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It’s your responsibility as an employer, to pay close attention to your workers compensation insurance claims. The majority will be legitimate claims that your employees are entitled to. But even one fraudulent claim can adversely impact your bottom line.

There are important red flags you can watch for to identify possible workers compensation fraud. Here are ten red flags. Seeing just one red flag probably isn’t cause for alarm, but if you see multiple red flags on one workers’ compensation claim, it’s a good idea to bring it to your adjuster’s attention.

Ten Workers Compensation Fraud Red Flags

#1. Questionable Incident Description

An injured employee should be able to describe the incident – what happened, how, and when - with a fair amount of detail and clarity. The details should be consistent and not change as you ask questions or when the employee describes the incident to someone else (doctor, adjuster, employer). If there’s more than one medical report, the details of the event should be the same, and the nature of the injury should be consistent with the type of work the employee performs.

#2. Lack of Witness Corroboration

If the employee usually works around others, there should be a witness, and the witness account of the accident should match the employee’s description of the accident. If the witnesses are all close friends of the employee making a claim or if the employee’s co-workers express uncertainty that the accident occurred, it may be a red flag.

#3. Delayed Reporting

Injured employees usually report their injury immediately – not days or even weeks later.

#4. Disgruntled Employee

Is the employee unhappy with his job or employer? When a workers’ compensation insurance claim is made, check if the employee was recently demoted or passed over for a promotion, if his evaluations are less than stellar and he’s in danger of termination, or if he is scheduled to be laid off. An incident immediately before a strike, plant closing, or end of seasonal employment may be a red flag.

#5. Early Morning Claims

If the employee reports an incident that occurred over the weekend or very early in the morning before the supervisor and other employees have arrived, it could be a red flag.

#6. Inability to reach the injured employee

The employee should provide his address – not a PO Box and not a friend’s address – and you should be able to contact the injured employee. If you find they aren’t home during regular working hours or if you’re always told he’s sleeping or can’t be disturbed, it could be a red flag.

#7. Shaky Finances

If an employee is having financial issues, he may see a workers’ compensation claim as a way out. Find out if the employee has financial problems, is nearing retirement, is in the middle of a divorce, or if they took a lot of time off just before the injury. Check if the spouse is working or receiving any of these payments: workers’ comp benefits, disability, welfare, or unemployment. If the employee asks about a settlement early into the process or applies for social security benefits before the incident occurred, that could be a red flag.

#8. Medical Care

Watch out for subjective injuries - such as soft-tissue and emotional - or injuries that seem to move from one body part to another; frequent changes in physicians or inconsistencies between employee and physicians’ reports; or missed doctors’ appointments or refusal of diagnostic testing. Carefully examine the medical reports to make sure there aren’t any whiteouts, and it doesn’t look like it’s been photocopied multiple times. Most employees don’t have extensive knowledge of the medical or insurance field. If he does, it may be a red flag.

#9. Inconsistent Physically Ability

An injured employee who is out of work on workers’ compensation should not be able to do similar activities to what he was doing at work. So look for evidence that he is performing those activities outside of work such as callused or grimy hands, medical reports that use adjectives like “muscular” or “tanned.”

#10. Over-eager

If the employee is pushy to settle the claim or has an attorney letter of representation dated the day of (or even before) the injury, it could be a red flag.

Final Advice: Don't Assume Insurance Fraud, But ... 

Don’t go into every workers compensation claim assuming there’s fraud. The majority of claims are legitimate. But at the same time, don’t be blind to the red flags that may indicate fraud. If you see multiple red flags, let your adjuster know. It may just help you save on your workers’ compensation costs.

Remember the Easy Way to Save on Workers Comp Insurance!

To learn more about workers compensation insurance, call the American Insuring at (800) 947-1270 or (610) 775-3848, or contact us online.

And remember, the easiest way to save on workers comp insurance is to buy it from an independent agent like those at American Insuring Group! We shop competing insurance providers, matching their policies to your needs, and identifying the best value for your particular situation. Get the right coverage at a great price. Call or click today to get started!

