Workers' Compensation Management Strategy

The following checklist was presented by expert Jane C. Hall at a workers' compensation conference. The checklist outlines an overall strategy for managing workers'compensation.

Structuring an effective organization 

____ 1. Identify the process champion. Involve the process champion, the person who drives the process, usually a senior management person who can authorize and provide funding to make the necessary changes. 

____ 2. Determine the process owner. Find out who in the organization is the process owner, the person who is really in charge of workers' compensation and who pulls together all of the people who have a stake in the program. This person is often not formally defined, but could be the safety or medical director or the risk manager. 

____ 3. Apply policies consistently. Ensure that all policies and procedures are understood by stakeholders and consistently applied. 

____ 4. Eliminate disincentives to effective program. Benefit policies that discourage early reporting of injuries and early return to work should be eliminated. These policies may include factors such as performance rewards based on productivity vs. safety, as well as a piecework or overtime pay system that discourage an employee from reporting injuries until the condition become severe. Utilize internal rehabilitation programs. 

____ 5. Foster a positive organizational climate, morale, and attitude. Factors that improve workplace safety include a drug free workplace, pride in the environment, a quality improvement philosophy, personal responsibility by workers, and management by walking around. 

____ 6. Develop an evaluation process. Ensure that a process is in place for monitoring changes and addressing issues and problems. 

Loss Control

____ 1. Make managers and supervisors accountable. Do the managers and supervisors know the cost and effect of workers' compensation in their departments? Managers and supervisors should be accountable based on activities related to education and prevention rather than just tracking the number of OSHA recordable incidents.

__ 2. Empower safety management committees. Safety committees should have the support of top management and an appropriate budget to enable them to fix hazardous conditions. 

____ 3. Develop an employee safety culture. Suffuse the work environment with a think safety attitude. Ensure the use of hazard surveillance monitoring and personal protective equipment. 

Communication

____ 1. Communicate effectively with employees. Know the demographics of your employees, including appropriate written and verbal language and preferred learning methods. Good communication with line employees who have been injured is the number one strategy for litigation prevention. 

____ 2. Keep it simple. Do not speak to workers in technical jargon. 

____ 3. Identify a liaison person. Have someone that employees can call when they have questions about workers' compensation issues. The system is complicated and confusing-do not assume that employees understand it without explanation. 

____ 4. Ensure communication between stakeholders. Make sure that the people in the organization who are affected by the workers' compensation system know each other and are aware of what is happening in inter-related areas. Establish a system for regular and special communication between the employer, the workers' compensation administrator, the company nurse or doctor, medical providers, claims adjusters, and employees. 

____ 5. Survey employee satisfaction. Employee satisfaction surveys provide very helpful feedback. Employee attitudes toward management, supervisors, and the work environment may affect their recovery. 

Medical Management

____ 1. Plan for immediate response and care. Plan for injured employees to receive prompt medical treatment by a friendly medical person who provides simple explanations of what the injured employee can expect to happen. Choose educated responders who can reassure employees and establish a positive attitude.

____ 2. Carefully select the initial medical service provider. The initial provider sets the tone for employee satisfaction. First appearances count. Choose a provider that is physician based, known for good medical outcomes, knowledgeable about occupational health and workers' compensation, and supportive of an early return to work philosophy. A good bedside manner and good employee communication skills are important. Develop a preestablished communication agreement, agreed medical and disability management guidelines, and agreed compensation. Be willing to pay more than the fee schedule for customer service issues that make a difference in case outcomes. 

____ 3. Carefully select a specialty panel. The initial treating physician should refer an employee to a specialist on the panel when necessary, but remain involved in the case and available for case conferences and medical oversight. 

____ 4. Establish agreed upon medical and disability guidelines. All physicians should agree to follow established guidelines or be prepared to explain any deviations from the guidelines. Make sure that the guidelines are communicated to the claims manager. 

____ 5. Use case management indicators. Establish the parameters for those cases that need management. Case management should be pro-active, focused, and short-term. 

____ 6. Utilize vendor input. Work with the purchasing department, often a forgotten stakeholder, to consider the proper type of equipment, such as ergonomic devices, that may make a difference to your program. Establish customer service requirements so that vendor performance can be assessed. 

Claims Management

____ 1. Make a prompt initial determination of claim status. The claims adjuster must be part of the process. Ensure that the adjuster has the necessary information to make an immediate determination as to whether an employee's injury arose out of and in the course of employment. Immediate investigation or physician examination may be necessary to make this determination. Prompt, informed decisions on this issue may decrease litigation significantly. 

____ 2. Maintain ongoing communications. Make sure that all stakeholders are kept informed of case developments. 

____ 3. Do what you say you will do! The most common complaint by employees is that people in the workers' compensation system fail to follow-through in a timely manner. 

____ 4. Ensure timely benefits payments to employees. This policy is the number two litigation prevention strategy. 

____ 5. Pay medical providers in a timely manner. 

____ 6. Bill review/utilization review and communication. This process is the key to determining how the medical providers are practicing. 

____ 7. Monitor vendor performance. Establish performance metrics to measure vendor performance. Correlate the findings with employee satisfaction. 

Disability Management

____ 1. Have a disability plan in place. Disability management begins prior to any accident by having policies and procedures in place to handle disability situations.

____ 2. Plan an employee return to work program. Establish a plan to return employees to work as soon as possible. If necessary, the employee should return to modified, transitional duty to get back to work. Employee return to work should be planned, organized, and monitored.

____ 3. Involve supervisors. Employees and supervisors should all understand the rationale behind the return to work policy so that supervisors will support, not discourage, returning employees to work promptly.

____ 4. Integrate benefit programs. Make sure benefit programs are coordinated so that they do not provide employees with incentives not to return to work.

Tools for Strategic Management

Tools used in the process of developing and implementing a workers' compensation strategy include:

____ 1. Flow mapping. Map out the workers' compensation process, including paperwork flow and benefits payment to find out where the problems may be.

____ 2. Document review. Review the documents used and highlight the areas where policies or procedures disconnect.

____ 3. Stakeholder interviews. Get input from management, staff, and line employee. Perform an environmental walk through of the work area.

____ 4. Focus groups and surveys. Conduct focus groups and employee satisfaction surveys to determine how the program is working.

____ 5. Actuarial analysis and file audits. Review statistical claims data, cost analyses, and claim files.

Reprinted with permission. © CCH