workerscompbiz.com

Male pelvic pain misdiagnosed as work related?

workerscompbiz — Thu, 19 Aug 2010 20:08:15 +0000

“[Joe] Pope, of Charleston W.Va., initially thought that he had injured himself on the job. But the tingling sensation near his prostate… kept coming back, and kept getting more painful.”

In an article titled “Making sense of male pelvic pain” reporter Angela Townsend of the Plain Dealer on Tuesday, August 17, 2010, described the difficulty men face getting a diagnosis and appropriate treatment for male pelvic pain. “Some physicians estimate that as many as half of all men will develop chronic pelvic pain at least once in their lifetime.”

Considering Joe Pope’s statement in the Plain Dealer article, how many claims allowed for groin strain or other vague pelvic diagnoses may not be work-related at all?

When a condition is misdiagnosed as work related, the system kicks in and the BWC employees get their paychecks, the attorneys get paid, the hearing officers get paid, the claimant may get compensation, but the patient’s condition is not effectively addressed. And let’s not forget that the employer’s premiums will probably increase.

Some claimants may feel that the “green poultice” of dollars is enough to compensate for the discomfort, but others would prefer to have the condition correctly diagnosed and appropriately treated. And what’s to stop the claimant from enjoying the benefits of having a claim, and then getting a different diagnosis and correct treatment outside of his workers’ compensation claim?

Linchpin: Are You Indispensable?

workerscompbiz — Fri, 16 Jul 2010 21:15:50 +0000

I’ve been reading a lot this year about new ways to survive in the current economic climate. I am now reading Linchpin: Are You Indispensable? by Seth Godin. Here’s a quote from the inside flap. “There used to be two teams in every workplace: management and labor. Now there’s a third team, the linchpins…. They love their work, pour their best selves into it, and turn each day into a kind of art.”
Godin quotes Steve Jobs who said “Real artists ship.” In other words, do your work and send it out into the world. Don’t delay, procrastinate, form a committee, miss your deadline, hide in the crowd instead of standing out from the crowd. Do the work that you are passionate about, that you do as only you can do it. Put your soul into the work that you do.
Godin talks about the current education system that trains us to be consumers and to follow the rules. We are taught that the goal is to not make mistakes, otherwise we won’t get that 100%. We play board games like Candyland, where you draw a card and do what it says. We are taught that if we go to school, get a steady job, buy a house and car and stuff just like everyone else, we will have a good life. That’s the educational system devised by captains of industry decided a century ago. The industrial revolution made it possible to create more goods more quickly, and the factory owners had to create markets for the goods being produced. Henry Ford paid his workers enough so they could afford the cars they were producing. Who else would buy all those cars?
The book is frustrating to read because he doesn’t identify everyone he talks about, doesn’t document his stories, and it often feels like he’s continuing a conversation he had with someone else and he’s letting you listen in. Perhaps the book is a compilation of blog posts. But even though every idea is not explored thoroughly, the ideas are important. Perhaps his style is necessary for this era of information overload.

Which BWC safety program is best?

workerscompbiz — Fri, 25 Jun 2010 15:16:11 +0000

With the BWC touting “safety” in every program it offers, it’s easy to be confused about which program provides which benefit is to employers.
Safety Council Rebate Program: Employers get a rebate of their premiums when they join the local Safety Council, attend monthly meetings and provide injury statistics to the Council every six months. Rebates are good.
Drug Free Safety Program: This program replaces the Drug Free Workplace Program. Employers get a 3%, 4% or 7% discount stacked on top of their experience modifier (EM). There is paperwork that costs time & money to prepare and implement, although “DFSP employers may apply for reimbursement for specified start-up costs for the first two years of DFSP program operation.” Go to http://www.ohiobwc.com/employer/programs/dfspinfo/dfspdescription.asp for more information. The real downside is that employers will be prohibited from paying salary continuation for claims with dates of injury 1/1/2011 and later. See previous blog post RED FLAG Drug Free Safety Program for examples of how much the premiums are reduced by the discounts.
Group experience rating: This is still the best way to reduce premiums, but each employer has to meet various criteria and deadlines. The BWC now requires 2 hours of safety training on-line or in person for companies participating in group rating.
Group retrospective rating: The 7/1/09-6/30/10 policy year is the first for this program. Employers pay their individual premiums. At the end of 12, 24 and 36 months, the group experience is analyzed and employers either get a rebate because the group performed well, or they get a bill for more premiums due to poor group performance (too many claims). There does not appear to be a safety training requirement for employers in this program, but employers can participate in the Safety Council Rebate Program.

