Tag Archives: injured worker

5 Best Practices on Injured Workers

Putting the injured worker first is key to the “advocacy-based claims model,” which puts the worker at the center of all activity. Until now, most employers have focused on corporate outcomes, with goals such as cutting costs and reducing days lost. But experts now say focusing on the worker can improve all outcomes.

The stories of three injured workers provide an opportunity to see the importance of focusing on the injured worker.

Take Melanie. Melanie was working as a lifeguard for the summer at a recreational center. She slipped on some wet pavement that had been targeted for cleanup but not yet addressed. She fell on one knee, sustaining a shattered patella and a deep laceration.

Melanie needed immediate surgery for the laceration. She initially was put into a brace to stabilize her patella but was told by a different provider that she didn’t need the brace. She recalls feeling like there was a lot of uncertainty around how to treat her shattered patella. One provider told her he could wire it together with surgery; another said surgery would be a mistake. Ultimately, after a delay of almost a year, during which she was unable to work, she was referred to physical therapy.

Melanie found the physical therapy helpful in enabling her finally to go back to work. However, she was left with a great deal of concern about the future of her knee and the possibility of late-onset complications. She was also upset about the long delay before she could start physical therapy. Because of this uncertainty, and to ensure that her knee would be taken care of regardless of what happened to it in the future, Melanie retained an attorney to help her obtain lifetime medical benefits for her knee. Her claim is still open.

See also: Perspectives From Injured Workers

Amy’s story has a bit of a different take. Amy was working as an administrative assistant for an apartment complex. A large number of boxes were delivered to the office and were stacked up against her desk, such that she couldn’t leave her desk area without climbing over the boxes. She asked her manager to move the boxes several times, but they were not moved. At one point, while climbing over the boxes, she fell and injured a knee.

Amy reported the injury to her supervisor, who wanted her to go immediately to a hospital emergency room. Amy did not want to wait in an emergency room and successfully argued in favor of seeing an orthopedist the next day. The orthopedist obtained an MRI of her knee that showed both old, long-standing damage and newer areas of injury consistent with the fall Amy had just sustained. However, the day after her injury, Amy’s employer fired her.

The payer in Amy’s case tried to deny the claim based on the older damage in Amy’s knee. Amy did not deny that she had damage from years of being a dancer, but she felt it was the newer damage that was limiting her mobility, as she had previously been able to exercise and now had too much pain in the damaged knee. She simply wanted the payer to pay for a few sessions of physical therapy, but the claim denial coupled with being fired left her with no resources to pay for physical therapy.

Amy found the claims adjuster hostile and inflexible. She felt betrayed by both her former employer and the payer for her claim. She retained an attorney to fight the claim denial. Eventually, the claim was accepted, and Amy was given several sessions of physical therapy. By the time this came to pass, Amy was suffering pain in the other knee because of having to favor the injured knee. What could have been resolved within a limited time had morphed into a time-lost claim with the need for extended physical therapy.

Last, there is Arthur. Arthur was employed as a consultant for a nationally known consulting firm. One day, he was carrying some boxes filled with reports when he dropped a pen and tried to pick it up without dropping the boxes. As he twisted his body to try to pick up the pen, he felt a “pop” in his back and fell to the floor in pain. After a minute or two, he was able to get up without assistance, but the pain in his back remained.

Arthur was knowledgeable about the workers’ comp system and decided to file a claim. His pain was persistent and intrusive, but Arthur was still able to work, so his was a “medical-only” claim. Arthur told the claims adjuster that he wanted to see his own physician, with whom he already had a relationship. He alluded to wanting “to avoid retaining an attorney if at all possible.”

After an MRI, Arthur’s physician told him that he now had a protruding disk that he was going to have to deal with for the rest of his life. Arthur’s physician gave him the evidence-based statistics about the success rate of surgery for a protruding disk, which were not good, and recommended that he avoid surgery and deal with his problem with stretching and physical therapy.

