Risk Insider: Patty Hostine

What Is ‘Off Work’?

By: | May 26, 2015 • 3 min read
Patricia Hostine, MA, MBA, LPC, CRC, MSCC, CWCP, has more than 20 years’ experience in workers’ compensation from both the vendor and corporate perspectives. She is the Director of US Disability Management for The Flex N Gate Group of Companies. She can be reached at phostine@FLEXNGATE-MI.com.

Last week, I sat through a lovely presentation on FMLA processing. At one point, it was from the occupational health clinic perspective, which stated that stay at work and return to work are the first priority.

I was thinking, “Great, we’re all on the same page!” Then I realized that it was the same clinic we use. From experience, I know that’s not their past practice.

My first thought was “Why does an occupational health clinic even have a box that says ‘off work’ on the return to work slip?”

I’m a firm believer in the premise that we all have a part to play in the average workers’ compensation claim. The employee reports the injury and makes every effort toward recovery.

The employer files the claim and manages the employment relationship. The adjuster decides if the injury or accident is compensable under that specific jurisdiction with the facts as reported. Lastly, the clinic and doctors provide evaluation and treatment to get the employee to maximum medical improvement (MMI).

The hope is always that MMI is their pre-injury status, in all ways —medically, financially and emotionally the same as before the incident. This becomes difficult in the face of an ‘off work’ slip, which happens more often than it should.

This got me thinking about the nature of ‘work’ and how it impacts the employee’s ability to return to full function. The employees I’ve worked with have very specific tasks associated with their work, usually outlined by detailed work instructions. (Thank you, Quality!)

So when we get an ‘off work’ we are both surprised and dismayed. The employee now has a more difficult return to work process due to the financial burden of not being paid for the waiting period, a reduced salary and perhaps some discouragement about continuing to work for the employer. Making matters worse, the ‘off work’ slip gives no direction for what the employee should be doing to recover.

My first thought was “Why does an occupational health clinic even have a box that says ‘off work’ on the return to work slip?”

The employee goes home to heal or get treatment or use narcotics (that always keeps them off work).

What do employees do while ‘off work’? I have seen some video of employees that are not ‘working’ and they seem to perform all normal life activities. As a vocational counselor, I know that most tasks we do in everyday life are also things that other people do as an occupation.

For example, cook, fast food (DOT 313.374-010), chauffer, domestic service (DOT 359.673.010), maid (DOT 323.687-014) or laundry, domestic (DOT 302.685-010). By the way, I have just described my holiday weekend for you. I was not working but I did every one of those jobs in rotation.

It seems the only difference between work and activities of daily life is the pay. I conclude that ‘off work’ means ‘cannot do anything for pay.’

That limitation does not promote stay at work/return to work for anyone. If we can just convince doctors that ‘off work’ is a limitation that neither promotes recovery nor describes what the employee does while not working, we will all be better off.

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WC Cost Control

Non-Legislative Paths to Fix Workers’ Comp

Amid debate about legislative solutions to control workers' comp costs, let's not forget that core strategies such as modified duty programs can reap significant savings.
By: | May 4, 2015 • 3 min read
broken arm

Workers’ compensation has long been a burden to nearly all parties involved in the process. Be it the employer, injured employee or insurance company, few feel like they’re getting the fair end of the deal. It’s no surprise states across the country are taking a stab at legislative changes to improve the workers’ compensation system.

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Consider Tennessee. Not even a year after enacting workers’ comp reform, legislators are proposing to allow private employers to opt out of the traditional workers’ compensation plans in favor of writing their own rules.

While the driving force is to reduce the high costs typically associated with workers’ comp claims, it should be known that legislation is far from the only way to curb these costs. While there are multiple proactive back-end strategies, one of the most effective methods to significantly reduce claims costs is to enforce a well-defined modified duty program.

Beating Time, Saving Money, Reducing Risk With Modified Duty 

Time is the main culprit behind the high cost of workers’ comp. When employees remain off the clock, the financial burden of a claim quickly snowballs. Consider that lost time alone accounts for about 94 percent of typical claim costs. Implementing a modified duty program to get injured employees back to work sooner – even in a limited physical capacity – is essential to addressing this costly problem.

Not only does indemnity increase with every day an injured employee remains at home, it also becomes more likely that other issues will arise that can compound costs. Injured employees who remain at home for long periods of time to heal are more likely to fall victim to depression, weight gain or prolonged healing from remaining inactive, which in turn, keeps medical expenses and lost time expenses accumulating.

Without modified duty, costly litigation is also more likely to happen because of secondary medical issues arising or the breakdown of employer communication that can occur when an employee is out of the office.

Yet, a pre-determined, stringent modified duty allows injured employees to heal in a manner that:

  1. is approved by a physician
  2. gets an injured employee physically active and socially stimulated
  3. keeps communication open with employers and
  4. demonstrates value to judicial and medical officials as permanent or temporary impairment ratings are delivered.

It’s important for a modified duty program to be in place before an employee gets injured to eliminate confusion and, ultimately, prevent additional lost time.

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Work with employers to create modified job descriptions that accommodate a wide variety of injuries, including the inability to use one’s back, hands or legs, and keep them accountable to the program. Even if an injured employee does not live in the same area as the employer, as is often the case with truck drivers, for instance, he may be able to perform work for a local non-profit agency as a way to earn credit for modified duty.

While modified duty may be just one cog in the machine to reduce workers’ compensation claims costs, it can be the key to reducing significant expenses, removing the need for a legislative crutch.

