workerscompbiz.com

To pay your premiums online and take full advantage of the information on the BWC website, you must create an e-account.  You will need to create an ID and a password.  There will not be any secret questions.

Normally, when I give instructions for navigating the BWC website, I walk through the steps as I write them.  But I already have an e-account and don’t want to create another, so I trust you to follow the prompts.  As I recall, however, the BWC did not tell me the protocol for my ID and password until after the first one was rejected, so be prepared to make changes.

Write down the ID and password and make sure someone else at your company can find them, in case you are unavailable in the future.  Paying premiums late is not in your company’s best interest!

FRAUD ALERT:  E-account access enables you to change the contact information, including phone numbers, email and mailing addresses, and will provide access to the medical records in the claims filed against your company.  Be sure that only responsible and trustworthy persons have access to them.

Here’s something I’ve never seen before:  Someone was found guilty for filing a false workers’ compensation claim!

The claimant was involved in a motor vehicle accident the weekend before claiming he hurt his low back at work loading a truck.  The medical records showed he gave inconsistent descriptions of how he was hurt.  The BWC disallowed the claim.  The fraud unit investigated.  He pleaded guilty to workers’ compensation fraud for filing a false claim.  The judge ordered him to serve one year on probation and to pay $2,072.31 in investigation costs.

Thought #1:  It’s a minor miracle that the BWC disallowed the claim.

Thought #2:  The employer should have also been reimbursed for its costs in fighting the claim.

Thought #3:  It’s a bad idea to call everyone who files a claim an “injured worker”.  Let’s go back to the original term which was “claimant”.

“[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?

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.

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.

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.

PEO equals professional employer organization equals employee leasing

Leasing your employees from a PEO can be a way to provide more or better benefits to your employees; the PEO includes employees from other companies and should get economies of scale. Leasing employees may also be a way to offset the costs of one or more expensive claims, since the PEO will have a larger payroll. However, you will have no way of knowing about or controlling the safety of the other employer facilities, and so your workers’ compensation assessments from the PEO may change. You will not be able to verify the accuracy of the premium rates paid by the PEO.

Here are a few concerns.

First, you need to have a good relationship and open communication with your PEO. Every quarter, get a listing of claims filed by “your” employees, and every six months find out the amount of payroll assigned to “your” employees, by manual classification. That way, you can know what it would cost if you terminated the contract and the claims and payroll were assigned to your policy. You will know whether it would be less expensive to be in the PEO relationship.

Second, how will you be billed for the workers’ compensation assessment? One employer with a particular PEO had to pay not only the wages each week, but additional funds for the workers’ compensation premiums. He said it was easier to pay those assessments every quarter or six months. Plus, he was told the PEO was getting a group rating discount, but overall he paid more workers’ compensation premiums to the PEO than he had paid on his own. He was uncomfortable asking the PEO for claims and payroll information, so he had no data to determine what his rates would be if he terminated the PEO relationship. He didn’t know what claims had been filed, how much medical & compensation had been paid, or what payroll had been reported.

By law, the BWC may not tell you what payroll and claim data has been filed for “your” employees with the BWC.

If the PEO is self-insured, none of the payroll or claims will transfer back to you, which can affect whether you will be able to get into group rating. If you had one or more expensive claims before leasing your employees, not getting the PEO payroll can increase the impact of the expensive claims on your premium rates. Conversely, if you had few or no claims, getting the PEO payroll can help you get into a better group.

It’s in the best interests of your PEO to provide you with the information you need to decide whether to renew the contract or end it. By working with you, it can position itself as an employer-friendly company, so that even if the PEO situation is no longer right for you, you will be willing to recommend it to others.

What does it mean to certify a claim for medical only? Nothing good – if you are an employer.

Once a claim is allowed, the claimant can request compensation by filing an application with the BWC. The BWC will issue an order granting the compensation, and pay it unless the employer files an appeal within 14 days. If the employer objects, there will be a hearing and a hearing officer will decide how much, if any, compensation will be paid.

When does the BWC or a hearing officer consider whether the employer certified the claim for medical expenses only? NEVER.

