Tag: Workers Comp

The utilization of nonhospital and hospital outpatient services in the Illinois workers compensation system decreased in 2020, the drop attributed to medical facility closures and service limitations during the beginning of the pandemic, according to a new study from the Workers Compensation Research Institute.

Tuesday’s study said the percentage of workers comp claims with major surgery decreased mostly in the second quarter of 2020, likely due to limitations on non-essential procedures due to COVID-19.

Researchers found indemnity benefits per claim increased by 10% in 2020 and then dropped 3% in 2021, driven by duration of temporary disability.

Medical payments, on the other hand, decreased in 2020 and 2021, mainly due to the drop in facility utilization.

The study examined worker injuries between 2016 and 2021 but excluded COVID-19 claims.

In addition to medical facility closures and limitations on non-essential surgeries, the facility utilization drop was also attributed to workers postponing medical evaluations and procedures due to stay-at-home orders and fear of being exposed to COVID-19.

The average cost per comp claim in Illinois was also 21% higher than in other study states, the authors wrote, and indemnity benefits were the largest contributor to total costs per claim, accounting for 46% of total payments.

Indemnity benefits per claim in Illinois have grown at a rate of 2% to 3% each year since 2012, the study states.  

The authors said changes in Illinois’ economy may explain the indemnity benefit trends during the study period. 

 

 

The Supreme Court of Alaska reversed a lower court ruling that found a deceased worker’s employee status should be determined by a jury and not prior to trial.

The high court on Friday said a superior court judge wrongly determined a jury should decide whether Nicholson Tinker was an employee or an independent contractor when he was killed by a collapsed retaining wall at a construction site.

Mr. Tinker’s estate sued Mark Welty, and his company, North Country Services, for wrongful death, arguing Mr. Tinker was an employee and that Mr. Welty was negligent in not carrying workers compensation insurance.  

The defendants argued Mr. Tinker was an independent contractor who was not eligible for workers comp.  

During litigation, the estate attempted to have the employee status issue resolved ahead of trial, but the superior court agreed with the defendants that the matter should be left to the jury.

The trial court agreed with the defendants and the estate appealed.

The Supreme Court determined a judge, not a jury, should decide the issue of employee status ahead of trial because the state’s comp law doesn’t provide a right to a jury trial.

“We agree with the Estate that prompt resolution of employee status is important because of its possible effect on such basic issues as the type of action a party can bring or the burden of proof for negligence,” the high court wrote. 

 

Companies with robust benefits plans that include such perks as employee assistance and leave programs have a better handle on the risk of complicated workers compensation claims that include stress and anxiety, according to disability experts.

“These are absolutely connected,” said Bryon Bass, San Francisco-based senior vice president at Sedgwick Claims Management Services Inc., of the link between benefits programs that focus on worker wellbeing and good outcomes in workers comp at session Monday at Riskworld, the Risk and Insurance Management Society Inc.’s annual conference in Atlanta.

Co-presenter Kimberly George, Chicago-based global head of product development and innovation at Sedgwick Claims Management Services Inc., listed several factors she called “stress and anxiety influencers” that impede recovery for injured workers: pain, financial problems, the stigma of being injured, family issues, fear and life change.

“If you don’t acknowledge what is going on with that individual, then you’re not able to understand the barriers to recovery, and you may not be able to help that injured worker,” she said.

The solutions often can be found in group health benefits, said Mr. Bass, who encouraged attendees to provide more information to claimants on what is provided by employers under other programs that are often underutilized.

As many as 98% of employers offer employee assistance programs, but only a small amount of employees — 2% in some cases — take advantage of them, Ms. George said.

Some EAPs are designed around reintroducing into the workforce an employee who has been out for a long illness — a collaboration that can work seamlessly with workers comp, Mr. Bass said. 

“They actually engage the EAP in the process, and the EAP engages with the team to begin to work on a way to show acceptance of that individual coming back into the work environment,” he said.

“They can collaborate to ensure that that person has the support that they need to return to work. We wouldn’t typically think about using EAP for those types of resources.”

 

 

 

 

 

First-year employees, regardless of age or industry experience, represented more than one-third of all workers compensation claims and accounted for nearly 7 million missed workdays due to injury between 2016 and 2020, according to a report released Monday by Travelers Cos. Inc.

The insurer examined more than 1.2 million comp claims and determined a worker’s age and time spent in a particular role were significant factors when it came to injury frequency and cost.

The report said the industries most affected by first-year employment injuries were restaurants, construction and transportation. It said workers ages 35 to 49 had the highest percentage of injuries compared with other age groups, but that the average cost per claim increased with age, with costs higher for employees ages 60 or older.

The most common types of injuries were overexertion, slips, trips, falls, motor vehicle accidents, and getting struck by an object or caught between hazards.