Arthur told the claims adjuster that he preferred to have physical therapy over surgery. The claims adjuster not only approved the physical therapy but also, unsolicited, ordered a special desk chair for Arthur to use in his home office. Arthur felt well taken care of, and after six months of following the regimen his physical therapist had designed, Arthur’s back pain resolved, and his claim was closed. He had not needed an attorney and was extremely satisfied with how his claim had been handled.

What can these three journeys tell us about how to put the injured worker first? Here are five best practices:

  1. Ensure the injured worker is educated about the claims process and what to expect. One of the most common reasons why injured workers retain an attorney is because they are worried about whether their claim will be accepted and their bills paid. Reducing uncertainty and fear on the part of the injured worker improves his or her engagement in the treatment process and reduces the attorney involvement rate, which improves quality of care and reduces cost.
  2. Use technology to facilitate the injured worker’s interactions with other stakeholders, from the initial reporting of the injury (think mobile app, direct self-reporting of injuries) to selection of the right physician and finally to the collection of feedback from the injured worker on treatment. Technology is a powerful tool to provide high-quality, personalized, yet cost-effective service. However, it needs to be backed up by strong operational processes.
  3. Encourage injured workers to plan on returning to work right from the beginning. This means helping them select the right physicians proven to have good outcomes and encouraging them to be partners with their treating physicians in choosing wisely among treatment options. For example, there are several physicians who are waging an admirable fight against the opioid epidemic and pushing for more holistic pain-management techniques. We need to send more injured workers to them instead of physicians who have been proven to encourage opioid use.
  4. Trust the injured worker to want to return to work as soon as possible. Most injured workers honestly want to recover, not to game the system. We need to go with that assumption upfront. A good marriage of Math+Trust can help reduce attorney involvement in claims from 13% to 4%.
  5. Stay in close contact with the injured worker; keep the lines of communication open. Use this opportunity to determine if there are any treatment delays that can be mitigated or any questionable treatments that are being recommended. Expectations on communication speed have increased in this constantly connected world. We need to be as close to them as possible throughout their journey to recovery.

Gently guiding the injured worker to the best possible course of treatment will optimize outcomes, improve injured worker satisfaction and minimize costs.

See also: 3 Reasons to Talk With Injured Workers  

The primary purpose of the workers’ compensation system is to get injured workers back on track rapidly. As an industry, it’s time we realigned ourselves toward that goal. Using the “injured worker comes first” principle as a true north improves claim outcomes, lowers costs and improves workplace productivity. No longer do you need to make false trade-offs between cost and quality, cost and speed, etc. Just focus on getting the worker back on his or her feet fast. All operational metrics will follow.

As first published in Claims Journal.

How to Win at Work Comp Claims

So many people want to blame the injured worker for the high cost of workers’ compensation; they say the worker doesn’t want to get better.

But consider these two patients, limping into two different medical clinics with the same complaint. Both have trouble walking and appear to require hip surgery. The first patient is examined within the hour, is X-rayed the same day and has a time booked for surgery the following week. The second sees the physician after waiting three weeks for an appointment, then waits eight weeks to see a specialist, then gets an X-ray, which isn’t reviewed for another week, and finally has surgery scheduled for six months later, pending the review of a utilization board, which will determine the employee’s remaining value to his employer. Why the different treatment for the two patients? The first is a Golden Retriever taken to a veterinarian. The second is an injured employee entering the workers’ compensation system.

Maybe we need to send our injured employees to a good vet!

The No. 1 cost driver of a workers’ compensation claim is that the injured worker is not getting better. But the sad reality is that the injured worker isn’t even given an honest opportunity. Everyone just wants to kick the can down the work comp road, believing the best way to save money is by limiting treatment opportunities.

