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EXECUTIVES IN WORKERS COMPENSATION MAGAZINE ISSUE NO 4 WINTER 2020 EWC MAGAZINE EDUCATION STRATEGIES AND RESOURCES Rising above How to be a best place to work By Sabrina Darsey a safety state of mind MOVING BEYOND AWARENESS BY GARY L JARVIS communicating decisions effectively BY D DIANN COHEN legal experts SPECIAL ADVERTISING SECTION
CONTENTS 23 18 21 34 39 2 From the Editor 28 Management Skills 3 Workers Compensation 28 Communicating Decisions Effectively By D Diann Cohen 3 A Safety State of Mind Moving Beyond Awareness By Gary L Jarvis 7 Legal Experts A special advertising section that highlights exceptional law firms specializing in Workers Compensation 18 Workers Compensation 18 A New Approach to TBI Recovery Brain Injury Rehabilitation and Substance Misuse Treatment Contributed by Centre for Neuro Skills 21 Settling Claims by Focusing on the Future for Injured Individuals By Porter Leslie 23 The MSA Blind Spot By John V Cattie Jr 26 Return to Work Keys for Success By Beth Burry www ewcconference com ewc magazine 30 Rising Above How to Be a Best Place to Work By Sabrina Darsey 32 In the Spotlight One minute with industry leaders 34 Risk Management 34 Indicators of Excellence By David B Dolnick 37 Doctor s Perspective 37 Workers Compensation Claims and Nurse Triage By Lester Sacks MD PhD 39 Legal 39 The Independent Bill Review System By Paul C Herman and Aidan P McShane 41 Carl s Corner Negotiation tips for the claims professional 44 Resource and Panel Guide The one stop resource you ll want to keep year round Whether you need a service provider to add to your panel or to help with an immediate need please call on these companies to assist you 1
CONTENTS 23 18 21 34 39 2 From the Editor 28 Management Skills 3 Workers Compensation 28 Communicating Decisions Effectively By D Diann Cohen 3 A Safety State of Mind Moving Beyond Awareness By Gary L Jarvis 7 Legal Experts A special advertising section that highlights exceptional law firms specializing in Workers Compensation 18 Workers Compensation 18 A New Approach to TBI Recovery Brain Injury Rehabilitation and Substance Misuse Treatment Contributed by Centre for Neuro Skills 21 Settling Claims by Focusing on the Future for Injured Individuals By Porter Leslie 23 The MSA Blind Spot By John V Cattie Jr 26 Return to Work Keys for Success By Beth Burry www ewcconference com ewc magazine 30 Rising Above How to Be a Best Place to Work By Sabrina Darsey 32 In the Spotlight One minute with industry leaders 34 Risk Management 34 Indicators of Excellence By David B Dolnick 37 Doctor s Perspective 37 Workers Compensation Claims and Nurse Triage By Lester Sacks MD PhD 39 Legal 39 The Independent Bill Review System By Paul C Herman and Aidan P McShane 41 Carl s Corner Negotiation tips for the claims professional 44 Resource and Panel Guide The one stop resource you ll want to keep year round Whether you need a service provider to add to your panel or to help with an immediate need please call on these companies to assist you 1
WORKERS COMPENSATION From the Editor Cheers to five years A s we collectively celebrated the arrival of the New Year and more profoundly of a new decade we at EWC had added cause for celebration This year marks the fifth anniversary of The Executives in Workers Comp Conference Reaching this milestone has prompted me to reflect on the reasons I started The Executives in Workers Comp five years ago and to contemplate what s ahead EWC was born out of a twofold vision I wanted to host a symposium that would provide education for upper and middle management I also envisioned a platform to expose executives to business partners that could help them with their pain points Whether industry professionals were looking for cost containment solutions or a quicker turn around time in their processes I aspired to design a forum that would facilitate open discussions about their challenges and lead to solutions to their problems Along with having an open dialog with service providers I wanted to offer outstanding education with tips and takeaways so that attendees could apply the information to their jobs immediately I have been told many times by worker s comp and risk management professionals that they love the fact that in every session they know they are going to learn useful tips and tools that they can apply to their jobs It was the inspiration for this magazine also and I hope that as you read through you ll find tips and takeaways to help with your job EWC s mission has always had service at its core Going forward we aim to be your go to resource from our annual conferences to our magazine with its informative articles and helpful Legal Experts section and Resource Panel Guide This issue in particular is bursting with information useful for your work life This anniversary celebration also offers the perfect opportunity for me to express my appreciation to those who have helped make this an unforgettable five years Specifically to our amazing sponsors and exhibitors A profound thank you for your business and continued support throughout the years I ve been enriched personally and professionally by people who serve our industry in various ways many of you have also become trusted friends and advisors You have been critical to EWC s growth and success and I look forward to working with you in the coming years And to our board members The Small Business Administration states that 30 percent of new businesses fail during the first two years of being open and 50 percent fail during the first five years For an organization to beat the odds and remain in business for five years requires the support of an extraordinary team and I am beyond grateful to have you aboard I am deeply appreciative of the opportunity to partner with such talented passionate and loyal colleagues who are committed to impacting our industry Thank you for your unwavering dedication and the outstanding relationship we share You are the best Here s to celebrating the next successful chapter together While the arrival of this new year and new decade have been a time of reflection it is also a season of looking ahead There are unique challenges fresh opportunities and the need for new skills EWC was built with those needs in mind and we look forward to meeting those challenges With our contacts in the industry we re in position to tap the expertise of your colleagues and draw on insights from our network of business leaders And while new challenges and issues will inevitably arise in the coming months one thing at EWC won t change our commitment to providing resources and education to equip you for the year ahead I look forward to meeting the challenges of 2020 with you Debra Hinz Editor in Chief Art Director Managing Editor Hannah Peacock Lacey Atkinson To advertise contact info ewcevents com 760 613 4409 l 2 EWC Magazine A Safety State of Mind Moving Beyond Awareness By Gary L Jarvis Facilitator and Thought Leader at Qualifying America s Workers S afety is an awareness but it is also a state of mind Safety compliance is mandated however questionably effective So how do you develop a safety state of mind Traditional risk management safety training and hiring processes may be working to an extent and are essential to the safety discipline and reducing losses But we still have losses If you continue to experience claims but your goal is to have zero claims or a substantial and sustainable reduction in claims your safety program or safety training may be incomplete But more likely your hiring processes are deficient Safety and hiring processes start in the same place as everything else in the workplace with the human resources department Human resources departments are charged with the hiring process This process includes recruiting interviewing hiring onboarding and ensuring safe placement by physical abilities qualifying criteria to reduce the potential of injury Those are more than mere words they are safetyoriented words They have meaning they reflect the company culture the company s hiring reputation whether the company is safe the company s corporate community responsibility and integrity and most importantly the employees safety Human resources departments along with safety and risk management www ewcconference com ewc magazine and operations forge the direction by incorporating those words This ensures every employee is qualified to meet the physical demands required to successfully perform the essential functions of the job allowing safe placement Otherwise how do you know the person you are hiring can perform the physical tasks required of the job Determining this requires a different hiring process it is a safety process and is perceived as a safety process by applicants New hires and incumbent employees have a reasonable expectation of unconditionally safe work practices safe work conditions and safe placement in a job they qualified for By demonstrating that their physical abilities meet the physical demands of the job employees have a reduced potential for injury When non qualified workers are placed randomly in jobs they cannot handle you are handing them a gift permission to incur an injury in a position with a known history of being hazardous Isn t it time to look at other avenues I believe prudent human resources departments and safety and risk managers will answer yes Those with foresight will continually consider quality and operational improvements in protecting our most valuable and costly asset our human capital It makes sense to 3
WORKERS COMPENSATION From the Editor Cheers to five years A s we collectively celebrated the arrival of the New Year and more profoundly of a new decade we at EWC had added cause for celebration This year marks the fifth anniversary of The Executives in Workers Comp Conference Reaching this milestone has prompted me to reflect on the reasons I started The Executives in Workers Comp five years ago and to contemplate what s ahead EWC was born out of a twofold vision I wanted to host a symposium that would provide education for upper and middle management I also envisioned a platform to expose executives to business partners that could help them with their pain points Whether industry professionals were looking for cost containment solutions or a quicker turn around time in their processes I aspired to design a forum that would facilitate open discussions about their challenges and lead to solutions to their problems Along with having an open dialog with service providers I wanted to offer outstanding education with tips and takeaways so that attendees could apply the information to their jobs immediately I have been told many times by worker s comp and risk management professionals that they love the fact that in every session they know they are going to learn useful tips and tools that they can apply to their jobs It was the inspiration for this magazine also and I hope that as you read through you ll find tips and takeaways to help with your job EWC s mission has always had service at its core Going forward we aim to be your go to resource from our annual conferences to our magazine with its informative articles and helpful Legal Experts section and Resource Panel Guide This issue in particular is bursting with information useful for your work life This anniversary celebration also offers the perfect opportunity for me to express my appreciation to those who have helped make this an unforgettable five years Specifically to our amazing sponsors and exhibitors A profound thank you for your business and continued support throughout the years I ve been enriched personally and professionally by people who serve our industry in various ways many of you have also become trusted friends and advisors You have been critical to EWC s growth and success and I look forward to working with you in the coming years And to our board members The Small Business Administration states that 30 percent of new businesses fail during the first two years of being open and 50 percent fail during the first five years For an organization to beat the odds and remain in business for five years requires the support of an extraordinary team and I am beyond grateful to have you aboard I am deeply appreciative of the opportunity to partner with such talented passionate and loyal colleagues who are committed to impacting our industry Thank you for your unwavering dedication and the outstanding relationship we share You are the best Here s to celebrating the next successful chapter together While the arrival of this new year and new decade have been a time of reflection it is also a season of looking ahead There are unique challenges fresh opportunities and the need for new skills EWC was built with those needs in mind and we look forward to meeting those challenges With our contacts in the industry we re in position to tap the expertise of your colleagues and draw on insights from our network of business leaders And while new challenges and issues will inevitably arise in the coming months one thing at EWC won t change our commitment to providing resources and education to equip you for the year ahead I look forward to meeting the challenges of 2020 with you Debra Hinz Editor in Chief Art Director Managing Editor Hannah Peacock Lacey Atkinson To advertise contact info ewcevents com 760 613 4409 l 2 EWC Magazine A Safety State of Mind Moving Beyond Awareness By Gary L Jarvis Facilitator and Thought Leader at Qualifying America s Workers S afety is an awareness but it is also a state of mind Safety compliance is mandated however questionably effective So how do you develop a safety state of mind Traditional risk management safety training and hiring processes may be working to an extent and are essential to the safety discipline and reducing losses But we still have losses If you continue to experience claims but your goal is to have zero claims or a substantial and sustainable reduction in claims your safety program or safety training may be incomplete But more likely your hiring processes are deficient Safety and hiring processes start in the same place as everything else in the workplace with the human resources department Human resources departments are charged with the hiring process This process includes recruiting interviewing hiring onboarding and ensuring safe placement by physical abilities qualifying criteria to reduce the potential of injury Those are more than mere words they are safetyoriented words They have meaning they reflect the company culture the company s hiring reputation whether the company is safe the company s corporate community responsibility and integrity and most importantly the employees safety Human resources departments along with safety and risk management www ewcconference com ewc magazine and operations forge the direction by incorporating those words This ensures every employee is qualified to meet the physical demands required to successfully perform the essential functions of the job allowing safe placement Otherwise how do you know the person you are hiring can perform the physical tasks required of the job Determining this requires a different hiring process it is a safety process and is perceived as a safety process by applicants New hires and incumbent employees have a reasonable expectation of unconditionally safe work practices safe work conditions and safe placement in a job they qualified for By demonstrating that their physical abilities meet the physical demands of the job employees have a reduced potential for injury When non qualified workers are placed randomly in jobs they cannot handle you are handing them a gift permission to incur an injury in a position with a known history of being hazardous Isn t it time to look at other avenues I believe prudent human resources departments and safety and risk managers will answer yes Those with foresight will continually consider quality and operational improvements in protecting our most valuable and costly asset our human capital It makes sense to 3
WORKERS COMPENSATION identify upfront the new hire s capacity to perform the physical demands of the job The bottom line is this the companies that embrace these concepts have reduced or eliminated incidents in known high risk jobs and for the most part do not have a shortage of workers or recruitment challenges They maintain a pool of qualified workers to reach out to when needs arise offering what every employee seeks an opportunity for a safe hire or qualified advancement A useful tool for transforming employees from being safety aware to operating in a safety driven state of mind is a health care awareness known as Well Being Awareness This is an adjutant awareness of potential health issues that are known not known or known but not treated Well Being Awareness also allows employers to control the impact of health issues on workers compensation incidence related costs and health care benefits utilization costs We define policies procedures programs and practices that integrate protection from work related safety and health hazards in concert with the injury and illness prevention program and the workers Well Being Awareness The difference between wellness programs and Well Being Awareness is that one does something to you and is associated with exorbitant costs and questionable results The other does something for you by identifying potential or existing health issues making the employee aware of their options instilling awareness and providing the means to intervene on the employee s behalf During the new hire ability qualifying process specific metrics are obtained This data is shared only with the new hire and is the basis for providing awareness of potential medical conditions Metabolic obesity thyroid and cardiac high blood pressure issues the most common and most costly conditions are precursors for stroke and heart attack but would not preclude employers from hiring Without qualifying criteria you likely would hire the applicant but would not know about the potential safety and health issues that could be present leaving the conditions untreated and the employee s health awaiting a system failure It is interesting to discover that many individuals have preexisting medical conditions and did not know or the condition is known to the individual but it has been untreated On the positive side the awareness is turned into the new hire s action plan of continued awareness education and seeking medical care usually a lifesaver particularly when accompanied by early intervention The steward of safety management is the employer employee partnership This collaboration happens when the employer embraces responsibility for the employee s knowledge of safety practices and proper immediate injury care The process strengthens the employer employee relationship allowing open communication concerning partnering on safety practices and conditions and injury reduction Well Being Awareness promotes a healthier workforce and reduces health benefitutilization costs Additionally the employee feels the employer cares about them and their safety by investing in safe work placement and by taking an interest in their total health and well being This awareness spills over to the worker s family through early interventions not commonly practiced a win for all The process of safe work placement is like going to the gym where 4 EWC Magazine www ewcconference com ewc magazine a trainer sets you up initially with safe lifts and progresses you over time The same happens in the workplace The qualifying lift criteria are the baseline allowing an employee the opportunity to increasingly qualify for additional job positions that require progressively demanding performance The data supports the fact that employees can qualify for more physically demanding positions after eight weeks of work performance The positive effects of employee employer partnering are evident in an employee s work safety mindedness increased performance and proper job matching Safety management a job description requirement is a joint effort for all to identify report and become involved in reducing work related incidents and costs improve retention and transfer the legal liability to a third party when possible The most efficient and practical time to implement safety measures is at the point of hire The most effective method of reducing injuries is to hire persons who can qualify for highrisk jobs by demonstrating they have the physical ability to meet the physical demands required to perform the essential functions of the job There are several jobs particularly those requiring repetitive manual product or patient handling that have substantial physical requirements to complete the job tasks Ideally the employer will reduce these demands through ergonomic job re designs where possible Unfortunately not all demands can be eliminated New hire candidates with insufficient physical ability to meet the demands are at increased risk of injury when they are placed on these jobs They are less likely to be satisfied with the level of physical requirements they must meet to perform the tasks resulting in a disgruntled fatigued and frustrated worker As a basic business necessity human resources safety management and risk management must meet the employer s need for all new hires to be able to safely perform their job ensuring the retention of long term employees The components of a multidisciplinary safety and risk management operations and human resources department and ergonomically designed qualifying criteria are job analysis strength demands and endurance demands The first step in the job analysis process is to identify those essential functions within the job that appear to be physically demanding Physical demands arise from the performance of specific tasks e g lifting a heavy box and from the overall physiological impact of all the tasks performed over an entire shift It is important to note the emphasis on entire shift Fatigue is among the leading causations of injury Information regarding strength demands is obtained through interviews with workers and their supervisors and by taking measurements of the loads required by the job This information also includes the frequency of handling how an item is handled and the region of the body in which it is handled e g floor level knee level mid chest shoulder and above Whole body dynamic strength testing is used in the qualifying criteria This type of strength testing is more functional and allows the person to perform the qualifying criteria in the same manner as when lifting on the job A whole body strength criteria of ability to lift would allow females and older males to compensate for upper body weakness by using the legs so whole body testing would be 5
WORKERS COMPENSATION identify upfront the new hire s capacity to perform the physical demands of the job The bottom line is this the companies that embrace these concepts have reduced or eliminated incidents in known high risk jobs and for the most part do not have a shortage of workers or recruitment challenges They maintain a pool of qualified workers to reach out to when needs arise offering what every employee seeks an opportunity for a safe hire or qualified advancement A useful tool for transforming employees from being safety aware to operating in a safety driven state of mind is a health care awareness known as Well Being Awareness This is an adjutant awareness of potential health issues that are known not known or known but not treated Well Being Awareness also allows employers to control the impact of health issues on workers compensation incidence related costs and health care benefits utilization costs We define policies procedures programs and practices that integrate protection from work related safety and health hazards in concert with the injury and illness prevention program and the workers Well Being Awareness The difference between wellness programs and Well Being Awareness is that one does something to you and is associated with exorbitant costs and questionable results The other does something for you by identifying potential or existing health issues making the employee aware of their options instilling awareness and providing the means to intervene on the employee s behalf During the new hire ability qualifying process specific metrics are obtained This data is shared only with the new hire and is the basis for providing awareness of potential medical conditions Metabolic obesity thyroid and cardiac high blood pressure issues the most common and most costly conditions are precursors for stroke and heart attack but would not preclude employers from hiring Without qualifying criteria you likely would hire the applicant but would not know about the potential safety and health issues that could be present leaving the conditions untreated and the employee s health awaiting a system failure It is interesting to discover that many individuals have preexisting medical conditions and did not know or the condition is known to the individual but it has been untreated On the positive side the awareness is turned into the new hire s action plan of continued awareness education and seeking medical care usually a lifesaver particularly when accompanied by early intervention The steward of safety management is the employer employee partnership This collaboration happens when the employer embraces responsibility for the employee s knowledge of safety practices and proper immediate injury care The process strengthens the employer employee relationship allowing open communication concerning partnering on safety practices and conditions and injury reduction Well Being Awareness promotes a healthier workforce and reduces health benefitutilization costs Additionally the employee feels the employer cares about them and their safety by investing in safe work placement and by taking an interest in their total health and well being This awareness spills over to the worker s family through early interventions not commonly practiced a win for all The process of safe work placement is like going to the gym where 4 EWC Magazine www ewcconference com ewc magazine a trainer sets you up initially with safe lifts and progresses you over time The same happens in the workplace The qualifying lift criteria are the baseline allowing an employee the opportunity to increasingly qualify for additional job positions that require progressively demanding performance The data supports the fact that employees can qualify for more physically demanding positions after eight weeks of work performance The positive effects of employee employer partnering are evident in an employee s work safety mindedness increased performance and proper job matching Safety management a job description requirement is a joint effort for all to identify report and become involved in reducing work related incidents and costs improve retention and transfer the legal liability to a third party when possible The most efficient and practical time to implement safety measures is at the point of hire The most effective method of reducing injuries is to hire persons who can qualify for highrisk jobs by demonstrating they have the physical ability to meet the physical demands required to perform the essential functions of the job There are several jobs particularly those requiring repetitive manual product or patient handling that have substantial physical requirements to complete the job tasks Ideally the employer will reduce these demands through ergonomic job re designs where possible Unfortunately not all demands can be eliminated New hire candidates with insufficient physical ability to meet the demands are at increased risk of injury when they are placed on these jobs They are less likely to be satisfied with the level of physical requirements they must meet to perform the tasks resulting in a disgruntled fatigued and frustrated worker As a basic business necessity human resources safety management and risk management must meet the employer s need for all new hires to be able to safely perform their job ensuring the retention of long term employees The components of a multidisciplinary safety and risk management operations and human resources department and ergonomically designed qualifying criteria are job analysis strength demands and endurance demands The first step in the job analysis process is to identify those essential functions within the job that appear to be physically demanding Physical demands arise from the performance of specific tasks e g lifting a heavy box and from the overall physiological impact of all the tasks performed over an entire shift It is important to note the emphasis on entire shift Fatigue is among the leading causations of injury Information regarding strength demands is obtained through interviews with workers and their supervisors and by taking measurements of the loads required by the job This information also includes the frequency of handling how an item is handled and the region of the body in which it is handled e g floor level knee level mid chest shoulder and above Whole body dynamic strength testing is used in the qualifying criteria This type of strength testing is more functional and allows the person to perform the qualifying criteria in the same manner as when lifting on the job A whole body strength criteria of ability to lift would allow females and older males to compensate for upper body weakness by using the legs so whole body testing would be 5