Doesn’t it seem like kids grow up too fast these days? It’s easy to forget that as mature and as smart as they may seem, teenagers still lack the experience an adult has. And if you own a restaurant, there’s an excellent chance that you employ a few teenagers, which could impact your restaurant workers comp insurance costs if your accident rate increases.  

48% of all working teenagers (ages 15-17) in the U.S. work in the “leisure and hospitality” industry, which includes restaurants and other food service jobs.

This group of employees is particularly vulnerable to workplace injuries. Each year more than 210,000 teens are injured on the job, 70,000 are hospitalized, and 70 are killed, according to the U.S. Department of Labor. The injury rate for workers under the age of 25 is about two times higher than for older workers, and based on emergency room data, 38% of teens who are injured on the job are working in the leisure and hospitality industry.

Restaurant Industry Insurance Risks

Every workplace has its share of hazards, and restaurants are certainly no exception. Some of the most common dangers in the food industry include slippery floors, hot cooking equipment, and sharp objects like knives and slicers. Often teens are injured because they don’t receive adequate safety training and supervision or they’re working with unsafe equipment, or stressful conditions.

Most workplace injuries are preventable, and many of the same safety measures you take with your more mature employees also apply to teenagers. Proper training and supervision should be your first priorities. 

Reduce Risk With These Teen Safety Meaures 

Here are some safety measures for teens from the Texas Department of Insurance:

• Train them on the importance of safety and on the manufacturer’s instructions for machine use and cleaning.
• Provide appropriate personal protective equipment and available machine guarding and enforce the use of that equipment.

When teens operate a microwave oven:

• Train them on microwave safety, such as 1) following manufacturer’s instructions, 2) covering foods to avoid splattering, 3) opening tightly covered containers away from their face, 4) preventing the use of metals, foil, or whole eggs in a microwave, and 5) keeping the interior clean to avoid splattering and popping.
• Place the microwave at approximately waist level and within easy reach.
• Provide appropriate personal protective equipment such as hot pads.
• Make sure door seals are in excellent condition and free from food or grease buildup.

When teens use steamers/pressure cookers:

• Train them to shut off the steam supply and wait for the pressure to equalize before opening the lid of the pressure cooker and to stand to the side and open the pressure cooker away from themselves, keeping the open lid between them and the pressure cooker.

When teens use coffee makers:

• Train them to check to make sure the coffee filter is in place before making coffee and that the coffee has stopped dripping before removing the filter.
• Place hot coffee makers away from the edge of counters.

Comply With Child Labor Regulations

Also, you should be aware of child labor rules and regulations set by the Department of Labor and your state. There are restrictions on the hours a teen can work and restrictions that prohibit teens from using or cleaning specific equipment. Once you know the rules and regulations that apply to teens, take steps to implement safe work practices, such as labeling the equipment that teenagers are not permitted to use.

It’s your responsibility to provide a safe work environment for all of your employees, particularly teens who are more vulnerable to workplace injuries, and avoiding workplace injuries can increase production, improve employee morale, and lower insurance premiums.

Protect Your Business - Contact American Insuring Group

To learn more about saving on workers compensation insurance, restaurant insurance, or any type of coverage for your business, contact American Insuring Group online or call us at (800) 947-1270 or (610) 775-3848. Our independent insurance agents are sure to find you the right insurance at the best price. Don't take chances with your business - contact us today.

Most businesses outsource part (or sometimes all) of their workers compensation functions to improve their injured workers’ experiences and case outcomes. Some functions that are commonly outsourced include administrators, medical providers, pharmacy benefit managers, and medical bill review.

Outsourcing often makes good financial sense. Unfortunately, many businesses take the “set it and forget it” attitude and fail to manage their outsourced vendors properly. Too often, companies and vendors don’t take the time to make sure that their goals are aligned, which can cause issues down the road and reduce the cost-effectiveness.

Your outside vendors should be like partners in your business. They should be a part of your team.

Here are three tips for creating effective partnerships with your outsourced vendors:

#1. Find the best fit for your organization 

Working with key members of your organization, determine your goals, create a list of the requirements that are most important to your business, and then develop a model of the ideal vendor for your business.

