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Paul Binsfeld: Nurse Hotlines & Injury Triage: 9 Things You Should Know

Author DavidMalloy , 5/31/2012
From Company Nurse

Due to continued escalation of medical and indemnity costs, many organizations may soon experience a rise in workers’ compensation premiums. A recent report, “Workers’ Compensation: A Bumpy Road from Recession to Recovery,” released in April 2012 by Conning Research & Consulting outlines the key drivers that have led to inadequate rates and the industry not reaping a profit since 2006.

Whether organizations utilize commercial coverage or self-insurance, the industry has been hard hit with losses for the last few years. Although frequency of injuries had dipped for a short time, injuries are now on the rise, particularly those severe in nature and which require more time away from work. This challenging environment has called for innovative solutions that unite the claims community in a collaborative effort toward controlling costs over the long term and to support a happier, more productive workforce.

To do this, many organizations—whether insurance companies, third-party administrators, risk pools, employers or public entities—have successfully deployed nurse hotlines at the front-end of their claims process. This one strategy has helped to enhance injury management for the benefit and advantage of all stakeholders.

In fact, there are nine things you might not have known about nurse hotlines and how they help the overall workers’ compensation process:

1. Telephonic Demand Management.
In workers’ compensation, nurse hotlines have become an effective way to telephonically manage and direct the demand for care. This strategy, also known as injury triage, ensures the most effective use of medical resources; controls medical costs; and matches the severity of an injury to an appropriate disposition for care. For example, when an injured employee presents at the ER with a minor injury, they often have to wait two hours or longer to be seen, as the more critically ill or injured patients require treatment immediately and typically ahead of them. With a nurse hotline, telephonic demand management channels injured employees to a more appropriate level of service, which improves—not only costs—but also convenience and satisfaction for injured employees.

2. Prompt Reporting of Injuries.
The traditional injury reporting process has been plagued with challenges—primarily timeliness and compliance. Injuries are often reported late—sometimes as much as five to 10 days after an injury occurred. By that time, injured employees may have already visited an ER, taken time off from work, and entered a temporary disability status. In essence, the organization has missed its opportunity to manage care and influence return-to-work (RTW) results. In this way, an initial lag in reporting can result in multiple setbacks in coordinating the best-possible outcome. By using a nurse hotline, the injury reporting process is streamlined and immediate. The employee or supervisor can simply call the toll-free number to report the injury 24 hours a day. Triage nurses are trained to perform thorough questioning to gather comprehensive injury information. They also handle paperwork, which greatly reduces the burden on supervisors and injured employees to fill out and submit forms. With such an easy process, organizations often achieve a high rate of same-day reporting.

3. The “Day of Injury” Advantage.
The “day of injury” is the most critical point in the workers’ compensation process, as it is the time when organizations can exert the greatest influence over medical care and RTW results. Nurse hotlines provide a major advantage in injury management, as employees are able to speak with a nurse within minutes of an injury occurring. The triage nurse makes immediate, critical medical decisions that set claims on the right course from the start, and positively impact patient care, as well as claims’ costs and outcomes.

4. A Coordinated Approach.
After triaging an injury, the nurse hotline will send an immediate injury report to all designated contacts, including the worksite supervisor, claims adjuster, HR liaison, and RTW coordinator. Prompt distribution enables all stakeholders to initiate their respective roles in the workers’ compensation process, enabling each person to optimally affect the claim’s outcome. The nurse hotline also sends an alert to the medical provider office. Staff and physicians then know an injured employee is being sent to their facility for care. The report includes the employee’s personal and injury information, as well as employer details and workers’ compensation insurance. With this information, provider offices are able to handle workers’ compensation cases much more efficiently, and the physician is able to stay focused on providing the best-possible care and getting employees back to work quickly and safely.

5. Triage Algorithms & Nurse Expertise.
Nurse hotlines have been around for a while, but the sophistication of the model has grown and evolved significantly over time—from structured protocols to clinical algorithms that lead to a more reliable and systematic process in triaging injuries. Algorithms are decision trees that enable nurses to make an in-depth evaluation of an injury and the patient’s medical background. The result is a sound triage decision based on clinical knowledge and supplemented by a nurse’s compassionate, personalized attention to each and every injured employee.