WORKERS COMPENSATION a direct measure of the ability to meet job requirements and safely perform the job Whole body testing would also have a less adverse impact on females and older males at least relative to isolated strength testing The endurance demands parameters are obtained through energy expenditure measurements Working muscles require oxygen to perform the dynamic contractions involved during extended repetitive manual materials product and patient handling The energy expenditure requirement is typically measured by determining the amount of oxygen consumed in the course of performing the work In the jobs of interest in these studies it was important to study the energy expenditure over the course of the shift Total Worker Health is a system developed by the National Institute for Occupational Safety and Health to control the impact of workers compensation incidence related costs and health care benefits utilization costs through awareness Total Worker Health is defined as policies procedures programs and practices that integrate protection from work related safety and health hazards in concert with an injury and illness prevention program and the workers Well Being Awareness Recruiting for community workforce shortages is challenging How does qualifying workers help First it enhances the company s community reputation of promoting safety and fostering a safety culture that is dictated by and distributed among the workforce The concept is equivalent to consumer satisfaction if the product has a poor performance history the word gets around The same is true for the company Further LEGAL EXPERTS when employees experience the company caring for their safety and well being and the company introduces measures to reduce the potential exposure of the employee to injury by proper qualifying criteria and safe job placement this effort becomes noticeable and communicable among workers peers and community job seekers Coveted statements by employees such as A good place to work and The company cares about me indicate a successful transition from safety awareness to a safety state of mind J TIPS AND TAKEAWAYS WHAT TO CONSIDER RED FLAGS STEPS TO TAKE DON T FORGET Instill safety as a state of mind as opposed to a passive awareness Safety is inclusive multipurpose multidisciplinary multicultural and a business necessity Safety begins with a new hire process that incorporates cognitive ergonomics how does the worker process safety and functionality and what are their physical abilities for safe placement paired with the physical demands of the job Implement a Well Being Awareness program for total employee health and safety substantial and sustainable reductions in claims and total expense and improved worker retention YOUR NEEDS OUR FOCUS Recovery from a work related injury can be complex From medications to medical supplies to therapies and beyond There is a lot to manage for both the injured person and the claims professional Let Optum simplify the process we look beyond the transactional savings and provide solutions to look at all aspects of a claim Our network management focus on clinical care and our client support and tools help you make informed decisions to lower claim costs and improve the claim experience One Optum your solution for total care management expectmore optum com workcompauto optum com PHARMACY CARE SERVICES 6 ANCILLARY SERVICES MEDICAL SERVICES CLAIM RESOLUTION SETTLEMENT EWC Magazine The legal teams featured on these pages are diverse but they all share an unwavering dedication to their clients When the need for an attorney arises you can count on the law firms listed here to help you reach a favorable outcome www ewcconference com ewc magazine 7
WORKERS COMPENSATION a direct measure of the ability to meet job requirements and safely perform the job Whole body testing would also have a less adverse impact on females and older males at least relative to isolated strength testing The endurance demands parameters are obtained through energy expenditure measurements Working muscles require oxygen to perform the dynamic contractions involved during extended repetitive manual materials product and patient handling The energy expenditure requirement is typically measured by determining the amount of oxygen consumed in the course of performing the work In the jobs of interest in these studies it was important to study the energy expenditure over the course of the shift Total Worker Health is a system developed by the National Institute for Occupational Safety and Health to control the impact of workers compensation incidence related costs and health care benefits utilization costs through awareness Total Worker Health is defined as policies procedures programs and practices that integrate protection from work related safety and health hazards in concert with an injury and illness prevention program and the workers Well Being Awareness Recruiting for community workforce shortages is challenging How does qualifying workers help First it enhances the company s community reputation of promoting safety and fostering a safety culture that is dictated by and distributed among the workforce The concept is equivalent to consumer satisfaction if the product has a poor performance history the word gets around The same is true for the company Further LEGAL EXPERTS when employees experience the company caring for their safety and well being and the company introduces measures to reduce the potential exposure of the employee to injury by proper qualifying criteria and safe job placement this effort becomes noticeable and communicable among workers peers and community job seekers Coveted statements by employees such as A good place to work and The company cares about me indicate a successful transition from safety awareness to a safety state of mind J TIPS AND TAKEAWAYS WHAT TO CONSIDER RED FLAGS STEPS TO TAKE DON T FORGET Instill safety as a state of mind as opposed to a passive awareness Safety is inclusive multipurpose multidisciplinary multicultural and a business necessity Safety begins with a new hire process that incorporates cognitive ergonomics how does the worker process safety and functionality and what are their physical abilities for safe placement paired with the physical demands of the job Implement a Well Being Awareness program for total employee health and safety substantial and sustainable reductions in claims and total expense and improved worker retention YOUR NEEDS OUR FOCUS Recovery from a work related injury can be complex From medications to medical supplies to therapies and beyond There is a lot to manage for both the injured person and the claims professional Let Optum simplify the process we look beyond the transactional savings and provide solutions to look at all aspects of a claim Our network management focus on clinical care and our client support and tools help you make informed decisions to lower claim costs and improve the claim experience One Optum your solution for total care management expectmore optum com workcompauto optum com PHARMACY CARE SERVICES 6 ANCILLARY SERVICES MEDICAL SERVICES CLAIM RESOLUTION SETTLEMENT EWC Magazine The legal teams featured on these pages are diverse but they all share an unwavering dedication to their clients When the need for an attorney arises you can count on the law firms listed here to help you reach a favorable outcome www ewcconference com ewc magazine 7
LEGAL EXPERTS LEGAL EXPERTS Stacey L Tokunaga Founder LAW OFFICES OF STACEY L TOKUNAGA Strength Loyalty Trust What we do together matters SLT Law was founded in 1994 by Stacey L Tokunaga who is still the rm s managing partner The rm promises a commitment to excellence aggressive le management responsiveness and focused client service in the practice of Workers Compensation Defense law From the beginning Stacey s passion and mission have remained unchanged Her passion has always been about delivering the highest quality management and defense of Workers Compensation claims while educating and supporting her clients Her mission for the rm remains To provide exceptional legal defense services while assisting self insured employers third party administrators and insured clients in defending and minimizing the cost of their Workers Compensation claims This boutique rm offers its clients a talented staff of attorneys with a combined experience of over 10 decades in Workers Compensation and civil litigation In addition to private self insured clients and carriers the rm has a Public Agencies Division that was formed to address the unique needs of cities counties and school districts in California Our experience our ability to obtain favorable results for our clients and our integrity make our rm suited to your needs 8 CONTACT US Orange 301 N Rampart St Suite F Orange CA 92868 714 634 7000 Walnut Creek 1600 Riviera Ave Suite 320 Walnut Creek CA 94596 925 363 7300 WWW SLTLAW COM EWC Magazine www ewcconference com ewc magazine 9
LEGAL EXPERTS LEGAL EXPERTS Stacey L Tokunaga Founder LAW OFFICES OF STACEY L TOKUNAGA Strength Loyalty Trust What we do together matters SLT Law was founded in 1994 by Stacey L Tokunaga who is still the rm s managing partner The rm promises a commitment to excellence aggressive le management responsiveness and focused client service in the practice of Workers Compensation Defense law From the beginning Stacey s passion and mission have remained unchanged Her passion has always been about delivering the highest quality management and defense of Workers Compensation claims while educating and supporting her clients Her mission for the rm remains To provide exceptional legal defense services while assisting self insured employers third party administrators and insured clients in defending and minimizing the cost of their Workers Compensation claims This boutique rm offers its clients a talented staff of attorneys with a combined experience of over 10 decades in Workers Compensation and civil litigation In addition to private self insured clients and carriers the rm has a Public Agencies Division that was formed to address the unique needs of cities counties and school districts in California Our experience our ability to obtain favorable results for our clients and our integrity make our rm suited to your needs 8 CONTACT US Orange 301 N Rampart St Suite F Orange CA 92868 714 634 7000 Walnut Creek 1600 Riviera Ave Suite 320 Walnut Creek CA 94596 925 363 7300 WWW SLTLAW COM EWC Magazine www ewcconference com ewc magazine 9
LEGAL EXPERTS LEGAL EXPERTS Ryan Soriano Defense Attorney THE SORIANO LAW GROUP Resilient Resourceful and Respected We do things differently Managing Partner Ryan Soriano has been defending employers insurers and municipalities against workers compensation claims for over 18 years Practicing in Southern California Mr Soriano is board certified in workers comp with the State Bar of California In addition to general matters of workers compensation the Law Offices of Ryan Soriano provides aggressive and intuitive defense of cases involving public safety law 132 a Serious and Willful Misconduct and defense of Industrial Disability Retirement claims What separates our firm from the competition is our commitment to zealous case handling forward thinking litigation strategies and commitment to unmatched client services We are dedicated to being your trusted ally and treat your claims dollars as if they were our very own You can expect our relentless pursuit of evidence based medicine approach to every unique fact pattern whether at cross examination of medical legal experts or at the WCAB at trial Lastly and most importantly we are dedicated to maintaining the highest standards of communication throughout the entire claim process We truly value your business and recognize the choices you have in our constantly evolving community Your complete satisfaction is our priority CONTACT US Southern California 21250 Hawthorne Blvd Suite 500 Torrance CA 90503 310 792 7050 PRACTICE AREAS Workers Compensation Defense Public Safety Law Disability Retirement Claims CAL PERS 10 EWC Magazine www ewcconference com ewc magazine WWW SORIANOLAWOFFICES COM 11
LEGAL EXPERTS LEGAL EXPERTS Ryan Soriano Defense Attorney THE SORIANO LAW GROUP Resilient Resourceful and Respected We do things differently Managing Partner Ryan Soriano has been defending employers insurers and municipalities against workers compensation claims for over 18 years Practicing in Southern California Mr Soriano is board certified in workers comp with the State Bar of California In addition to general matters of workers compensation the Law Offices of Ryan Soriano provides aggressive and intuitive defense of cases involving public safety law 132 a Serious and Willful Misconduct and defense of Industrial Disability Retirement claims What separates our firm from the competition is our commitment to zealous case handling forward thinking litigation strategies and commitment to unmatched client services We are dedicated to being your trusted ally and treat your claims dollars as if they were our very own You can expect our relentless pursuit of evidence based medicine approach to every unique fact pattern whether at cross examination of medical legal experts or at the WCAB at trial Lastly and most importantly we are dedicated to maintaining the highest standards of communication throughout the entire claim process We truly value your business and recognize the choices you have in our constantly evolving community Your complete satisfaction is our priority CONTACT US Southern California 21250 Hawthorne Blvd Suite 500 Torrance CA 90503 310 792 7050 PRACTICE AREAS Workers Compensation Defense Public Safety Law Disability Retirement Claims CAL PERS 10 EWC Magazine www ewcconference com ewc magazine WWW SORIANOLAWOFFICES COM 11
LEGAL EXPERTS LEGAL EXPERTS Kathleen Roberts Kimberly Dyess Ted Richards Aaron Hemmings Stewart Reubens Timothy Kinsey Joanne Thomas Bethe Barkley David Chun STANDER REUBENS THOMAS KINSEY California s Leading Workers Compensation Law Firm Founded in 1979 Stander Reubens Thomas Kinsey provides aggressive representation and defense in all aspects of workers compensation claims and litigation Our clients include self insured employers third party administrators and insurance companies doing business in the State of California We conduct thorough research formulate practical opinions and prepare effective educational presentations to put our clients in the best position to avoid and defend against employee claims We are passionate and proactive in representing our clients and also understand that our clients rely on us to achieve the best possible results in each case Our foundation is built on caring ethics excellence leadership loyalty results and service We are dedicated to our clients our employees and to delivering excellence in all that we do 12 EWC Magazine www ewcconference com ewc magazine CONTACT US Greater Los Angeles 310 649 4911 bbarkley srtklaw com Sacramento Stockton 916 922 7390 trichards srtklaw com Orange County 714 543 9090 tkinsey srtklaw com San Jose 408 224 2689 kroberts srtklaw com San Diego County 858 678 9448 kdyess srtklaw com Fresno Bakers eld 559 436 8136 dchun srtklaw com Inland Empire 951 778 2514 jthomas srtklaw com Chico Redding 530 895 8927 jrempel srtklaw com Greater San Francisco 415 892 7676 sreubens srtklaw com San Fernando Valley 818 436 0170 ahemmings srtklaw com Central Coast 805 654 0256 ahemmings srtklaw com WWW SRTKLAW COM 13
LEGAL EXPERTS LEGAL EXPERTS Kathleen Roberts Kimberly Dyess Ted Richards Aaron Hemmings Stewart Reubens Timothy Kinsey Joanne Thomas Bethe Barkley David Chun STANDER REUBENS THOMAS KINSEY California s Leading Workers Compensation Law Firm Founded in 1979 Stander Reubens Thomas Kinsey provides aggressive representation and defense in all aspects of workers compensation claims and litigation Our clients include self insured employers third party administrators and insurance companies doing business in the State of California We conduct thorough research formulate practical opinions and prepare effective educational presentations to put our clients in the best position to avoid and defend against employee claims We are passionate and proactive in representing our clients and also understand that our clients rely on us to achieve the best possible results in each case Our foundation is built on caring ethics excellence leadership loyalty results and service We are dedicated to our clients our employees and to delivering excellence in all that we do 12 EWC Magazine www ewcconference com ewc magazine CONTACT US Greater Los Angeles 310 649 4911 bbarkley srtklaw com Sacramento Stockton 916 922 7390 trichards srtklaw com Orange County 714 543 9090 tkinsey srtklaw com San Jose 408 224 2689 kroberts srtklaw com San Diego County 858 678 9448 kdyess srtklaw com Fresno Bakers eld 559 436 8136 dchun srtklaw com Inland Empire 951 778 2514 jthomas srtklaw com Chico Redding 530 895 8927 jrempel srtklaw com Greater San Francisco 415 892 7676 sreubens srtklaw com San Fernando Valley 818 436 0170 ahemmings srtklaw com Central Coast 805 654 0256 ahemmings srtklaw com WWW SRTKLAW COM 13
LEGAL EXPERTS LEGAL EXPERTS Michael W Sullivan General Managing Partner Bartholomew R Sullivan II Senior Partner Quality Assurance Operations Keith E Figgins Senior Partner Manager of Fullerton and Ontario Offices Megan M Sullivan Senior Partner Manager of Northern California Offices MICHAEL SULLIVAN ASSOCIATES Michael Sullivan Associates was founded in 1996 The firm started in a small office over the Santa Monica playhouse but by 2008 we relocated our corporate office to Los Angeles and opened satellite offices in Orange County and the Central Valley The firm grew quickly as clients were attracted to our aggressive and proactive work and associates sought employment with the firm to receive our extensive professional training MS A has continued to grow over the years and currently has nine offices located in key regions throughout California with hundreds of clients and a talented group of partners and associates Robust civil employment and immigration law sections have been added to our initial workers compensation practice allowing MS A to become a full service firm for California employers and carriers In 2011 MS A published its first edition of Sullivan on Comp our multivolume treatise on California workers compensation law This annually updated treatise has since become the standard research text on California workers compensation law and has helped establish MS A as a leader in that practice area MS A looks forward to continued growth based on our distinctive practice Basic principles are the key to our success these include listening to clients and partnering with them to achieve their goals establishing productive and innovative culture based upon systemic empirical examination of work product within the firm and a strong principle driven dedication to strong relationships within and outside the firm 14 CONTACT US El Segundo 310 337 4480 Fullerton 714 202 3440 San Diego 619 757 2750 Westlake Village 818 338 4000 Ontario 909 694 1444 Emeryville 510 858 7777 Fresno 559 785 6000 San Jose 408 627 4812 Sacramento 916 978 5860 FOLLOW US Twitter sullivanattys Facebook www facebook com sullivanattorneys Instagram www instagram com sullivanattorneys LinkedIn www linkedin com company michael sullivan associates WWW SULLIVANATTORNEYS COM EWC Magazine www ewcconference com ewc magazine 15
LEGAL EXPERTS LEGAL EXPERTS Michael W Sullivan General Managing Partner Bartholomew R Sullivan II Senior Partner Quality Assurance Operations Keith E Figgins Senior Partner Manager of Fullerton and Ontario Offices Megan M Sullivan Senior Partner Manager of Northern California Offices MICHAEL SULLIVAN ASSOCIATES Michael Sullivan Associates was founded in 1996 The firm started in a small office over the Santa Monica playhouse but by 2008 we relocated our corporate office to Los Angeles and opened satellite offices in Orange County and the Central Valley The firm grew quickly as clients were attracted to our aggressive and proactive work and associates sought employment with the firm to receive our extensive professional training MS A has continued to grow over the years and currently has nine offices located in key regions throughout California with hundreds of clients and a talented group of partners and associates Robust civil employment and immigration law sections have been added to our initial workers compensation practice allowing MS A to become a full service firm for California employers and carriers In 2011 MS A published its first edition of Sullivan on Comp our multivolume treatise on California workers compensation law This annually updated treatise has since become the standard research text on California workers compensation law and has helped establish MS A as a leader in that practice area MS A looks forward to continued growth based on our distinctive practice Basic principles are the key to our success these include listening to clients and partnering with them to achieve their goals establishing productive and innovative culture based upon systemic empirical examination of work product within the firm and a strong principle driven dedication to strong relationships within and outside the firm 14 CONTACT US El Segundo 310 337 4480 Fullerton 714 202 3440 San Diego 619 757 2750 Westlake Village 818 338 4000 Ontario 909 694 1444 Emeryville 510 858 7777 Fresno 559 785 6000 San Jose 408 627 4812 Sacramento 916 978 5860 FOLLOW US Twitter sullivanattys Facebook www facebook com sullivanattorneys Instagram www instagram com sullivanattorneys LinkedIn www linkedin com company michael sullivan associates WWW SULLIVANATTORNEYS COM EWC Magazine www ewcconference com ewc magazine 15
LEGAL EXPERTS 16 EWC Magazine www ewcconference com ewc magazine 17
LEGAL EXPERTS 16 EWC Magazine www ewcconference com ewc magazine 17
