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What is the Size Limit for Workers’ Compensation?

Author DMalloy , 5/17/2017
Worker’s compensation insurance can cover the medical injuries of a work-related injury, but is there a size limit for this policy?

 Workers’ compensation is a policy that covers the business of your clients should one of their employees get injured or sick while on the job. Without it, they are subject to a lawsuit that could drive their business into the ground. Many people believe that workers’ compensation is only required if their business possesses heavy equipment that poses an actual threat to human lives. They believe that only big businesses require this policy. But this kind of thinking is incorrect. There is no such size limit for workers’ compensation. Here are a few reasons your business clients need to consider workers’ compensation–regardless of the size of their business.

Most Common Workplace Accidents

Author DMalloy , 2/15/2017
The workplace is supposed to be a space for productivity and profits, not accidents and lawsuits. One should work to prevent and avoid these common workplace accidents.

Orthopaedic Workers Comp department opens

Author DavidMalloy , 7/13/2012
The Physicians of Illinois Bone and Joint Institute Glenview/Wilmette recently announced their new dedicated Orthopaedic Workers’ Compensation (WC) department.
As one of the most comprehensive WC systems in the Chicagoland area, the new WC department is an onsite resource for patients, employers and industry professionals in the North Shore area.

The department helps employers save money on WC costs through IBJI OrthoAccess, their walk-in immediate Orthopaedic care clinic in Glenview. They offer timely case management. Injured employees have access to highly skilled orthopaedic physicians who will help them return to work as quickly as possible. Their WC physicians are certified in AMA Impairment Ratings. They treat injured employees in the areas of Orthopaedics, Pain Management and Rheumatology.

For more info and latest news on Workers Comp issues, please call use today.

Ask the Workers' Comp Expert: Internal Investigations Can Reduce Claims, Costs

Author DavidMalloy , 6/4/2012
Ask the Workers' Comp Expert: Internal Investigations Can Reduce Claims, Costs
by Robert G. Jones, Vice President, PMC Insurance Group

Recent "Ask the Expert" columns addressed certain aspects of return-to-work programs. Today, we address strengths and flaws within a workers’ compensation program focusing on reducing the number of claims and overall cost.

The number of lost time claims is a key metric and should be reviewed at least annually. If this number exceeds 25 percent of total claims, further investigation is recommended. Another important metric is the number of claims that are litigated. If this number exceeds 20 percent of all claims, a comprehensive internal investigation is necessary. Business owners experiencing significant numbers of lost time and/or litigated claims need to examine the root cause(s) driving these adverse claims results.

The business owner should review the following as a part of an internal investigation:
  • Is the hiring process effective in screening prospective employees? Background checks and drug testing at minimum. 
  • Are supervisors trained and accountable to build high performing teams that integrate workplace safety into job duties? Personal responsibility and employee morale are key components. 
  • How quickly are workers’ compensation claims reported to the insurance company? Within 24 hours is the goal. 
  • Are accidents and incidents investigated with findings documented and acted upon? How the business owner responds is an important component of organizational culture. 
  • Is communication with injured employees consistent and supportive? The goal being an early and successful return to work. 
  • Are wellness programs integrated into work activity? Tracking and communicating results reinforces the business owner’s commitment to a safe and healthy work environment. 

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 offering guidelines to help business owners reduce the number of claims and overall cost.

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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Our unique Social Services Program

Author DavidMalloy , 5/28/2012
The Social Service industry currently employs over 1.6 million employees through 94,000 establishments. Over the next 10 years this industry is projected to grow 40%, making it one of the fastest growing industries in the economy.

PMC Insurance Group is offering a broad Workers’ Comp Program to address this growing industry

Target Classes/Operations:

  • Sheltered Workshops
  • Residential Programs
  • Drug and Alcohol Rehab and Counseling
  • Children and Family Services
  • Counseling Services
  • Vocational Rehabilitation Services
  • Day Care Centers
  • Crisis Centers
  • Class Codes 8832, 8836, 8837, 8861, 8864, 8868, 8869, 9059, 9101, 9110
  • State specific and other incidental classes are eligible

Program Parameters:

  • Minimum premium $2,500
  • Available in all states, except AK & HI
  • Start-ups Eligible
  • Guaranteed Cost
  • Loss Sensitive/Deductible programs for larger accounts
  • Admitted A- or higher Rated Carriers

Submission Requirements:

Have a question about this topic? Ask the Expert

Home health care is one of the most profitable franchises

Author DavidMalloy , 5/18/2012


WASHINGTON – A new report lists home health care as one of the top five most profitable franchises in the U.S., even as the industry fights new Department of Labor rules calling for mandatory overtime and minimum wage requirements for home health employees.

Franchise Business Review, a market research firm, found that the median amount paid for a new franchise in 2012 was about $66,000, and the "potential return on investment is significantly higher than many other franchise businesses."

The company surveyed home care owners two years ago and found the fairly new industry was growing fast, but this report, company President Michelle Rowan said, shows it's not just a trend. "It's a very strong business," she said. "It was neat to come back two years later and see that they're still performing well."

