A driver of workers compensation medical costs lies in the number of comorbid factors—diseases or disorders that exist simultaneously, but independently, with another disorder—that injured workers may have that make it more difficult to recover from work injuries. These conditions include systemic problems, such as hypertension, obesity or diabetes. Often, injured workers who have been out of work for a long period of time have lost their medical insurance because their employers can no longer carry them on the books as employees. This lack of insurance makes it difficult for them to afford prescriptions for any of these underlying systemic conditions. These untreated medical conditions then slow recovery from the work injury, which leads to higher costs for the workers compensation carrier.
Slips, trips, and falls constitute the majority of general industry accidents. They cause 15% of all accidental deaths, and are second only to motor vehicles as a cause of fatalities. The OSHA standards for walking/working surfaces apply to all permanent places of employment, except where only domestic, mining, or agricultural work is performed.
Walking/working surfaces are addressed in specific standards for the general industry, shipyard employment, marine terminals, longshoring, and the construction industry.
Back injuries have a bad reputation. “The workman looks upon them with apprehension, the insurance company with doubt, the medical examiner with suspicion, the lawyer with uncertainty, and the court with as open a mind as is possible under the circumstances….”
This statement was written in 1917. Not much has changed since then.
Workers’ Comp Claimant fraud–when an employee deliberately falsifies facts about an illness or injury to collect benefits–is the most commonly discussed form of workers’ comp fraud. Here are a few examples of how to recognize this type of fraud:
- An employee becomes injured or sick and claims that it was caused by work-related circumstances when, in reality, it was not.
- An employee experiences a minor accident and exaggerates the extent of the resulting injury.
- An employee who has an injury claim collects benefits while secretly continuing to work or consciously participates in activities that otherwise would not be possible based on the extent of the reported injury and medical limitations.
- A claimant with a legitimate injury or illness, who is capable of transitional work or modified duty, malingers and makes no effort to return to any work activity, all the while receiving workers’ compensation benefits.
Routine work can dull alertness and a relaxed attitude can replace the caution that existed when the job was new and interesting. In many jobs the same route is traveled daily over the same roads or the same tasks are repeated with little conscious thought. Without some periodic reawakening to the ever-present hazards, lethargy deepens and the odds of an accident occurring can increase.
Workers may not always recognize the importance of safety training or think of it as unnecessary because they’ve “been doing it for years.” But an important benefit of periodic safety training is the reminder that a danger can exist and the no one is immune to accidents. Therefore, it is important for workers to understand the purpose of the training session, why it will be useful to them, and what can result from not following safety rules and procedures.
It is widely accepted that lifestyle choices such as poor eating habits, smoking, alcohol and drug use are key medical cost drivers. Simply put, healthier people are less likely to have a Workers’ Comp claim and will recover more quickly when they do. A 2009 study in the Journal of Occupational Medicine noted, “…targeted workplace interventions may provide opportunities to reduce not only the risk of disease associated with working conditions but also the risk of workplace injury.” If a wellness program identifies medical risks, teaches employees how to manage their risks and keeps them on track, Workers’ Comp savings will follow.
via WORKCOMP ADV!SORY.
On and after January 1, 2013, services are employment if the services are performed by an individual whom the Michigan administrative hearing system determines to be in an employer-employee relationship using the 20-factor test announced by the internal revenue service of the United States department of treasury in revenue ruling 87-41.
This is a big change in the law and seems to return us to the days of the economic reality test. It appears that employer control over an individual will now be a major factor in the determination of employment status. This change will hopefully reduce the number of employers who try to game the system.