Develop a list of questions and start interviewing prospective vendors that meet most of your requirements. Here are three crucial questions you’ll want to ask:

1) Are the vendor’s control environments aligned with your internal framework

2) Is there ongoing oversight that uses measurable information and external alerts

3) Does the vendor conduct internal audits; if so, how frequently, and will they share their findings with you?

You should also ask for a client list and speak to a few of them to see if they’re satisfied with the service they’re receiving from the vendor.

#2. Set Expectations

Set Expectations. Once you’ve found the vendor that is most aligned with your business goals, get everything in writing including the length of the term and if your relationship with the vendor will be exclusive. Watch for hidden costs.

You may want to use a service level agreement (SLA) and risk/reward strategies. An SLA will define the level of service you’re expecting, such as time frames for reports and performance measures. You can also include incentives to the vendor for meeting certain expectations and penalties for failing to meet those expectations.

#3. Regular Communication

Outsourced vendors can be an asset or liability to your company. By choosing the vendors that align best with your goals, being clear about expectations up front, and communicating with them regularly, you can create a great partnership with outsourced vendors that help ensure the best outcomes for injured workers.

Get The Best Deal on Quality Workers Comp Insurance!

At American Insuring Group, Ltd., we offer high quality, cost-effective worker's compensation insurance from a great variety of competing insurance companies. We'll work hard to get you the best price on quality insurance to protect your employees and your business. So give us a call at (800) 947-1270 or (610) 775-3848 or click here to contact us online.

Hearing is one of those things that many people take for granted … until it’s gone.

A Chronic Condition

Hearing loss is the third most common chronic physical condition in American adults – following hypertension and arthritis. Hearing loss is even more common than vision trouble.

Approximately 11% of US workers have hearing difficulty, and about 24% of that hearing difficulty is caused by occupational exposures according to the National Institute for Occupational Safety and Health (NIOSH).

Hearing loss can also lead to miscommunication and accidents, potentially harming employees while driving up workers compensation insurance costs.

20 Million in Workforce Affected

There are more than 20 million people in the U.S. workforce currently experiencing hearing loss, and it’s affecting their jobs and costing businesses money. Any worker can suffer work-related hearing loss, but the top industries include construction, carpentry, mining, entertainment, military, and agricultural according to Healthy Hearing.

Impact of Hearing Loss

According to the CDC, Hearing loss can lead to miscommunications and depression. It has also been associated with cognitive decline and heart problems. Hearing loss can affect safety within the workplace, and the Better Hearing Institute found that workers with hearing loss are five times more likely to take sick days due to severe stress.

Epic Hearing Healthcare says, “… when workers have trouble following conversations, misunderstand what is being said, or pretend to hear things that they don’t hear, it can negatively affect the worker’s productivity and the company’s bottom line. Untreated hearing loss affects companies – whether through lost productivity or increased healthcare costs.”

Causes of Hearing Loss

The causes of hearing loss in the workplace include loud noises and chemicals that cause damage to the inner ear (ototoxic chemicals). When sound reaches 85 decibels or higher or if a person needs to raise their voice to speak to someone who is three feet away, noise is considered potentially harmful. Ototoxic chemicals include organic solvents like trichloroethylene, heavy metals like mercury and lead, and asphyxiants like carbon monoxide.

Approximately 30 million U.S. workers are exposed to dangerous noise levels or ototoxic chemicals.

How To Prevent or Minimize Hearing Loss

The good news is that much of this hearing loss is preventable. NIOSH has created a hierarchy of controls:

1. Prevent or contain the escape of the hazardous workplace agent at its source (engineering control),
2. control exposure by relocating the worker to a safe area (administrative controls),
3. and control the exposure with barriers between the worker and the hazard (personal protective equipment).

Here are a few simple steps recommended by the CDC to reduce your employees’ risk for hearing loss:

1. Use quieter equipment and keep equipment well maintained and lubricated.
2. Put a barrier between employee and the source or enclose the source completely
3. Increase distance between employee and source
4. Reduce employee’s time in noisy areas
5. Provide and enforce the use of hearing protection in noisy areas.
6. Educate your employees about noise hazards

Here are tips to reduce hearing loss due to exposure to ototoxic chemicals:

1. Use a less-toxic or non-toxic chemical
2. Provide and enforce the use of gloves, eye protection, respirator and other protective equipment as appropriate.
3. Follow all chemical safety instructions.

