Work Comp Costs Get Healed Through On-Site Treatment
It all starts with a workplace injury. Somebody leaves oil on a floor, forgets to wear their safety goggles, fails to remember to replace a safety guard on a saw, touches something that should absolutely, positively, never ever be touched. And once that happens a chain of events takes place, most of them bad.
We're all familiar with the process: The injured worker is taken to an overcrowded occupational clinic (often accompanied by one or more co-workers—who are no longer doing their jobs) where they can pretty much figure to spend a good portion of their working day. Then the OC doctor (if you ever get that high on the medical food chain), who just assisted a 10-year old with crayon stuck up a nostril, will now try to diagnose an industrial accident. From there, it becomes a labyrinth of missteps and wrong turns as everything gets sorted out by the supervisor, the claims people, the insurance company, and your HR department . . . and, all the time, the injury clock is ticking and your premiums are getting ready to escalate.
As a business owner, you feel the frustration at this turn of events. The increased costs, the ascending experience mod, the loss of productivity with anywhere from one to three employees not on the plant floor doing their job. Now, think how frustrated you would be if you found out that 90 percent of all non-life-threatening workplace injuries could have been quickly resolved with on-site first aid.
It's no secret that medical costs continue to rise at double-digit rates and, as a result, now comprise approximately 60 percent of the average claim. Indemnity costs are also problematic. Even though organizations have spent considerable time and resources to facilitate return-to-work (RTW) programs, these initiatives have failed to yield optimal outcomes. Within this current state of flux, many organizations are looking to implement innovative strategies to overcome traditional hurdles -- but what is new in workers' compensation?
Some companies have come forth offering telephonic nurse triage services. But this type of service has only a 20-40 percent success rate, plus the injured employee gets the feeling that the employer doesn't care about his situation, to the point they aren't even taking him to a medical provider.
Injury Triage
Recently, a more positive trend has emerged. Instead of taking the injured worker to a medical professional, the medical professional visits the scene of the injury and treats the worker. This is known as "injury triage." The medical professional is able to assess an injury where the injury takes place. Why describe how an employee was injured to a doctor 10 or 20 miles away, when you can actually show how it happened, perhaps even reenacting the injury to some degree? Such triage-treated injuries can include abrasions, lacerations, burns, eye irritation, neck or back pain, extremity injury, and heat illness, to name a few. The triage worker will call in the troops should the injured party lose consciousness or have a possible spinal injury, serious burns, bone fractures, or loss of limbs or extremities.
The workers' compensation industry is just beginning to catch on to this concept, leveraging injury triage to harvest benefits and savings as a result of prompt medical action on site (the longer an employee has to wait for treatment, the more likely the injury will get worse). Benefits include the rapid processing of claims and a drastic reduction in the loss of production due to employees being away from their jobs. No longer does processing a claim happen at a glacial pace, where some injuries can take five to 10 days to be reported, for a myriad of reasons.
A recent study by the Hartford Financial Group pointed out that prompt reporting of injuries leads to improved claims costs and outcomes. Triage nurses are trained to handle all of the facets of paperwork. This reduces the burden on supervisors and injured employees to fill out and submit claim forms. In most cases, the nurse sends an injury report to all concerned parties, including the employer contacts, treating physician, and the claims adjuster.
Feedback thus far from employers who have utilized injury triage has been promising. "We already treated a few employees with hand laceration, ankle sprain, and knee sprains," said Isaac Valle, safety coordinator for Jensen Corporate Holdings in San Jose, Calif. "The service has been prompt and effective thus far and has helped us keep these three incidents as first aid incidents, with our employees feeling comfortable with the service."
Another key is that this process ensures that every injured employee will receive the appropriate level of medical care. You can train your supervisor, your VP, even your cafeteria worker on first aid tips and how to respond in a medical emergency, but do you really want to put that burden on those folks to make a medical decision? One that has potential liabilities should improper treatment be administered? No, you don't . . . and neither do they. Which is all the reason the easiest course of action was either to call an EMT or transport the injured worker via car to the nearest hospital. And it has been reported that as a result of that decision, companies ended up using occupational clinic services in 20-30 percent of their incidents, resulting in an unnecessary level of care and expense. Another positive factor is that additional services are also available through this type of operation, including on-site drug testing, tetanus shots, first aid training, forklift training, CPR training, and more.
Also important is the mindset of the injured workers. When they see that their employer has taken the action to have a medical professional on site as quickly as possible to personally treat them, as opposed to a grueling wait in the OC, it establishes a culture of caring between employer and employee, that their safety and well-being are a top priority within the company, and results in a reported 40-67 percent reduction in claims litigation.
All of these benefits have enabled workers' compensation programs to decrease overall costs. These reductions have significantly helped employers, particularly in light of today's difficult economy and ever-increasing workers' compensation costs.
Janice Berthold is a senior vice president with Heffernan Insurance in San Francisco, Califa. She has more than 25 years of commercial insurance experience and holds the insurance designations of Chartered Property Casualty Underwriter and CWCA. She can be reached at 650-842-5205 and at [email protected].
Posted on May 23, 2016