Look at back pain, which is the most expensive industrial injury and the most common cause of disability in patients under 45 years of age. More than five million Americans are disabled by back pain, and more than half of those will develop a permanent condition. Studies show that direct healthcare expenditures exceed $20 billion annually, and indirect expenditures associated with back-related injuries are greater than $30 billion. Disorders of the musculoskeletal system are the most common causes of absence from work in both men and women between the ages of 30 and 65. Back pain is the dominating subgroup and is the second leading cause of workplace absenteeism.

See Also: How Should Workers’ Compensation Evolve?

There are plenty of statistics showing the direct costs associated with occupational back injuries average $37,000. Indirect costs range from $147,000 to $300,000.

It therefore follows that if an employer could redirect its resources and attention to the aggressive treatment of the acute back pain patient, with a view to preventing chronicity, the company would be able to reduce costs.

In fact, we have a proven system that has direct and indirect cost savings; however, it requires the employer to take control of its workers’ comp group and change the way business is being done.

Unfortunately, only a small minority of employers play at the tip of the spear and way too many employers who sit on the sideline and expect everyone else to take care of the issues.

So, we are challenging you, the employer, to get in the game, change your team line-up and win the game of managing your workers’ compensation division.

Here’s how:

Once the injured employee enters the world of workers’ compensation as either a medical, indemnity or future medical claim, the healthcare professional becomes one of the key decision makers in the employee’s recovery and return-to-work. Usually, the professional helps the injured worker recover through minimum symptomatic treatment protocols authorized by utilization review boards and return to her job in a modified duty capacity with appropriate restrictions.

The employee comes back to work, with restrictions, and in most cases the safety supervisor or human resources person assists in monitoring the employee to verify that the healthcare professional’s recommendations are being reasonably accommodated.

In a perfect world, this scenario may work. The employee recovers, the medical bills are paid and the work tasks are re-evaluated. However, in most cases, once the employee is injured, delayed treatment ensues, the injured worker develops co-morbidities associated with his injury, an applicant’s attorney gets involved and the reserves then begin escalating. At this point, any optimal solution becomes a distant thought. The only player who has the incentive to change the game is the one paying the bills… the employer!!

How can an employer change the workers’ compensation cycle to bring about solutions for all the players involved? It takes moral courage to change your team line-up and manage your claims better. Can it be done? Absolutely, and we’ve done it.

Employers have historically taken an adversarial approach to workers’ compensation claims even though the law is on the employee’s side. It makes sense to immediately engage the injured employee and set the expectations for recovery. This is part of the overall strategy to create a claims handling “team” that will align with the core competencies of the business environment. Setting the team line-up to implement an active approach to claims management will be a game changer.

As an employer, here’s an outline of what this would look like:

  1. Identify your team members; business unit manager, risk manager, safety professional, claims examiner manager, claims examiner, medical director, healthcare providers, nurse case manager, legal counsel and medical fitness consultant.
  2. Have a prominent seat at the workers’ compensation round table, whether you are fully insured or a self-insured employer.
  3. Know the workers’ compensation claim life cycle and your role in influencing outcomes.
  4. Be sure the claim examiners on your files know and understand the employer’s risk management goals and objectives.
  5. Have essential job functions (EJFs) for all positions readily accessible for the healthcare professionals and claims examiner.
  6. Perform quarterly claim review meetings on all open and recently closed claims. The meetings should include your entire workers’ comp team, so discussions can progress around treating the whole person and not just the affected body part. Remember, at some point a body part adds to the potentially new claim of cumulative trauma.
  7. As the employer, limit the claim examiner case load to 100 claims or less per examiner. This allows for more in-depth understanding of claim resolution solutions in addition to claims handling by regulatory deadlines.
  8. Make sure your insurance broker supports your desire to incorporate a medical aftercare program managed by a medical fitness organization that understands the workers’ compensation process and your strategic claims management system.

