Involvement of top management is key to containing comp claims, costs
By actively participating in safety management activities and engaging in the claims process, employers can control and reduce their workers' comp claims and costs.
"All accidents are preventable," said Treasa Turnbeaugh, CEO of the Board of Certified Safety Professionals. "Management is responsible for preventing accidents."
Turnbeaugh was one of several presenters at the recent National Workers' Compensation and Disability ConferenceŽ & Expo.
As Turnbeaugh explained, an effective safety and health process can reduce both direct workers' comp and indirect costs, reduce the frequency of workplace accidents, increase site productivity, and improve the quality of products and services. Companies can develop a "world class safety culture" by ensuring it permeates all levels of an organization.
"Top management support is critical," Turnbeaugh said. "If it's not one of the priorities of the organization, front-line workers can't make it happen."
Top managers need to set the example of safe behavior, for example, by wearing the proper equipment when entering a company facility.
"Start off each management meeting asking about safety results within each department and expect department heads to respond to corrective measures they are taking," she said.
Companies with a safety manager have an added benefit in that the person can serve as a consultant to help the organization foster a safety culture. The safety person can make the idea of safety a priority throughout the organization "through coaching of upper management, training of supervisors in accordance to what the culture is and be there to provide support for policies and procedures," she said.
An important aspect of an effective safety and health program is regulatory compliance at a very minimum. "It's a requirement but beyond that there is a lot they can do with the culture," she said. "Regulations don't always go far enough to prevent injuries."
strategies. Despite the best efforts of organizations, injuries likely will still occur. Turnbeaugh says employers should remain involved in the process.
"One thing organizations can do themselves to help control the postinjury cost is have a good return-to-work program," she said. "It needs to be something that is productive to the organization and the individual."
Having a good working relationship with medical providers is important so they understand what the job tasks entail. In that way, employers can ensure physicians don't return injured workers to jobs in which they may reinjure themselves.
"Getting the claims people and the organization involved with physicians as soon as possible is a very important move, especially if it is a serious or catastrophic injury," Turnbeaugh said. "If you can get the team working together, the better the outcome."
The organization itself can be actively involved in understanding the care and progress of getting the worker healthy and back on the job. That may involve finding a different provider.
"One of the biggest mistakes I see organizations make is not having the correct panel of physicians in states where the employer can direct medical care," said Shannon Gardner, director of risk management for Chick-fil-A Inc. "They allow the third-party administrator or insurance carrier to drive that process."
Simply inputting the employer address into a network database to determine which occupational providers are closest will not necessarily result in selecting the best providers for the injured employee. "Claim examiners, local defense counsel, etc. should be consulted in the development of panel of physicians," she said. "These panels should be reviewed and updated at a minimum annually to ensure accuracy and ongoing appropriateness."
The next step would be for employers to engage the medical providers selected in a conversation about their business and employment-related job functions, Gardner said.
As Gardner explained, the more an organization can become involved in the claims management process, the greater the chances of success for their employees, as well as the organization as a whole.
"The first thing to understand is what the hot buttons are for the organization," she said. "Determine what pieces of the program need to be measured accordingly."
At Chick-fil-A, Gardner determined that containing costs was a big motivator. "So I evaluated my claims exposure through a loss stratification process and attacked the largest claims first, claims driving the most costs."
Two strategies she endorses are claims reviews and claims audits. "The review is what the claims administrator wants you to know," she said. "The audit is what you need to know."
Claims reviews target individual claims to drive them toward resolution.
"An audit is designed to evaluate the claims adjudication process and determine if the process is truly driving results," Gardner said. "Companies need to dive into the notes, payment history, images, etc. They need to read the letters and correspondence. Do you have Spanish-speaking employees receiving correspondence in English?"
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February 4, 2013
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