Corey Lile is the founder and CEO of OccuSure Workers’ Compensation Specialists, a Brentwood, Tennessee-based Managing General Agent specializing in lowering workers’ compensation claims. He can be reached at clile@occusure.com.
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Sponsored Content by CorVel

RIMS Recap: Tech Trends that Could Change Everything

The future is here, and emerging technology is transforming the landscape of workers' compensation.
By: | May 8, 2015 • 5 min read
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Last month, Gordon Clemons, CEO and Chairman of CorVel Corporation, presented at the RIMS Conference in New Orleans, La. about emerging technology and how it is impacting risk management and workers’ compensation. The discussion served as a springboard for new insights on how technology will change the industry, and reaffirmed the need for integrated systems and human interaction for the best results.

The presentation noted the future is here – and technology is constantly evolving in hopes of outpacing tomorrow’s needs. As these technology platforms become more inherent in daily life, the gap in translating their utilization to workers’ compensation will begin to close.

Technology in Healthcare

Gordon Clemons, CEO and Chairman, CorVel Corporation

While many consumer-based technology advancements exist in other industries, perhaps most notably in the retail space helping vendors to reduce various delays in the sales experience, people may forget that healthcare, too, is a consumer industry. And as such, healthcare also experiences workflow lags, which can be collapsed.

While patients and claims may not lend themselves as freely to mobile applications and technology that subscribes to the “Internet of Things” philosophy, the rapid rate of development foretells the not-too-far-off arrival of the “a-ha,” “wow factor”-type application that consumers are seeking in the healthcare industry.

Once we get there, we can only expect that the Pangea of resources will yield better outcomes. The potential impact to medical management includes more affordable/accessible healthcare, patient convenience, personal assistance, automatic inputs to claims systems and less administration from both patients and injured workers.

“Healthcare is stubborn about change. There are more data points in healthcare and there is a greater need for high quality and accuracy,” Clemons said.

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Tech Trends for the Next Digital Decade

As an industry advocate in all things innovation, CorVel has been keeping tabs on emerging tech trends. As they begin to influence in other industries, it sparks the question – will they eventually change workers’ compensation?

Here are some of the trends on CorVel’s radar:

Wearables

Smart phones and tablets were the first mobile devices to really start to gain traction across people’s personal lives. Since then, wearables (like Fitbits and smart watches) have been part of the next digital generation to be taken up by consumers.

As these personal devices quickly advance, wearables could offer payors and employers added insight into the wellness of claimants through the extent of their retrievable data.

Beacons

Beacons are devices that use low-energy Bluetooth connections to communicate messages or triggers directly to a smart device (such as a phone or tablet). Retailers have started using this technology, sending offers to near-by consumers’ phones. Now the concepts of smart mirrors and smart walls offer a one-stop-shop with recommendations related to the preferences of the shopper – making a hyper-efficient business model. It is possible that we could see these devices adapted to being a catalyst for healthcare’s business model by reducing the delays of administrative work.

Drones

Formally known as unmanned aerial vehicles (UAV), drones can be remote-controlled or flown autonomously through pre-defined flight plans within their internal systems. Some carriers are testing the use of drones to potentially be used to evaluate property damage and responding to natural disasters.

Telemedicine

As most injuries reported in workers’ compensation are musculoskeletal injuries, the industry lends itself well to the benefits of telecommunications and telemedicine. With the rise of electronic capabilities, telemedicine becomes another option to help guide an injured worker through their entire episode of care, reducing time delays.

In order to get to that point in time, implementing these trends (and those that are yet to be launched) will only be as successful as the population willing to accept them. Buy-in will require a commitment to the long-standing pillars of the industry. According to Clemons, “While technology can truly move the needle in workers’ compensation, it will take more than bells and whistles to maximize its impact.”

“People’s feelings are valid. The skepticism surrounding new technology is not misplaced, but neither is the enthusiasm,” Clemons said.

New Trends, Same Priorities

SponsoredContent_CorVelBeyond the buzzwords and hype surrounding the latest apps and devices, for new technology to succeed within the workers’ compensation realm, it boils down to the two primary concepts that drive the industry to begin with – effective infrastructure and a people-first philosophy.

The power of applicable resources and the actionable data that results from them is in the foundation of the systems themselves; that primarily being through the influence of integration. It is not a new concept; however, as technology advances and the reach of analytic capabilities broadens, it is important to find a provider that can harness this data and channel it into effective workflows to increase efficiencies and promote better outcomes.

CorVel’s proprietary claims management system has been developed and supported by an in-house, full-time information systems division to be intuitive and user-friendly. Complex, proprietary algorithms link codified data across the system, facilitating collaboration between services, workflows, customers, and technology and eliminating the risk that a crucial piece of information will be missed. The result is an active “ecosystem” providing customers with actionable data to provide the most accurate, comprehensive picture at any time, while also collapsing inherent delays.

For the injured worker, the critical human touch connection in the workers’ compensation process can never be minimized. By cutting lag time throughout the various inefficiencies underlying the industry’s workflows, CorVel can connect injured workers with quality care sooner. As systems advance, claims and managed care associates do not have to spend as much time on administrative work and will instead be able to devote more time to the injured workers, reviving the human touch aspect that is just as impactful within the industry.

Regardless of the technology that lies ahead, CorVel looks to the future with investments in innovation, while not losing sight of their role and responsibility to clients and patients. Dedicated to constant improvement for the services they provide injured workers and industry payors, CorVel is committed to improving industry services one app, click, drone (or whatever is yet to come) at a time – perhaps something to discuss in San Diego at next year’s RIMS conference.

For more information, visit corvel.com.

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This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with CorVel Corporation. The editorial staff of Risk & Insurance had no role in its preparation.




CorVel is a national provider of risk management solutions for employers, third party administrators, insurance companies and government agencies seeking to control costs and promote positive outcomes.
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