6. Right Level of Care.
Worksite supervisors are often involved in making treatment decisions on where to send injured employees for care. However, these managers are not trained medical professionals. Many decide it is best to err on the side of caution, sending every employee for treatment with a medical provider. The result is unnecessary medical costs for minor and non-emergency injuries. With a nurse hotline and triage process, every injury is assessed by a medical professional and is referred to a level of care appropriate to the injury’s acuity. In an analysis performed by Company Nurse, it was shown that many employers reduce “unnecessary” ER visits by as much as 300 percent.

7. First Aid.
With approximately 20 to 40 percent of incoming calls, a nurse hotline may recommend first aid or self-care guidelines. After speaking with a nurse, many of these employees do not require or request additional medical services. Others may utilize first aid advice to address injuries prior to seeing a physician, which often improves treatment results. Many calls, however, result in “report only” or “first aid” injuries, which do not enter the workers’ compensation system and do not become compensable claims. This can often lead to a 10 to 30 percent reduction in claims.

8. Improved Utilization of Preferred Providers.
Many organizations invest time and effort in establishing a list or network of preferred providers, who are most qualified to treat occupational injuries and understand workers’ compensation objectives. However, the rate of referrals to these providers is often less than optimal. If this type of list does not exist, organizations will encourage their worksites to identify providers on their own and to establish a consistent referral process. However, this is very difficult to do without proper knowledge and a structured system. A nurse hotline has the expertise to help organizations identify and pre-designate quality providers within a reasonable radius of worksites. This list of providers or an existing network can be integrated into the hotline’s triage process. In this way, organizations have a mechanism to consistently utilize the best, most cost-effective facilities in their area.

9. Compassion Reduces Litigation.
Injured employees usually experience a higher level of recovery and satisfaction if they’re able to speak to someone about their injuries. A nurse hotline serves this purpose, so it’s the injured workers who benefit most. By speaking with a triage nurse, employees receive a compassionate response to what is often an upsetting workplace accident. Nurses listen closely to the details of each injury and focus on the individual’s unique medical needs. As a result, employees have an overall positive experience with the triage process and walk away with greater peace of mind. With nurse triage in place, one Florida-based employer reduced its rate of litigation by almost 40 percent.
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Ask the Workers’ Comp Expert: NCCI to Change Experience Modification Formula

Author DavidMalloy , 5/8/2012
Ask the Workers’ Comp Expert: NCCI to Change Experience Modification Formula
by Robert G. Jones, Vice President, PMC Insurance Group

Typically, business owners paying $5,000 or more annually in workers’ compensation insurance premium qualify to be experience rated (some variations by state). The result is an insurance premium modification factor will be calculated annually for such businesses based upon individual three prior years’ payroll and loss history. This data is reported to the appropriate rating bureaus by the individual business owner’s past insurance companies.

In general, historical loss data for a particular business is compared to the average loss data for all similar businesses in its state of domicile. This comparison results in a debit or credit experience modification factor that is used to adjust the business owner’s annual workers’ compensation insurance premium. Most states use the National Council on Compensation Insurance to calculate experience modification factors for individual businesses. A few states, including New York, have their own separate workers’ compensation rating bureaus.

Effective January 2013, NCCI will implement a new formula for calculating experience modification factors. The key change in the formula is the increase in the loss per claim, from $5,000 currently to $15,000 in the new formula. Thus the size of losses per claim will have significantly greater impact on driving up the experience modification factors for business owners with large individual claims. (More information to come in the months ahead.)

PMC Insurance Group is IIABNY’s endorsed workers’ compensation specialist. Our insurance professionals have extensive experience helping IIABNY members expand their marketing capabilities by providing workers’ compensation solutions for their clients. Give Bob Jones a call at (440) 313-5002.  

 Operating in the Continental US!
 Phone: 1-877-PMC-COMP| (781)-449-7744
Email PMC | Visit our website

Why Workers Comp is Important

Author DavidMalloy , 4/27/2012
PMC Insurance GroupPMC insurance group is a leader in finding workers compensation solutions for all businesses.  We have a dedicated group of experienced Small and Large Business underwriters ready to partner with you in finding solutions and markets for your clients.  We have structured the organization to be efficient in handling  business accounts, respond quickly and provide you with a knowledgable and friendly team. Why do I need Worker's Compensation Insurance you ask, check out this video and see if it changes your mind. 