WORKERS COMPENSATION WORKERS COMPENSATION I ncreasingly when workers experience a traumatic brain injury TBI on the job an underlying malady that exacerbated the accident may be revealed substance misuse Too often drugs and alcohol are involved in that fall from a ladder or jackknife of a tractor trailer Insurers and employers face complex challenges in settling such claims especially with the rise of opioid and benzodiazepine misuse among employees Traditionally treating brain injury and addiction simultaneously involved two rehabilitation efforts one for TBI and another for substance misuse TBI care is often the priority but what about the employee s chemical dependency If untreated employers risk repeated accidents caused by impairment However a model of rehabilitation is emerging that treats both TBI and addiction helping patients achieve and maintain sobriety as they recover from work accidents The need for dual diagnosis care is evident Workers under the influence can create legal physical and financial harm Causing injury or death to others is serious enough but these individuals also face criminal charges civil suits unemployment and damaged personal relationships Serious consequences also affect worker s compensation insurers and the companies they serve as two complicated health issues are involved in the claim Thus for the worker s compensation adjuster treating TBI and addiction under one roof is cost effective Data on TBI and substance misuse illustrate the magnitude of injury and addiction Corrigan 1995 Bombardier et al 2003 Over 50 percent of persons who sustain a second TBI are under the influence at the time of injury An estimated two thirds of persons who sustain a TBI A New Approach to TBI Recovery Brain Injury Rehabilitation and Substance Misuse Treatment are intoxicated BAC 0 08 at the time of injury People who misused alcohol or other drugs before a TBI are 10 times more likely to resume substance misuse after the injury the first six months after injury may be a critical window for intervention The traditional approach has been to isolate the two conditions and treat them separately in a linear fashion rather than in a comprehensive holistic way In the dual treatment model patients still participate in deficit reduction therapies that address TBI issues But they re also given counseling education and post treatment tools to support sobriety A multidisciplinary team thus addresses both conditions simultaneously focusing on cognitive physical and behavioral improvement while introducing new methods of living drug free As powerful as this is people in recovery can still revert to bad habits and drift into old haunts The good news for insurers and employers is the treatment model s emphasis on relapse prevention Lifestyle change is a core component including an introduction to community based support programs nutrition sleep and physical health education and establishing healthy daily routines This departure from the cookie cutter approach is becoming a path of rebuilding and healing the whole person Within the all encompassing rehabilitation approach the Transtheoretical or Stage Change Model Prochaska DeClemente 2005 is an established clinical approach being utilized by rehabilitation professionals who treat substance misuse in TBI patients For many the traditional or 12 step approach may not work as the patient may not realize he or she has hit bottom despite a catastrophic work accident Thus the model provides a structured methodology that evaluates the readiness to change and helps patients work through that process Without a foundation that sets up success many people won t succeed Contributed by Centre for Neuro Skills Contact Kelly Lopez Public Relations Communications Manager 18 EWC Magazine www ewcconference com ewc magazine 19
WORKERS COMPENSATION WORKERS COMPENSATION I ncreasingly when workers experience a traumatic brain injury TBI on the job an underlying malady that exacerbated the accident may be revealed substance misuse Too often drugs and alcohol are involved in that fall from a ladder or jackknife of a tractor trailer Insurers and employers face complex challenges in settling such claims especially with the rise of opioid and benzodiazepine misuse among employees Traditionally treating brain injury and addiction simultaneously involved two rehabilitation efforts one for TBI and another for substance misuse TBI care is often the priority but what about the employee s chemical dependency If untreated employers risk repeated accidents caused by impairment However a model of rehabilitation is emerging that treats both TBI and addiction helping patients achieve and maintain sobriety as they recover from work accidents The need for dual diagnosis care is evident Workers under the influence can create legal physical and financial harm Causing injury or death to others is serious enough but these individuals also face criminal charges civil suits unemployment and damaged personal relationships Serious consequences also affect worker s compensation insurers and the companies they serve as two complicated health issues are involved in the claim Thus for the worker s compensation adjuster treating TBI and addiction under one roof is cost effective Data on TBI and substance misuse illustrate the magnitude of injury and addiction Corrigan 1995 Bombardier et al 2003 Over 50 percent of persons who sustain a second TBI are under the influence at the time of injury An estimated two thirds of persons who sustain a TBI A New Approach to TBI Recovery Brain Injury Rehabilitation and Substance Misuse Treatment are intoxicated BAC 0 08 at the time of injury People who misused alcohol or other drugs before a TBI are 10 times more likely to resume substance misuse after the injury the first six months after injury may be a critical window for intervention The traditional approach has been to isolate the two conditions and treat them separately in a linear fashion rather than in a comprehensive holistic way In the dual treatment model patients still participate in deficit reduction therapies that address TBI issues But they re also given counseling education and post treatment tools to support sobriety A multidisciplinary team thus addresses both conditions simultaneously focusing on cognitive physical and behavioral improvement while introducing new methods of living drug free As powerful as this is people in recovery can still revert to bad habits and drift into old haunts The good news for insurers and employers is the treatment model s emphasis on relapse prevention Lifestyle change is a core component including an introduction to community based support programs nutrition sleep and physical health education and establishing healthy daily routines This departure from the cookie cutter approach is becoming a path of rebuilding and healing the whole person Within the all encompassing rehabilitation approach the Transtheoretical or Stage Change Model Prochaska DeClemente 2005 is an established clinical approach being utilized by rehabilitation professionals who treat substance misuse in TBI patients For many the traditional or 12 step approach may not work as the patient may not realize he or she has hit bottom despite a catastrophic work accident Thus the model provides a structured methodology that evaluates the readiness to change and helps patients work through that process Without a foundation that sets up success many people won t succeed Contributed by Centre for Neuro Skills Contact Kelly Lopez Public Relations Communications Manager 18 EWC Magazine www ewcconference com ewc magazine 19
WORKERS COMPENSATION WORKERS COMPENSATION In tandem with intensive TBI therapy focused on independence the model maximizes patient progress and achieves dual recovery Adjusters and insurers also benefit as they interface with the same treatment team and facility from admission to discharge Settling Claims by TIPS AND TAKEAWAYS WHAT TO CONSIDER RED FLAGS STEPS TO TAKE DON T FORGET When a patient s injury involves drugs or alcohol consider a provider that can treat TBI and addiction in one facility Simultaneous treatment of both issues maximizes the time and money spent on rehabilitation Focusing on the Future for Injured Individuals Ensure that the facility offers community based treatment which focuses on reintegration with family and society while connecting patients with resources to maintain sobriety By Porter Leslie President of Ametros The Transtheoretical or Stage Change Model provides a structured approach to substance misuse rehabilitation by assessing the readiness to change while helping patients work through that process If untreated employers risk repeated accidents caused by impaired workers A good claim is a closed claim Helping Patients Return to Work is Our Goal Lifelong Recovery is Our Legacy This is the bedrock of the Centre for Neuro Skills philosophy Since 1980 we ve inspired encouraged and trained patients to learn vital skills Our intensive therapies measure progress Our collaboration with workers compensation insurers results in goals that are achieved Our rehabilitation in real world settings is the foundation of lifelong durable outcomes Although the injured worker may not like the workers compensation system they have grown used to the assistance and are scared to have no support resources after settlement A nurse case manager or adjuster has helped them find providers secured appointments answered CNS now has six programs located in Bakersfield Los Angeles San Francisco Dallas Fort Worth and Houston To make a referral please call 800 922 4994 or visit neuroskills com 2019 Centre for Neuro Skills All Rights Reserved 20 is a phrase often overheard in risk manager and claims adjuster circles Employers insurance carriers and other workers compensation payers tend to focus on settling claims and phrases like this reinforce a one dimensional view to settlement as a way for the payer to eliminate financial exposure While this is true to reach a settlement in workers compensation both parties are required to agree to a compromise So on the other hand what s in it for the injured person There need to be perceived or real benefits that outweigh the risk A greater understanding by all sides of the potential benefits and pitfalls is crucial to informing injured workers and their attorneys how to evaluate that trade off As a professional administrator I have found that when all parties involved in settlement discussions give thought to what the injured worker s life will be like after settlement it allows them to address concerns that the individual has that are creating obstacles to settlement These concerns can often be overcome with proper planning and the help of a professional administrator to set up the injured worker for long term success With that in mind perhaps another phrase to adopt would be A closed claim leads to a happier and healthier injured worker Below are a few common concerns and how an administrator can convert them into potential benefits EWC Magazine www ewcconference com ewc magazine questions and educated them on their treatment Also most injured individuals haven t had to pay or even touch any medical bills for their claim Injured workers lose these resources after settlement and become responsible for managing their care and paying for treatment from their settlement funds In my experience I have found that nearly 32 percent of injured workers have had a significant change in treatment in the first five years since their settlement such as a change in drug regimen or different type of therapy being introduced Navigating health care alone can be a real concern for an injured worker A professional administrator is equipped with a care team that can provide hands on coordination and guidance to the injured worker Just because the case has settled does not mean their journey to getting well is over Having resources on hand after settlement can be an enormous benefit for the injured individual and can help them feel comfortable that they can make good choices for their health care after settlement Injured workers that are on or expected to be on Medicare will likely have to deal with the reporting requirements of a Medicare Set Aside MSA once they settle the case 21
WORKERS COMPENSATION WORKERS COMPENSATION In tandem with intensive TBI therapy focused on independence the model maximizes patient progress and achieves dual recovery Adjusters and insurers also benefit as they interface with the same treatment team and facility from admission to discharge Settling Claims by TIPS AND TAKEAWAYS WHAT TO CONSIDER RED FLAGS STEPS TO TAKE DON T FORGET When a patient s injury involves drugs or alcohol consider a provider that can treat TBI and addiction in one facility Simultaneous treatment of both issues maximizes the time and money spent on rehabilitation Focusing on the Future for Injured Individuals Ensure that the facility offers community based treatment which focuses on reintegration with family and society while connecting patients with resources to maintain sobriety By Porter Leslie President of Ametros The Transtheoretical or Stage Change Model provides a structured approach to substance misuse rehabilitation by assessing the readiness to change while helping patients work through that process If untreated employers risk repeated accidents caused by impaired workers A good claim is a closed claim Helping Patients Return to Work is Our Goal Lifelong Recovery is Our Legacy This is the bedrock of the Centre for Neuro Skills philosophy Since 1980 we ve inspired encouraged and trained patients to learn vital skills Our intensive therapies measure progress Our collaboration with workers compensation insurers results in goals that are achieved Our rehabilitation in real world settings is the foundation of lifelong durable outcomes Although the injured worker may not like the workers compensation system they have grown used to the assistance and are scared to have no support resources after settlement A nurse case manager or adjuster has helped them find providers secured appointments answered CNS now has six programs located in Bakersfield Los Angeles San Francisco Dallas Fort Worth and Houston To make a referral please call 800 922 4994 or visit neuroskills com 2019 Centre for Neuro Skills All Rights Reserved 20 is a phrase often overheard in risk manager and claims adjuster circles Employers insurance carriers and other workers compensation payers tend to focus on settling claims and phrases like this reinforce a one dimensional view to settlement as a way for the payer to eliminate financial exposure While this is true to reach a settlement in workers compensation both parties are required to agree to a compromise So on the other hand what s in it for the injured person There need to be perceived or real benefits that outweigh the risk A greater understanding by all sides of the potential benefits and pitfalls is crucial to informing injured workers and their attorneys how to evaluate that trade off As a professional administrator I have found that when all parties involved in settlement discussions give thought to what the injured worker s life will be like after settlement it allows them to address concerns that the individual has that are creating obstacles to settlement These concerns can often be overcome with proper planning and the help of a professional administrator to set up the injured worker for long term success With that in mind perhaps another phrase to adopt would be A closed claim leads to a happier and healthier injured worker Below are a few common concerns and how an administrator can convert them into potential benefits EWC Magazine www ewcconference com ewc magazine questions and educated them on their treatment Also most injured individuals haven t had to pay or even touch any medical bills for their claim Injured workers lose these resources after settlement and become responsible for managing their care and paying for treatment from their settlement funds In my experience I have found that nearly 32 percent of injured workers have had a significant change in treatment in the first five years since their settlement such as a change in drug regimen or different type of therapy being introduced Navigating health care alone can be a real concern for an injured worker A professional administrator is equipped with a care team that can provide hands on coordination and guidance to the injured worker Just because the case has settled does not mean their journey to getting well is over Having resources on hand after settlement can be an enormous benefit for the injured individual and can help them feel comfortable that they can make good choices for their health care after settlement Injured workers that are on or expected to be on Medicare will likely have to deal with the reporting requirements of a Medicare Set Aside MSA once they settle the case 21
WORKERS COMPENSATION This means that for the rest of their life they need to make sure they are spending funds on Medicare approved items related to their injury using appropriate fee schedules and reporting their expenses per Medicare rules and regulations This prospect can be overwhelming If they misuse or misreport their MSA funds and spend down the account Medicare will refuse to cover future injury related medical expenses It has been my experience that when MSA accounts entirely run out of money 100 percent of the time the professional administrator will receive a call from the Benefits Coordination and Recovery Center at Medicare to go over all the reporting to make sure everything lines up before Medicare begins paying for bills Medicare is unquestionably paying attention and is issuing denials when they cannot track what happened This inquiry could be a daunting call for an injured worker A professional administrator can give them comfort that they will be prepared and ensures that all this reporting is taken care of for them The thought of spending the settlement money too quickly and running out is a common fear that most injured workers have Medical inflation on certain items can be a scary unknown risk and can eat into the settlement funds Also new and more effective treatments may be more costly as well Using a professional administrator that can provide medical bill equipment and pharmacy discounts can help ease an injured worker s mind by ensuring their funds will last as long as possible Administrators may offer discount networks that provide savings and keep more money in the accounts for future treatment Using a skilled administrator can significantly reduce the chance that members run out of funds in a given year WORKERS COMPENSATION and pharmacy discounts available through the administrator produced significant savings on Jim s treatments Now Jim can afford to take all the medications he needs He s back on track with his treatment plan and is feeling better knowing that his administrative care team is there for him he is more confident in having settled his case and his prospects for recovery How it Works Professional administrators set up a custodial bank account for individuals who have settled their case and thereafter they become members Members receive a card that they present to their medical providers and pharmacies that enables the electronic direction of bills to the professional administrator The administrator s health care payment technology automatically verifies the bill s accuracy applies negotiated discounts to reduce the bill and electronically pays the appropriate amount to the provider While every case is different members can potentially enjoy savings that range from 5 percent to over 50 percent on their expenses and the saved money stays in their account Administrators have tools that can record all transactions and submit required reporting to Medicare for members with MSAs The administrator may offer members access to an online portal and mobile app to monitor their accounts and view expenses savings and transactions so they always have transparency into their accounts without the hassle of handling the bills themselves Plus they don t have to manage their care alone many administrators have expert member service teams that are available to answer questions help find providers and sometimes just to listen Professional administration is bringing patient advocacy to injured workers post settlement managing their medical issues so members can focus on regaining their health and enjoying their lives All these benefits stack up and can in turn make injured workers more apt to settle their claim thereby creating more good claims in the eyes of risk managers but also promoting more happy and healthy injured workers as well 22 WHAT TO CONSIDER RED FLAGS STEPS TO TAKE BLIND SPOT By John V Cattie Jr Managing Partner at Cattie F TIPS AND TAKEAWAYS Jim s Story Each of the concerns above were becoming a reality for Jim a former laborer and supervisor for a construction company in Indiana who had suffered a serious back injury He was skeptical of settlement but decided to go for it After settlement some of his worst nightmares were coming true he and his wife were watching his bills closely and were struggling with the cost of his medications the coordination of his care and navigating Medicare s guidelines Fearful of running out of money too soon Jim even cut back on some treatments so that his money would last The family turned to their attorney for advice and were directed to a professional administrator The medical networks The MSA DON T FORGET Find concerns Rather than laying out reasons to settle ask why would you not settle and unearth concerns This method will help inform you of what areas need focus Have patience Settlement is an educational process It s hard to reach a compromise on such a complicated agreement in one sitting or one phone call Have patience and don t be discouraged if the stars don t align on the first try Many claims can be open for years before a settlement occurs Seek help Don t believe you need to have all the answers Whether you are an adviser or adjuster don t be shy to ask third party experts to help assess unknowns like medical costs legal issues structured settlement opportunities and Medicare rules EWC Magazine or years the workers compensation WC industry has suffered from Medicare SetAside MSA blind spots Current WC industry practices do not align with Centers for Medicare and Medicaid Services CMS expectations CMS clearly discusses its expectations in its WCMSA Reference Guide Until the danger posed by these MSA blind spots is remedied parties resolving WC claims will continue to possess an exposure for future medicals which it fails to account for today Ideally the MSA blind spots should be remedied by a lawyer well versed in MSA obligations under the Medicare Secondary Payer MSP Act Medicare s WCMSA Workload Review Thresholds In Section 8 1 CMS shares the situations under which it is willing to review a WCMSA proposal Those are The claimant is a Medicare beneficiary and the total settlement amount is greater than 25 000 00 or www ewcconference com ewc magazine The claimant has a reasonable expectation of Medicare enrollment within 30 months of the settlement date and the anticipated total settlement amount for future medical expenses and disability or lost wages over the life or duration of the settlement agreement is expected to be greater than 250 000 00 1 These thresholds are well known and cited often by WC industry stakeholders Most WC industry stakeholders however interpret these to be the only situations where a WCMSA might be warranted Taking CMS guidance at face value the WC industry is dead wrong in its safe harbor interpretation This incorrect interpretation has created huge MSA blind spots for parties resolving WC claims Section 8 1 explains in detail that the workload review thresholds provide no safe harbor These thresholds are created based on CMS workload and are not intended to indicate that claimants may settle below the threshold with impunity Claimants must still consider Medicare s interests in all WC cases and ensure that Medicare pays secondary to WC in such cases 2 23