Savvy Health Solutions has worked strategically with employers as part of their claims management team and addresses the whole person by focusing on improving overall strength and flexibility, postural responsiveness to activities of daily living and a motivational element that embeds the components of the program into sustainable lifestyle changes. Savvy has found that, the sooner an employee begins the program, the quicker the employee is returned to full duties, and the claim is closed:

  1. The safety person, now having a more comprehensive understanding of musculoskeletal issues, can revisit the company’s job hazard analysis for accuracy and completeness. This technique breaks each job down into individual tasks to identify hazards and focuses on the worker, the task, the tools and the work environment. The analysis is also a key component for compliance with OSHA’s injury and illness prevention program requirements.
  2. The claims examiner is educated on the work environment. With fewer claims to handle, the examiner can spend extra time on the job to better understand the work environment from an employee’s perspective. Essential job functions and job hazard analysis have more meaning once seen in action. Claims examiners will begin to understand how people do the work, in addition to meeting the expectations of the Department of Workers’ Compensation in managing a claim.
  3. A team approach helps the claims examiner to think more like a business person. Outside consultants, like Savvy Health Solutions, help the employer see a new way of claims resolution and prevention of further injuries.
  4. The effectiveness of the workers’ compensation team can be measured with metrics created as part of your annual insurance renewal process/contract or as part of your third party administrator contract renewal.

Too many internal silos and “leaving it to the claims experts” can run against a culture of treating employees with respect and dignity when injured. The employer needs to be the key stakeholder in the process, having the same key performance indicators (KPIs) for workers’ compensation as it is done for safety metrics and profitability.

This methodology is counterintuitive to the typical workers’ compensation claims handling structure. Success starts with the employer and involves every single team member, business unit manager, risk manager, safety professional, claims examiner manager, claims examiner, medical director, healthcare providers, nurse case manager, legal counsel, insurance agents and brokers and medical fitness consultants.

Developing a winning line-up with your team will improve your ability to control costs and reach a desired outcome for the employee first, and then the organization. Because when the injured employee recovers from his injury, restores normal function and improves quality of life, then everyone wins.

What Happens When Big Firms Opt Out?

A 74-page study released on March 18, 2016, covers 15 large, multi-state employers that provided their Texas employees with customized occupational injury benefits in lieu of workers’ compensation coverage between 1998 and 2010. This is Professor Morantz’s second research study on Texas “nonsubscription” (also known as the Texas “option” to workers’ compensation).

The new report is found here.

Major findings:

1. Option programs paid better wage replacement benefits than workers’ comp programs did.
2. The frequency of severe, traumatic employee injury claims was cut in half.
3. The percentage of employees disabled dropped by a third.
4. Employer costs were cut in half.
5. Coverage exclusions had minimal impact on cost savings.
6. Negligence liability exposure gave incentives to option employers to invest in safety.
7. As large Texas employers elected the option, workers’ compensation costs dropped.

In the study, Morantz stated all the study participants “offered employees private plans whose benefits roughly resembled (yet also differed from) those available through workers’ compensation.” She said, “Some ubiquitous features of private plans—such as first-day coverage of lost earnings  and wage replacement rates that are not capped by the state’s average weekly wage—are more favorable to injured workers than workers’ compensation.”

See Also: Texas Work Comp: Rising Above Critics

Morantz expressed concern in her study because past studies have confirmed the existence of two moral hazard effects:

  1. “Risk-bearing” moral hazard predicts employees will take more risks on the job as benefit levels increase; and
  2. “Claims-reporting” moral hazard refers to the expectation that a worker will be more likely to file an injury claim (including for a feigned or off-the-job injury) as benefit levels increase.

The study says: “Consistent with the existence of both moral hazard, nearly all studies have found that increasing benefits or shortening waiting periods increases the frequency, cost and duration of claims.”

Fewer Traumatic Claims and Lower Costs

In spite of this historic research on injury benefit improvements, Morantz found:

  • Frequency of severe, traumatic injury claims declines by about 47% under the Texas option;
  • Serious claims involving replacement of lost wages are about 33% less common in the option environment;
  • Employer costs per claim fell by 49% under the option;
  • Employer costs per worker hour fell by about 44%; and
  • Although the fall in wage-replacement costs is larger in percentage terms, the decline in medical costs was equally consequential.