Hearing Loss Prevention Program Benefits

According to the CDC, “A successful hearing loss prevention program benefits both the company and the affected employee. Employees are spared disabling hearing impairments, and evidence suggests that they may experience less fatigue and generally better health. Ultimately, the company benefits from reduced medical expenses and worker compensation costs. In some cases, there may be improved morale and work efficiency.”

Contact Us For Advice on Reducing Workers Compensation Insurance Costs 

To learn more about workplace safety and ways to save on workers compensation insurance costs, give American Insuring Group a call at (800) 947-1270 or (610) 775-3848 or Contact Us Online. We specialize in workers comp insurance for employers in Pennsylvania, Delaware and New Jersey.

Our independent agents will shop and compare competing insurers to find a policy that meets your needs at the best price possible. Contact us today to learn more!

Some companies believe that taking the time to develop a return-to-work (RTW) program for injured employees costs more than its worth.

Some don’t think they have enough injuries to justify the cost of an RTW program, or they don’t think they have any “light duty” jobs available.

Some employers just don’t like the idea of paying an employee their full salary for doing light-duty work.

Studies Prove Return-to-Work Programs are Effective

But studies have shown that getting an injured employee back to work as quickly and safely as possible is the best approach for both the employee and the company. Return-to-work programs save employers on medical costs, lost time days, and workers compensation insurance costs. These programs can even reduce the number of lawsuits, wage replacement costs, and productivity losses.

The longer an injured employee is out of work, the less likely they’ll be to return to work and the more it costs the employer. Return-to-work programs reduce the length of claims and help injured employees recover more quickly.

RTW programs show that the employer cares about the well-being of the employer and wants to help them get back to work. And getting an employee back to work can help lift the injured employee’s spirits and the morale of their co-workers.

Keep Your RTW Program Simple and Cost-Effective

Despite common misconceptions, back-to-work programs don’t need to be costly or complicated.

First, you’ll want to work with your managers, supervisors, and insurance agent to ascertain if specific jobs are more prone to injuries, approximately how many injuries occur within your company each year, and how your injury stats compare with others in your industry.

Once you have this information, work with your insurer and possibly a trusted physician to develop a return-to-work program that fits your company.

Here are 3 Components of an Effective Return-to-Work Program:

1. The Right Medical Providers
   You want to find medical providers who are on the same page as you. You want them to focus on what an injured employee can do, rather than what they can’t do, and you want the provider’s focus to be on safely returning the employee to work as quickly as possible.
   
   
2. Communication
   Every employee should know that there is a return-to-work program in place and that it is followed. They should be familiar with the details of the program. And all employees should understand that the company’s goal is to return an injured employee to work as soon as it’s safe to do so – even if that means a light-duty job.
   
   
3. Alternative Jobs
   You should have a list of light-duty jobs that may be appropriate for someone who is injured. Most companies have tasks that need to be done or activities that once completed could make other jobs easier or improve production, but these tasks or activities aren’t done because there isn’t time or manpower to do them. These tasks may be perfect for an injured employee. When the time comes, discuss the possibilities with the injured employee to see what would be a good fit with their abilities and their medical restrictions.

Taking the time to develop a return-to-work program for your company – no matter how big or small it is – can help your business reduce costs.

We Can Help You Lower Your Costs

American Insuring Group can assist you in creating an effective return-to-work program that works for you and your employees.

Our Independent Agents can also help lower the cost of your Workers Compensation Insurance. So give us a call at (800)947-1270 or (610) 775-3848 or contact us online to start saving.

Contractors and handymen, do you remember the days before nail guns? When you had to use a hammer to nail something.

Today, you probably can’t imagine doing your job without a nail gun! They’ve probably made your job a lot easier, and, unfortunately, more dangerous, which can lead to increased workers compensation insurance claims and higher insurance costs.

According to the CDC, nail guns are responsible for approximately 37,000 emergency room visits every year. Sixty-eight percent of those injuries are work-related. Severe nail gun injuries can even cause death.