WORKERS COMPENSATION This means that for the rest of their life they need to make sure they are spending funds on Medicare approved items related to their injury using appropriate fee schedules and reporting their expenses per Medicare rules and regulations This prospect can be overwhelming If they misuse or misreport their MSA funds and spend down the account Medicare will refuse to cover future injury related medical expenses It has been my experience that when MSA accounts entirely run out of money 100 percent of the time the professional administrator will receive a call from the Benefits Coordination and Recovery Center at Medicare to go over all the reporting to make sure everything lines up before Medicare begins paying for bills Medicare is unquestionably paying attention and is issuing denials when they cannot track what happened This inquiry could be a daunting call for an injured worker A professional administrator can give them comfort that they will be prepared and ensures that all this reporting is taken care of for them The thought of spending the settlement money too quickly and running out is a common fear that most injured workers have Medical inflation on certain items can be a scary unknown risk and can eat into the settlement funds Also new and more effective treatments may be more costly as well Using a professional administrator that can provide medical bill equipment and pharmacy discounts can help ease an injured worker s mind by ensuring their funds will last as long as possible Administrators may offer discount networks that provide savings and keep more money in the accounts for future treatment Using a skilled administrator can significantly reduce the chance that members run out of funds in a given year WORKERS COMPENSATION and pharmacy discounts available through the administrator produced significant savings on Jim s treatments Now Jim can afford to take all the medications he needs He s back on track with his treatment plan and is feeling better knowing that his administrative care team is there for him he is more confident in having settled his case and his prospects for recovery How it Works Professional administrators set up a custodial bank account for individuals who have settled their case and thereafter they become members Members receive a card that they present to their medical providers and pharmacies that enables the electronic direction of bills to the professional administrator The administrator s health care payment technology automatically verifies the bill s accuracy applies negotiated discounts to reduce the bill and electronically pays the appropriate amount to the provider While every case is different members can potentially enjoy savings that range from 5 percent to over 50 percent on their expenses and the saved money stays in their account Administrators have tools that can record all transactions and submit required reporting to Medicare for members with MSAs The administrator may offer members access to an online portal and mobile app to monitor their accounts and view expenses savings and transactions so they always have transparency into their accounts without the hassle of handling the bills themselves Plus they don t have to manage their care alone many administrators have expert member service teams that are available to answer questions help find providers and sometimes just to listen Professional administration is bringing patient advocacy to injured workers post settlement managing their medical issues so members can focus on regaining their health and enjoying their lives All these benefits stack up and can in turn make injured workers more apt to settle their claim thereby creating more good claims in the eyes of risk managers but also promoting more happy and healthy injured workers as well 22 WHAT TO CONSIDER RED FLAGS STEPS TO TAKE BLIND SPOT By John V Cattie Jr Managing Partner at Cattie F TIPS AND TAKEAWAYS Jim s Story Each of the concerns above were becoming a reality for Jim a former laborer and supervisor for a construction company in Indiana who had suffered a serious back injury He was skeptical of settlement but decided to go for it After settlement some of his worst nightmares were coming true he and his wife were watching his bills closely and were struggling with the cost of his medications the coordination of his care and navigating Medicare s guidelines Fearful of running out of money too soon Jim even cut back on some treatments so that his money would last The family turned to their attorney for advice and were directed to a professional administrator The medical networks The MSA DON T FORGET Find concerns Rather than laying out reasons to settle ask why would you not settle and unearth concerns This method will help inform you of what areas need focus Have patience Settlement is an educational process It s hard to reach a compromise on such a complicated agreement in one sitting or one phone call Have patience and don t be discouraged if the stars don t align on the first try Many claims can be open for years before a settlement occurs Seek help Don t believe you need to have all the answers Whether you are an adviser or adjuster don t be shy to ask third party experts to help assess unknowns like medical costs legal issues structured settlement opportunities and Medicare rules EWC Magazine or years the workers compensation WC industry has suffered from Medicare SetAside MSA blind spots Current WC industry practices do not align with Centers for Medicare and Medicaid Services CMS expectations CMS clearly discusses its expectations in its WCMSA Reference Guide Until the danger posed by these MSA blind spots is remedied parties resolving WC claims will continue to possess an exposure for future medicals which it fails to account for today Ideally the MSA blind spots should be remedied by a lawyer well versed in MSA obligations under the Medicare Secondary Payer MSP Act Medicare s WCMSA Workload Review Thresholds In Section 8 1 CMS shares the situations under which it is willing to review a WCMSA proposal Those are The claimant is a Medicare beneficiary and the total settlement amount is greater than 25 000 00 or www ewcconference com ewc magazine The claimant has a reasonable expectation of Medicare enrollment within 30 months of the settlement date and the anticipated total settlement amount for future medical expenses and disability or lost wages over the life or duration of the settlement agreement is expected to be greater than 250 000 00 1 These thresholds are well known and cited often by WC industry stakeholders Most WC industry stakeholders however interpret these to be the only situations where a WCMSA might be warranted Taking CMS guidance at face value the WC industry is dead wrong in its safe harbor interpretation This incorrect interpretation has created huge MSA blind spots for parties resolving WC claims Section 8 1 explains in detail that the workload review thresholds provide no safe harbor These thresholds are created based on CMS workload and are not intended to indicate that claimants may settle below the threshold with impunity Claimants must still consider Medicare s interests in all WC cases and ensure that Medicare pays secondary to WC in such cases 2 23
WORKERS COMPENSATION CMS is unequivocal here and always has been One can go as far back as at least 2005 to witness CMS position that these workload review thresholds do not equal safe harbors for parties resolving WC claims 3 Note that all WCMSA guidance issued by CMS has been incorporated into its WCMSA Reference Guide as of March 2013 Workload Review Thresholds Do Not Equal Safe Harbors As early as 2005 CMS has been saying that its WCMSA workload review thresholds do not equal safe harbors For at least 12 years parties resolving WC claims have virtually ignored this MSA blind spot How has the WC industry s interpretation missed the mark here so widely Here s one example to help establish the boundaries of the MSA blind spot Parties are settling a WC case involving a Medicare beneficiary and closing future medicals They agree to settle for 24 999 In so doing they believe they do not have to worry about an MSA issue Have you seen that Have you been a party to that Would it surprise you to hear that ignoring the MSA issue because you settled just under threshold does not mean that CMS grants you safe harbor How many have mistakenly believed it was OK to ignore the MSA issue under those circumstances For too long parties have ignored the MSP Act when it involves future medicals The MSP Act says Medicare won t pay where payment has been made under a workers compensation policy or plan 4 CMS says Claimants must still consider Medicare s interests in all WC cases and ensure that Medicare pays secondary to WC in such cases 5 Who s to Blame for the Bad Advice There s plenty of blame to go around Perhaps you as a WC stakeholder have been on autopilot ignoring the MSA blind spot Consider this your wake up call You have an MSA blind spot that endangers yourself and many others The size of the blind spot corresponds to the number of WC claims you are resolving annually Your current protocols fail to meet CMS expectations in 2020 CMS doubled down on this point in January 2019 In version 2 9 of its WCMSA Reference Guide CMS added case specific examples to the workload review thresholds Those new examples do not advise what to do when a case or claim meets the threshold Instead they contemplate situations where the case or claim does not meet the threshold Those examples are Example 1 A recent retiree aged 67 and eligible for Medicare benefits under Parts A B and D files a WC claim against their former employer for the back injury sustained shortly before retirement that requires future medical care The claim is offered settlement for a total of 17 000 00 However this retiree will require the use of an anti inflammatory drug for the balance of their life The settling parties must consider CMS future interests even though the case would not be eligible for review Failure to do so could leave settling parties subject to future recoveries for payments related to the injury up to the total value of the settlement 17 000 00 24 WORKERS COMPENSATION Example 2 A 47 year old steelworker breaks their ankle in such a manner that leaves the individual permanently disabled As a result the worker should become eligible for Medicare benefits in the next 30 months based upon eligibility for Social Security Disability benefits The steelworker is offered a total settlement of 225 000 00 inclusive of future care Again there is a likely need for no less than pain management for this future beneficiary The case would be ineligible for review under the non CMS beneficiary standard requiring a case total settlement to be greater than 250 000 00 for review Not establishing some plan for future care places settling parties at risk for recovery from care related to the WC injury up to the full value of the settlement 6 In both examples the WCMSA review process is not available to the settling parties However CMS expects steps to be taken to ensure that Medicare is not asked to pay future bills that are someone else s responsibility Parties resolving WC cases under threshold do not take the steps necessary to protect themselves on this issue To continue to do so will further jeopardize parties resolving WC claims Take Immediate Action to Remedy the MSA Blind Spot The MSA status quo is broken and it must change to protect all stakeholders I highly encourage you to reassess your current MSA protocols Are they up to present day standards Question the MSA vendors you trust about this issue They should be able to explain why they believe MSAs have been and may continue to be a non issue for claims under the threshold What s the justification for the explanation From a risk perspective if that risk is acceptable to you maintain status quo If their explanation is not acceptable to you you should consider a legal review of your current MSA protocols from a lawyer well versed in MSA legal obligations Empower your claims examiners to hire a lawyer to review MSA obligations and provide legal advice about your MSA exposure Add a law firm that provides MSA legal opinions to your panel Seeking legal advice has become an acceptable means of considering and protecting Medicare s interests in 2020 The MSA issue needs to be examined in every WC case Anything less than that needlessly exposes stakeholders to potential CMS recovery actions And we can all agree that no one wants to see that J A HIGHER STANDARD IN MEDICARE COMPLIANCE To learn more about Cattie s unique approach to overcoming challenges to resolving your claims contact STEPHANIE REYNOLDS 844 546 3500 Stephanie cattielaw com www cattielaw com MEDICARE LAWS AND REGULATIONS CREATE A COMPLEX INTERWOVEN TRAP FOR THE UNWARY Cattie is an innovative Medicare Secondary Payor MSP compliance company deep enough in resources to handle any project or client yet nimble and creative enough to develop a client specific approach on every case We pride ourselves on timely delivery of high quality reports responsive communication and positive outcomes Cattie s staff has unparalleled expertise in MSP compliance and takes a boutique approach to service Our goal is to develop long term relationships with our clients by gaining trust through collaboration and fulfilling our commitments Cattie helps clients navigate the Medicare web Medicare Set Asides MSA Legal Opinions Conditional Payment Resolution Section 111 Mandatory Insurer Reporting Drug Utilization Review Customized Client Reporting Workers Compensation Medicare Set Aside Arrangement WCMSA Reference Guide 2019 3rd ed ebook Available at https www cms gov Medicare Coordination of Benefits and Recovery WorkersCompensation Medicare Set Aside Arrangements Downloads WCMSAReference Guide Version 3_0 pdf Accessed 15 Jan 2020 1 2 I bid 3 C ms gov n d Archive CMS online Available at https www cms gov Medicare Coordination of Benefits and Recovery Workers CompensationMedicare Set Aside Arrangements Archive Accessed 15 Jan 2020 4 U nited States Code 2006 Edition Supplement 4 Title 42 THE PUBLIC HEALTH AND WELFARE 1395y b 2 A ii 5 h ttps www cms gov Medicare Coordination of Benefits and Recovery Workers Compensation Medicare Set Aside Arrangements Downloads WCMSA Reference Guide Version 3_0 pdf 6 I bid Section 2 9 EWC Magazine www ewcconference com ewc magazine 25
WORKERS COMPENSATION CMS is unequivocal here and always has been One can go as far back as at least 2005 to witness CMS position that these workload review thresholds do not equal safe harbors for parties resolving WC claims 3 Note that all WCMSA guidance issued by CMS has been incorporated into its WCMSA Reference Guide as of March 2013 Workload Review Thresholds Do Not Equal Safe Harbors As early as 2005 CMS has been saying that its WCMSA workload review thresholds do not equal safe harbors For at least 12 years parties resolving WC claims have virtually ignored this MSA blind spot How has the WC industry s interpretation missed the mark here so widely Here s one example to help establish the boundaries of the MSA blind spot Parties are settling a WC case involving a Medicare beneficiary and closing future medicals They agree to settle for 24 999 In so doing they believe they do not have to worry about an MSA issue Have you seen that Have you been a party to that Would it surprise you to hear that ignoring the MSA issue because you settled just under threshold does not mean that CMS grants you safe harbor How many have mistakenly believed it was OK to ignore the MSA issue under those circumstances For too long parties have ignored the MSP Act when it involves future medicals The MSP Act says Medicare won t pay where payment has been made under a workers compensation policy or plan 4 CMS says Claimants must still consider Medicare s interests in all WC cases and ensure that Medicare pays secondary to WC in such cases 5 Who s to Blame for the Bad Advice There s plenty of blame to go around Perhaps you as a WC stakeholder have been on autopilot ignoring the MSA blind spot Consider this your wake up call You have an MSA blind spot that endangers yourself and many others The size of the blind spot corresponds to the number of WC claims you are resolving annually Your current protocols fail to meet CMS expectations in 2020 CMS doubled down on this point in January 2019 In version 2 9 of its WCMSA Reference Guide CMS added case specific examples to the workload review thresholds Those new examples do not advise what to do when a case or claim meets the threshold Instead they contemplate situations where the case or claim does not meet the threshold Those examples are Example 1 A recent retiree aged 67 and eligible for Medicare benefits under Parts A B and D files a WC claim against their former employer for the back injury sustained shortly before retirement that requires future medical care The claim is offered settlement for a total of 17 000 00 However this retiree will require the use of an anti inflammatory drug for the balance of their life The settling parties must consider CMS future interests even though the case would not be eligible for review Failure to do so could leave settling parties subject to future recoveries for payments related to the injury up to the total value of the settlement 17 000 00 24 WORKERS COMPENSATION Example 2 A 47 year old steelworker breaks their ankle in such a manner that leaves the individual permanently disabled As a result the worker should become eligible for Medicare benefits in the next 30 months based upon eligibility for Social Security Disability benefits The steelworker is offered a total settlement of 225 000 00 inclusive of future care Again there is a likely need for no less than pain management for this future beneficiary The case would be ineligible for review under the non CMS beneficiary standard requiring a case total settlement to be greater than 250 000 00 for review Not establishing some plan for future care places settling parties at risk for recovery from care related to the WC injury up to the full value of the settlement 6 In both examples the WCMSA review process is not available to the settling parties However CMS expects steps to be taken to ensure that Medicare is not asked to pay future bills that are someone else s responsibility Parties resolving WC cases under threshold do not take the steps necessary to protect themselves on this issue To continue to do so will further jeopardize parties resolving WC claims Take Immediate Action to Remedy the MSA Blind Spot The MSA status quo is broken and it must change to protect all stakeholders I highly encourage you to reassess your current MSA protocols Are they up to present day standards Question the MSA vendors you trust about this issue They should be able to explain why they believe MSAs have been and may continue to be a non issue for claims under the threshold What s the justification for the explanation From a risk perspective if that risk is acceptable to you maintain status quo If their explanation is not acceptable to you you should consider a legal review of your current MSA protocols from a lawyer well versed in MSA legal obligations Empower your claims examiners to hire a lawyer to review MSA obligations and provide legal advice about your MSA exposure Add a law firm that provides MSA legal opinions to your panel Seeking legal advice has become an acceptable means of considering and protecting Medicare s interests in 2020 The MSA issue needs to be examined in every WC case Anything less than that needlessly exposes stakeholders to potential CMS recovery actions And we can all agree that no one wants to see that J A HIGHER STANDARD IN MEDICARE COMPLIANCE To learn more about Cattie s unique approach to overcoming challenges to resolving your claims contact STEPHANIE REYNOLDS 844 546 3500 Stephanie cattielaw com www cattielaw com MEDICARE LAWS AND REGULATIONS CREATE A COMPLEX INTERWOVEN TRAP FOR THE UNWARY Cattie is an innovative Medicare Secondary Payor MSP compliance company deep enough in resources to handle any project or client yet nimble and creative enough to develop a client specific approach on every case We pride ourselves on timely delivery of high quality reports responsive communication and positive outcomes Cattie s staff has unparalleled expertise in MSP compliance and takes a boutique approach to service Our goal is to develop long term relationships with our clients by gaining trust through collaboration and fulfilling our commitments Cattie helps clients navigate the Medicare web Medicare Set Asides MSA Legal Opinions Conditional Payment Resolution Section 111 Mandatory Insurer Reporting Drug Utilization Review Customized Client Reporting Workers Compensation Medicare Set Aside Arrangement WCMSA Reference Guide 2019 3rd ed ebook Available at https www cms gov Medicare Coordination of Benefits and Recovery WorkersCompensation Medicare Set Aside Arrangements Downloads WCMSAReference Guide Version 3_0 pdf Accessed 15 Jan 2020 1 2 I bid 3 C ms gov n d Archive CMS online Available at https www cms gov Medicare Coordination of Benefits and Recovery Workers CompensationMedicare Set Aside Arrangements Archive Accessed 15 Jan 2020 4 U nited States Code 2006 Edition Supplement 4 Title 42 THE PUBLIC HEALTH AND WELFARE 1395y b 2 A ii 5 h ttps www cms gov Medicare Coordination of Benefits and Recovery Workers Compensation Medicare Set Aside Arrangements Downloads WCMSA Reference Guide Version 3_0 pdf 6 I bid Section 2 9 EWC Magazine www ewcconference com ewc magazine 25
WORKERS COMPENSATION WORKERS COMPENSATION assignments When expectations or a targeted timeline is not established there is an increased risk that the employee may be left in the temporary position much longer than necessary This can cause frustration on the employer s part as they need someone performing the full duty job and on the employee s part because it is unclear when the temporary position may end or when they are expected to reassume their full time duty position With a clear timeline and outlined expectations both parties can plan accordingly Return to Work Keys for Success By Beth Burry VP Clinical Operations Vocational Return to Work Behavioral Health at Sedgwick In any workplace regardless of occupation there is a risk of an employee becoming injured on the job Given that employees are an organization s most valuable asset and that employees tend to remain more engaged when they are productive securing a safe return to work as soon as possible benefits both the employer and the employee In order to provide the best outcomes for both parties it is vital that employers work collaboratively with claims managers return to work specialists and case managers to create a comprehensive return to work solution Be Proactive Although no one wants to think about employees becoming injured on the job it is crucial that a plan is in place when a workplace injury occurs Being proactive is a critical component of a return to work initiative particularly if an employee is out due to a job related injury Without a proper return to work plan in place employees may have unexpected time out of work a reduction in pay or benefits and a sense of disconnection from their employer Similarly employers may 26 experience a loss in productivity an increase in claim costs and longer claim durations when a proactive plan is not followed An important part of a proactive return to work plan is having up to date functional job descriptions A job description that is either out of date or does not accurately describe the specific functions of the job can make it challenging to plan an effective return to work strategy For example a job description may describe the duties of a warehouse worker but it may not speciify the number of pounds the employee is lifting and at what frequency or what type of flexion extension is needed to perform lifting functions A basic job description may not address other functions like distance or time spent walking climbing steps stairs or ladders Without an adequately detailed functional job description of what the employee s essential and non essential functions are the return to work plan may not result in an expedited return to work or represent the employee s required job duties Furthermore in developing a proactive return to work plan employers should also establish a clear return to work timeline as well as outline expectations for temporary duty EWC Magazine Seek Out Resources In a comprehensive return to work program it is important for the employer to identify effective resources to remain current on related policies and procedures Expert resources help employers to be knowledgeable about physical restriction compliance and how to identify temporary duty opportunities If employers are not well versed in temporary modified or light duty opportunities and how to ensure that employees comply with their physical restrictions employees may be re injured or have the amount of time they are on restricted duties extended unnecessarily Ensuring compliance with state workers compensation statutes and federal laws is also vital when it comes to return to work programs Claims examiners or other workers compensation jurisdictional experts can assist the employer in what documents forms or other requirements employers must follow One item that may fall to the wayside is having an official document that offers temporary modified or light duty in states where required Not only is it critical to follow jurisdictional requirements in offering temporary modified and light duty but having job duties documented helps all parties employers employees and medical providers An official document allows them to have something to refer to when discussing an employee s ability to perform a job within restrictions It also serves as a documented agreement outlining what job duties can be tolerated within the employee s restrictions Keep Employees Engaged Communication between the employer and employee is essential even when the employee has sustained a workplace injury resulting in time off Being out of work especially for an extended period of time when the employer is not in contact with the employee can leave the employee feeling disengaged and uninvolved in the return to work process Employee engagement and communication as part of a larger return to work program benefit the employer and employee For employees work can be a substantial part of how they see themselves tying into a sense of belonging from a vocational and social perspective Without that sense of belonging they can begin to feel isolated and unproductive Feeling productive is a key motivator both in recovery and resuming a productive lifestyle When employers actively stay in contact with their employees during the recovery process they are making an effort to retain a valued employee This engagement ultimately reduces the likelihood of the employee never returning to work and the employer having to train and onboard a brand new employee www ewcconference com ewc magazine thereby incurring additional time and expense Having an employee who is motivated and engaged in the recovery and return to work process produces better overall outcomes from a medical cost and claims perspective The bottom line is that it is in the best interest of the employer to keep employees productive and working Measuring Success Measuring the success of a return to work program should be done in both a qualitative and quantitative manner Quantitatively employers with a strong return to work program should see an overall reduction in total disability and lost time days as well as incurred medical and claims expenses Additionally employers may want to examine their out ofwork recidivism rates For example they should monitor how many employees have returned to work following an injury only to go out of work again If this is happening frequently then some components of the program need to be changed There are also aspects to look at from a qualitative standpoint For example was the employer able to expedite a claim resolution that resulted in a successful return to work outcome Additionally how was the employee s experience Was the employee actively engaged in the process If so what was the employee s perception Employers with sound programs will see more employees who successfully return to work and who are satisfied with their recovery and experience Key Lessons The creation of a return to work program is a valuable investment After all employees are an organization s most valued asset It is vital to address the multiple facets of a return to work program when an employee sustains a workplace injury It is also crucial to remember that this isn t just about a work injury but about a valuable individual who the employer can retain if return to work is approached from a proactive engaged perspective With open communication and ongoing use of effective resources a successful return to work program can reap rewards for everyone J TIPS AND TAKEAWAYS WHAT TO CONSIDER RED FLAGS STEPS TO TAKE DON T FORGET Establish and maintain a proactive return to work plan Develop up to date functional job descriptions as a part of the plan Establish a clear return to work timeline and outline expectations for temporary duty assignments Identify effective resources to remain current on related policies and procedures Follow jurisdictional requirements in offering temporary modified and light duty Communicate and engage employees throughout the recovery and return to work process Measure effectiveness of a return to work program in both a qualitative and quantitative manner 27
