In the early 1990’s when many states began passing workers compensation insurance acts, there was a prerequisite that any compensable injury had to have a physical impact. That has changed over the years.

Today most states accept that mental injuries can occur and, therefore, can be classified as a compensable injury. Mental injury workers comp claims can be expensive to defend, and expensive if found to be compensable.

3 Types of Mental Injury Cases Affecting Workers Compensation Insurance 

Pennsylvania workers compensation law distinguishes between three (3) types of mental injury cases:

• Mental / Physical
  A work-related mental or emotional experience causes physical consequences. Sometimes a heart attack or cardiac condition can qualify as a compensable event under this standard. In this case, most courts apply a two-part test. The first part is the need for an accumulation of workplace stress beyond the ordinary day-to-day stress employees are exposed to. The second part is the need for legal causation between the stress and the alleged work injury.
  
  
• Physical / Mental
  A physical stimulus causes a mental injury. A good example of a “physical/mental” case involves an amputation or orthopedic injury of sufficient severity to necessitate later psychological counseling or psychiatric treatment for a condition such as depression or PTSD. Although the physical injury need not be the only cause of the mental injury, the element of “contact” is required.
  
  
• Mental / Mental
  A mental or emotional stimulus causes purely emotional sequela (an aftereffect of a disease, condition, or injury).  There is no physical impact or harm. This applies to any employee that is subjected to “abnormal working conditions.” Typically a verbally abusive boss is not sufficient grounds, but a store clerk who has been robbed at gunpoint, is traumatized by the event, and can no longer function normally may be.

The categorization determines the burden of proof.  In physical/mental and mental/physical cases, the claimant needs to provide evidence that establishes that his or her injuries arose in the course and scope of employment.  Mental/mental injuries require a higher burden of proof. The Claimant needs to demonstrate the presence of “abnormal working conditions.”

Proper Handling of Workers Compensation Insurance Claims

In addition to understanding the laws in your state regarding mental injury workers’ compensation claims, you also need to learn how to work with medical experts. Here are three tips when choosing and working with medical experts.

1. Prior to the independent medical/psychological evaluation by your medical expert, provide a complete set of medical records  - including review of all pre- and post- injury medical records related to the employee’s conditions - if you want your expert’s opinions to be accepted.
   
   
2. You never know how a court may respond to a medical expert. It may accept your expert’s opinions based on a rational explanation that the employee’s condition is affecting their recovery or they may be more receptive to the medical expert’s opinion when the report is detailed and supported by deposition testimony. Therefore, provide a detailed and logical explanation for an expert’s opinions to help prove your theory or position.
   
   
3. Accurate and concise reporting is essential when it comes to the acceptance of an expert’s opinions. If your expert makes the slightest error or omission, all of his opinion could be disregarded.

Learn More About Your Workers' Compensation Insurance Options

To learn more about saving on workers’ compensation insurance costs and all your workers comp insurance options,  click here to contact American Insuring Group or call us at (800) 947-1270 or (610) 775-3848.

Changing your Workers’ Compensation Insurance provider will cost money and time.  Not only will you need to spend time researching your options, but you will also probably end up spending more time answering employees’ questions. One way to save money on Workers’ Compensation expenses is to develop a strong long-term relationship with your third-party administrator (TPA).

A competent TPA can help lower your worker's comp insurance cost

The best TPAs have strong medical management skills that allow them to control the medical cost of your claims and work in conjunction with workers’ compensation adjusters.

