Workers Compensation Audit and Mod Reviews For Employers
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Oct 22, 2014

Keeping Your Website Up To Date Can Save Workers Comp Premiums

Keeping your company's website up to date is one of the best ways to increase your business no matter the size.  One of the first background materials we request from clients is their website address(es).   Why?

One of the first places that insurance carrier premium auditors examine for information about an employer is their website.  The auditor searches for certain areas in the webpages such as type of products produced; locations; Board of Directors, owners; company-specific or audit-specific  information.

If your website says that you manufacture widgets and your company has not produced those for many years, then your website should be updated with that information.  Your website can be thought of as a sales brochure.   Your website is not the place for out-of-date information.  

We came across an employer that was disputing their audit in California.  They produced ink dyes a few years ago, but then changed to manufacturing a type of sealant.   The auditor became confused when he/she looked at their website.   The result was being assessed a larger premium audit bill.

With our help, the situation was cleared up after it was discovered that their website even had a place to order the old ink dyes still active.

This happens more often when the website matches the company less and less each year.  One area to watch is that your Google profile links to an active but unlisted website.  Googling your company may show many links to a website you quit using long ago.

We actually switched blog sites in 2010.   Google still lists some of the old blog and website in their index from 2007.   

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Oct 21, 2014

Pemium Audit Workpapers Can Save Future Headaches

Audit Workpapers can be one of the easiest ways to document your yearly WC premium audit.  The workpapers are  prepared by the premium auditor.  They can be either hand-written or computerized, showing how the auditor arrived at the payroll numbers that are used to determine the audited premium.  

We always recommend that any employer ask for a copy of the workpapers before the premium auditor leaves your premises   Even if you agree with the audit, these documents can become very elusive as time passes.   


A large amount of confusion can be eliminated with the workpapers even if they are computerized or multiple Excel (R) worksheets.   The best workpapers are spreadsheets that are emailed by the auditor.  This allows you to analyze the premium audit without having to input all of the data. 


Workpapers are the most often set of missing documents when our clients provide us with requested information.  


Audit checklists may also be beneficial.  The auditor will sometimes have a standard checklist they go through for every premium audit.  The checklist can be thought of as a map of your premium audit.   


You do have the right as the employer to be provided with a copy.  We have rarely seen where an auditor will not comply with the  request for workpapers.  If an auditor refuses the request,  this should raise a red flag with you.    

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Oct 9, 2014

Florida Court Orders Advance On Workers Compensation Benefits

I was reading an article recently that referred to a case in Florida where the court ordered a Florida school system to pay a claimant  an advance on benefits.  For an adjuster to pay benefits in advance in usually verboten in most cases.  

The case was HATTIE BONNER,Appellant v. MIAMI DADE PUBLIC SCHOOLS.  This is one of the decisions that once again can harm a Workers Compensation system.  There have been other decisions of this type in Florida.

The full decision is below.   Notice the dissent at the end.  I apologize ahead of time for the spacing.

HATTIE BONNER,
Appellant,
v.
MIAMI DADE PUBLIC
SCHOOLS/GALLAGHER
BASSETT SERVICES, INC.,
Appellee.

IN THE DISTRICT COURT OF APPEAL
FIRST DISTRICT, STATE OF FLORIDA
NOT FINAL UNTIL TIME EXPIRES TO
FILE MOTION FOR REHEARING AND
DISPOSITION THEREOF IF FILED
CASE NO. 1D14-1200
_____________________________/
Opinion filed October 7, 2014.
An appeal from an order of the Judge of Compensation Claims.
Ralph J. Humphries, Judge.
Date of Accident: April 9, 2012.
Kimberly A. Hill of Kimberly A. Hill, P.L., Fort Lauderdale, for Appellant.
Michael J. Ring of the Law Office of Michael J. Ring, LLC, Pompano Beach, for
Appellee.