WORKERS COMPENSATION WORKERS COMPENSATION assignments When expectations or a targeted timeline is not established there is an increased risk that the employee may be left in the temporary position much longer than necessary This can cause frustration on the employer s part as they need someone performing the full duty job and on the employee s part because it is unclear when the temporary position may end or when they are expected to reassume their full time duty position With a clear timeline and outlined expectations both parties can plan accordingly Return to Work Keys for Success By Beth Burry VP Clinical Operations Vocational Return to Work Behavioral Health at Sedgwick In any workplace regardless of occupation there is a risk of an employee becoming injured on the job Given that employees are an organization s most valuable asset and that employees tend to remain more engaged when they are productive securing a safe return to work as soon as possible benefits both the employer and the employee In order to provide the best outcomes for both parties it is vital that employers work collaboratively with claims managers return to work specialists and case managers to create a comprehensive return to work solution Be Proactive Although no one wants to think about employees becoming injured on the job it is crucial that a plan is in place when a workplace injury occurs Being proactive is a critical component of a return to work initiative particularly if an employee is out due to a job related injury Without a proper return to work plan in place employees may have unexpected time out of work a reduction in pay or benefits and a sense of disconnection from their employer Similarly employers may 26 experience a loss in productivity an increase in claim costs and longer claim durations when a proactive plan is not followed An important part of a proactive return to work plan is having up to date functional job descriptions A job description that is either out of date or does not accurately describe the specific functions of the job can make it challenging to plan an effective return to work strategy For example a job description may describe the duties of a warehouse worker but it may not speciify the number of pounds the employee is lifting and at what frequency or what type of flexion extension is needed to perform lifting functions A basic job description may not address other functions like distance or time spent walking climbing steps stairs or ladders Without an adequately detailed functional job description of what the employee s essential and non essential functions are the return to work plan may not result in an expedited return to work or represent the employee s required job duties Furthermore in developing a proactive return to work plan employers should also establish a clear return to work timeline as well as outline expectations for temporary duty EWC Magazine Seek Out Resources In a comprehensive return to work program it is important for the employer to identify effective resources to remain current on related policies and procedures Expert resources help employers to be knowledgeable about physical restriction compliance and how to identify temporary duty opportunities If employers are not well versed in temporary modified or light duty opportunities and how to ensure that employees comply with their physical restrictions employees may be re injured or have the amount of time they are on restricted duties extended unnecessarily Ensuring compliance with state workers compensation statutes and federal laws is also vital when it comes to return to work programs Claims examiners or other workers compensation jurisdictional experts can assist the employer in what documents forms or other requirements employers must follow One item that may fall to the wayside is having an official document that offers temporary modified or light duty in states where required Not only is it critical to follow jurisdictional requirements in offering temporary modified and light duty but having job duties documented helps all parties employers employees and medical providers An official document allows them to have something to refer to when discussing an employee s ability to perform a job within restrictions It also serves as a documented agreement outlining what job duties can be tolerated within the employee s restrictions Keep Employees Engaged Communication between the employer and employee is essential even when the employee has sustained a workplace injury resulting in time off Being out of work especially for an extended period of time when the employer is not in contact with the employee can leave the employee feeling disengaged and uninvolved in the return to work process Employee engagement and communication as part of a larger return to work program benefit the employer and employee For employees work can be a substantial part of how they see themselves tying into a sense of belonging from a vocational and social perspective Without that sense of belonging they can begin to feel isolated and unproductive Feeling productive is a key motivator both in recovery and resuming a productive lifestyle When employers actively stay in contact with their employees during the recovery process they are making an effort to retain a valued employee This engagement ultimately reduces the likelihood of the employee never returning to work and the employer having to train and onboard a brand new employee www ewcconference com ewc magazine thereby incurring additional time and expense Having an employee who is motivated and engaged in the recovery and return to work process produces better overall outcomes from a medical cost and claims perspective The bottom line is that it is in the best interest of the employer to keep employees productive and working Measuring Success Measuring the success of a return to work program should be done in both a qualitative and quantitative manner Quantitatively employers with a strong return to work program should see an overall reduction in total disability and lost time days as well as incurred medical and claims expenses Additionally employers may want to examine their out ofwork recidivism rates For example they should monitor how many employees have returned to work following an injury only to go out of work again If this is happening frequently then some components of the program need to be changed There are also aspects to look at from a qualitative standpoint For example was the employer able to expedite a claim resolution that resulted in a successful return to work outcome Additionally how was the employee s experience Was the employee actively engaged in the process If so what was the employee s perception Employers with sound programs will see more employees who successfully return to work and who are satisfied with their recovery and experience Key Lessons The creation of a return to work program is a valuable investment After all employees are an organization s most valued asset It is vital to address the multiple facets of a return to work program when an employee sustains a workplace injury It is also crucial to remember that this isn t just about a work injury but about a valuable individual who the employer can retain if return to work is approached from a proactive engaged perspective With open communication and ongoing use of effective resources a successful return to work program can reap rewards for everyone J TIPS AND TAKEAWAYS WHAT TO CONSIDER RED FLAGS STEPS TO TAKE DON T FORGET Establish and maintain a proactive return to work plan Develop up to date functional job descriptions as a part of the plan Establish a clear return to work timeline and outline expectations for temporary duty assignments Identify effective resources to remain current on related policies and procedures Follow jurisdictional requirements in offering temporary modified and light duty Communicate and engage employees throughout the recovery and return to work process Measure effectiveness of a return to work program in both a qualitative and quantitative manner 27
MANAGEMENT SKILLS MANAGEMENT SKILLS Communicating Decisions Effectively This scenario has happened to all of us at one time or another we ask management a question and get back a quick response of yes or no with no explanation If you are looking for a yes and get it it rarely raises an issue but if you get a no response it can be maddening not knowing why Simply providing an answer without an explanation fails to teach our future decision makers anything As executives it is our responsibility to teach our management and employees how to make decisions that are in line with our management ideas and practices The best way to do that is by example The right way to groom future leaders to make decisions that are in line with our business model and philosophy is to provide them with the reasons for our answers This practice also helps us avoid the unintended consequences that can occur when providing answers with no explanation Here is an example We receive a request to hire another employee for a department and respond to the request with not approved Those asking for the help not only feel like they are overworked but also feel undervalued based on the lack of communication the unintended consequences Naturally this is not how we want our employees and management to feel The best practice in this case is to deliver a response that will help the team understand the decision and in the future help them communicate when they are issuing a decision In this case the following message would help the team understand the decision By D Diann Cohen Vice President Client Relations MacroPro Inc At this time we are unable to approve your request to hire an additional employee For the last four months we have been working with our IT department to automate some of the processes in your department and we will be unveiling those improvements in the next 30 days We are looking forward to relieving some of the workload from your team soon This response does several things First it relays the decision and explains why the decision was made Second it provides additional information that the management team can share with the employees in that department Although the request was denied there was still good news to share with the staff which is great for morale When it comes to company philosophy and sensibilities our employees must understand our corporate culture and mission If your company s mission is to provide the fastest and highest level of services in California at the lowest possible price then that should be part of your messaging when making decisions Let s say the marketing department wants permission to go to Chicago to exhibit at a national conference A response that reinforces the company s vision would be appropriate The communication back to the requester might look like this Our company s mission is to serve businesses in the state of California at the best possible price A national conference does not fit within our business model as we strive to be the low cost leader in the industry and the impact of the expenses associated with this conference is in conflict with our mission In addition only a small percentage of the attendees will be from our target market For these reasons we must say no to your request After getting a response like this a few times your employees will know which conferences are appropriate to attend The fact of the matter is that we are all busy our days are long and time slips away from us However we can t let these teaching opportunities go unused A good leader understands that what and how we communicate with our employees provides valuable education and ultimately strengthens our organizations when done properly J TIPS AND TAKEAWAYS WHAT TO CONSIDER RED FLAGS STEPS TO TAKE DON T FORGET It is imperative that we explain why we made a particular decision when considering an employee s request l Detailed answers to employees teach the company s sensibilities to future decision makers Detailed communications prevent unintended consequences 28 EWC Magazine www ewcconference com ewc magazine 29
MANAGEMENT SKILLS MANAGEMENT SKILLS Communicating Decisions Effectively This scenario has happened to all of us at one time or another we ask management a question and get back a quick response of yes or no with no explanation If you are looking for a yes and get it it rarely raises an issue but if you get a no response it can be maddening not knowing why Simply providing an answer without an explanation fails to teach our future decision makers anything As executives it is our responsibility to teach our management and employees how to make decisions that are in line with our management ideas and practices The best way to do that is by example The right way to groom future leaders to make decisions that are in line with our business model and philosophy is to provide them with the reasons for our answers This practice also helps us avoid the unintended consequences that can occur when providing answers with no explanation Here is an example We receive a request to hire another employee for a department and respond to the request with not approved Those asking for the help not only feel like they are overworked but also feel undervalued based on the lack of communication the unintended consequences Naturally this is not how we want our employees and management to feel The best practice in this case is to deliver a response that will help the team understand the decision and in the future help them communicate when they are issuing a decision In this case the following message would help the team understand the decision By D Diann Cohen Vice President Client Relations MacroPro Inc At this time we are unable to approve your request to hire an additional employee For the last four months we have been working with our IT department to automate some of the processes in your department and we will be unveiling those improvements in the next 30 days We are looking forward to relieving some of the workload from your team soon This response does several things First it relays the decision and explains why the decision was made Second it provides additional information that the management team can share with the employees in that department Although the request was denied there was still good news to share with the staff which is great for morale When it comes to company philosophy and sensibilities our employees must understand our corporate culture and mission If your company s mission is to provide the fastest and highest level of services in California at the lowest possible price then that should be part of your messaging when making decisions Let s say the marketing department wants permission to go to Chicago to exhibit at a national conference A response that reinforces the company s vision would be appropriate The communication back to the requester might look like this Our company s mission is to serve businesses in the state of California at the best possible price A national conference does not fit within our business model as we strive to be the low cost leader in the industry and the impact of the expenses associated with this conference is in conflict with our mission In addition only a small percentage of the attendees will be from our target market For these reasons we must say no to your request After getting a response like this a few times your employees will know which conferences are appropriate to attend The fact of the matter is that we are all busy our days are long and time slips away from us However we can t let these teaching opportunities go unused A good leader understands that what and how we communicate with our employees provides valuable education and ultimately strengthens our organizations when done properly J TIPS AND TAKEAWAYS WHAT TO CONSIDER RED FLAGS STEPS TO TAKE DON T FORGET It is imperative that we explain why we made a particular decision when considering an employee s request l Detailed answers to employees teach the company s sensibilities to future decision makers Detailed communications prevent unintended consequences 28 EWC Magazine www ewcconference com ewc magazine 29
MANAGEMENT SKILLS MANAGEMENT SKILLS RISING ABOVE How to Be a Best Place to Work Providing a healthy work environment is directly related to building a better place to work A quality work environment By Sabrina Darsey Division Claims Manager at Athens Administrators encourages employees to work harder and more efficiently R ecently my office received the honor of being ranked in the Top 5 Best Places to Work in San Diego for the fourth year in a row Many factors go into shaping a company and office into one of the Best Places to Work I have worked for 30 years in the workers compensation industry both for insurance companies and third party administrators For five of those years I worked in marketing for an occupational medical group and physical therapy company I started my workers comp career as a claims assistant and worked my way up to a division claims manager Through this experience including 15 years in management I ve learned some principles behind what makes a great 30 company and an enjoyable work environment If building the company of your dreams is your aspiration I offer my findings on how to create the most productive and rewarding work environment possible First Best Places to Work ensure that the company culture and values come from the top If the leadership such as the CEO CFO president executive vice presidents managers and supervisors genuinely believe in their company culture and values and they live and breathe them then the staff will also believe in them Not only does leadership need to talk the talk but they need to walk the walk Leaders need to invest in their employees who work hard to make the company successful they should work alongside EWC Magazine their employees and keep the culture and values intact as the company grows Without their valued employees the company won t achieve success and certainly won t be able to stay in business I embrace my company s philosophy on this subject Take care of your employees they will take care of our clients and our clients will take care of us It seems like such a simple concept yet why do companies struggle so hard to put it into practice I believe the disconnect happens when organizations lose sight of what made them successful in the first place As employers grow the employees they once cared about become merely a number then they become expendable How many times have we heard that line everyone is replaceable Is everyone indeed replaceable And at what cost If companies changed their mentality from everyone is replaceable to what can we do to retain our employees and make them succeed employee morale would increase improving the quality of the company Building a successful company with a positive work environment starts with hiring the right people Hire quality team members that are compatible with your company culture and values and don t be afraid to let the bad ones go Don t just settle to fill a position compromising your hiring standards is one of the worst mistakes you can make Spend time and money to rigorously screen applicants take your time in interviewing to find the right fit Speaking from experience it is well worth the investment Creating a pleasant work environment is crucial in keeping your employees happy It is a key factor impacting a company and its worker productivity Providing a healthy work environment is directly related to building a better place to work A quality work environment encourages employees to work harder and more efficiently Wouldn t you work harder for a company that cares about you and provides you with a supportive work environment We have probably all known companies that didn t care about their employees the work environment was toxic and nobody was motivated to work No one went above and beyond to work diligently they did the minimum required to get by No one wants to be a part of that type of organization We want our employees to take pride in their performance and our company www ewcconference com ewc magazine Another key to becoming one of the Best Places to Work is to invest in your employees by providing them with incentives At our firm we offer a variety of incentives such as monthly chair massages quarterly company meetings team lunches flexible work schedules company paid summer picnics and holiday parties a casual dress code and a workfrom home program By investing in your employees you will gain much more in return Consider asking your employees for feedback You can start by asking employees for positive feedback such as why they like working for the company You will find out what matters most to them and it will open the door to deeper communication You can also ask what they think would make a better work environment You can keep responses anonymous if needed but listen to their input and try to implement some ideas to build a more rewarding work environment I asked my employees what they thought made our office one of the Best Places to Work and I repeatedly received the same responses Company culture Work life balance Team atmosphere Power is not abused Positive environment Shows appreciation to employees Comfortable respectful compatible office atmosphere Opportunities and incentives to learn grow and develop Not just a place to work but a rewarding place to work The company treats us like family they take care of us TIPS AND TAKEAWAYS WHAT TO CONSIDER RED FLAGS STEPS TO TAKE DON T FORGET If you want to improve your company culture retain employees and become one of the Best Places to Work I suggest the following Provide a clear vision and be transparent Lead with honesty and integrity Provide flexibility and promote growth Practice open communication and collaboration Promote harmony in the workplace Never forget to treat your employees in the way in which you would want to be treated Make it your goal to offer employees opportunities for growth and development so they are equipped to succeed If they succeed you succeed 31
MANAGEMENT SKILLS MANAGEMENT SKILLS RISING ABOVE How to Be a Best Place to Work Providing a healthy work environment is directly related to building a better place to work A quality work environment By Sabrina Darsey Division Claims Manager at Athens Administrators encourages employees to work harder and more efficiently R ecently my office received the honor of being ranked in the Top 5 Best Places to Work in San Diego for the fourth year in a row Many factors go into shaping a company and office into one of the Best Places to Work I have worked for 30 years in the workers compensation industry both for insurance companies and third party administrators For five of those years I worked in marketing for an occupational medical group and physical therapy company I started my workers comp career as a claims assistant and worked my way up to a division claims manager Through this experience including 15 years in management I ve learned some principles behind what makes a great 30 company and an enjoyable work environment If building the company of your dreams is your aspiration I offer my findings on how to create the most productive and rewarding work environment possible First Best Places to Work ensure that the company culture and values come from the top If the leadership such as the CEO CFO president executive vice presidents managers and supervisors genuinely believe in their company culture and values and they live and breathe them then the staff will also believe in them Not only does leadership need to talk the talk but they need to walk the walk Leaders need to invest in their employees who work hard to make the company successful they should work alongside EWC Magazine their employees and keep the culture and values intact as the company grows Without their valued employees the company won t achieve success and certainly won t be able to stay in business I embrace my company s philosophy on this subject Take care of your employees they will take care of our clients and our clients will take care of us It seems like such a simple concept yet why do companies struggle so hard to put it into practice I believe the disconnect happens when organizations lose sight of what made them successful in the first place As employers grow the employees they once cared about become merely a number then they become expendable How many times have we heard that line everyone is replaceable Is everyone indeed replaceable And at what cost If companies changed their mentality from everyone is replaceable to what can we do to retain our employees and make them succeed employee morale would increase improving the quality of the company Building a successful company with a positive work environment starts with hiring the right people Hire quality team members that are compatible with your company culture and values and don t be afraid to let the bad ones go Don t just settle to fill a position compromising your hiring standards is one of the worst mistakes you can make Spend time and money to rigorously screen applicants take your time in interviewing to find the right fit Speaking from experience it is well worth the investment Creating a pleasant work environment is crucial in keeping your employees happy It is a key factor impacting a company and its worker productivity Providing a healthy work environment is directly related to building a better place to work A quality work environment encourages employees to work harder and more efficiently Wouldn t you work harder for a company that cares about you and provides you with a supportive work environment We have probably all known companies that didn t care about their employees the work environment was toxic and nobody was motivated to work No one went above and beyond to work diligently they did the minimum required to get by No one wants to be a part of that type of organization We want our employees to take pride in their performance and our company www ewcconference com ewc magazine Another key to becoming one of the Best Places to Work is to invest in your employees by providing them with incentives At our firm we offer a variety of incentives such as monthly chair massages quarterly company meetings team lunches flexible work schedules company paid summer picnics and holiday parties a casual dress code and a workfrom home program By investing in your employees you will gain much more in return Consider asking your employees for feedback You can start by asking employees for positive feedback such as why they like working for the company You will find out what matters most to them and it will open the door to deeper communication You can also ask what they think would make a better work environment You can keep responses anonymous if needed but listen to their input and try to implement some ideas to build a more rewarding work environment I asked my employees what they thought made our office one of the Best Places to Work and I repeatedly received the same responses Company culture Work life balance Team atmosphere Power is not abused Positive environment Shows appreciation to employees Comfortable respectful compatible office atmosphere Opportunities and incentives to learn grow and develop Not just a place to work but a rewarding place to work The company treats us like family they take care of us TIPS AND TAKEAWAYS WHAT TO CONSIDER RED FLAGS STEPS TO TAKE DON T FORGET If you want to improve your company culture retain employees and become one of the Best Places to Work I suggest the following Provide a clear vision and be transparent Lead with honesty and integrity Provide flexibility and promote growth Practice open communication and collaboration Promote harmony in the workplace Never forget to treat your employees in the way in which you would want to be treated Make it your goal to offer employees opportunities for growth and development so they are equipped to succeed If they succeed you succeed 31