7 Risk Factors for Nail Gun Injuries

The CDC has identified 7 major risk factors that can lead to nail gun injury:

1. Unintended nail discharge from double fire
   
   
2. Unintended nail discharge from knocking the safety contact with the trigger squeezed
   
   
3. Nail penetration through lumber workpiece
   
   
4. Nail ricochet after striking a hard surface or metal feature
   
   
5. Missing the workpiece
   
   
6. Awkward position nailing
   
   
7. Bypassing safety mechanisms
   
   

Nail Gun Safety Prerequisite: Know Your Triggers!

Before we can discuss ways to avoid nail gun injuries, it’s important to understand the different types of nail gun triggers.

There are two controls with every nail gun: a finger trigger and a contact safety tip on the nose of the gun.

1. Full sequential trigger – This is the safest type of trigger. The controls need to be activated in a very specific order for the gun to fire, and nails can’t be bump fired – also called bounce nailing. Bump firing or bounce nailing is using a nail gun with a contact trigger held squeezed and bumping or bouncing the tool along the workpiece to fire nails.
   
   
2. Contact trigger – This type of trigger fires a nail when the safety contact and trigger are activated in any order. A nail will be fired each time the safety contact is pushed in if you keep the trigger squeezed. Nails can be bump fired with this type of trigger. Contact trigger nailers are prone to double firing, according to the Consumer Product Safety Commission (CPSC).
   
   
3. Single sequential trigger – To fire this type of trigger, controls must be activated in a specific order and nails cannot be bump fired just like the full sequential trigger. However – unlike the full sequential trigger – only the trigger must be released to fire the second nail.
   
   
4. Single-actuation trigger – This trigger will fire a single nail when the safety and trigger are activated in any order just like the contact trigger. To shoot the second nail, you can release the trigger, move the tool and squeeze the trigger again without releasing the safety again. Nails can be bump

6 Ways to Avoid Nail Gun Injuries

The CDC offers six steps to help avoid nail gun injuries:

1. Use full sequential trigger nail guns, which reduce the risk of unintentional discharge and double fires especially with inexperienced employees.
   
   
2. Provide safety training to both new and experienced employees that covers topics such as how triggers differ and the leading causes of injuries and how to avoid them.
   
   
3. Establish nail gun work procedures specific to your company that address risk factors.
   
   
4. Provide personal protective equipment (PPE) such as safety shoes, high-impact eye protection, etc.
   
   
5. Encourage reporting and discussion of injuries and close calls to draw attention to possible risks, so they can be avoided and to ensure that your employees are getting medical care when needed.
   
   
6. Provide first aid and medical treatment. Sometimes, what seems like a minor injury can be more severe. For example, materials such as nail strip glue or clothing can become embedded, which can cause infection.
   
   

Play it Safe with Proper Workers Compensation Insurance!

It is your responsibility to provide the safest workplace environment for your employees. The fact that it also reduces your workers’ compensation costs is just icing on the cake!

To learn more about saving on workers compensation insurance, give American Insuring group a call at (800) 947-1270 or (610) 775-3848 or contact us online. Our independent agents are ready to get you solid coverage options at a great price. Call or click today.

Trust… What is trust? Merriam Webster defines it as “one in which confidence is placed” or “assured reliance on the character, ability, strength, or truth of someone or something.”

But what does trust have to do with workers’ compensation claims? EVERYTHING!

Studies have found that the biggest single factor that determines the success or failure of a workers’ compensation insurance claim is trust between the injured employee and his or her employer. And that trust (or lack of trust) begins as soon as the claim is reported (often before).

Workers Compensation Insurance Fraud is Rare. Surprised? 

Now, you may be thinking that there are so many cases of Workers Compensation Insurance fraud that you can’t trust anyone. We have an interesting statistic for you: studies show that only 1 to 2 percent of all workers' compensation claims are fraudulent. That means 98 to 99 percent are legitimate. So, yes there should be a thorough investigation of every claim, but you should also give your employees the benefit of the doubt. After all, trust is a two-way street.

How to Build Trust

Here are two areas that employers should focus on when trying to develop trust, plus one magic question that can help lead to a mutually successful claim.