PER CURIAM.In this workers’ compensation appeal, Claimant argues that the Judge of
Compensation Claims (JCC) erred in denying her request for a $2,000 advance. We
agree that the JCC erred in denying the advance.
Section 440.20(12), Florida Statutes (2011), permits advances of up to $2,000
on the following proof:

(c) In the event the claimant has not returned to the same or
equivalent employment with no substantial reduction in wages or
has suffered a substantial loss of earning capacity or a physical
impairment, actual or apparent:
. . . .
2. An advance payment of compensation not in excess of
$2,000 may be ordered by any [JCC] . . . after giving due
consideration to the interests of the person entitled thereto.
The advance must, of course, “have some plausible nexus to” “medical and related
financial needs arising from workplace injuries.” ESIS/ACE Am. Ins. Co. v. Kuhn,
104 So. 3d 1111, 1114-15 (Fla. 1st DCA 2012). Here, the JCC concluded that “the
nexus between the accident and the circumstances suggesting the need for an
advance is missing” because Claimant’s “difficulty in managing those [financial]
circumstances is unrelated to her workplace injury.” Thus, the JCC has found that
Claimant has both a financial need and difficulty in managing her financial
circumstances. But from whence does that difficulty spring? Solely from
Claimant’s reduction in earnings, which – it is undisputed – is due to her workplace
injury.

2  Claimant’s uncontroverted testimony was that she was off work for “more
than 18 months on sick leave,” that she returned to work at a reduction in total pay,
and that an advance “would put me up to date . . . so that I could put food in my
refrigerator, for one thing, gas in my car, and to pay my bills.” By this testimony,
which the JCC did not reject, Claimant has met her burden of proof.
The JCC’s conclusion that Claimant’s difficulty in managing her finances is
unrelated to her injury is seemingly based on his categorization of some of
Claimant’s monthly bills as “luxury expenses.” But whether an item is classified as
a “luxury” is not a proper factor for consideration under section 440.20(12)(c)2.
These small advances are merely a stopgap to help a claimant avoid defaulting with
creditors while awaiting the potential distribution of workers’ compensation
benefits, when the reduction in income is caused by the injury. A claimant is not
required to live a pauper’s life to be eligible for an advance of up to $2,000 under
section 440.20(12)(c)2.

Advances in excess of $2,000 are permitted under subsections 440.20(12)(c)3.
and (12)(d), and those subsections mandate that a JCC inquire into the
reasonableness of those larger advances. In contradistinction to advances over
$2,000, advances in a smaller amount do not permit this inquiry, but involve only a
consideration of the claimant’s interests; the burden of proof on the claimant is
lighter precisely because the financial burden on the employer or carrier is lighter.
3 As we made clear in Lopez v. Allied Aerofoam, 48 So. 3d 888, 889 (Fla. 1st
DCA 2010), “[s]ection 440.20(12)(c)2. requires the JCC to consider the ‘interests of
the person entitled [to the advance].’” We distinguish Worthy v. Jimmie Crowder
Excavating, 100 So. 3d 727 (Fla. 1st DCA 2012), on the ground that there the JCC
“was unable to adequately consider Claimant’s interests” without additional
evidence, which was Worthy’s burden to produce and prove, whereas here the JCC
found he had sufficient evidence to give Claimant’s interests due consideration.
Accordingly, we REVERSE the order denying the advance and REMAND
this matter for entry of an order awarding the requested $2,000 advance.
PADOVANO and CLARK, JJ., CONCUR; THOMAS, J., DISSENTS WITH
OPINION.