IN THE SPOTLIGHT IN THE SPOTLIGHT In the Spotlight STACEY TOKUNAGA Principal Attorney at The Law Offices of Stacey L Tokunaga Industry leaders answer our most searching questions SARAH JANE JARA CLP Senior Risk Analyst at Red Bull North America Inc Name a person who has had a tremendous impact on you as a leader The person that has had a tremendous impact on me as a leader and a mentor is hands down my boss Simon Keshishian He is the true definition of a leader by not only mentoring me but also mentoring anyone that crosses his path He leads by example and is a true team player Lastly he never stops learning and is more than happy to pass his knowledge down and lead the way What three words would you use to describe your company Energy Creative and Extreme Where does your ambition come from what drives you My ambition comes from my desire to live life to the fullest and experience all that life has to offer In my current professional position that may be while helping my colleagues execute a great event with risk and safety top of mind or by networking with industry connections to continue learning and growing I believe in putting my all into my commitments so I can enjoy a work life balance What makes a perfect weekend for you All perfect weekends are spent with family and friends either at a backyard BBQ or traveling to old and new places I love to spend time at a lake or in the desert exploring the great outdoors Otherwise you re likely to find me at Disneyland Do you have a favorite quote or motto All the World s a Stage Sarah Jane can be reached at sarahjane jara redbull com 32 What are your views on leadership Many equate leadership with a position title or stature in the workplace I perceive leadership as a process a series of steps focused on building the best team to achieve our firm s core values vision and mission It is the domain of risktakers committed to a lifetime of excellence in their quest to reach the pinnacle of their field It is a journey filled with blood sweat tears resiliency fleeting disappointments and resolved failures that line the path to successful leadership SLT Law is a people oriented firm that focuses on people development providing opportunities to hone leadership skills and teamwork in an environment of growth and learning We value employee development because we believe it is the key to the continued success and growth of the company A wise man once said If you perceive yourself as a leader and no one is following you you are merely taking a solitary walk Therefore teamwork is a way of life for all potential leaders at SLT Law Our leaders are successful because they practice the three Ls of our organization Listen Learn and Lead If you are only listening to yourself speak you are not learning and will be a weak leader Listening to other team members will give you insights that you can incorporate into your thought processes to help broaden your scope of interpretation enabling you to make more informed decisions and become a more effective leader The Inner Circle in leadership is a critical aspect and the stabilizing force of a leader Developing an inner circle is crucial in keeping a leader grounded The Inner Circle tells me what I need to know rather than what I want to hear complements my weaknesses emulates my strengths helps bear burdens instead of adding to them works as a team adds value to the company watches my back and is honest and trustworthy Members of the Inner Circle must remember that they are the Eyes Ears Heart and Soul of the company and must be vigilant to keep the company safe from potential harm Above all Inner Circle members must help their leader avoid the pitfalls of believing his or her own press and believing they are God s gift to others What is the most courageous thing you have done After graduating from law school passing the Bar exam and receiving licensure I began working at a defense firm to learn about California s workers compensation system Nearly two years later I mustered the courage to jump into the fire body and soul and start my own defense law firm Being young adventurous and immature in the business arena and driven by a fierce passion I ventured out on a road rarely traveled by females let alone an Asian American female attorney I left my secure job took a bold step forward and vowed to devote my life to reaching my goals Fast forward 27 years later and I remain committed to growing SLT Law and its future leaders through my daily actions being proactive being a good listener setting clear expectations showing sincerity promoting teamwork keeping promises practicing small acts of kindness saying I m sorry showing loyalty taking responsibility for right or wrong decisions being passionate about what I do and maintaining a strong commitment to our values mission and vision What have you learned from the stakeholders in your journey I attribute my inspiration in my journey to my parents From early childhood throughout my formal school years love honor ethics fairness perseverance giving sharing and the value of hard work as prerequisites to contributing to society and living a happy fulfilling life were instilled in me as my parents practiced what they preached They were my mentors and staunchest supporters who made me what I am today One of the formost lessons I learned from them was to not look at a glass as being half empty but instead to look at the same glass as half full with tremendous opportunities to fill it to the brim I strive to fulfill these ideals in treating people the way I would like to be treated To this day this philosophy has not failed me As a leader I am ecstatic to see this philosophy thrive in the workplace My mirror on the wall does not tell me who the fairest in all the land is rather it asks me What have you done today to make someone s life better Do you have a favorite quote The greatest gifts my parents gave to me were their unconditional love and a set of values that they lived by and just didn t lecture about values that included understanding the simple difference between right and wrong the importance of hard work education self respect and a belief in America Colin Powell Dedicated citizen of the USA retired US Army four star general and former US Secretary of Defense Stacey can be reached by phone at 714 634 7000 by fax at 714 634 7009 or visit www sltlaw com What are your goals with your clients Our goal is to deliver successful cost effective timely outcomes for our clients We are guided by our Four Cs Communication constant phone calls e mails messaging Collaboration conference calls face to face meetings working lunches Confidence successful outcomes through communication and collaboration and Credibility positive cost saving outcomes and timely case closures Our goal is client satisfaction and a mutually satisfying relationship EWC Magazine www ewcconference com ewc magazine 33
IN THE SPOTLIGHT IN THE SPOTLIGHT In the Spotlight STACEY TOKUNAGA Principal Attorney at The Law Offices of Stacey L Tokunaga Industry leaders answer our most searching questions SARAH JANE JARA CLP Senior Risk Analyst at Red Bull North America Inc Name a person who has had a tremendous impact on you as a leader The person that has had a tremendous impact on me as a leader and a mentor is hands down my boss Simon Keshishian He is the true definition of a leader by not only mentoring me but also mentoring anyone that crosses his path He leads by example and is a true team player Lastly he never stops learning and is more than happy to pass his knowledge down and lead the way What three words would you use to describe your company Energy Creative and Extreme Where does your ambition come from what drives you My ambition comes from my desire to live life to the fullest and experience all that life has to offer In my current professional position that may be while helping my colleagues execute a great event with risk and safety top of mind or by networking with industry connections to continue learning and growing I believe in putting my all into my commitments so I can enjoy a work life balance What makes a perfect weekend for you All perfect weekends are spent with family and friends either at a backyard BBQ or traveling to old and new places I love to spend time at a lake or in the desert exploring the great outdoors Otherwise you re likely to find me at Disneyland Do you have a favorite quote or motto All the World s a Stage Sarah Jane can be reached at sarahjane jara redbull com 32 What are your views on leadership Many equate leadership with a position title or stature in the workplace I perceive leadership as a process a series of steps focused on building the best team to achieve our firm s core values vision and mission It is the domain of risktakers committed to a lifetime of excellence in their quest to reach the pinnacle of their field It is a journey filled with blood sweat tears resiliency fleeting disappointments and resolved failures that line the path to successful leadership SLT Law is a people oriented firm that focuses on people development providing opportunities to hone leadership skills and teamwork in an environment of growth and learning We value employee development because we believe it is the key to the continued success and growth of the company A wise man once said If you perceive yourself as a leader and no one is following you you are merely taking a solitary walk Therefore teamwork is a way of life for all potential leaders at SLT Law Our leaders are successful because they practice the three Ls of our organization Listen Learn and Lead If you are only listening to yourself speak you are not learning and will be a weak leader Listening to other team members will give you insights that you can incorporate into your thought processes to help broaden your scope of interpretation enabling you to make more informed decisions and become a more effective leader The Inner Circle in leadership is a critical aspect and the stabilizing force of a leader Developing an inner circle is crucial in keeping a leader grounded The Inner Circle tells me what I need to know rather than what I want to hear complements my weaknesses emulates my strengths helps bear burdens instead of adding to them works as a team adds value to the company watches my back and is honest and trustworthy Members of the Inner Circle must remember that they are the Eyes Ears Heart and Soul of the company and must be vigilant to keep the company safe from potential harm Above all Inner Circle members must help their leader avoid the pitfalls of believing his or her own press and believing they are God s gift to others What is the most courageous thing you have done After graduating from law school passing the Bar exam and receiving licensure I began working at a defense firm to learn about California s workers compensation system Nearly two years later I mustered the courage to jump into the fire body and soul and start my own defense law firm Being young adventurous and immature in the business arena and driven by a fierce passion I ventured out on a road rarely traveled by females let alone an Asian American female attorney I left my secure job took a bold step forward and vowed to devote my life to reaching my goals Fast forward 27 years later and I remain committed to growing SLT Law and its future leaders through my daily actions being proactive being a good listener setting clear expectations showing sincerity promoting teamwork keeping promises practicing small acts of kindness saying I m sorry showing loyalty taking responsibility for right or wrong decisions being passionate about what I do and maintaining a strong commitment to our values mission and vision What have you learned from the stakeholders in your journey I attribute my inspiration in my journey to my parents From early childhood throughout my formal school years love honor ethics fairness perseverance giving sharing and the value of hard work as prerequisites to contributing to society and living a happy fulfilling life were instilled in me as my parents practiced what they preached They were my mentors and staunchest supporters who made me what I am today One of the formost lessons I learned from them was to not look at a glass as being half empty but instead to look at the same glass as half full with tremendous opportunities to fill it to the brim I strive to fulfill these ideals in treating people the way I would like to be treated To this day this philosophy has not failed me As a leader I am ecstatic to see this philosophy thrive in the workplace My mirror on the wall does not tell me who the fairest in all the land is rather it asks me What have you done today to make someone s life better Do you have a favorite quote The greatest gifts my parents gave to me were their unconditional love and a set of values that they lived by and just didn t lecture about values that included understanding the simple difference between right and wrong the importance of hard work education self respect and a belief in America Colin Powell Dedicated citizen of the USA retired US Army four star general and former US Secretary of Defense Stacey can be reached by phone at 714 634 7000 by fax at 714 634 7009 or visit www sltlaw com What are your goals with your clients Our goal is to deliver successful cost effective timely outcomes for our clients We are guided by our Four Cs Communication constant phone calls e mails messaging Collaboration conference calls face to face meetings working lunches Confidence successful outcomes through communication and collaboration and Credibility positive cost saving outcomes and timely case closures Our goal is client satisfaction and a mutually satisfying relationship EWC Magazine www ewcconference com ewc magazine 33
RISK MANAGEMENT RISK MANAGEMENT Indicators of Excellence By David B Dolnick Dolnick Risk Advisors O ne of the most common questions claims professionals ask me has always been What is it you are looking for What do you want from us I m a risk manager I started my career in workers compensation and have accrued considerable experience in the field but this can be a complex question That s true when you consider the various levels that question encompasses It s a perfectly valid query for any service provider to ask stakeholders and especially their clients Knowing what employers expect is a good place to start when evaluating and planning for your performance This article will explore several key areas of excellence and high performance that many risk managers myself included will seek from their business partners First and foremost I want stability I need to be able to know and understand what to expect from my service providers and that implies that we all minimize needless 34 disruptions or changes in personnel policy software or the practices being employed I far prefer to deal with one or two adjusters or a stable and well running team not a random field chosen at whim or by the first letter of a claimant s last name yes I did encounter a carrier that assigned claims in exactly that manner Stability matters because workers compensation is not a commodity Success and sound results are best built on strong relationships and that means working for an extended period with a consistent team of professionals Disruptions to that team cost me time effort and money Second I want the claim professionals on my team to care It s such a simple concept caring I want you to care about what happens to my employee I want you to care about the impact on his or her life and to respect that things may never be the same for them if the injury was a serious one with long term repercussions You aren t there to be a shoulder for them to cry EWC Magazine on but you should care about what they are going through and do your best to minimize the negative impacts as much as you are able I want you to care about your profession and your professionalism to care about the processes and methods you use and rely upon and most of all to care about the quality of your work Care about what the employer or insured wants care about what your firm and your supervisors want you won t last long there if you don t after all I also want you to care about the various mandated rules regulations and timetables we all work with and care about living up to our industry s ethical rules and standards of conduct Most of all though care about your reputation and your good name at the end of the day that s all any of us truly own Fortunately this isn t a problem for the vast majority of the professionals I ve worked with Still sometimes it can get lost in the stresses and hassles of tackling a difficult claim or of dealing with difficult people www ewcconference com ewc magazine Third please remember why we re all here dealing with workers compensation matters and issues There are always going to be difficult demanding or fraudulent claims There will always be difficult claimants physicians with questionable skill or ethics or vendors who are just plain greedy We all deal with those situations far too often for comfort and it becomes temptingly easy to focus on those kinds of negative factors We run into far too many of them far too often and we remember them far too long It s easy to become cynical about what we do about the people we deal with but that s a perilous path to travel It can taint and poison all that we do and can color all our interactions Try to remember that while any given phone call with a claimant may be your 27th challenging conversation of the day it s probably the claimant s first sometimes their first ever Injured workers can become frightened nervous and uneasy dealing with our complex and opaque system of laws regulations coverage and rules The professionals know the ropes so to speak but the claimants typically don t They often fill that gap with their imaginations with research on the internet or with advice from friends and family members They may recall their own claim whether three or five or 25 years ago and think that experience was typical of how workers compensation works or should work regardless of whether that s accurate Remember why we are here We are administering a vital social insurance program delivering benefits mandated by law Let s not move too far away from that in our reaction to the problems and challenges we face Fourth on my list is a set of skills that unfortunately many in our business place most of their emphasis on technical competence I didn t list this as number one because it s a baseline need It s not unimportant quite the opposite but in my four decades of experience I ve known many workers compensation professionals that rely on their technical knowledge of the field and make no real effort to do anything but meet those minimum standards There s no passion no desire to excel no drive to succeed Technical competence is important and vitally so but it forms only the basis for success it isn t excellence in itself You do need to know the law the regulations the product or services that you offer But that skillset is not enough by itself It serves as the platform for exceptional performance in the field performance that builds on the technical skills this industry demands So how to measure or know if these four skills are a part of your routine of the way you conduct yourself every day Here are some measures of performance that while commonly used don t really address the first three skills I ve discussed above It s hard to measure those because they are not the what of claim handling and its allied services they are the how It s hard to measure caring objectively or to quantify how well you understand the nature of our industry How you approach these tasks and skills however will help your clients know your true value to your organization and to them 35
RISK MANAGEMENT RISK MANAGEMENT Indicators of Excellence By David B Dolnick Dolnick Risk Advisors O ne of the most common questions claims professionals ask me has always been What is it you are looking for What do you want from us I m a risk manager I started my career in workers compensation and have accrued considerable experience in the field but this can be a complex question That s true when you consider the various levels that question encompasses It s a perfectly valid query for any service provider to ask stakeholders and especially their clients Knowing what employers expect is a good place to start when evaluating and planning for your performance This article will explore several key areas of excellence and high performance that many risk managers myself included will seek from their business partners First and foremost I want stability I need to be able to know and understand what to expect from my service providers and that implies that we all minimize needless 34 disruptions or changes in personnel policy software or the practices being employed I far prefer to deal with one or two adjusters or a stable and well running team not a random field chosen at whim or by the first letter of a claimant s last name yes I did encounter a carrier that assigned claims in exactly that manner Stability matters because workers compensation is not a commodity Success and sound results are best built on strong relationships and that means working for an extended period with a consistent team of professionals Disruptions to that team cost me time effort and money Second I want the claim professionals on my team to care It s such a simple concept caring I want you to care about what happens to my employee I want you to care about the impact on his or her life and to respect that things may never be the same for them if the injury was a serious one with long term repercussions You aren t there to be a shoulder for them to cry EWC Magazine on but you should care about what they are going through and do your best to minimize the negative impacts as much as you are able I want you to care about your profession and your professionalism to care about the processes and methods you use and rely upon and most of all to care about the quality of your work Care about what the employer or insured wants care about what your firm and your supervisors want you won t last long there if you don t after all I also want you to care about the various mandated rules regulations and timetables we all work with and care about living up to our industry s ethical rules and standards of conduct Most of all though care about your reputation and your good name at the end of the day that s all any of us truly own Fortunately this isn t a problem for the vast majority of the professionals I ve worked with Still sometimes it can get lost in the stresses and hassles of tackling a difficult claim or of dealing with difficult people www ewcconference com ewc magazine Third please remember why we re all here dealing with workers compensation matters and issues There are always going to be difficult demanding or fraudulent claims There will always be difficult claimants physicians with questionable skill or ethics or vendors who are just plain greedy We all deal with those situations far too often for comfort and it becomes temptingly easy to focus on those kinds of negative factors We run into far too many of them far too often and we remember them far too long It s easy to become cynical about what we do about the people we deal with but that s a perilous path to travel It can taint and poison all that we do and can color all our interactions Try to remember that while any given phone call with a claimant may be your 27th challenging conversation of the day it s probably the claimant s first sometimes their first ever Injured workers can become frightened nervous and uneasy dealing with our complex and opaque system of laws regulations coverage and rules The professionals know the ropes so to speak but the claimants typically don t They often fill that gap with their imaginations with research on the internet or with advice from friends and family members They may recall their own claim whether three or five or 25 years ago and think that experience was typical of how workers compensation works or should work regardless of whether that s accurate Remember why we are here We are administering a vital social insurance program delivering benefits mandated by law Let s not move too far away from that in our reaction to the problems and challenges we face Fourth on my list is a set of skills that unfortunately many in our business place most of their emphasis on technical competence I didn t list this as number one because it s a baseline need It s not unimportant quite the opposite but in my four decades of experience I ve known many workers compensation professionals that rely on their technical knowledge of the field and make no real effort to do anything but meet those minimum standards There s no passion no desire to excel no drive to succeed Technical competence is important and vitally so but it forms only the basis for success it isn t excellence in itself You do need to know the law the regulations the product or services that you offer But that skillset is not enough by itself It serves as the platform for exceptional performance in the field performance that builds on the technical skills this industry demands So how to measure or know if these four skills are a part of your routine of the way you conduct yourself every day Here are some measures of performance that while commonly used don t really address the first three skills I ve discussed above It s hard to measure those because they are not the what of claim handling and its allied services they are the how It s hard to measure caring objectively or to quantify how well you understand the nature of our industry How you approach these tasks and skills however will help your clients know your true value to your organization and to them 35