#1. Work on The Employee / Supervisor Relationship

Research has shown that a supervisor’s response to an injured worker at the moment the claim is reported is key to building trust, and once trust is lost, it’s very difficult (if not impossible) to get it back.

If the supervisor responds with blame or anger by saying something like “What did you do to cause the injury?” there will be an immediate lack of trust. Perhaps even worse is expressing apathy with something like “You’re not hurt; get back to work.” Both of these show a lack of trust in the employee and puts them immediately on the defense.

If the supervisor responds positively by taking every workers’ compensation claim seriously and by showing genuine concern for the employee’s well-being, trust is built. And with trust you will have a significantly better claim outcome.

Supervisors should continue to leverage that trust by following up with a call or a visit to the hospital the day of the injury to let the injured employee know how sorry they are that he or she got hurt and how eager they are for the employee to return to work. Follow this up with a get well card signed by the supervisor and the injured employee’s co-workers. Again, say something like, “We’re so sorry that you got hurt. We look forward to seeing you back at work.”

The supervisor should continue to solidify that trusting relationship over time with weekly conversations reaffirming that they care about the employee’s well-being. These discussions also allow the supervisor to assess the attitude of the injured employee, how their medical treatment is going, and how their transitional duty job (if there is one) is going.

#2. Work On The Employee / Insurance Adjuster Relationship

First impressions are crucial. If you present a positive reaction to an injured employee during the first interaction, it’s much easier to build that trust. The adjuster should avoid using insurance jargon, such as “adjudication” and avoid calling the injured worker the “claimant."

And remember that this is probably the employee’s first workers comp insurance claim, so they probably don’t understand the process, what is going to happen, or what they need to do. It’s up to the adjuster to guide them through the process as a trusted advisor. If the injured employee believes their rights are not being protected, they will call an attorney, which often makes a claim even more complicated and more costly.

#3. Ask The “Magic” Question

One of the most powerful questions you can ask an injured employee is, “Do you think you will be back to work within four weeks without any restrictions?” If they say no, ask them why and offer additional resources and support. If they answer yes, they’ve set the expectation in their mind, which will drive them back to work more quickly. This question helps builds trust and should be asked with every Workers’ Compensation claim.

This may sound like a lot of work, but if you want to resolve workers’ compensation claims quickly and minimize your workers’ compensation insurance claims costs, these are necessary actions.

Contact Us To Learn More About Workers Comp Insurance 

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

Our independent insurance agents are motivated to help you save on the best workers comp plans from reliable insurers.Best of all, as independents we are free to shop among lots of competing insurance providers, so you can be confident of getting a great price on the right coverage!

For helpful tips and plenty of insightful blog posts on the topic, visit our Workers Compensation Insurance page.

The majority of workers’ compensation insurance claims are legitimate, and if an employee is injured on the job, they are entitled to the medical care and indemnity benefits stated in the workers’ compensation statutes. Unfortunately, there are also a number of fraudulent workers’ compensation claims every year.

Workers Compensation Insurance Fraud Statistics

The National Insurance Crime Bureau (NICB) estimates that workers’ compensation insurance fraud costs the insurance industry $7.5 billion every year, which in turn drives up the cost of workers’ compensation premiums. This doesn’t even take into account the cost of replacing the “injured” employee, training a new employee, overtime, and even a decrease in employee morale and productivity.

“Workers’ comp fraud is a large crime in America today,” according to the Coalition Against Fraud Insurance. “Scams are forcing premiums higher — draining business profits and costing honest workers their pay and jobs.”

Tips for Investigating Workers Comp Insurance Claims

Yet, many employers don’t investigate workers’ compensation claims properly. There is one simple thing every employer can and should do immediately following an accident or injury: collect written incident reports from the injured employee and any witnesses.

The injured employee should provide a written description of the incident including details of the accident, what caused the injury, the nature and scope of the injury, and what the employee thinks could be done to prevent the accident from happening again because.

Here’s why:

1. Immediately following an incident, the employee should be able to recall the accident or injury more accurately than they could months or years later.
   
