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Insurance Manager
Virginia Workers' Compensation Commission

Playing it Safe, Straight and Fair

To this day, people in Vermont are still talking about the manager who reversed her approach and assumed employers cared but simply didn't know.


Powerful tools for workplace safety were piling up by the hundreds inside the Vermont Department of Labor.

They were "First Reports of Injury," documents filed by companies as part of the workers' compensation process -- but largely ignored until Laura Collins began flipping through them in the early 2000s when she worked for Vermont's workers' comp program.

The reports described injuries, the times they took place, the equipment involved and other crucial details. Collins was struck by the prevalence of injuries that could have been prevented, and she began urging employers to mine the documents for data.

"It's actually invaluable information, and it's unique for each company," she said.

Collins has moved on -- she now is insurance manager for the Virginia Workers' Compensation Commission -- but she remains an advocate of sifting through first reports of injury in search of clues to prevent accidents.

The idea sounds simple: look at routine documents to identify and reduce risks in the workplace. But for many employers, it's a revelation, Collins said.

Most companies feel they have little control over workers' compensation, she said. They file injury reports with their insurers, but they don't understand how their experience affects their premiums, or they spend more time worrying about what happens after an employee is hurt, she said.

"They question the claim and what's going on in the claim rather than focusing on what they can do to prevent this again," Collins said.

Employers may face another obstacle depending on who is responsible for filing reports. They may originate in human resources rather than departments charged with overseeing safety, Collins said.

"I'm sure there are good, safe employers where safety managers take into consideration first reports of injury, and they sure should look at their claims, particularly their higher-cost claims," Collins said. "But generally speaking, it's just not something that's done."

Once employers start looking, they are able to cut down on injuries and save money on workers' comp premiums, she said. "The employer actually has so much more control than they realize."

In addition to promoting a closer look at first reports, Collins collaborated with Vermont's largest employers and connected smaller employers with a state-funded program, called Project WorkSAFE, that offers free safety consulting.

As a state official, Collins struck the right balance between labor and business, said Doug Robie, risk manager for DEW Construction Corp., a contractor in Williston, Vt., that worked closely with Collins and Project WorkSAFE. In 2005, DEW became the first Vermont business to receive a Governor's Award for Outstanding Workplace Safety in the large employer category.

"She played it straight, and she played it fair," Robie said.

Statewide, the results have been dramatic, said a former co-worker, Trudy Smith, a vocational rehabilitation specialist in the Vermont Department of Labor. The agency used to collect between 25,000 and 26,000 first reports of injury per year. Today the number is closer to 17,000.

"She didn't make the assumption that a lot of our directors have made, that the employer knows and just doesn't care," Smith said. "She went with the opposite assumption: the employer cared and didn't know."

Project WorkSAFE, meanwhile, continues to see an uptick in inquiries, fueled by word of mouth from satisfied employers, Smith said. "People are still saying, 'Go to Project WorkSAFE. They can help you out.'"

Smith herself has benefited from Collins' focus on workplace safety. As a supervisor, Collins helped Smith find a position inside the agency that addressed a recurring pain issue, Smith said.

"That's the way she was as a boss and as a director," Smith said. "She wanted to try to prevent the injury from occurring instead of dealing with the fallout from an injury. Of course, you're never going to have an injury-free workplace. People are going to get hurt. People are going to lift boxes that are far too heavy for them, even if they've been informed of what they should and shouldn't do. But she wanted to make sure that employers at least had the information."

Collins spent a decade as a personal-injury attorney before entering state government in 2000 as director of Vermont's workers' compensation program. She spent four years in workers' comp before moving up in the Labor department, eventually becoming the agency's commissioner. She moved to New Hampshire in 2006, then to Virginia in 2010. In Virginia, Collins has continued to peel back problems, identify the sources and fix them, said Suzanne Soule, an assistant manager in the state's workers' compensation commission. Collins is her supervisor. "She's definitely made an impact," Soule said.
-- By Joel Berg

President
Emerge Diagnostics

Changing the Injury Assessment Game

An innovative assessment of soft-tissue damage both before and after an incident is making a big impact on workers' comp costs.


Advocates of Dr. MaryRose Reaston's Electrodiagnostic Functional Assessment test say it has the potential to do nothing less than revolutionize worker's compensation.