RISK MANAGEMENT 1 Prompt case setup Clients need to know that claims are being processed efficiently So do claimants The claim handlers and the service providers need to be on the same timeline Delays especially at the outset of the process will impact the claim increase the potential for needless litigation and often lead to misunderstandings and a loss of trust 2 E arly contact Establishing a dialogue with claimants with treating physicians and with employers helps to reduce uncertainty and fear and lets all the parties to the claim begin the process of moving forward 3 T imely ISO searches Understanding a claimant s history is an essential evaluation point for claim handling Workers who have no prior contact with the workers compensation system may need a bit more guidance in knowing what to expect while a significant and repetitive history of claim activity may raise its own questions that need clarification 4 T imely investigations Not every claim needs to be assigned to an outside investigator but every claim does need basic confirmation of the stated facts some additional information from the parties Confirming the facts early helps a claim handler make prompt and accurate decisions especially where AOE COE questions arise or where there is a potential for subrogation recoveries 5 Timely reserves The only thing absolutely true about an initial reserve on a complex claim is that it will most likely change Nobody expects perfection two weeks into a catastrophic claim but handling those changes as soon as accurate and additional information becomes available is vital I know reserves are likely to change and the more complex a claim is the more likely that multiple revisions to the reserves will be needed Do those corrections but please do them promptly That helps me focus on those claims where time and attention may have a positive impact If your timing has an impact and needs to be adjusted we ll talk about it but that s rare 6 T imely special investigations When red flags are raised in a claim referring them to an SIU or outside investigation team is vital and the sooner the better This is especially true in cases where either fraud is suspected or where subrogation or risk transfer may come into play 7 Timely medical management decisions Claim handlers know who the effective treating physicians are and can help guide employers and employees alike to proper treatment whether from a primary care provider or from a specialist 8 T imely communications Don t wait for a quarterly or semi annual claim review to tell your client about a potential problem or the need for them to address return to work Taking a moment to send an email or make a telephone call in between more formal meetings and reviews can make all the difference In addition consider visiting the worksites for major clients both employer and adjustor will benefit from those interactions and the dialogue they create 36 DOCTORS PERSPECTIVE Similarly risk managers should visit their adjusters to see and understand the reality of claim handling Consider a chairside visit to see how the claims process really works 9 Timely Return to Work help Injured workers who return to gainful employment rapidly even if in some limited or transitional manner tend to fare better which lowers costs and difficulty for all the participants in a claim 10 T imely referral to counsel When claims do litigate finding the right time to bring in counsel can be critical Referring too late causes extra work for the attorney potentially at additional cost while referring too early has the same effect for the opposite reason There is for each claim a right time to make the referral and knowing this timing is a vital skill for claim handlers to develop 11 Prompt closure Don t let a claim linger for months it serves no purpose and only skews claim handling statistics and reports As you will notice almost all of these 11 steps are focused on the primary claim handler and their team There are some additional criteria that I and others apply to the TPA or carrier as a whole Specifically I want an accurate idea of the current and planned workloads each claim handler will manage along with an estimate of the complexity of those claims e g the age of the claim since inception estimated permanent disability involved whether the claim was litigated etc Some measure of the stability of that book of claims is also helpful typically measuring the ratio between total new arisings versus total closings The particulars of the claims themselves help me address the complexity of the claims There is after all a vast difference between handling 250 med pay only claims and handling 130 major catastrophic injuries Those extremes of the workload require different skills I also want to know what internal programs the company has in place to assure quality handling and what steps are taken to correct any deficiencies that are observed An additional question for the companies is whether they offer a risk management information system RMIS or whether their system will coordinate with my data processing capabilities One newer area that I look for is the data analytics capabilities of the carrier or TPA There is a wealth of information in both general data and industry specific information and if there is a sufficient volume of claims in employer specific data Those firms that possess in depth capacity for analyzing that data can gain a significant advance view of trends probabilities and insights in how to address common problems in handling claims Data analytics is a newer field but it s now starting to take off in an exciting and novel fashion There is a common thread here and it s an expectation that applies equally to all the participants in this process we call workers compensation Simply put it s a two part formula consisting of equal parts competence and communication If we all strive for those goals good things will happen in the most unfortunate of circumstances and the system can work well for all of us J EWC Magazine Workers Compensation Claims and Nurse Triage By Lester Sacks MD PhD Medical Director at Arissa Cost Strategies If one of your employees is injured what do you as an employer do Has your human resources department written protocols so your employees know exactly what to do Communicating the proper information and process is important so that the injured employee receives the most immediate and appropriate care Nurse triage can be a most effective approach to managing an incident Nurse triage service by trained telephonic licensed professionals can support the 24 7 needs of the employer and employee The nurse triage team will make all the arrangements for your organization including the desired medical process and protocols to effectively support the individualized protocols including addressing the utilization of appropriate physicians in your network PROCESS FOR CARE 1 In addition to managing the medical aspects of immediate care triage nurses use not only credible guidelines but also their experience and judgment so that immediate care is delivered without always referring to a physician 2 T he team will handle the required reporting to the appropriate offices as required by the State s guidelines 3 I f more formal care is required the nurse will make the necessary referral to the physician within network or company recommendation and discuss medical findings 4 W hen necessary the triage nurse will pre certify needs and authorizations for care 5 Most importantly the triage nurse can give immediate instructions to the injured worker for self care making www ewcconference com ewc magazine it unnecessary for the worker to lose time and visit the physician s office NEXT STEPS PROTOCOL Once the necessary medical attention is managed the nurse manages the required paperwork with emails to the necessary parties identified initially in the protocols such as the State the claims organization and of course the employer maintaining all mandatory HIPAA rules WHY A NURSE TRIAGE PROGRAM The value of a nurse triage program can be discussed forever because we all have difficulty embracing a change in process It becomes obvious to those mindful of future projections that a more efficient method of dealing with workplace injuries can be of significant value Here are a few ways the nurse triage program offers value 1 It reduces direct and indirect costs of a claim 2 I t provides the injured worker appropriate medical service immediately 3 It ensures timely State reporting 4 I t avoids unnecessary emergency room and physician office care 5 It removes the supervisor from making a medical decision which is not their job 6 It delivers rapid information to claims 7 All calls can be recorded for accuracy and a permanent record J 37
RISK MANAGEMENT 1 Prompt case setup Clients need to know that claims are being processed efficiently So do claimants The claim handlers and the service providers need to be on the same timeline Delays especially at the outset of the process will impact the claim increase the potential for needless litigation and often lead to misunderstandings and a loss of trust 2 E arly contact Establishing a dialogue with claimants with treating physicians and with employers helps to reduce uncertainty and fear and lets all the parties to the claim begin the process of moving forward 3 T imely ISO searches Understanding a claimant s history is an essential evaluation point for claim handling Workers who have no prior contact with the workers compensation system may need a bit more guidance in knowing what to expect while a significant and repetitive history of claim activity may raise its own questions that need clarification 4 T imely investigations Not every claim needs to be assigned to an outside investigator but every claim does need basic confirmation of the stated facts some additional information from the parties Confirming the facts early helps a claim handler make prompt and accurate decisions especially where AOE COE questions arise or where there is a potential for subrogation recoveries 5 Timely reserves The only thing absolutely true about an initial reserve on a complex claim is that it will most likely change Nobody expects perfection two weeks into a catastrophic claim but handling those changes as soon as accurate and additional information becomes available is vital I know reserves are likely to change and the more complex a claim is the more likely that multiple revisions to the reserves will be needed Do those corrections but please do them promptly That helps me focus on those claims where time and attention may have a positive impact If your timing has an impact and needs to be adjusted we ll talk about it but that s rare 6 T imely special investigations When red flags are raised in a claim referring them to an SIU or outside investigation team is vital and the sooner the better This is especially true in cases where either fraud is suspected or where subrogation or risk transfer may come into play 7 Timely medical management decisions Claim handlers know who the effective treating physicians are and can help guide employers and employees alike to proper treatment whether from a primary care provider or from a specialist 8 T imely communications Don t wait for a quarterly or semi annual claim review to tell your client about a potential problem or the need for them to address return to work Taking a moment to send an email or make a telephone call in between more formal meetings and reviews can make all the difference In addition consider visiting the worksites for major clients both employer and adjustor will benefit from those interactions and the dialogue they create 36 DOCTORS PERSPECTIVE Similarly risk managers should visit their adjusters to see and understand the reality of claim handling Consider a chairside visit to see how the claims process really works 9 Timely Return to Work help Injured workers who return to gainful employment rapidly even if in some limited or transitional manner tend to fare better which lowers costs and difficulty for all the participants in a claim 10 T imely referral to counsel When claims do litigate finding the right time to bring in counsel can be critical Referring too late causes extra work for the attorney potentially at additional cost while referring too early has the same effect for the opposite reason There is for each claim a right time to make the referral and knowing this timing is a vital skill for claim handlers to develop 11 Prompt closure Don t let a claim linger for months it serves no purpose and only skews claim handling statistics and reports As you will notice almost all of these 11 steps are focused on the primary claim handler and their team There are some additional criteria that I and others apply to the TPA or carrier as a whole Specifically I want an accurate idea of the current and planned workloads each claim handler will manage along with an estimate of the complexity of those claims e g the age of the claim since inception estimated permanent disability involved whether the claim was litigated etc Some measure of the stability of that book of claims is also helpful typically measuring the ratio between total new arisings versus total closings The particulars of the claims themselves help me address the complexity of the claims There is after all a vast difference between handling 250 med pay only claims and handling 130 major catastrophic injuries Those extremes of the workload require different skills I also want to know what internal programs the company has in place to assure quality handling and what steps are taken to correct any deficiencies that are observed An additional question for the companies is whether they offer a risk management information system RMIS or whether their system will coordinate with my data processing capabilities One newer area that I look for is the data analytics capabilities of the carrier or TPA There is a wealth of information in both general data and industry specific information and if there is a sufficient volume of claims in employer specific data Those firms that possess in depth capacity for analyzing that data can gain a significant advance view of trends probabilities and insights in how to address common problems in handling claims Data analytics is a newer field but it s now starting to take off in an exciting and novel fashion There is a common thread here and it s an expectation that applies equally to all the participants in this process we call workers compensation Simply put it s a two part formula consisting of equal parts competence and communication If we all strive for those goals good things will happen in the most unfortunate of circumstances and the system can work well for all of us J EWC Magazine Workers Compensation Claims and Nurse Triage By Lester Sacks MD PhD Medical Director at Arissa Cost Strategies If one of your employees is injured what do you as an employer do Has your human resources department written protocols so your employees know exactly what to do Communicating the proper information and process is important so that the injured employee receives the most immediate and appropriate care Nurse triage can be a most effective approach to managing an incident Nurse triage service by trained telephonic licensed professionals can support the 24 7 needs of the employer and employee The nurse triage team will make all the arrangements for your organization including the desired medical process and protocols to effectively support the individualized protocols including addressing the utilization of appropriate physicians in your network PROCESS FOR CARE 1 In addition to managing the medical aspects of immediate care triage nurses use not only credible guidelines but also their experience and judgment so that immediate care is delivered without always referring to a physician 2 T he team will handle the required reporting to the appropriate offices as required by the State s guidelines 3 I f more formal care is required the nurse will make the necessary referral to the physician within network or company recommendation and discuss medical findings 4 W hen necessary the triage nurse will pre certify needs and authorizations for care 5 Most importantly the triage nurse can give immediate instructions to the injured worker for self care making www ewcconference com ewc magazine it unnecessary for the worker to lose time and visit the physician s office NEXT STEPS PROTOCOL Once the necessary medical attention is managed the nurse manages the required paperwork with emails to the necessary parties identified initially in the protocols such as the State the claims organization and of course the employer maintaining all mandatory HIPAA rules WHY A NURSE TRIAGE PROGRAM The value of a nurse triage program can be discussed forever because we all have difficulty embracing a change in process It becomes obvious to those mindful of future projections that a more efficient method of dealing with workplace injuries can be of significant value Here are a few ways the nurse triage program offers value 1 It reduces direct and indirect costs of a claim 2 I t provides the injured worker appropriate medical service immediately 3 It ensures timely State reporting 4 I t avoids unnecessary emergency room and physician office care 5 It removes the supervisor from making a medical decision which is not their job 6 It delivers rapid information to claims 7 All calls can be recorded for accuracy and a permanent record J 37
LEGAL LEGAL The Independent Bill Review System By Paul C Herman and Aidan P McShane Law Offices Paul C Herman Here it is the most dreaded topic bills invoices and liens In this article we provide information and timeframes mandated by Senate Bill SB 863 to combat and control the cost services provided post January 1 2013 With SB 863 the Legislature removed much of the decisionmaking process on med legal invoice dispute issues from judges and put it in the hands of independent experts That legislation is Independent Bill Review IBR a process by which a bill review expert examines fee disputes The IBR structure controls the submission and response to all medical and med legal billing However IBR is only applicable where 1 services were provided on or after January 1 2013 and 2 the only issue left to be determined is the v alue of services IBR does not apply to services where there is no fee schedule IBR does not address any threshold issues related to lien resolution These threshold issues include but are not limited to whether services were preauthorized liens were properly filed or if there are defenses like Statute of Limitations Once the WCAB decides upon threshold issues the disputed balance is processed through IBR Two types of services are submitted to IBR MedLegal Costs and Treatment Expenses Each service is processed differently Per Labor Code 4620 a a medical legal expense may include X rays laboratory fees other diagnostic tests medical reports medical records medical testimony and interpreter s fees for the purpose of proving or disproving a contested claim All other charges medical surgical chiropractic durable medical equipment interpreter home health care etc are Medical Treatment Expenses IBR PROCESS FOR MED LEGAL COSTS If a dispute is only to the proper amount payable per the fee schedule then the dispute must go through IBR LC 9794 The process begins with a service provider serving a completed bill to an adjuster with supporting evidence such as a medical report photocopy orders or proof of attendance by an interpreter with the certification number Thereafter Defendants must object or pay within 60 days Objections must be on the Defendant s Explanation of Review EOR Any services that are not objected to must be paid in full Within 90 days from the Defendant s service of the EOR the service provider may contest the EOR and request a second review 38 EWC Magazine www ewcconference com ewc magazine The Defendant then has 14 days from the request for a second review to respond with a final written determination Any services not objected to in the final written determination are payable within 21 days At this point the second review is completed After the Defendant has submitted its final written determinations from the second review of the submitted bill the service provider has 30 days to object or respond If the service provider s only issue is the amount paid per the applicable fee schedule the service provider may request IBR The service provider must pay the IBR fees up front At this time the disputed bill is reviewed and analyzed by an independent bill review expert Upon the completion of the review the bill review expert issues his or her findings The following are the options 1 If it is found that the Defendant owes more money then the Defendant shall pay the additional amounts and reimburse the IBR fees advanced by the service provider 2 I f the report determines the employer prevails then the employer owes nothing further IMPORTANT If any of the foregoing deadlines are missed then the consequences are as follows 1 If the service provider fails to timely comply with its obligations the bills submitted are deemed paid and neither Applicant nor Defendant are liable for anything further 2 I f the employer fails to timely comply with a deadline then the full amount is payable along with interest and fees If the med legal dispute is about anything other than the application of the fee schedule then that issue must be determined through the Non IBR system LC 9794 and CCR 10451 1 c The Non IBR system is processed as follows 1 Service provider submits billing with information validating the invoice 2 D efendant has 60 days from receipt to pay any uncontested services and to object by way of EOR with supporting evidence of those services which are disputed 3 Service provider now has 90 days to object to the EOR 4 I f the provider s objection is timely and not based on just the amount per fee schedule then the Defendant must file a Petition for Determination of Non IBR Medical Legal Dispute and a DOR with Proof of Service within 60 days 39
LEGAL LEGAL The Independent Bill Review System By Paul C Herman and Aidan P McShane Law Offices Paul C Herman Here it is the most dreaded topic bills invoices and liens In this article we provide information and timeframes mandated by Senate Bill SB 863 to combat and control the cost services provided post January 1 2013 With SB 863 the Legislature removed much of the decisionmaking process on med legal invoice dispute issues from judges and put it in the hands of independent experts That legislation is Independent Bill Review IBR a process by which a bill review expert examines fee disputes The IBR structure controls the submission and response to all medical and med legal billing However IBR is only applicable where 1 services were provided on or after January 1 2013 and 2 the only issue left to be determined is the v alue of services IBR does not apply to services where there is no fee schedule IBR does not address any threshold issues related to lien resolution These threshold issues include but are not limited to whether services were preauthorized liens were properly filed or if there are defenses like Statute of Limitations Once the WCAB decides upon threshold issues the disputed balance is processed through IBR Two types of services are submitted to IBR MedLegal Costs and Treatment Expenses Each service is processed differently Per Labor Code 4620 a a medical legal expense may include X rays laboratory fees other diagnostic tests medical reports medical records medical testimony and interpreter s fees for the purpose of proving or disproving a contested claim All other charges medical surgical chiropractic durable medical equipment interpreter home health care etc are Medical Treatment Expenses IBR PROCESS FOR MED LEGAL COSTS If a dispute is only to the proper amount payable per the fee schedule then the dispute must go through IBR LC 9794 The process begins with a service provider serving a completed bill to an adjuster with supporting evidence such as a medical report photocopy orders or proof of attendance by an interpreter with the certification number Thereafter Defendants must object or pay within 60 days Objections must be on the Defendant s Explanation of Review EOR Any services that are not objected to must be paid in full Within 90 days from the Defendant s service of the EOR the service provider may contest the EOR and request a second review 38 EWC Magazine www ewcconference com ewc magazine The Defendant then has 14 days from the request for a second review to respond with a final written determination Any services not objected to in the final written determination are payable within 21 days At this point the second review is completed After the Defendant has submitted its final written determinations from the second review of the submitted bill the service provider has 30 days to object or respond If the service provider s only issue is the amount paid per the applicable fee schedule the service provider may request IBR The service provider must pay the IBR fees up front At this time the disputed bill is reviewed and analyzed by an independent bill review expert Upon the completion of the review the bill review expert issues his or her findings The following are the options 1 If it is found that the Defendant owes more money then the Defendant shall pay the additional amounts and reimburse the IBR fees advanced by the service provider 2 I f the report determines the employer prevails then the employer owes nothing further IMPORTANT If any of the foregoing deadlines are missed then the consequences are as follows 1 If the service provider fails to timely comply with its obligations the bills submitted are deemed paid and neither Applicant nor Defendant are liable for anything further 2 I f the employer fails to timely comply with a deadline then the full amount is payable along with interest and fees If the med legal dispute is about anything other than the application of the fee schedule then that issue must be determined through the Non IBR system LC 9794 and CCR 10451 1 c The Non IBR system is processed as follows 1 Service provider submits billing with information validating the invoice 2 D efendant has 60 days from receipt to pay any uncontested services and to object by way of EOR with supporting evidence of those services which are disputed 3 Service provider now has 90 days to object to the EOR 4 I f the provider s objection is timely and not based on just the amount per fee schedule then the Defendant must file a Petition for Determination of Non IBR Medical Legal Dispute and a DOR with Proof of Service within 60 days 39