   
2. Having the details of the accident in writing will discourage the employee from embellishing the details later, and having documentation of exactly which body parts were injured, limits the employee’s ability to add additional body parts to the claim at a later time. Tales do tend to grow taller on down the line.
   
   
3. Often, if a claim is questionable, the adjuster will take a recorded statement from the employee. A written report allows them to compare the two reports to look for deviations. In this interview, the adjuster may also ask if the employee has any prior claims, accidents, and any prior injuries to the same body part.

Keeping the WC Claims Process Honest

The bottom line is that knowing that an employer has the details of the incident written in the employees’ own words goes a long way to help keep an injured employee honest.

Obtaining a written report from every witness immediately following the incident will help provide additional information about the accident and the extent of the injuries. Employers should be cautious of any accidents that have no witnesses or that the only witnesses are friends of the injured employee.

The employee’s supervisor or someone familiar with the work process should review the reports to confirm the accuracy of the information, and those reports should be given to the workers’ compensation adjuster. The employer should also provide information to the adjuster about any previous workers’ compensation claims, any other accidents or injuries the employee has incurred in the past, and any strenuous activities, sports, or hobbies the employee participates in.  

Create a Standard Protocol for Investigating Workers Comp Accidents

Having an established protocol for investigating accidents can help ensure that the proper steps are taken each time. It’s important that you react quickly to an accident or injury, capture the details quickly, and take the right actions to investigate the claim. Doing this will help limit the ability of dishonest employees to exploit legitimate workers’ compensation claims and help you keep workers’ compensation costs down.

How to Get the Best PA Workers Comp Insurance Coverage

To learn more about protecting your company against WC insurance fraud or your workers compensation insurance coverage options, you can reach us via our Contact Page or call American Insuring Group at (800) 947-1270 or (610) 775-3848.

Our independent agents are ready to help you get affordable insurance protection. We'll drive down your cost by comparing prices and coverages among lots of competing WC insurance carriers. Don't delay - contact us today and start saving!

You’ve probably heard that the United States is in the middle of an opioid overdose epidemic. Opioids - a class of drugs that include both heroin and prescription pain relievers such as oxycodone, codeine, and fentanyl - are being prescribed at an alarming rate and too often those prescriptions are leading to opioid addiction and even death. Workers compensation insurance costs are, of course, impacted by the epidemic.

INFOGRAPHIC:
The Opioid Overdose Epidemic And Workers Compensation Insurance

259 Million Opiod Prescriptions in the US?

The American Society of Addiction Medicine reported that in 2012, 259 million prescriptions were written for opioids, which is more than enough to give every American adult their own bottle of pills!

The Center for Disease Control (CDC) reported that every day, over 1,000 people are treated in emergency departments for misusing prescription opioids, and in 2014, almost 2 million Americans abused or were dependent on prescription opioids.

“Opioids were involved in the overdose deaths of more than 33,000 Americans in 2015, nearly quadruple the number from the year 2000 and more than any year on record,” according to the CDC.

The Impact on Your Workers Compensation Insurance

There is no denying that the human costs of this epidemic are tragic, but have you ever considered what this epidemic is costing your business? The CDC reports that the side effects of opioids – drowsiness, mental confusion, depression, nausea, etc. - can increase the risk of workplace incidents, errors and injury. In 2013, the estimated lost productivity for people in the United States with opioid use disorder totaled $20.4 billion and a cost of $29 billion in increased health care and substance abuse treatment.

60% of Injured Workers May be Addicted to Opiods

According to the International Risk Management Institute, Inc. (IRMI), 5,000 employees a week are injured and disabled for at least a week and pain management is often part of their treatment. The CDC reported that in 2011 approximately 25 percent of workers compensation prescription drug claim costs were for opioids. IRMI says, “While reliable data showing the proportion of injured workers that may be addicted to opioids is hard to find, it is estimated around 60 percent of all those prescribed.“

Reducing the Human and Financial Impact of Opiod Abuse

At the 2017 Workers Compensation Research Institute Conference earlier this year, experts provided two recommendations to reduce the human and financial impact of this epidemic.