Amputations constituted some of the most expensive claims, costing nearly five times the average. But it is considered an outlier, as are electric shock and multiple trauma injuries, such as breaking multiple bones at once.

Rich Ives, vice president of business insurance claims for Travelers, said in a statement that it can be harder for injured workers to return to work the longer they remain out, “especially if they’re dealing with a psychosocial barrier, such as fear or worry.”

 

 

 

Sentry Insurance announced Monday the development of a predictive modeling tool designed to help identify early risk factors in injured worker cases.

The Injured Employee Complexity Factor Models will look at early factors in workplace injury claims, such as chronic pain and psychosocial risks, which are believed to prolong and prevent successful injured worker recovery.

The Stevens Point, Wisconsin-based insurer says that average comp claims involving early risk factors can remain open longer and cost employers more.

Risk factors can include anxiety, stress, lack of familial support, financial concerns, fear of re-injury and difficulty adjusting to physical and emotional changes.

Greg Larson, assistant vice president of workers compensation claims, said the goal is to identify certain physical or psychological markers early in the life of a claim and provide tools and support to injured workers that will help them “deal with their pain, their injury, their recovery. All of those anxiety points that most people go through if they’re in that situation.”

“As an industry, we’re great about providing and supporting an injured worker from a physical perspective,” he said. “Ultimately, we’ve missed the opportunity to really help the psyche or the psychosocial piece of a recovery.”

The tool enables Sentry to create managed care plans for injured workers that address both physical and mental barriers that may delay recovery.

 

The U.S. Occupational Safety and Health Administration has issued proposed financial penalties against online retailer Amazon Inc. after inspectors said employees were not given proper medical care at a fulfillment center in Castleton, New York, after suffering work-related injuries.

OSHA on Friday said the investigation in Castleton, which is part of an ongoing inspection that began at Amazon’s upstate New York fulfillment center in August 2022, was spurred by reports that at least six employees with head injuries and four with back injuries did not receive timely and necessary medical care.

The workers were instead returned to their jobs after suffering injuries and many saw their conditions worsen as a result, according to OSHA.

OSHA, which proposed fines of $15,625, said the reports show a “callous disregard” for the well-being of Amazon’s Castleton fulfillment center workers.

Amazon disputed OSHA’s account.

“We take the safety and well-being of our employees extremely seriously, and the claims in this citation are just plain wrong, so we plan to appeal,” Amazon spokeswoman Maureen Lynch Vogel wrote in a statement.

Ms. Vogel wrote that the company’s policy is to encourage injured workers to seek outside medical attention immediately and onsite clinics are there for first aid, “not formal medical diagnosis.”

A Robbinsville, New Jersey, Amazon facility received a hazard letter for deficient on-site medical practices in January 2016, and a similar warning was issued in January to a Deltona, Florida, facility.

OSHA said it also cited the Castleton location in February for ergonomic violations.

The latest case marks the fourth time this year that OSHA cited Amazon for various workplace safety violations at seven warehouses in Colorado, Florida, Idaho, Illinois and New York.

Amazon has 15 days to contest the proposed penalties in the latest case. 

 

 

 

 

 

The Appellate Division of the Supreme Court of New York upheld a determination by the state’s Workers’ Compensation Board that a woman whose husband died from COVID-19 failed to prove the virus was contracted at the workplace.

The appeals court on Thursday said the board was correct to reverse a comp judge’s decision that found the man’s death was causally related to his employment.

The worker’s widow had filed a workers comp claim for death benefits after her husband died from COVID-19 in late March 2020, soon after the pandemic was declared.  

The deceased claimant worked as a house manager for the Office for People with Developmental Disabilities and alleged that he started to exhibit symptoms of the virus during a scheduled vacation day two days after he last worked a shift.

He died just over two weeks later.

The appeals court said the widow failed to present evidence showing any cases of COVID-19 among those living or working in the group home where her husband was employed.

A witness for the employer even testified that the claimant was the first known COVID-19 infection at his workplace, the court noted.

The court wrote that the widow failed to meet her burden showing her husband contracted the virus in the course of his employment. It affirmed the board’s decision to deny the claim for death benefits.  

 

 

Insurers who are late paying benefits under no-fault insurance, such as workers compensation, would lose the protection of medical fee schedules in covering claims under a bill set to be introduced in the Michigan House of Representatives on Tuesday.

H.B. 4493 amends state law on fee schedules, and that charges by medical providers providing care under insurance “must not exceed the amount the person customarily charges for like treatment or training in cases that do not involve insurance.” The law goes on to provide guidance on fee schedules based on rates set by Medicare.

New language outlined in the bill states fee schedules would “apply only if payment of the benefits is not overdue” and that the payment rate “is not admissible in an action against an insurer for overdue benefits.”