4THOMAS, J., DISSENTS.
I dissent. This case presents nothing more than a failure of proof on
Claimant’s part, who bore the burden of persuasion. See Fitzgerald v. Osceola Cnty.
Sch. Bd., 974 So. 2d 1161, 1164 (Fla. 1st DCA 2008) (“Claimant bore the burden
over the course of the proceedings below to prove her entitlement to workers’
compensation benefits.”); Mitchell v. XO Commc’ns, 966 So. 2d 489, 490 (Fla. 1st
DCA 2007) (“Claimant has the burden to prove entitlement to . . . benefits. . . .
Accordingly, Claimant must present evidence the JCC finds persuasive.”). The JCC
found that Claimant’s “income and expenses roughly equate,” the record supports
that finding, and in the absence of any evidence of specific indebtedness connected
to the workers’ compensation case, the JCC properly denied the
advance. See Worthy v. Jimmie Crowder Excavating, 100 So. 3d 727, 728-29 (Fla.
1st DCA 2012) (noting claimant did not “provide any evidence to show that $2,000,
as opposed to something less than that, was appropriate in his situation”). Thus, I
respectfully dissent.

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Fling a Workers Compensation Claim in China

China has now overtaken us as the world's largest economy.  China's Workers Compensation system seems to be a very complex.   The system on paper looks very straightforward.  There are five basic steps that are very similar to the US system:

  1. A claim is filed
  2. Diagnosis by an official health authority; 
  3. Verification by the local labor and social security authorities that the diagnosed injury/illness is actually work-related; 
  4. Assessment of the worker’s degree of disability as a result of the injury/illness; and
  5. Calculation by the social security authorities of the benefits to be paid. 
After researching the information more thoroughly, one would have to say the Chinese system is very similar in many aspects to the US. 

The one major difference is the collusion of the medical providers and the employers.  It seems that corruption exists very heavily in this area.  The social security system is tasked with adjusting the WC claims.  There are no insurance carriers. 

The four main compensable claim definitions are in some sense even more liberal than the US system. Definition #3 is sometimes denied by US carriers when the employee is on break. 
  1. The contraction of an illness as a direct result of the employee’s working conditions.
  2. Injuries suffered during work hours and within the workplace, when the worker is the victim of violence or suffers an unexpected injury whilst carrying out their duties. 
  3. Accidental injuries suffered before or after formal work hours and within workplace, due to activity considered preparation for work or conclusion of work. 
  4. Injuries suffered in an accident when the employee is on a business trip or assigned to work outside of the work place, including cases where the body cannot be found.
The main reasons for a claim denial are:
  1. Intoxication by alcohol or drugs
  2. Employee is knowingly committing a crime.
  3. The employee deliberately self-harms or commits suicide.
  4. Cases where an employee does not die within 48 hours of the onset of sudden illness while at work - interesting that the employee must die within 48 hours to collect benefits. 
There are corresponding grades for the severity of the disability due to injury.   The levels of disability are:  (by Grade) 
  • 1 to 4 indicate that the employee no longer has any ability to work; grades 
  • 5 and 6 signify that an employee has lost most of their ability to work 
  • 7 to 10 injuries are classified as partially disabled.
This is an example of a chart of benefits for an injured worker (click here) .  The specific grades are determined by a description of each grade.  

I am sure there are off-paper differences between the Chinese and American Workers Compensation systems.  However, there are many striking similarities.  

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Oct 7, 2014

Will Cutting or Eliminating Health Insurance Cause a Rise In WC Claims

One of  the under-the-radar effects of cutting or eliminating health insurance is a rise in Workers Compensation claims.  If an employee has no health insurance or has to pay a very large deductible, this may cause them to turn to Workers Comp as a way to pay for an accident that happened off the job.   This is one of the assumptions that have been made in the WC arena for years.

I came across a 2005 study that seems to fly in the face of this assumption.  Actually, I was researching to backup my assumption that employees will substitute WC for health insurance.  The Rand Study known was titled "How Does Health Insurance Affect Workers’ Compensation Filing?"