1. Mandate for Physicians to check Prescription Drug Monitoring Data

Kentucky, which was has been at the epicenter of the opioid drug problem and opioid overdose deaths, became the first state (2012) to require physicians to search patients’ prescription drug histories on an electronic database - Prescription Drug Monitoring Program (PDMP) - before prescribing opioid painkillers, sedatives or other potentially harmful and addictive drugs. According to a former employee at the Kentucky Department of Workers Compensation Claims, this one step had the biggest impact. Since then, fifteen more states – including Pennsylvania – have instituted the same mandate.

2. Alternative Pain Treatment

The current medical model for the treatment of pain isn’t working because it doesn’t consider the biopsychosocial factors of pain management. This includes “biological factors (genetic, biochemical, etc.), psychological factors (mood, personality, behavior, etc.), and social factors (cultural, familial, socioeconomic, medical, etc.),” according to John W. Santrock, Ph.D. Some popular options for pain management include mindfulness and Cognitive Behavioral Therapy (CBT).

When it comes to Workers’ Compensation claims taking a collaborative approach that includes a variety of experts, different pain management approaches, and the injured worker has shown to be more effective in reducing medical costs and in getting employees back to work more quickly.

Don't Overpay for Worker's Compensation Insurance - Contact Us

To learn how we can help you save on workers compensation insurance, contact American Insuring Group online or call at (800) 947-1270 or (610) 775-3848. Our independent insurance agents will check for the best rates among many competing insurance carriers. You'll get a quality policy at a geat rate.

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Recently, I learned of a book called Made to Stick: Why Some Ideas Survive and Others Die. It refers to a phenomenon called “the curse of knowledge,” which states that “when we know something, it becomes hard for us to imagine not knowing it.

As a result, we become lousy communicators.”

This “curse” often affects individuals who work with the workers’ compensation insurance claim process, which can be quite complicated – especially to an injured worker who has never filed a claim.

Here are 5 Common Questions an Injured Worker May Have When Filing a Workers Comp Claim

1. How and when will I get paid, and how much 
   will I get paid?

If the case is determined to be compensable (which usually takes a week or two to a month or so), the injured employee will receive a check (which is typically about 66-80% of their net pay) either by mail or direct deposit every week or two. A payment from Workers Comp is not taxable income, so the employee will not receive a W2 for this payment.

2. What physician can I go to?

This can vary by jurisdiction, but generally after a certain period of time, the injured employee can go to his or her primary care physician, and usually, the first appointment will be paid for by the insurance company handling the claim. Whether or not they can continue with their primary care physician will be determined by two things: 1) if the adjuster authorizes it and 2) if the doctor accepts workers compensation patients.

3. Why isn’t my adjuster more attentive?

Just because the adjuster doesn’t return a call immediately, it doesn’t mean that the injured worker isn’t important to them. Most adjusters handle hundreds of workers compensation cases at the same time – all at different stages in the process and all of varying complexity. Advise your employee to try to be patient and give the adjuster a day or two to return the call; however, if they’ve left several messages and a few days go by, suggest that they call and ask for a supervisor. Every adjuster is obligated to return calls from the cases they are handling and can incur penalties or fines if they fail to return calls within a reasonable amount of time.

4. Can a light duty job pay less than my regular job?

Yes, it can, but the insurance carrier will take the reduced wages the injured employee earns and issue a supplemental check for the difference. That amount can vary depending on the jurisdiction the claim is made in.

5. Should I contact an attorney?

Only the injured employee can answer this question. They can speak with a lawyer without filing a lawsuit against their employer, and if talking with a legal professional helps put them at ease, then they should do so.

Don't Assume - Think Before You Communicate About Workers Compensation Claims

Don’t fall prey to “the curse of knowledge.” Remember that this may be the first and only time an employee files a workers compensation insurance claim, and they may have questions. Do your best to answer their questions, and when in doubt, reach out to his or her adjuster for clarification.

Are You Paying Too Much for PA Workers Compensation Insurance? We Can Help!

To learn more about saving on workers compensation insurance, contact American Insuring Group online or call at (800) 947-1270 or (610) 775-3848. Our independent agents will compare policies from competing insurers to find the best insurance at the best price. Call or click today to start saving.