Coverage Exclusions Have Minimal Impact.

The option injury benefit plans studied all contain:

  1. Exclusions (non-coverage) for permanent partial disabilities;
  2. Exclusions for certain diseases (such as any caused by mold, fungi, pollen or asbestos) and some non-traumatic injuries (such as non-inguinal hernias, cumulative trauma if the employee has worked less than 180 days, carpal tunnel syndrome, chronic fatigue syndrome and fibromyalgia),
  3. Caps on total benefits; and
  4. An exclusion for chiropractic care.

Morantz found these exclusions from benefit coverage account for little of the estimated cost savings, writing, “Even when all four factors are accounted for, [the Texas option] is still predicted to lower total cost per worker hour by more than 35%.”

Benefit Enhancements and Liability Exposure Lead to Safety Improvements

Morantz mentioned a prior research finding that a rise in benefits can spur employers to invest more heavily in safety. Also, the study says the significantly lower frequency of severe, traumatic accident claims “provides strong evidence for a real safety effect, which is precisely what economic theory would lead one to expect. [Texas option employers] are, at least in theory, internalizing all of the costs associated with workplace accidents (including tort liability), which should induce them to invest more in safety-enhancing technologies.” The negligence liability exposure for employers that elect the Texas option “may prove costly in exceptional cases” and “may strengthen their incentives to implement costly safety improvements” which, in turn, offsets the above moral hazard effects.

Grounds for Denying or Terminating Benefits

Morantz found the majority of private plans include more grounds for denying claims or terminating benefits in particular cases than are commonly found in workers’ compensation. These provisions focus on employee accountability just before or after the injury takes place and on the nature of the injury. (Those provisions are commonly subject to a “good cause” exception that must be administered by a fiduciary under ERISA in the best interests of the injured worker.)

Impact of Employment Status

Contrary to option critics’ claims that all injury benefits cease upon any termination of employment, Morantz found that medical benefits continue unless the employee is fired for gross misconduct. She also found that option plans commonly do not terminate wage-replacement benefits if an employee is laid off, but such benefits do cease if the employee voluntarily quits or is fired for other reasons. Only one study participant’s plan reserved the right to terminate wage-replacement benefits if the employee was fired for any reason at all.

See Also: What Schrodinger Says on Opt-Out

Retaliatory Discharge Claims 

Morantz noted that the Texas’ Workers’ Compensation Act protects employees who file workers’ compensation claims from retaliatory discharge but that employees covered by option programs enjoy no similar protection under state law. However, she also noted the anti-discrimination/anti-retaliation claim available to workers under Section 510 of ERISA.

Drop in Texas Workers’ Compensation Rates as Large Employers Moved to the Option

Although very small firms (those with one to four employees) have always been disproportionately likely to forgo participation in Texas workers’ compensation, Morantz noted that substantial numbers of very large employers (those employing at least 500 workers) began doing so around the turn of the millennium. In 2001, Texas had among the highest reported cost-per-claim among the 14 states included in the annual Workers’ Compensation Research Institute (WCRI) cost benchmarking study. Since then, both medical costs and indemnity payments per claim under Texas workers’ compensation have plummeted.

Need for More Study

Morantz concluded there is an urgent need for further analysis of the economic and distributional effects of workers’ compensation systems co-existing with privately provided forms of occupational injury insurance. This includes the need to further (1) identify which specific characteristics of private plans are producing the majority of cost savings, (2) study potential cost-shifting to government programs or group health plans and (3) consider differences between option programs sponsored by small-, medium- and large-sized employers.

settlement

A Better Reality for Injured Workers

When is the last time you haggled with your doctor over pricing?