"I believe this technology she has created will be a game changer in the work comp industry," said Jerry Suther, workers compensation manager at Heartland Express, a national trucking company based in North Liberty, Iowa. "I think it's that unique and significant."

Added Judi Tipps, workers' compensation manager at Johnsburg, Ill.-based Lankford Construction, a nationwide company: "It's the only soft-tissue test of its kind. It can basically tell you whether a person has a muscular or neurological problem. It can really tell me if it's [a work-related] injury ... . And it's the only test like this that is FDA-approved. One of these days everybody is going to know what this is."

Known by the EFA acronym, the test diagnoses and assesses soft-tissue damage of ligaments, tendons and muscles, commonly referred to as sprains and strains -- ailments that have proven to be very difficult to accurately diagnose and assess and represent the highest incident rate, lost days and medical costs in the workers' compensation system.

Dr. Reaston's quest to develop the EFA began when she was in a car accident and discovered there was no reliable way to test for soft-tissue damage.

"The EFA is a medical test that combines five medically accepted tests," she said. "It makes [the tests] better, it makes them non-invasive and it makes them more reproducible. It looks at muscle activity and basically integrates that with range of motion and function.

"We can look at any muscle in the body doing anything and then we can evaluate the amount of muscle compensation and muscle patterns that look at acute injuries or chronic injuries," she added.

Dr. Reaston also has developed a system of checks and balances for the test so a baseline assessment of individuals can be compared with a functional assessment after an event involving moving, lifting, pulling or pushing, etc.

"It kind of creates a physiological picture of everything the body is doing relative to soft-tissue injuries," she noted.

Both employees and employers benefit from the EFA, she said.

Dr. Reaston said she and her husband, Phil, who serves as chief technology officer at their company, Emerge Diagnostics, developed the EFA so people could get proper care. Later, they developed it to help level the playing field in the worker's compensation field.

"If an employee says he can do the job, we say, 'Absolutely. We can trust you,' " she said, noting that an EFA test is taken, but not read at that time. "But if there is an injury, the test is repeated on a post-op basis and a comparison is made.

"If there's no change, there's no claim," she observed. "That's the advantage to the employer. If there is a change, then the individual gets the right care from Day One. That's the program we started a year ago and we have done more than 2,000 baseline tests in difficult jurisdictions with no post-loss claims."

Dr. Reaston underscored her belief that injuries related to work should definitely be taken care of by the employer. If it's not related to work, however, it should be taken care of by the private health care sector, she noted.

"She has actually reformed our whole workers' comp claims system," said Judi Tipps at Lankford Construction. "We have thoroughly incorporated her technology into our program. If any of our people get hurt, they automatically take the EFA test. And because of that, we have actually been on top of our claims."

Tipps noted that, on a personal level, Dr. Reaston is always available. "You can pick up the phone and always be able to talk to her at any time."

Added Jerry Suther at Heartland Express: "What Dr. Reaston has developed is encouraging because all that's often being used currently are radiology tests that can't specifically identify soft-tissue injuries per se. There are a lot of false positives involved with that and so the EFA can pinpoint whether or not a person has an acute injury and, if so, the specific injury to that muscle."

Suther noted his company has used the EFA technology to take baselines of its employees, creating a snapshot of an employee's current condition.

"So if they have a soft-tissue injury while working for us we can do a post-EFA test and then do a comparison between those two tests," he noted.

--By Steve Yahn

Giving People Their Lives Back

Dr. MaryRose Reaston, president of Tulsa, Okla.-based Emerge Diagnostics and founder of Insight Diagnostics Inc., has spent so much time finding ways to diagnose soft-tissue injury that she often feels like a physician.

Injured workers have often come up to Reaston and thanked her for her healing powers in the middle of a trade show. "People feel like they have their lives back," Reaston said.

Indeed they do. As anyone suffering from musculoskeletal damage to tendons, ligaments and muscles knows, such injuries are painful and tedious.

Diagnosing the damage isn't as easy as it sounds, and it's entrepreneurs like Reaston who move the industry forward. Her strategies and techniques to tackle the billion-dollar challenges posed by soft-tissue injuries may also yield benefits in the fight against other diseases like multiple sclerosis not normally associated with workers' comp.

Reaston, a founding member of the Nevada Disability Prevention Coalition, serves on the board of that organization. She is also a member of the International Society of Electrophysiology and Kinesiology.

-- By Cyril Tuohy