Operating in the Continental US!

           Phone: 1-877-PMC-COMP | (781)-449-7744

Email PMC | Visit our website

Impact of an Aging Workforce on Costs

Author DavidMalloy , 4/9/2012
PMC Insurance GroupAsk the Workers’ Comp Expert: Impact of an Aging Workforce on Costs
by Robert G. Jones, Vice President, PMC Insurance

Much has been written and speculated about the impact of older workers and the presumed increased cost of workers’ compensation. The numbers of jobs held by baby boomers will more than double in the period from 1995 to 2020, due in part to older workers postponing retirement.

According to the National Council on Compensation Insurance, while the loss costs are higher for older workers due to the severity of their claims, those costs tend to be offset by higher premiums resulting from higher wages earned by older workers. Also, older workers file fewer claims than younger workers, which tend to offset their higher claim costs.

Research indicates that workers age 35 to 64 appear to have similar loss costs per worker. On the indemnity side, higher wages paid to older workers drive higher costs. For medical costs, older workers may require more treatments per claim, which drives total costs.

NCCI research indicates that frequency has fallen across all age groups, and differences in frequency by age have narrowed. Occupational mix does not present a material impact on frequency as in general workplaces keep getting safer for all occupations. Of note, the generation following baby boomers in the workplace is now proportionally a larger group. Currently, the impact of an aging workforce on higher loss costs is less than conventional wisdom had predicted.

PMC Insurance Group is IIABNY’s endorsed workers’ compensation specialist. Our insurance professionals have extensive experience helping IIABNY members expand their marketing capabilities by providing workers’ compensation solutions for their clients. Give us a call at (440) 313-5002.  

Operating in the Continental US!

           Phone:  1-877-PMC-COMP | (781)-449-7744

Email PMC | Visit our website

New Workers' Compensation needlestick reimbursement program (available now)

Author DavidMalloy , 4/4/2012

PMC Insurance GroupThe Hartford's new Workers' Compensation needlestick reimbursement program NOW includes: Reimbursement for the initial cost of testing the patient for blood- borne diseases in addition to the employee Not all Workers' Compensation insurance reimburses for patient testing, which saves insureds costs and gives affected employees peace of mind


To ensure the safety of your workplace, Contact PMC Insurance Group today!!!


Call us today and put our expertise to work for you!

PMC Insurance Group (P) 877-PMC-COMP (P) 781-449-7744 (F) 781-449-7889


MA Workers Comp Rates Could Increase By 19.3 Percent

Author DavidMalloy , 4/2/2012
PMC Insurance Group The cost of employee compensation insurance for Massachusetts employers could rise dramatically later this year if rates proposed by insurers are approved by state regulators.

The Workers’ Compensation Rating and Inspection Bureau of Massachusetts, which represents companies that write workers’ compensation polices, asked the state to approve an average rate increase of 19.3 percent. Most businesses are required to carry workers’ compensation insurance, which covers the medical treatment, rehabilitation, and lost wages of employees injured on the job.

If approved, the rates would go into effect in September.

The substantial increase is necessary, the bureau said, because the cost of claims continues to rise, but the state has denied smaller requests in three of the past four years. The Division of Insurance rejected proposed increases of 2.3 percent increase in 2008, 4.5 percent increase in 2010, and a 6.6 percent increase in 2011.

“If these three small increases in rates had been granted by the Commonwealth,’’ said Paul Meagher, president of the Workers’ Compensation Rating and Inspection Bureau of Massachusetts, “we would not need such a significant rate increase now.’’

Richard C. Lord, president of Associated Industries of Massachusetts, the state’s largest employers’ group, said yesterday in a blog post that the rate request deserves consideration. He said he is concerned that without an increase, fewer companies will offer the insurance, making it harder for businesses to buy policies.

“Private-market coverage is harder to come by because the economics of workers compensation no longer add up for insurers,’’ Lord wrote. “The growing disconnect between costs and premiums has already prompted several insurance companies to scale back their activity in Massachusetts.’’

Massachusetts once had some of the highest worker compensation costs in the country, but following reforms in 1991, those costs have declined steadily, falling by two-thirds over the past 20 years. If a premium cost $100 in 1991, the current rate would be $33.21. If the new rate request is approved, that premium would rise to $39.62, according to the Workers’ Compensation Rating and Inspection Bureau of Massachusetts.