It’s certainly not a negotiation most Americans are prepared for or even one they know how to approach. However, when it comes to workers’ compensation settlements, the system anticipates that, after settlement, injured workers can persuade their doctors to bill them fairly, according to the state’s fee schedule. In reality, the system is naïve, and injured workers are instead being unfairly stripped of their settlement funds because they are routinely overpaying for treatment.

Injured workers deserve better, and engaging a professional administration service like CareGuard provides them just that. CareGuard offers injured workers a sophisticated advocate and group-buying power to make sure they can navigate the healthcare system and get the lifetime of treatment they were promised in their settlement, with money to spare.

Each year, tens of thousands of injured workers decide to settle their cases. The vast majority (more than 95%) of these workers have no help when it comes to properly spending their funds on healthcare. After settlement, most injured workers pay out-of-pocket for treatments related to their injury, relying on their often limited knowledge of healthcare to figure out what treatments they should pay for with their funds. When they do decide to use their funds to pay, they must navigate a complex maze of fee schedule guidelines that have been provided by the state to find the correct prices. In reality, it’s nearly impossible to comply with the guidelines without a computer application deciphering the numerous pages of schedules, CPT codes, rates, modifiers and rules.

The result is that, in most instances, when injured workers are left on their own after settlement, they fail to manage their care appropriately. They overpay for treatments and drugs, depleting their funds more rapidly than expected. They lose track of bills and fail to comply with regulations, putting their Medicare and other benefits at risk. And even when they are aware they can negotiate, injured workers are left to haggle out pricing on their own, pitted against a complex and apathetic medical system. Keep in mind that most of these individuals have far more healthcare needs than the average person.

Professional administration services provide access to discounted drug, provider and medical equipment pricing, as well as access to technology that provides a hassle-free experience with medical care. Those services also provide support from a dedicated team of representatives and advocates to answer questions and help the injured worker navigate their medical care. With professional administration, there is no utilization review or any requirement to use a medical provider network (MPN). Instead, injured workers can see any provider they would like, giving them the freedom to get the care they need with the added support to help minimize administrative red tape.

The culmination of all these benefits is that professional administration helps alleviate injured workers’ concerns about settling their cases. It is a tool that can help everyone at the settlement table prepare the claimant for post-settlement success and minimize any backlash or misunderstandings after settlement.

Professional administration is often overlooked because of a common misconception that it is very expensive, costing tens of thousands of dollars. At CareGuard, our pricing is typically below $5,000, and it can be even less for smaller cases. As a result of the low pricing and high discounts we offer our members, we also find that, on average, we save the injured worker over five times the cost of our services each year.

The workers’ compensation system was built to protect injured workers. Significant work and resources are dedicated to ensuring the system runs well. However, the system was poorly designed to care for injured workers who have settled their case and have exited the system. Professional administrators pick up where the system left off and ensure the injured worker has a smooth transition to life post-settlement.

How Bureaucracy Drives WC Costs

Workers’ compensation is one of the most highly regulated lines of insurance. Every form filed and every payment transaction is an opportunity for a penalty. Claims can stay open for 30 years or longer, leading to thousands of transactions on a single claim. Each state presents different sets of compliance rules for payers to follow. This bureaucracy is adding significant cost to the workers’ compensation system, but is it improving the delivery of benefits to injured workers?

Lack of Uniformity

Workers’ compensation is regulated at the state level, which means every state has its own set of laws and rules governing the delivery of indemnity and medical benefits to injured workers. This state-by-state variation also exists in the behind-the-scenes reporting of data. Most states now require some level of electronic data interchange (EDI) from the payers (carriers or self-insured employers). There is no common template between the states; therefore carriers must set up separate data feeds for each state. This is made even more complex when you factor in the multiple sources from which payers must gather this data for their EDI reporting. Data sources include employers, bill review and utilization review vendors. The data from all these vendors must be combined into a single data feed to the states. If states change the data reporting fields, each of the vendors in the chain must also make changes to their feeds.