LEGAL 5 Defendant s failure to timely respond is a waiver of all objections to that provider s billing except as to the issue of the amount 6 I f the employer does not proceed with Step 5 above then the service provider may file the Petition for Determination of Non IBR Medical Legal Dispute The service provider does not need to file a DOR At this point the matter will be submitted to the WCAB for determination of the noncost related threshold issues The WCJ has the option to defer until the case in chief is ready to be heard in the interest of judicial economy Once those are decided and only disputes regarding amounts remain then the parties return to and begin the IBR process as initially described CASH IS KING If it is not already patently clear the workers compensation system is driven by two primary factors the severity of injuries and the cost of determining the extent of those injuries and treating them Here we focus on the Legislature s attempt to harmonize providing treatment to injured workers payment to those medical providers and limiting excessive treatment and costs to the insured the dual roles of the independent medical review IMR and independent bill review IBR systems Independent bill review appears to have been ignored Through 2016 165 000 IMR applications were filed while only 2 700 IBR applications were filed Only 1 6 percent of the disputes the system addressed were through the IBR process However of those IBR applications filed medical providers were successful in approximately 75 percent of their disputes Moreover with these successful determinations the medical providers are automatically entitled to penalties interest sanctions attorneys fees and reimbursement of the IBR processing fee As success with liens dwindles savvy medical providers may learn to navigate the IBR system to recoup funds Next we focus on medical treatment expense charges including without limitation medical surgical and chiropractic services medical equipment interpreters and home health care In general form and structure the Labor Code and California Code of Regulations treat medical legal expenses and medical treatment expenses relatively similarly However there are significant differences in the time frame to object to medical provider billing and issue payments Being mindful of these differences is the only way to prevent an inadvertent waiver and automatic penalties and interest IBR PROCESS FOR MEDICAL TREATMENT EXPENSES IBR is only applicable to disputes over the amount payable per the applicable fee schedule There are some treatment areas where there is no applicable fee schedule implemented Until a fee schedule is developed the Workers Compensation Appeals Board retains jurisdiction over determining the proper amount in dispute All remaining disputes are submitted to the independent bill review process Labor Code 9794 40 The IBR process begins when a service provider serves a completed bill to an examiner with supporting documentation such as medical reporting authorized RFAs Proof of Attendance by an interpreter with a certification number etc This must be done within 12 months of the date of service Thereafter the defendant must object within 30 days of receipt via the appropriate Explanation of Review EOR If billing is submitted electronically the time to issue an EOR is reduced to 15 days Any services that are not objected to must be paid within 45 days of receipt from the date of receipt of the invoice initially submitted If the employer is a governmental entity they have 60 days to pay under Labor Code 4603 2 b 3 If the billing is submitted electronically the time to issue payment for both private and governmental employers is reduced to 15 days Any services that are not objected to must be paid in full A failure to pay may include an automatic 15 percent penalty increase on the balance as well as interest at the prevailing civil rate currently 10 percent per annum or 7 percent if a governmental entity Within 90 days from the defendant s service of the EOR the service provider may contest the EOR and request secondary bill review If the provider fails to request a secondary review within 90 days the bill shall be deemed satisfied and neither the employer nor the employee shall be liable for any further payment Labor Code 4603 2 e 2 If a request for secondary review is filed the defendant has 14 days to respond with a final written determination on each disputed item or amount Any balance not in dispute shall be paid within 21 days of receipt of the request for secondary bill review At this point it is the provider s obligation to initiate the independent bill review by making a formal request on the form presented by the administrative director AD along with supporting documentation If the provider fails to request an independent bill review within 30 days from the final written determination the bill will be deemed satisfied Neither the employer nor the employee will have liability for further payment If the provider requests IBR the defendant will have 10 days upon receipt of any Notice of Assignment of IBR to provide all requisite billing documentation EORs requests for secondary review and final written determinations to the independent reviewer The provider must initially pay the IBR fee to the AD If the provider prevails the fee for IBR is reimbursed by the defendant along with the other amounts awarded to the provider The final determination of IBR is deemed a Final Order of the Administrative Director As such the aggrieved party can file an appeal Unless an appeal is filed within 20 days this will be considered a final and binding Order If an appeal is filed the aggrieved party must dispute the presumptively correct determination of the administrative director at a trial before the Workers Compensation Appeals Board J EWC Magazine Carl s Corner By Carl Van ITP If You Have to Say No Be Nice About It By Carl Van ITP President CEO of International Insurance Institute Inc and Jon Coscia President CMO of Latitude Subrogation Services We all have to say no at times Some people find it easier than others Interestingly almost all of us struggle with the right way to say no People who hate to say no find it hard to do so and sometimes do something much worse than hurt someone s feelings They either don t say anything which passively sends an incorrect message of yes or they say no in such a way that the other person doesn t know what is being said sending the message of maybe People who don t mind saying no don t find it hard to do so but can lack the skills to do it gracefully and often instill hard feelings even when that is not their intent For those of you who have no problem saying no but need a little guidance on how to say it more effectively here are some tips Tip 1 I m Sorry doesn t have to mean you are really sorry A little empathy can go a long way Tip 2 Repeat back to the other person their point of view That will allow them to listen to yours Once you prove to someone you understand their point of view by repeating it back to them they can stop explaining it over and over again Tip 3 You don t have to prove to someone that the situation is their fault Most people want empathy not for you to take the blame If possible take their side as much as you can but return to the situation at hand Tip 4 Show the other person you wish it could be different Telling someone I wish I could do this for you However I just can t is much more powerful than I won t do this for you because I don t have to Tip 5 Help solve the problem in another way if possible Even if alternatives aren t the answer the fact that you offered them shows you care Most people when being told no can take it a little better if it is coming from someone who seems to genuinely care Tip 6 Avoid the word but when empathizing When you say I understand but the other person hears I don t understand Using the tips above you can say no and avoid conflict www ewcconference com ewc magazine The following examples show how a different approach can save you from an unpleasant situation Scenario 1 Pat is a hotel clerk who is trying to help Mr Donnelly It s late at night and he needs a hotel room Mr Donnelly Look I really need a room tonight You re the sixth hotel I ve been to and I m getting really tired Pat I m sorry there are no rooms we re completely booked Mr Donnelly Please I m exhausted Pat I understand but that doesn t change the fact that we have no rooms Mr Donnelly But I m exhausted Pat I understand but how is that our fault You should have made a reservation Mr Donnelly Can t you do something for me Pat Turning the terminal toward Mr Donnelly Look we have no rooms Notice how Pat said she was sorry but she didn t convey that very effectively She was also concerned with proving Mr Donnelly was at fault She offered no real solution and certainly did not sound as if she wished circumstances were different The next example shows how Pat does when she applies the tips above Mr Donnelly Look I really need a room tonight You re the sixth hotel I ve been to and I m getting really tired Pat Oh I m very sorry there are no rooms we have a conference here and we re completely booked Mr Donnelly Please I m exhausted Pat Mr Donnelly I understand that you are exhausted I know you don t want to have to keep searching for a room at other hotels I see how tired you are and understand what you are going through Believe me if I had a room I would definitely give it to you The truth is I just don t have a room available I d do it if I could but I just can t Can I help you find a room somewhere else Mr Donnelly Ugh Okay yes please Pat s approach led to a much better result Mr Donnelly isn t thrilled but he is ready to move on 41
LEGAL 5 Defendant s failure to timely respond is a waiver of all objections to that provider s billing except as to the issue of the amount 6 I f the employer does not proceed with Step 5 above then the service provider may file the Petition for Determination of Non IBR Medical Legal Dispute The service provider does not need to file a DOR At this point the matter will be submitted to the WCAB for determination of the noncost related threshold issues The WCJ has the option to defer until the case in chief is ready to be heard in the interest of judicial economy Once those are decided and only disputes regarding amounts remain then the parties return to and begin the IBR process as initially described CASH IS KING If it is not already patently clear the workers compensation system is driven by two primary factors the severity of injuries and the cost of determining the extent of those injuries and treating them Here we focus on the Legislature s attempt to harmonize providing treatment to injured workers payment to those medical providers and limiting excessive treatment and costs to the insured the dual roles of the independent medical review IMR and independent bill review IBR systems Independent bill review appears to have been ignored Through 2016 165 000 IMR applications were filed while only 2 700 IBR applications were filed Only 1 6 percent of the disputes the system addressed were through the IBR process However of those IBR applications filed medical providers were successful in approximately 75 percent of their disputes Moreover with these successful determinations the medical providers are automatically entitled to penalties interest sanctions attorneys fees and reimbursement of the IBR processing fee As success with liens dwindles savvy medical providers may learn to navigate the IBR system to recoup funds Next we focus on medical treatment expense charges including without limitation medical surgical and chiropractic services medical equipment interpreters and home health care In general form and structure the Labor Code and California Code of Regulations treat medical legal expenses and medical treatment expenses relatively similarly However there are significant differences in the time frame to object to medical provider billing and issue payments Being mindful of these differences is the only way to prevent an inadvertent waiver and automatic penalties and interest IBR PROCESS FOR MEDICAL TREATMENT EXPENSES IBR is only applicable to disputes over the amount payable per the applicable fee schedule There are some treatment areas where there is no applicable fee schedule implemented Until a fee schedule is developed the Workers Compensation Appeals Board retains jurisdiction over determining the proper amount in dispute All remaining disputes are submitted to the independent bill review process Labor Code 9794 40 The IBR process begins when a service provider serves a completed bill to an examiner with supporting documentation such as medical reporting authorized RFAs Proof of Attendance by an interpreter with a certification number etc This must be done within 12 months of the date of service Thereafter the defendant must object within 30 days of receipt via the appropriate Explanation of Review EOR If billing is submitted electronically the time to issue an EOR is reduced to 15 days Any services that are not objected to must be paid within 45 days of receipt from the date of receipt of the invoice initially submitted If the employer is a governmental entity they have 60 days to pay under Labor Code 4603 2 b 3 If the billing is submitted electronically the time to issue payment for both private and governmental employers is reduced to 15 days Any services that are not objected to must be paid in full A failure to pay may include an automatic 15 percent penalty increase on the balance as well as interest at the prevailing civil rate currently 10 percent per annum or 7 percent if a governmental entity Within 90 days from the defendant s service of the EOR the service provider may contest the EOR and request secondary bill review If the provider fails to request a secondary review within 90 days the bill shall be deemed satisfied and neither the employer nor the employee shall be liable for any further payment Labor Code 4603 2 e 2 If a request for secondary review is filed the defendant has 14 days to respond with a final written determination on each disputed item or amount Any balance not in dispute shall be paid within 21 days of receipt of the request for secondary bill review At this point it is the provider s obligation to initiate the independent bill review by making a formal request on the form presented by the administrative director AD along with supporting documentation If the provider fails to request an independent bill review within 30 days from the final written determination the bill will be deemed satisfied Neither the employer nor the employee will have liability for further payment If the provider requests IBR the defendant will have 10 days upon receipt of any Notice of Assignment of IBR to provide all requisite billing documentation EORs requests for secondary review and final written determinations to the independent reviewer The provider must initially pay the IBR fee to the AD If the provider prevails the fee for IBR is reimbursed by the defendant along with the other amounts awarded to the provider The final determination of IBR is deemed a Final Order of the Administrative Director As such the aggrieved party can file an appeal Unless an appeal is filed within 20 days this will be considered a final and binding Order If an appeal is filed the aggrieved party must dispute the presumptively correct determination of the administrative director at a trial before the Workers Compensation Appeals Board J EWC Magazine Carl s Corner By Carl Van ITP If You Have to Say No Be Nice About It By Carl Van ITP President CEO of International Insurance Institute Inc and Jon Coscia President CMO of Latitude Subrogation Services We all have to say no at times Some people find it easier than others Interestingly almost all of us struggle with the right way to say no People who hate to say no find it hard to do so and sometimes do something much worse than hurt someone s feelings They either don t say anything which passively sends an incorrect message of yes or they say no in such a way that the other person doesn t know what is being said sending the message of maybe People who don t mind saying no don t find it hard to do so but can lack the skills to do it gracefully and often instill hard feelings even when that is not their intent For those of you who have no problem saying no but need a little guidance on how to say it more effectively here are some tips Tip 1 I m Sorry doesn t have to mean you are really sorry A little empathy can go a long way Tip 2 Repeat back to the other person their point of view That will allow them to listen to yours Once you prove to someone you understand their point of view by repeating it back to them they can stop explaining it over and over again Tip 3 You don t have to prove to someone that the situation is their fault Most people want empathy not for you to take the blame If possible take their side as much as you can but return to the situation at hand Tip 4 Show the other person you wish it could be different Telling someone I wish I could do this for you However I just can t is much more powerful than I won t do this for you because I don t have to Tip 5 Help solve the problem in another way if possible Even if alternatives aren t the answer the fact that you offered them shows you care Most people when being told no can take it a little better if it is coming from someone who seems to genuinely care Tip 6 Avoid the word but when empathizing When you say I understand but the other person hears I don t understand Using the tips above you can say no and avoid conflict www ewcconference com ewc magazine The following examples show how a different approach can save you from an unpleasant situation Scenario 1 Pat is a hotel clerk who is trying to help Mr Donnelly It s late at night and he needs a hotel room Mr Donnelly Look I really need a room tonight You re the sixth hotel I ve been to and I m getting really tired Pat I m sorry there are no rooms we re completely booked Mr Donnelly Please I m exhausted Pat I understand but that doesn t change the fact that we have no rooms Mr Donnelly But I m exhausted Pat I understand but how is that our fault You should have made a reservation Mr Donnelly Can t you do something for me Pat Turning the terminal toward Mr Donnelly Look we have no rooms Notice how Pat said she was sorry but she didn t convey that very effectively She was also concerned with proving Mr Donnelly was at fault She offered no real solution and certainly did not sound as if she wished circumstances were different The next example shows how Pat does when she applies the tips above Mr Donnelly Look I really need a room tonight You re the sixth hotel I ve been to and I m getting really tired Pat Oh I m very sorry there are no rooms we have a conference here and we re completely booked Mr Donnelly Please I m exhausted Pat Mr Donnelly I understand that you are exhausted I know you don t want to have to keep searching for a room at other hotels I see how tired you are and understand what you are going through Believe me if I had a room I would definitely give it to you The truth is I just don t have a room available I d do it if I could but I just can t Can I help you find a room somewhere else Mr Donnelly Ugh Okay yes please Pat s approach led to a much better result Mr Donnelly isn t thrilled but he is ready to move on 41
CARL S CORNER Scenario 2 Debbie is a salesperson at a department store The store has a strict policy about not accepting refunds after 30 days Mr Adams I want to return this for a refund please Debbie This was purchased over 30 days ago so I can t do that Mr Adams I didn t know that when I bought it Debbie I understand but you should have read the return policy It s right there on the sales receipt Mr Adams Who reads sales receipts Debbie People who want refunds Mr Adams Come on It s been 34 days What s the big deal Debbie I understand but 30 days is the limit Sorry You re going to have to be reasonable about this Mr Adams Now angry I am being reasonable Notice how Debbie failed to empathize with the customer She blamed the customer for not understanding the store policy She even went so far as to imply that the customer is an unreasonable person The next example shows what happens when Debbie approaches the situation with the tips to say no in mind Mr Adams I want to return this for a refund please Debbie I m very sorry Mr Adams but since this was purchased over 30 days ago no refunds are allowed Mr Adams But I didn t know that Debbie I understand that It s on the receipt and often people don t read their receipts so I can understand that you didn t know about the policy Mr Adams Well I have to return it I can t use it now and it s expensive Debbie Mr Adams I really do understand This is an expensive item and you now realize you can t use it I truly wish the store policy were different and wish there were some way to make an exception The policy is quite firm however and there is just no way to provide a refund Can I help you find something you can exchange it for that might be acceptable to you Mr Adams Oh okay Do you have a catalog or something Again a change in approach led to a better result Remember saying no doesn t have to create bad feelings if you show a little empathy Follow these simple tips and you might get a little less resistance from people J Free QME Check QMECHECK COM Check the ratings of your QMEs before you strike QMECHECK com offers statewide ratings of QME doctors for your review before you strike from the QME panel list The QMEs are rated by defense attorneys applicant attorneys workers compensation adjusters and injured workers Rate QME doctors on a scale of 1 10 to help others decide whom to strike EWC is sponsoring a FREE ACCOUNT FOR YOU TO USE FOR THE NEXT 2 MONTHS UserName EWC1 Password EWC1 42 EWC Magazine
CARL S CORNER Scenario 2 Debbie is a salesperson at a department store The store has a strict policy about not accepting refunds after 30 days Mr Adams I want to return this for a refund please Debbie This was purchased over 30 days ago so I can t do that Mr Adams I didn t know that when I bought it Debbie I understand but you should have read the return policy It s right there on the sales receipt Mr Adams Who reads sales receipts Debbie People who want refunds Mr Adams Come on It s been 34 days What s the big deal Debbie I understand but 30 days is the limit Sorry You re going to have to be reasonable about this Mr Adams Now angry I am being reasonable Notice how Debbie failed to empathize with the customer She blamed the customer for not understanding the store policy She even went so far as to imply that the customer is an unreasonable person The next example shows what happens when Debbie approaches the situation with the tips to say no in mind Mr Adams I want to return this for a refund please Debbie I m very sorry Mr Adams but since this was purchased over 30 days ago no refunds are allowed Mr Adams But I didn t know that Debbie I understand that It s on the receipt and often people don t read their receipts so I can understand that you didn t know about the policy Mr Adams Well I have to return it I can t use it now and it s expensive Debbie Mr Adams I really do understand This is an expensive item and you now realize you can t use it I truly wish the store policy were different and wish there were some way to make an exception The policy is quite firm however and there is just no way to provide a refund Can I help you find something you can exchange it for that might be acceptable to you Mr Adams Oh okay Do you have a catalog or something Again a change in approach led to a better result Remember saying no doesn t have to create bad feelings if you show a little empathy Follow these simple tips and you might get a little less resistance from people J Free QME Check QMECHECK COM Check the ratings of your QMEs before you strike QMECHECK com offers statewide ratings of QME doctors for your review before you strike from the QME panel list The QMEs are rated by defense attorneys applicant attorneys workers compensation adjusters and injured workers Rate QME doctors on a scale of 1 10 to help others decide whom to strike EWC is sponsoring a FREE ACCOUNT FOR YOU TO USE FOR THE NEXT 2 MONTHS UserName EWC1 Password EWC1 42 EWC Magazine
RESOURCE PANEL GUIDE 44 EWC Magazine
RESOURCE PANEL GUIDE 44 EWC Magazine