RED FLAG Drug Free Safety Program

workerscompbiz — Thu, 24 Jun 2010 14:35:02 +0000

The deadline for enrolling in the Drug Free Safety Program is June 30, 2010. The program used to be called the Drug Free Workplace Program, but is has been renamed to alert you that the program has changed.
RED FLAG: If you enroll in the Drug Free Safety Program starting 7/1/2010, your company cannot pay salary continuation in any claim with a date of injury of January 1, 2011 or later.
The good news is that a company will be able to stay in the program longer than the current 5 years – at least until the BWC changes the program again. If your company was in drug-free and was eliminated after 5 years, it can apply again. There are 2 levels, Basic and Advanced.
Basic level: 4% discount for non-group experience rated employers. The components are similar to the current program, including written policy, testing, education, training and assistance, and the hourly education and training requirements have been reduced. A safety review, and supervisor accident analysis training and accident reporting have been added. If your company will receive a group experience rating discount, it will not get an additional discount for the Basic level.
Advanced level: 7% discount for non-group experience rated employers. Your company must meet all requirements of the Basic level plus 15% random drug testing, safety action plan and a second chance after first positive. A group experience rated employer can stack up to 3% on top of the group discount, as long as the total discount is equal to or less than the maximum discount (currently 49%).
Is a 3%, 4% or 7% discount worth the paperwork hassle and the inability to pay salary continuation?
Here’s an example. A company has yearly payroll of 3.5 million dollars. Without group rating, its EM would be 120. If it enrolled in the Advanced level, its EM would be 113 and its premiums would be $7,400 lower. With group experience rating, its EM will be 83. Enrolling in the Drug Free Safety Program would lower its EM to 80, and reduce its premiums by $3,000. Are those savings in one year worth giving up the ability to control its claims costs in lost time claims?

MCO Myth #1 addendum

workerscompbiz — Fri, 14 May 2010 21:58:49 +0000

If you are a very small business, you may think that you want a TPA that “rubber stamps” all treatment requests, because you are the only one who will ever be injured. But beware!
A claim with substantial medical costs could get your company eliminated from group rating in two years.
Here’s an example when rubber-stamping is not a good idea: The employee hurt her shoulder at work. She was seen in the ER and got a diagnosis of strained shoulder. She was then seen by an orthopedist, who recommended 3 weeks of physical therapy (PT), and if no relief, injection into the shoulder. She started PT, and at each follow up visit was seen by a Certified Nurse Practitioner (CNP), who recommended that the PT continue, despite the patient’s complaints that her shoulder felt unstable. The MCO authorized 10 additional PT sessions, but I (the TPA) suggested that the patient be seen by a medical doctor instead. The doctor suspected a tear, and recommended evaluation by a surgeon.
If you were the patient, would you want the MCO to approve all requests, or would you want an MCO to review and actively manage your claim?

Open enrollment Myth #2

workerscompbiz — Mon, 10 May 2010 18:15:43 +0000

Will your company be well served by using an MCO and TPA that are sister corporations?
MCO stands for Managed Care Organization. Its job is to manage the medical care of the injured workers. It is paid a percentage of your premiums, so its financial best interest is to authorize as many treatments as possible.
TPA stands for Third Party Administrator. Its job is to manage all of your claims to keep your premiums as low as legally possible. The TPA should be a watchdog over the medical services authorized by the MCO.
If the TPA and MCO are sister corporations, how likely is it that the TPA will challenge the services authorized by its sister? In my experience, companies that use a TPA and MCO owned by the same corporation will see increases in their claims costs, and may then be eliminated from group rating.
If the TPA offers to manage your claims for a minimal amount, like $75, how likely is it that the TPA will aggressively work to keep your claims costs down? Can a business really be profitable when it gives its services away for such a small amount?

Open enrollment: MCO myth #1

workerscompbiz — Wed, 28 Apr 2010 02:09:19 +0000

Is bigger better when choosing your MCO?
One of the most important jobs for an MCO is to approve or disapprove treatment requests, which are submitted on a C-9 form. When treatment requests are authorized, the provider treats and then bills for its services. Authorizing treatment therefore authorizes expenditure, which results in higher premiums for employers.
How does your MCO handle treatment requests? Large MCOs want to be efficient in handling the many C-9 forms. Some MCOs use staff members who are not registered nurses to rubberstamp all requests, as long as the treatment can be considered reasonably related to the allowed conditions in the claim. They don’t look at how many of the requested services have already been provided, so they will authorize all physical therapy, chiropractic, consultations, MRIs, CT scans, etc. Your MCO may not tell you when it has authorized treatments; you just get a big surprise when you see the claims costs that caused the increase in your new premiums rates. The MCO may only tell you when they don’t authorize treatment.
Another “efficient” MCO practice is to authorize any and every treatment described in the Official Disability Guidelines (ODG). The chiropractor can ask for the maximum of 12 treatments and get them approved, without demonstrating “functional improvement” after the first 2 or 3 sessions as recommended in the Guidelines. If there are additional conditions later allowed for the same body part, more treatment will be authorized, even though that body part has already been treated. For example, the ODG recommends up to 9 visits over 8 weeks for an elbow sprain/strain. The ODG recommends 9 visits over 8 weeks for olecranon bursitis. Should the provider be paid for 18 visits over 16 weeks, when the same body part is being treated? Is the therapy for sprain/strain really so different from treatment for inflammation of the bursa?
MCOs are paid a percentage of your premiums, so it’s in their financial best interest to approve lots of treatments to increase the claims costs and increase your premiums. The BWC will say that it has “incentives” in place to make sure that doesn’t happen, but it does happen.
Your two best defenses against rubber-stamping are 1) choose an MCO that has nurse case managers review all C-9 requests, and 2) choose a TPA that will be a watchdog over your MCO.