The bureau said insurers need the increase to cover the rising costs of health care and wage replacement, driven by higher salaries and the longer leaves that claimants are taking. The number of claims has declined, but not fast enough to offset the increases in medical and wage replacement costs, the bureau said.

“While we recognize that the current filing calls for a significant rate increase, it reflects the real costs of providing this kind of insurance,’’ said Meagher. “Without a rate increase, we will be unable to maintain a competitive market for workers’ compensation insurance in Massachusetts.’’

The proposed rates will be examined in hearings held by Joseph G. Murphy, the state insurance commissioner. Murphy said yesterday that his office intends to “take a long, hard look at the process. This is a large increase, and this administration is particularly sensitive to the cost of doing business in the state.’’

Murphy said he expects to schedule a public hearing by the end of March.  

This article is courtesy of, Source- Boston Globe dated mar 2, 2012  

Call us today and put our expertise to work for you!

PMC Insurance Group (P) 877-PMC-COMP (P) 781-449-7744 (F) 781-449-7889


To contact us, and for more information, please visit our CompleteMarkets storefront.

Five New Ways To Grow Your Health Care book of Business

Author DavidMalloy , 2/13/2012

The Hartford has long been a market leader for the outpatient healthcare industry, and we continue to enhance our offerings to help make it easy to grow your healthcare book of business.

Register for this webinar to learn more about The Hartford's new Outpatient Healthcare offerings: Wednesday, May 19 1:00 - 2:00 pm ESTWednesday, May 26 1:00 - 2:00 pm EST

Business Owner's Policy (BOP)

1. Streamlined and enhanced Healthcare Stretch endorsements* (available 5/12/10)
  • We have streamlined the number of Stretch options available to Outpatient Healthcare classes to simplify the coverage selection process. The Stretch options available create a "Good, Better, Best" coverage approach:
    • Stretch
    • Super Stretch For Medical and Dental Offices and Healthcare Service Providers
    • Premium Stretch For Medical and Dental Offices and Healthcare Service Providers
  • The new Super and Premium Healthcare Stretch endorsements provide broader coverage offerings:
    • Higher blanket limits for key coverages important to healthcare practices
    • New optional daily limit options for Business Income that make it easier for healthcare practices to recover income from canceled patient appointments due to a covered loss
    • New spoilage coverage tailored to the specific needs of the healthcare industry

2. Inclusion of high-valued MRIs, CT Scans, Linear Accelerators, and Lithotripters on Spectrum* (available 5/12/10)
  • In the past, if insureds had any MRIs, CT Scans, Linear Accelerators, and Lithotripters valued over $1MM, all of this equipment became ineligible for the Spectrum policy and had to be excluded.
  • We can now offer coverage including Equipment Breakdown under Spectrum on these types of equipment, without being subject to a value threshold. A rating factor to Equipment Breakdown** and minimum Equipment Breakdown deductible requirements will apply (will be determined by the type of equipment covered and controls in place). Replacement cost values of all equipment must be provided, and the replacement cost value must be included in the Business Personal Property limit.

3. New Optional Limits for "Reimbursement of Legal Expenses For Court Or Review Boards" coverage (available now)
  • Spectrum automatically includes a $5,000 limit for specified healthcare classes
  • Now have the option to purchase additional limits ($25k, $50k, $75k)

Workers' Compensation

4. New Workers' Compensation needlestick reimbursement program
(available now)
  • Now includes reimbursement for the initial cost of testing the patient for blood-borne diseases in addition to the employee
  • Not all Workers' Compensation insurance reimburses for patient testing, which saves insureds costs and gives affected employees peace of mind
  • To learn more about The Hartford's new Workers' Compensation needlestick reimbursement program, click here to view the short video

Needlestick Video

Market Expansion

5. New Healthcare classes
(available now)
  • Spectrum BOP and Workers' Compensation are now available for Ambulatory Surgery Centers, Dialysis Centers, and Medical Spas
  • The larger than average premium for these classes can help grow your business

For more information on how to grow this area of your practice, call PMC Insurance Group, located in MA

Operating in the Continental US! Phone: 1-877-PMC-COMP | (781)-449-7744 Email PMC | Visit our website .