Variation also exists in the forms that must be filed and notices that must be posted in the workplaces. This means that payers must constantly monitor and update the various state requirements to ensure they stay in full compliance with the regulations.

Unnecessary Burden

Much of the workers’ compensation compliance efforts focus on the collection of data, which is ultimately transmitted to the states. The states want this information to monitor the system and ensure it is operating correctly, but is all this data necessary? Some states provide significant analytical reports on their workers’ compensation systems, but many do little with the data that they collect. In a world concerned about cyber risk, collecting and transmitting claims data creates a significant risk of a breach. If the data is not being used by the states, the risk associated with collecting and transmitting it seems unnecessary.

Another complication is that there are multiple regulators involved in the system for oversight in each jurisdiction. Too often, this means payers have to provide the same information to multiple parties because information sent to the state Department of Insurance is not shared with the state Division of Workers’ Compensation and vice versa.

Some regulation is also outdated based on current technology. Certain states require the physical claims files to be handled within that state. However, with many payers now going paperless, there are no physical claims files to provide. Other states require checks to be issued from a bank within those states. Electronic banking makes this requirement obsolete.

How Is This Driving Costs?

All payers have a significant amount of staffing and other resources devoted to compliance efforts. From designing systems to gathering and entering data, this is a very labor-intensive process. There have not been any studies on the actual costs to the system from these compliance efforts, but they easily equate to millions of dollars each year.

States also impose penalties for a variety of things, including late filing of forms and late and improper payment of benefits. The EDI process makes it possible for these penalties to be automated, but that issue raises the question of the purpose of the penalties altogether. These penalties are issued on a strict liability basis. In other words, either the form was filed in a timely manner or it was not. A payer could be 99% compliant on one million records, but they would be automatically penalized for the 1% of records that were incorrect. In this scenario, are the penalties encouraging compliance, or are they simply a source of revenue for the state? A fairer system would acknowledge where compliance efforts are being made. Rather than penalize every payer for every error, use the penalties for those that fall below certain compliance thresholds (say, 80% or 90% compliance).

The laws themselves can be vague and open to interpretation, which leads to unnecessary litigation expenses. Terms such as “reasonable” and “usual and customary” are intentionally vague, and often states will not provide further definition of these terms.

How Can We Improve?

One of the goals of workers’ compensation regulations is to ensure that injured workers are paid benefits in a timely manner at the correct rate and that they have access to appropriate medical treatment. There was a time when payers had offices located in most states, with adjusters handling only that state. Now, with most payers utilizing multi-state adjusters, payers must be constantly training and educating their adjusters to ensure that they understand all of the nuisances of the different states that they handle.

The ability to give input to regulators is also invaluable, and payers should seek opportunities to engage with organizations to create positive change. Groups such as the International Association of Industrial Accident Boards and Commissions (IAIABC) and the Southern Association of Workers’ Compensation Administrators (SAWCA) provide the opportunity for workers’ compensation stakeholders to interact with regulators on important issues and also provides the opportunity to seek uniformity where it makes sense (EDI, for example).

There needs to be better transparency and communication between all parties in the rule-making process so that regulators have a better understanding of the impact these rules have on payers and the effort required to achieve compliance.

Developing standards in technology would be helpful for both the payers and the states. If your systems cannot effectively communicate with the other systems, you cannot be efficient. Upgrading technology across the industry, particularly on the regulatory side, has to become a priority.

Finally, we need to give any statutory reforms time to make an impact before changing them again because the constant change adds to confusion and drives costs. In the last 10 years, there have been more than 9,000 bills introduced in various jurisdictions related to workers’ compensation. Of those, about 1,000 have actually been turned into law. People expect that these reforms will produce the desired results immediately, when in reality these things often take time to reach their full impact.

These issues were discussed in depth during an “Out Front Ideas With Kimberly and Mark” webinar on Feb. 9, 2016. View the archived webinar at http://www.outfrontideas.com/archives/.