward a Notice of First Injury by phone, fax or e-mail to the insurance company and tell themselves, “I pay my premiums, accidents happen, and it’s their job to take care of this.”

Employers will reap huge benefits by taking a more active role in the claims process. They can take the following steps before an injury occurs:

• Train employees on how and when to report injuries.
• Select an employee to act as a Back-On-The-Job Coordinator.
• Implement a Back-On-The-Job Program.
• Establish a relationship with the local medical clinic and educate their staff on your philosophy about returning employees to work in modified jobs if necessary.

After the injury occurs, the Back-On-The-Job Coordinator must spring into action with a clearly defined plan of action. Caring and communication with all parties is the key. Most important is not to let the employee feel lost, isolated, confused or afraid. Many employees turn to attorneys for help because no one else will talk with them.

We recognize that some employees will go to an attorney before the “ink” is dry on the accident report. But, those employees account for less than 5 percent of all injured employees. Yet, the other 95 percent of injured employees often get treated with suspicion and blame which can trigger exaggeration and malingering.

It is clear that getting an employee back to work as soon as medically appropriate is critical. This will involve educating supervisors on the need to accommodate injured employees in transitional modified duty assignments. A positive and cooperative attitude of the injured employee’s supervisor sets the stage for a faster recovery to full duty and productivity.

The medical community needs to be brought onboard as an ally in assisting the employee and the employer. Most doctors have not been trained in disability management, or as we prefer to call it, ability management. Doctors will agree that returning an employee to the workplace is good therapy and the employee will heal faster if they remain active even if on a modified status.

Doctors that have been surveyed complain that they lack the necessary information to return the employee to work. They are not usually aware of the employer’s interest or ability to create modified duty assignments.

An injured employee’s initial visit to a doctor usually puts the employee in front of the doctor for six to ten minutes. Asking a doctor to diagnose and create a treatment plan as well as formulate an ability management plan is a lot to ask in that short amount of time. Advanced planning and communication with the medical community is essential to assisting the employee.

Employers should have an active safety program but should also be encouraged to go beyond a safety emphasis. Getting the right employees that are fit for the job will prevent injuries. You can have the best safety program ever created, but if the employee is not fit for the job, they will get hurt.

And, when your safety program and hiring process fails and an employee gets injured, the employer must take an active role. It is no knock on the insurance companies to suggest they can’t get the results you want alone. Only the employer, employee, supervisors and the medical community working together will bring the best results.

Frank Pennachio is the curriculum director for The Institute of WorkComp Advisors. The Institute trains and certifies insurance agents to help business owners fight overcharges caused by mistakes rampant in the workers’ compensation system. For more information, visit www.workcompadvisor.org or e-mail Preston Diamond at pdiamond@workcompadvisors.org.

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Insurance Journal West July 19, 2004
July 19, 2004
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