The conclusion of  the 38 page working paper was:
  • Uninsured and more vulnerable workers are actually less likely to file claims than the insured.
  • The likelihood of filing WC claims has more to do with the employers' characteristics and not the employees'  circumstances 
  • Whether or not employers offer health insurance to employees appears most important, much more important even than the insurance status of workers themselves
  • Even repeat injury-sufferers are more likely to file during episodes in which their employer offers health insurance, but not statistically more likely to file during episodes in which they themselves are insured. 
  • This suggests that the workplace environment and employer incentives may have a significant, or perhaps even the dominant, impact on workers’ compensation filing.
Some of the conclusions drawn in the study do make sense.   I also found another study from The Rand Corporation  titled The Impact of Health Care Reform on Workers’ Compensation Medical Care.  The author of the 2012 study used Massachusetts as his basis for drawing any conclusions as the state had been under healthcare reform previously.   

The conclusion drawn was that healthcare reform caused some of the Workers Comp hospital bills to be paid under health.   This was due to a 5 - 10%  reduction in WC hospital volume since Massachusetts enacted healthcare reform.  

The most recent study somewhat contradicts the previous study.   I am now confused as to whether or not health insurance reductions by employers will have an effect on WC. 

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Oct 2, 2014

BLS Publishes Pilot Test On Modified and Restricted Duty - Full of Great Charts and Data

The BLS (Bureau of Labor and Statistics) has more labor statistics than any site on the web.  If you are a writer or presenter, the BLS is the go-to place for any type of out-of-work statistics.   The list of documents available is enormous.

In April 2014, the BLS published a study known as Occupational Injuries and Illnesses: A pilot study of job-transfer or work-restriction cases, 2012.   The summary page at the bottom the study shows one very interesting statistic.

On page 35, the study has a chart which indicates that Food Manufacturers and Warehousing/Storage are the best in the study at returning injured workers to alternative jobs or modified duty.   The ability to return an injured worker to modified duty or an alternative job could also result from the type of   work involved with these specific employers.

The pilot study did not analyze all employers.   The BLS may do a full analysis in the future. 

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Oct 1, 2014

Five Reasons For Sharp E-Mod Increases

Over the last few weeks, we have had many inquiries on why an employer's E-Mod (X-Mod) has increased very significantly in just one year.   Five reasons for the sharp Mod increases are:

  1. The E-Mod may have grown gradually without notice.   Checking back to see the E-Mods (X-Mods) over the prior five to seven years may show a pattern starting to develop that went unnoticed as there was no one big jump. 
  2. Your company's safety program is just not working properly.   This would be the reason for the largest number of sharp E-Mod increases.  The X-Mod system is specially designed to require larger premium payments from unsafe employers.   A large number of injuries in even one year can easily penalize an employer for being unsafe.   We have seen many employers eliminate or severely cut back their safety programs.  The old adage - "Pay it now or pay it later" is very true. 
  3. Your company does not review your loss runs.  Online access to your claims can be golden in monitoring your current claims situation.   Many posts have been published in this blog regarding  reviewing loss runs and online claims access.   The loss runs can be seen as a map to find your way to what is occurring in your WC claims. 
  4. Not following the Six Keys To Workers Comp Savings.  Use the search box in the upper right corner of the blog for the Six Keys.   It is worth your time.   I wrote the first four over 20 years ago.  They have not changed since my initial article in the '80s.  
  5.  Workers Comp is not the main priority - even in the insurance budgeting.   Over the past three years, the new health insurance regulations have become a higher priority until a massive Workers Comp audit bill is received from the carrier.   Once a large increase in an X-Mod or premiums is in place,  expert advice is usually the best method to reduce your WC budget. 
This list is a small percentage of the reasons for a larger premium bill or X-Mod (E-Mod) increase.   Each WC situation has some unique aspects.  This list is the most common reasons that we see overall.  

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Sep 30, 2014

Upcoming WCRI Teleconference on Predicting WC Outcomes - One to Put on Your Calendar

WCRI (Workers Compensation Research Institute) has scheduled a a one-hour webinar on Thursday, October 16, 2014 at 2 p.m. ET (1 p.m. CT, 12 p.m. MT, and 11 a.m. PT) to discuss this new research.  The cost of the seminar is only $79 for non-members.  