Before hiring a TPA, ask which of the following techniques they use to control medical costs:

• Telephonic nurse case mangers (TCM) or Field nurse case managers (FCM) – experienced nurses help coordinate and manage the medical care of an injured employee, including consulting with physicians; providing frequent updates to the adjuster; and facilitating communicate between the employee, employer, and physician.
• Senior nurse reviews – a highly experienced nurse who provides continuous oversight of medical care, identifying recovery obstacles early in the claim.
• Utilization reviews – provides an independent confirmation that medical services are necessary with a pre-certification review, a concurrent review, and/or a retrospective review.
• Medical bill reviews – reviews and verifies the accuracy of the diagnostic codes and charges.
• Prescription management – helps ensure the best prices and the prevention of overutilization of drugs.
• Physician review – If an injured worker isn’t responding to medical care within the normal recovery time, a specialist can evaluate and document the past, current , and future medical treatments.
• On-site clinics – a medical clinic located on an employers’ worksite can reduce the cost of medical care for both personal and work-related injuries and illnesses.
• Injury triage – a triage nurse evaluates the injured employee’s needs and directs them to the most appropriate medical providers within the network.
• Wellness programs – a company sponsored wellness program lowers the cost of health insurance and the cost of workers’ compensation costs, lowers absenteeism, and increases productivity.
• Preferred provider networks – a network of doctors, hospitals, diagnostic facilities, and other medical providers that have agreed to provide medical services at a reduced cost to injured employees covered by workers’ compensation insurance. 

Get educated and lower your Workers Comp costs!

• Become more informed about the services offered by your claims administrator. Ask for samples of reports and deliverability’s. Read through their brochures and ask lots of questions.
• Visit one or two of their claims offices and learn their processes. Find out if adjusters have backup or clerical assistance. Watch the process as a medical bill enters the system through to the time that it is paid. You’ll have a better understanding and appreciation of how they work and how you can work with them more efficiently.
• Educate your adjusters on your business. Invite them to come in and see what your business does, the kinds of jobs and skills your employees have. This will help them understand better how an injury can occur. This may also allow them to offer more possible transitional duties for injured workers.

Need help finding a good TPA?

Amercian Insuring Group can help you find the right TPA for your organization. We can also help you find the best Workers Compensation Insurance coverage. That's because as independent agents, we're free to shop among competing insurance providers to find the best workers comp insurance to meet your unique needs at the best price.

Give us a call at (800)947-1270 or (610)775-3848 or click here to contact us. 

Workers Compensation Premium Audits - a necessary evil (some would say) for any employer - determines the final cost of your workers compensation insurance premiums. Sometimes the results of these audits can significantly change your premium compared to the estimated insurance premium originally used in the policy – and not always in a positive way. These audits can be stressful, disruptive and time-consuming for you.

Don’t wait until you receive a notice that you are about to be audited to begin collecting data.  Sometimes you only know a few weeks ahead of time, and you don’t want to scramble around for information, which can cause incorrect, missing or inadequate information. 

Here are a few tips to make a workers comp insurance audit as painless as possible:

Before the Workers Comp Audit:

• Review your original workers compensation insurance policy to see how the initial estimated premium was determined – including classification codes, rates, and payrolls.
• Look at your last audit report to see what information was required and what errors were made.  If this is your first workers comp audit, ask the auditor for a list of documents and information that they will be requesting.
• Review all job descriptions and ensure that the correct NCCI class code descriptions are applied to each job.
• Review all of your payroll records and check that employees are on the correct corporate payroll.  Make sure that any outside contract employees are kept separate from corporate employees and have copies of other insurance provisions for these contracted employees, such as hold harmless agreements or insurance certificates that show the employer as also insured on the contracted employees’ insurance policy.
• If there are unusual situations, such as an unexpected project that required additional over-time, make sure that you understand and are able to explain the situation.
• Place documents and physical evidence in chronological order.
• Ensure that information on your website or any other places a workers compensation insurance auditor would have access to is up-to-date, correct and not misleading
• Secure a private and comfortable room for the auditor(s) and ensure that internet is available in that space.