The surveys also showed owner satisfaction was high.

"In senior care, they're more involved in the day-to-day operations," Rowan said. "That's opposed to someone who owns a fast-food franchise who might be dealing with lower-end employees who make $10 an hour. Many home care givers are "doing what they want to do for the rest of their lives."

The survey, released last week, showed top franchises grossed $1 million or more, with gross margins at 30% to 40%. As a comparison, opening a food or retail franchise can cost $500,000 in initial investments while operating with slim margins.

The report found owners kept their costs low by operating out of their homes, and that the economy did not affect the industry as much as others because the number of seniors needing care continues to grow. Rowan said more families have adults who both are employed, so there's no one to stay home with an aging parent.

Home care representatives have appeared before Congress to argue that overtime pay would force them to charge seniors more — and that home care workers already make minimum wage and above.

One of the industry's leading companies, Home Instead Senior Care, spent at least $362,000 in 2011 fighting the proposal.

Sheila McMackin, president of the National Private Duty Association, said her group has asked the Labor Department to consider that home care often includes overnight care, and seniors won't be able to afford that if workers receive overtime.

And, she said, industry numbers have shown revenue growth has gone down overall since 2009.

Net profits, she said, typically average 12% to 15%. New companies average first year revenue of $248,000, she said.

But Dorie Seavey, director of policy research at the Paraprofessional Healthcare Institute, an employee training and advocacy group, said that 15 states already require overtime payment and minimum wage for home health workers, and that the businesses in those states are still making a profit.

And, according to a 2009 National Private Duty Association survey, businesses charge clients twice as much as they pay employees. She said there's not enough overhead to justify not paying employees more.

"I find it really hard to reconcile that one of the most profitable sectors is pinching pennies when it comes to workers," Seavey said.

The Department of Labor received 26,000 comments about the proposed rules, three-quarters of them positive, she said. The department now will decide if any changes need to be made and then send the rules to the Office of Management and Budget, where the rules will be made official. Seavey said she hopes that will happen by the end of summer.

Operating in the Continental US!

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

Email PMC | Visit our website


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

Online Newsletters Available to You

Author DavidMalloy , 4/6/2012

Here are our Online Newsletters, please feel free to subscribe to any article of your choice for free!

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These articles focus on workplace safety, insurance, and Workers Comp issues of interest to small and medium-size construction companies. Please let us know what topics you would like to see.


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Risk Management

These articles focus  on Risk Management. Practical Tips for Business Owners and Managers.


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Work Place Safety

For any business with employees! Special updates, and advice on holding down Workers Comp claims.      

Operating in the Continental US!

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

Email PMC | Visit our website

Tyson Foods Settles EEOC Disability Discrimination Lawsuit

Author DavidMalloy , 3/30/2012
PMC Insurance GroupSt Louis, MO – Tyson Foods, Inc., one of the world’s largest processors of chicken, beef and pork, will pay $35,000 and furnish other relief to settle a disability discrimination lawsuit filed by the U.S. Equal Employment Opportunity Commission (EEOC), the agency announced today.

The EEOC had charged that Tyson Foods refused to hire a former employee because he had epilepsy.   The EEOC lawsuit filed in May 2010 (EEOC v. Tyson Foods, Inc., Case No. 2:10-cv-04072-NKL) alleged that Tyson failed to hire Mark White for an open maintenance job in its Sedalia, Mo., plant because he had epilepsy and that Tyson’s refusal to hire White violated the Americans with Disabilities Act (ADA). White’s epilepsy had been controlled by medication for twelve years and he had been previously employed by Tyson on two occasions during this time period. However, Tyson instituted a new medical assessment procedure since last hiring White, and refused to hire him because he did not pass a medical evaluation required for applicants with epilepsy to determine whether he could safely perform the job. The doctor who performed the evaluation for Tyson did not examine White, but relied on outdated medical research in determining that he could not safely perform the job. At the same time, Tyson employed several other persons with epilepsy who had been grandfathered in.

Besides agreeing to pay White $35,000 as back pay and compensatory damages, Tyson agreed to institute a new assessment procedure for similar cases. Henceforth, an applicant who is disqualified from employment because of Tyson’s required medical assessment has the right to a second medical assessment at the applicant’s expense. Further, an independent and determinative third medical assessment will be made for any applicant not hired after the second assessment. The consent decree settling the suit, which must be approved by U.S. District Judge Nanette Laughrey, also provides for injunctive relief, including training to individuals involved in the assessment procedure, posting notification to employees, and compliance reporting to the EEOC.

“The potentially three-step medical assessment process agreed to by the parties is an extraordinary step in the right direction in terms of making sure disabled employees are given a full and fair opportunity to compete in the workplace,” said EEOC attorney Melvin Kennedy.

EEOC Regional Attorney Barbara Seely said, “While the terms of the consent decree only affect Tyson’s Sedalia facility, Tyson employs more than 117,000 people at more than 400 facilities and offices, and we are hopeful that the process we have agreed to works well enough that Tyson adopts it in other facilities.”

PMC Insurance Group offers various forms of Workers Compensation Insurance, please contact an insurance agent 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


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