Your MCO will ask you to certify the claim for medical-only expenses just to get you to say yes, so it can check the box.

Currently, the BWC codes the status of every new claim with employer certification as ALLOW.

When a claim is coded ALLOW, prescription drugs can be paid, and the BWC policy is not to credit for drug bills (unless the claim is completely denied).

Without certification, the BWC has up to 30 days to issue an order allowing or disallowing a claim. During that time, the employer can find out what treatments have been recommended or completed, and if any additional diagnoses are contemplated. Any medical care is authorized with a disclaimer. Bills will not be paid until the appeal period is over or the claim is allowed by a hearing officer.

When should an employer certify a claim? NEVER.

Has the BWC or your MCO ever asked you if you will certify the new claim? Have they asked if you agree that “something happened” at work? If so, here’s the right response: “We don’t have enough information to make a decision.”

What does it mean to certify a claim? There is no legal definition of “certify” regarding a workers’ compensation claim.

Here’s a little history: back in the 1980’s, employers were expected to type the long pink form (C-3) and file a workers’ compensation claim against themselves. There was a box on the back where the employer provided its contact information. The employer was expected to sign that everything was correct and asked to certify or not certify the claim. If the employer checked the certification box, then the BWC considered the claim accepted by the employer and started paying bills. If the employer checked not certified, then the BWC sent the claim for a hearing officer to decide whether to allow the claim. Nowhere on the form was it clear that the employer was accepting the claim by certifying; it could be interpreted as certifying that all information about the employer was correct.

Then, the BWC realized that employers don’t know whether a claim meets the legal requirements to be compensable, and began to request the medical records which would provide a description of the medical condition of the claimant and a diagnosis.

Now, the employer’s MCO obtains medical records and talks to the claimant, the medical provider and the employer. The MCO will ask if the employer will certify the claim.

So, what does it mean to certify a claim? Nothing that is good for an employer.

Will the claim be processed faster? It might, before you or your representative have enough time to get all the information necessary to make an informed decision whether to contest the claim.

As the employer, do you know what the claimant told the doctor about his work or his complaints? Have you seen all the medical records? Do you know how many other workers’ compensation claims your employee has ever filed, and for what conditions? Do you know whether the claimant has used attorneys in any prior claims and gotten compensation?

If you can’t say yes to all the above questions, you don’t have enough information to make an informed decision, and that’s exactly what you should tell the BWC or MCO when they ask.

Employers in Ohio get can get charged for drug costs that are questionable at best and fraudulent at worst.

On November 1, 2009, SXC Health Solutions Corporation will begin its 3-year contract with the BWC to manage the drug expenses for claimants. In its press release, the BWC touted the “state-of-the art, Web-based prior authorization technology that will enable prescribers to obtain instant approval to fill many pharmaceutical requests.”

In my years of reviewing the claim documents and bills for drugs expenses in Ohio claims, I have seldom seen any indication that claimants or prescribers have to get prior authorization for drugs. What I have seen are numerous examples of claimants getting drugs for conditions that are clearly not related to their claims paid by the BWC.

My favorite example is the claimant who was diagnosed with a strain to her forearm, returned to work, and two months later began getting anti-seizure medication paid in the claim. The claim was not allowed for seizure, and the physician of record did not prescribe the drug for her injury. When I brought this to the attention of the BWC, its response was to call the claimant, who said that she had taken anti-seizure meds since she was 12 and that the pharmacist had made a mistake. The pharmacist told the BWC that the claimant had instructed him to bill her workers’ compensation claim. In this case, the BWC told both the claimant and the pharmacist to stop billing the BWC for that medication, but then paid for two more months anyway.

Less clear-cut examples include doctors prescribing drugs “off label”, which means that the drug is prescribed for a condition not approved by the FDA. It is seldom possible for the employer to find out what doctor prescribed the drug, so it cannot investigate whether the drug has been prescribed for a condition not allowed in the claim.

Even when it is obvious that certain drugs should not have been paid in the claim, the BWC does not deduct those costs from the total claim costs. The BWC position is that its doctors can only state that a claimant doesn’t need the drug in the future for the allowed condition.