During the Workers Compensation Insurance Audit:

• Be professional and friendly
• Make sure that the workers comp insurance auditor is comfortable and knows where everything is (coffee, restrooms, photocopiers, etc.)
• Assign a primary contact person from senior management who will act as a liaison between the company and the auditor.   This person should be very familiar with all the work done within each department and by each employee, audit procedures, and the materials prepared for the audit.
• Do not lose your temper.  Be cooperative and answer all questions accurately and to the best of your abilitiy.  Keep your answers short, direct, and to the point.
• Do not invite auditors to lunch or dinner or offer any other items that could be interpreted as a bribe.
• You should have the opportunity to meet with the workers compensation insurance auditor(s) before they leave the premises to go over his or her findings and make corrections if needed.   This wrap-up meeting should be held in a private location.

After the Workers Comp Audit:

If you do not reach an agreement on the published report at the wrap up meeting, immediately prepare a written document along with all the necessary documents to support your position and request that any adverse premium changes be held until the challenge is resolved.  Legal assistance may be required.

Premium audits are a part of being an employer.  In order to see the best results, be prepared and cooperative, and be ready to provide any information the auditor requires. 

Get the Right Workers Compensation Insurance

For more information about premium audits or how to get the best deal on workers compensation insurance, contact an American Insuring Group independent agent at (800) 947-1270 or (610) 775-3848. As independent agents, we're free to find you the best insurance at the best price, selecting from among competing insurance carriers. We serve Phildelphia, Lancaster, Harrisburg, Allentown, Reading, Pittsburgh, Erie, PA and beyond. Call today.

Safety and Lower Workers Compensation Insurance Costs Go Hand in Hand

Creating a safe working environment for your employees is one of the best things you can do to help control the cost of Workers’ Compensation Insurance.  Whether you run an office, a warehouse, or a manufacturing facility, there are certain steps that apply to the main structure of any successful safety program.  Here are a few:

Set the Standard

Create an atmosphere and culture of safety; it will spread to your workers.  This can be as simple as carpeting that is free of rips and holes, clearly marked hazards, clean floors, and machines with real guards in place.  If you set the right standard, everything will follow.  

Create an Emergency Response Team

Your workforce may be the most efficient and responsive team during the course of regular business, and you may assume that they would react the same way in an emergency, but too often that efficiency and responsiveness turns to confusion and chaos during an emergency situation.  Employees need to know ahead of time what their responsibilities are in the event of an emergency, so they can react quickly like a group of well-trained marines rather than the bumbling Stooges. 

First, create a team that is a mix of serious-minded workers, supervisors, and management that understand that – in the event of an emergency -  lives may depend on them.  Make sure every employee knows who those team members are and how to reach them.  Consider creating a special code for emergencies or maybe a special name tag for members of this team.  Then, establish protocol for reporting an injury along with the chain of command.  Everyone on that team needs to understand what his or her responsibility is – whether that’s calling 911, applying CPR, or alerting other staff.

Finally, stage a few “accidents” for practice drills.  Don’t let employees know ahead of time and start easy, working your way up to accidents with increasing severity.

Communicate!

Your goal with Workers’ Compensation is to report zero claims, but if you do find yourself filing a claim, make sure your adjuster and carrier are good at communicating with the injured worker.  Set standards and make sure they are followed.  An injured worker should receive a call from a triage nurse or the adjuster within 24 hours.  The injured worker’s manager should call him or her once a week to check in on them.  Let the employee know that he or she matters and that you care about their welfare.

Lack of communication has been the down-fall of many marriages and statistically, it’s one of the biggest complaints of insurance claimants.  Too often, injured workers don’t know what is going on, what doctor they can and can’t go to, etc.   Effective communication decreases litigation, gets workers back to work more quickly, and keeps the claim moving forward to a resolution.

Get Upper Management Involved

My dad used to say to me, “Do as I say, not as I do.”  How do you think that went?  Not very well.  Good leaders lead by example.  If upper management repeatedly breaks the rules, you’ll lose whatever cooperation you’ve achieved with your employees.  Safety standards need to apply to everyone, even if that means writing up someone in senior management for a safety violation.  Your safety program needs to be enforced 100 percent of the time.

We Can Help You Save on Workers Comp Insurance

To find out more ways to save on workers’ compensation insurance, contact American Insuring Group at (800) 947-1270 or (610) 775-3848.