MCOs have to train providers?

workerscompbiz — Thu, 15 Apr 2010 19:27:17 +0000

Here’s an example of the BWC pushing its work onto its customers.
The claim had not yet been allowed. The IW needed physical therapy. The provider wouldn’t provide the therapy unless it got a letter from the employer stating that it wouldn’t appeal the claim. To be a certified provider for workers’ comp claims, the provider has to agree to treat the IW as needed for a quick and safe return to work. Obviously, the provider in this example was more concerned about getting paid than providing treatment.
The BWC says that the MCO is required to train the provider.
Here are the problems with this procedure:
The BWC sets the rules for a provider to be part of the Health Partnership Program (HPP) and accepts the provider into the program. The MCO has no ability to discipline the provider if it does not comply. Also, the MCO would have no way of knowing about any other “training” the provider has received from other MCOs. The MCO has to decide whether to spend time & resources on “training” a provider.
The BWC will only step in after the MCO shows what it has done to train the provider and that the provider has continued the inappropriate behavior.
So in this example, the IW is delayed from returning to her full duties, and employer is denied the full value of its employee while waiting for PT to be completed. The provider gets away with its behavior, because it hasn’t refused to treat anyone else that our MCO knows of. The BWC does nothing to demonstrate its commitment to the rules it sets for providers.
Self-insured employers do not use MCOs, so what does the BWC do when they complain about non-compliant providers? The BWC should monitor the practices of all providers that it accepts into the HPP, and investigate when complaints are filed. The BWC should eliminate the providers who refuse to comply with the requirements of the program.

Wipe your hard drive occasionally

workerscompbiz — Tue, 30 Mar 2010 18:58:14 +0000

Is your computer slower than you think it should be? Slower than you remember it being when you started with it?
I got a virus three weeks ago. We saved my data and then wiped the hard drive and reinstalled all my programs. The computer ran silky-smooth and so much faster. The computer technicians all told me I should wipe the hard drive and reinstall my programs once a year to “clean out the registry.”
But here’s the downside: I lost all the changes that had accumulated since I bought it in August 2007.
My custom dictionary words. The auto-fill for e-mail recipients in Outlook. My business card in Outlook. Favorites listed in my ISP. And the cursor in Excel now automatically moves to the next cell down when I hit enter instead of staying in the same cell. I know I’ll find the way to change that eventually, but right now I have to think about it.
I had to download my favorite label from Avery Zweckform, but now it has its own folder, and I have to enter every address because cut and paste has different line spacing.
It takes a while to make all these changes, and it slows you down when you have to limp around your own computer.
People who create and/or knowingly distribute computer viruses should be taken to Guantanamo Bay permanently.

Lapsed coverage: Who cares?

workerscompbiz — Fri, 12 Mar 2010 15:06:43 +0000

A company’s coverage lapses if it does not pay its premiums on time. Here are the consequences of lapsed coverage:

First, claims with dates of injury during a period of lapsed coverage will be quickly allowed by the BWC. All claim costs will be paid by the BWC. All claims costs for the life of the claim will be billed directly to the employer for reimbursement. Depending on the seriousness of the injury, you could be paying years and years of compensation and medical costs. Failure to pay the amounts billed will result in certification to the Ohio Attorney General, who will file liens against the business.

Second, the BWC will bill the employer for estimated premiums. If the employer does not report its correct payroll and then pay the premiums due, the amounts will be certified to the Ohio Attorney General. If the premiums plus interest and fees are not paid, a lien will be filed against the business.

Contractors and subcontractors may not be permitted to have liens filed against them as a condition of getting the work they bid on. Banks may charge higher interest rates or refuse to loan money or to companies with outstanding liens.

What can you do if you know you won’t be able to pay all the premiums due? Record your payroll on-line and sign up for a payment plan before the premiums are due. If the on-line options aren’t sufficient, work with the BWC to develop a payment plan and then follow it. If you get notification from the BWC that you owe money, contact the BWC immediately to find out how and when to pay. The BWC is much easier to work with, and less expensive, than the Attorney General.