This is a rare opportunity to see statistics from the "other side of the table." as the data was compiled directly from the injured workers.   I will be listening on this one as we have many clients in the states WCRI will be covering on the 16th.  

Some of the areas that WCRI will cover are:
  • Why was trust one of the more important predictors of worker outcomes?
  • What role did comorbid medical conditions have on an injured workers ability to return to work?
  • How do things like severity and type of injury as well as other characteristics (age, sex, education, language, marital status and job history) impact worker outcomes?
  • Do labor market conditions, such as local urbanization and the unemployment rate, have an impact?
WCRI is the only research provider of Workers Comp that actually performs studies by directly contacting the injured employees.  The studies are based on telephone interviews with 3,200 injured workers across eight states:
  • Indiana
  • Massachusetts
  • Michigan
  • Minnesota
  • North Carolina
  • Pennsylvania 
  • Virginia
  • Wisconsin. 
The studies interviewed workers who suffered a work place injury in 2010 and spent at least 7 days away from work. The surveys were conducted during February through June 2013—on average, about three years after these workers sustained their injuries.

I attended WCRI's March 2013 annual conference where the speakers covered the same subject.  The presentation was very  interesting.   For more information or to register go to the teleconference page. 

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Sep 25, 2014

23rd National Annual Workers Compensation and Disability Conference - 25% Discount Code In Article

The largest yearly Workers Compensation conference will be in  Las Vegas  November 19 - 22, 2014.   If you register before November 3rd and use discount code MOORE, you will receive the 25% discount.  Most of the discount codes have already expired for the conference.

MOORE must be in all caps.  

I will be attending if my schedule permits.  

Go here to register

These are the breakout sessions.

CM = Claims Management
MM = Medical Management
PM = Program Management
DM = Disability Management
LR = Legal and Regulatory Issues

Wednesday, Nov. 19
11 a.m. - 12:15 p.m.
Wednesday, Nov. 19
2:30 - 3:45 p.m.
Thursday, Nov. 20
8:30 - 9:45 a.m.
Thursday, Nov. 20
10:45 a.m. - 12 p.m.
Thursday, Nov. 20
1:30 - 2:45 p.m.
Thursday, Nov. 20
3:45 - 5 p.m.
Friday, Nov. 21
10 - 11:15 a.m.
-
Wednesday, Nov. 19
11 a.m. - 12:15 p.m.
Wednesday, Nov. 19
2:30 - 3:45 p.m.
Thursday, Nov. 20
8:30 - 9:45 a.m.
Thursday, Nov. 20
10:45 a.m. - 12 p.m.
Thursday, Nov. 20
1:30 - 2:45 p.m.
Friday, Nov. 21
10 - 11:15 a.m.

Wednesday, Nov. 19
11 a.m. - 12:15 p.m.
Wednesday, Nov. 19
2:30 - 3:45 p.m.
Thursday, Nov. 20
8:30 - 9:45 a.m.
Thursday, Nov. 20
10:45 a.m. - 12 p.m.
Thursday, Nov. 20
3:45 - 5 p.m.
Friday, Nov. 21
10 - 11:15 a.m.

-Wednesday, Nov. 19
11 a.m. - 12:15 p.m.
Wednesday, Nov. 19
2:30 - 3:45 p.m.
Thursday, Nov. 20
8:30 - 9:45 a.m.
Thursday, Nov. 20
10:45 a.m. - 12 p.m.
Thursday, Nov. 20
1:30 - 2:45 p.m.
Friday, Nov. 21
10 - 11:15 a.m.
-
Wednesday, Nov. 19
11 a.m. - 12:15 p.m.
Wednesday, Nov. 19
2:30 - 3:45 p.m.
Thursday, Nov. 20
8:30 - 9:45 a.m.
Thursday, Nov. 20
10:45 a.m. - 12 p.m.
Thursday, Nov. 20
1:30 - 2:45 p.m.
Thursday, Nov. 20
3:45 - 5 p.m.
-

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