You say you have good business insurance, and that you've taken the time to obtain the right workers compensation insurance protection for your employees and your business. Good for you!

But, have you taken all the proper precautions to protect your construction workers or other employees from asbestos exposure? Doing so is the right thing to do for their protection, and over time it could also lower your workers compensation insurance costs.

What is Asbestos?

Asbestos is a naturally occurring mineral-based material that is widely used in many building products because it is resistant to heat and corrosive chemicals and does not conduct electricity. Asbestos fibers are very fine and can remain suspended in the air for hours. Asbestos comes in all shapes, sizes, and colors, and it’s extremely difficult to see. 

Asbestos that is in good condition and undisturbed is safe, but scientists have confirmed that when asbestos materials start to rot or are disturbed by cutting, scraping, drilling, or sanding, toxic fibers are released into the air.  Once breathed in, these tiny fibers (1,200 times thinner than a human hair) can get trapped in the lungs and remain there for a long time.  As these fibers accumulate, they cause scarring and inflammation, which can affect breathing and cause significant health problems.

Asbestos has been classified as a carcinogen (cancer-causing substance).  Continued exposure to asbestos can cause mesothelioma (a cancer that affects the membranes lining the lungs and abdomen), asbestosis (scarring of the lungs, which causes a loss of lung function that often progresses to disability and death), lung cancer, pleural plaques, and cancers of the esophagus, stomach, colon, and rectum. 

Often, the symptoms don’t appear until many years after the first exposure (20-50 years is the average gap).  Even short-term exposure to a significant amount of asbestos can lead to breathing problems, coughing, and shortness of breath.  And, there is evidence that family members of workers heavily exposed to asbestos face an increased risk of developing mesothelioma, as a result of exposure to asbestos fibers brought into the home on the shoes, clothing, skin, and hair of workers. According to the World Health Organization, 43,000 people die annually from asbestos (10,000 Americans).

Banned in 55 Counties

Asbestos has been banned in 55 countries.  Its use is restricted in the U.S. (asbestos must account for less than 1 percent of the product.), but it has not been banned.  Two million metric tons of the substance are produced every year worldwide. Many U.S. companies have phased out most products that contain asbestos; however, asbestos building materials still exist at many jobsites – especially homes and commercial buildings built before the 1970’s.  In 1989, the U.S. Environmental Protection Agency (EPA) banned all new uses of asbestos; however, uses developed before 1989 are still allowed.  

Why Construction Workers are at Risk:

Everyone is exposed to asbestos at some time during their life.  Low levels of asbestos are present in the air, water, and soil.  However, most people don’t become ill from their exposure.  People who become ill from asbestos are usually those who are exposed to it on a regular basis. 

Throughout the twentieth century, asbestos was incorporated into thousands of construction products, including fire retardant coatings, concrete and cement, bricks, pipes, gaskets, insulations, drywall, flooring, roofing, joint compound, paints, and sealants. Asbestos is a serious risk for construction workers of any trade.  Demolition workers who unsafely dispose of asbestos experience some of the highest risks.  Roofers, electricians, drywall workers, painters, plumbers, and laborers all face regular exposures, but anyone working on an older structure should be cautious of asbestos.

According the National Institute for Occupational Safety and Health, nearly one-quarter of worker deaths caused by asbestosis between the years 1990-1999 were in the construction trades, by far the most dangerous industry in terms of asbestos exposure.

If your employees perform any of the following tasks, they are at risk of breathing asbestos fibers:

• Cut, drill, sand, or otherwise disturb textured wall/ceiling material or drywall that contains asbestos
• Collect asbestos samples for laboratory analysis
• Remove or repair pipe insulation that contains asbestos
• Strip electrical wiring that contains asbestos insulation
• Remove ceiling tiles that contain asbestos
• Drag cable or wiring through asbestos-containing vermiculite insulation or ceiling tiles, or through asbestos-cement conduit
• Remove vinyl floor tiles or linoleum that contains asbestos
• Demolish concrete block that contains asbestos-containing vermiculite insulation
• Remove asbestos-containing asphalt roofing materials

How Can You Protect Your Employees from Asbestos?

