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What to Do When Workers’ Compensation Is Not Enough!

Author DMalloy , 6/15/2017
Injuries are common occurrences across the nation, and your client’s business may be next. While all employees face a certain degree of danger, the individuals who are statistically higher to get into accidents are people like truck drivers, roofers, and agricultural workers. An accident can come in many forms, and the causes that were the result of the accident vary as well. Workers’ compensation can offset the consequences of injury, but what happens when the very policy meant to protect your clients’ employees falls short? What are employees to do when workers’ compensation is not enough?

Is It Possible to be Fired After a Workplace Injury?

Author DMalloy , 5/31/2017
After recovering from an injury, an employee is always scared they will be fired for missing so much time at work. But can employers fire employees after a workplace injury?

What to Do When Workers’ Compensation Is Not Enough!

Author DMalloy , 4/12/2017
When workers’ compensation is not enough, what are employees to do? Where can they find other sources of money? Injuries are common occurrences across the nation, and your client’s business may be next. While all employees face a certain degree of danger, the individuals who are statistically higher to get into accidents are people like truck drivers, roofers, and agricultural workers. An accident can come in many forms, and the causes that were the result of the accident vary as well. Workers’ compensation can offset the consequences of injury, but what happens when the very policy meant to protect your clients’ employees falls short? What are employees to do when workers’ compensation is not enough?

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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Author DavidMalloy , 5/11/2012
According to recent data collected by the Bureau of Labor Statistics, approximately 15 million people in the United States work on a rotating shift, night shift, or evening shift schedule. In addition, the total number of hours worked by employees in the United States is higher than most of Western Europe and Japan. Both working irregular shifts and working long hours have been shown to contribute to safety risks and health problems.

Shift workers tend to be more tired than the general population, which can lead to difficulty concentrating and slower reflexes. As a result, shift workers are more likely to make errors on the job or be involved in accidents. The stress of shiftwork might also cause such employees to acquire certain health conditions.

When an individual works at night, he or she is unable to get enough restorative sleep. Sleep following a night shift is usually shorter and less regenerative than sleep during the night would have been. During nighttime hours, body functions and brain activity slow down. Because the individual is already lacking sleep, he or she is likely to exhibit performance problems. Individuals who work rotating schedules will experience additional problems each time they must switch between day and night shifts.

In addition to fatigue and concentration problems, shiftwork can also lead to serious health problems. Research has shown that employees who work rotating shift schedules are more likely to experience digestive problems, such as nausea, constipation, and stomach ulcers. Heart conditions are also more common among shift workers than in the general population.

Because shiftwork is often unavoidable, it is important to design the work schedule so that it minimizes the stress of shiftwork as much as possible. A properly designed work schedule can prevent accidents, improve worker morale, and decrease the likelihood of employee health problems.

All workers have a natural circadian rhythm that tells their bodies when to sleep and be awake. For this reason, employees who must be at work during late night and early morning hours are likely to have more trouble focusing. Certain shift times might also prevent workers from seeing family and friends. To prevent problems that might result from unusual shift times, many employers avoid scheduling the same worker for late night or early morning shifts during all work periods.

Though it might seem like it would be easier for workers to adapt to an unusual shift if it were a permanent assignment, most workers readjust to a normal schedule on their days off. For this reason, the majority of employers assign shiftwork on a rotating schedule. Rotating schedules prevent a worker from constantly experiencing the stress associated with the night shift. However, rotating schedules require workers to make changes to readjust to new sleep patterns regularly. To prevent serious health problems, it is advisable to rotate a worker's shift every few weeks, rather than weekly or after only a few days.

Another important factor to consider in shiftwork is the amount of time an employee has to rest. Employees who work eight-hour shifts have more hours in the day remaining for rest than employees who work 12-hour shifts. Unfortunately, the other tasks employees must perform after their shift will not decrease when they work overtime, so employees who work long shifts must often sacrifice sleep in order to make ends meet. To prevent a buildup of fatigue, employers of employees who must work long hours should avoid scheduling too many consecutive workdays for the same employee.

Employers who require workers to perform shiftwork should also teach employees effective coping skills to deal with the stress of the schedule. Employees working rotating shifts can improve their situations by getting as much sleep as possible during their time off. They should also make an effort to spend time with family and friends, exercise, and eat a balanced diet.

Do your clients understanding the implications of shift work? PMC can help find you the best Policies for your clients to protect their liability.

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


Hiring Independent Contractors is Not Risk-Free

Author DavidMalloy , 2/22/2012
Ask the Workers' Comp Expert: Hiring Independent Contractors is Not Risk-Free
by Robert G. Jones, Vice President, PMC Insurance Group

In today’s challenging economy, business owners have turned to hiring independent contractors in lieu of adding traditional employees. Advantages might include: completion of specific, short-term assignments; obtaining unique, project specific skill sets; reduced costs for administration; and the avoidance of benefits, taxes and legal issues surrounding the hiring and firing of traditional employees.

However, there are risks associated with this practice. Legitimately hired contractors might win disability, workers’ compensation and medical insurance benefits if they were misclassified to avoid paying such benefits. A business owner could also be held responsible for paying all withholding taxes, plus interest, if the Internal Revenue Service finds employees have been misclassified as independent contractors. And, the IRS and other governmental agencies could impose additional financial penalties.

The number of worker class action lawsuits that claim employers misclassified employees as independent contractors rose 50 percent in 2010 to a record 300 or so, according to Garry Mathiason of Littler Mendelson, one of the nation’s largest employment and labor law firms. One reason is that using independent contractors has become common practice in construction, trucking and home health care.

The IRS created a list of 20 common law factors to determine whether a contractor is actually an employee. Under common law, a worker is an employee if the business owner (person for whom services are preformed) has the right to control and direct the way they work including when, where and how the work is done. It is important to understand the difference between the IRS definition of employee versus the definition under statutory workers’ compensation protection.

PMC Insurance Group’s only business is workers’ compensation. Our insurance professionals have extensive experience helping IIABNY members expand their marketing capabilities by providing workers’ compensation solutions for their clients, including appropriate insurance protection when hiring independent contractors.

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