• Read and understand the U.S. Occupational Safety and Health Administration (OSHA) regulations covering asbestos exposure in general industry and construction www.osha.gov/SLTC/asbestos
• Train employees who will be working with and around asbestos, including
  • How to recognize asbestos-containing materials http://www.hse.gov.uk/asbestos/gallery.htm
  • Awareness of the health hazards of asbestos
  • Proper use of personal protective equipment
  • Proper handling, removal, and disposal of asbestos
  • Develop and implement an exposure control plan for asbestos work
  • Have qualified people conduct risk assessments for any asbestos-containing materials that might be disturbed
  • Ventilate workspaces
  • Monitor employees for asbestos exposure levels
  • Keep warning signs and instructions in areas where asbestos-related work is performed
  • Require protective clothing, such as overall, gloves, foot coverings, face shields, and goggles.
  • Use protective equipment , such as respirators
  • Supply shower facilities and other post-exposure precautions
  • Require medical examinations for workers who are exposed to high levels of asbestos

Having the Right Health Insurance and Worker's Comp Insurance Pays Off

If one of your employees still becomes ill from exposure to asbestos while working for you, the right insurance – both liability, health, and workers’ compensation insurance – will help ensure the best care with the least financial impact. 

We're Here to Help

To determine your business insurance needs, contact American Insuring Group at (800)947-1270 or (610)775-3848.  We're independent insurance agents who offer insurance from over 25 competing brands. We’ll make sure you have the right coverage for your business at the right price. Contact us today.

The inability to get the right care, from the right provider, at the right time is one of the leading causes of increasing medical costs. 

Every business should complete its due diligence by taking the time to set up a network of medical providers and develop strong relationships with pharmacies to deliver quality care at reasonable prices to its employees. 

But if their employees aren’t taking advantage of those relationships, much of the opportunity for cost savings is lost. 

Better Communication = Lower Workers Comp Costs

This is especially true of employees who are injured on the job and utilizing workers’ compensation.  Too often, medical information is not being communicated properly, which can result in delays of medical treatment, increased absenteeism, duplication of medical services, and other inefficiencies, causing higher workers’ compensation costs for employers.  As medical costs - and nearly every other expense - continue to rise, it’s more important than ever to direct employees to preferred provider networks that provide the highest-quality and most cost-effective care.

Using Web-Based Communication Platforms to Reduce Workers Compensation Costs

One solution is to use a web-based communication platform such as the the Health Ticket. Such systems can include a virtual ID card that transmits all the relevant information – such as employer and employee names, date of injury, nature of injury, and the name of ancillary network vendors and contact information - to medical providers. Helpful information can be provided to the injured employee, such as participating pharmacies, phone numbers for additional medical providers, and network identification numbers.

The patient is able to access all the medical information he needs to find a provider via smart phone.  He can also print out a single page that details his health benefits, co-payments and deductibles.  He is also alerted if he is seeking care from a provider outside his plan’s provider network and how that will affect him financially.

Systems like The Health Ticket can communicate critical information while reducing costs. By providing real-time, accurate information about complex healthcare transactions, the Health Ticket helps guide injured workers through the preferred pathway of care.

What Can Web Based Communication Platforms Do For Your Business?

• Increase PPO network penetration

• Reduce claim costs by avoiding unnecessary or duplicate medical treatments.

• Maintain compliance with ever-changing regulatory environments and PPO contracts. 

• Contain costs by reducing billing errors, administrative costs, and out-of-network usage. 

• Improve the quality of care coordination and employee satisfaction.

• Reduce confusion over benefits and claims.

Contact Us for Workers Compensation Insurance Assistance

For more information about saving on workers compensation insurance, contact American Insuring Group at (800)947-1270 or (610)775-3848.