Controlling Worker's Comp Costs

The best way to control worker's comp costs is to prevent accidents. Safety pays dividends in every aspect of a glass business. But, the alleged accident has just occurred, or has just been reported. What can we do from here to control the costs for Joe the Glazier.

Two broad areas need to be addressed:

1. Reducing the costs of a legitimate claim


2. Reducing and eliminating the fake claims

Joe dislocated his shoulder and was cut when a lite broke that he was carrying on his shoulder. Yes, he should have worn arm guards, but that's not for now. How do we control the costs?

Two things will help...reduce his medical bills, and get him back to work ASAP. Ask Joe for permission to review his medical bills relating to the accident. Without his written permission, you won't get anywhere. Assuming Joe gives you the permission, go over the bills with your worker's comp carrier. Have them explain what you do not understand. If there are bills for specialists that you don't understand, ask. Many times a dishonest medical group will send patients for referrals, when they know it is a comp claim. Look for unneeded items, like orthopedic inserts after this shoulder injury. Or maybe a eye exam that was requested. Look to see if Joe is making his appointments. A missed doctor's visit pushes Joe's return to work out another couple of weeks in most cases.

See if Joe is going to physical therapy two-to-three times per week. If he isn't, either he is ready to go to work or the injury wasn't as bad as first perceived. Are all of Joe's appointments in the evening? Is he working somewhere off the books during the day? Is Joe keeping in touch with you or his supervisor from your company? If you haven't heard from Joe for a couple of weeks, call him to say hello. He should be either at therapy, the doctor's, or home. See how long it takes to call you back when you leave a message. Did Joe take a mini-vacation for five days?

Look at the worker's comp payouts for his wages. Do they have the correct wages? Did Joe include his overtime or holiday bonus in his base earnings he reported to the insurance company. When you get a request to verify his wages, and are too busy to answer, then Joe's numbers will be used by the insurance carrier.

Joe is basically an honest person but sitting home watching day-time TV can turn anyone dishonest. Every third ad is for a worker's comp attorney. So, one day Joe gets interested and suddenly he sees all new doctors, and his scheduled return to work has been extended by three months.

Enough already...Joe's accident was unavoidable, and he will return to work as soon as he can...you say. Congratulations, you are now entered into the naive-business-leader-of-the-year-contest. Every accident is avoidable. The question is do you want to spend the training time, invest in the correct equipment, and discipline yourself and your team to work safely?

Every worker says they want to get right back to work, but studies have shown that a worker out longer than three weeks, has a much lower return to work rate. Get Joe back to work, away from the TV and the doctors, and you come out ahead.

Set-up a light duty work program for all employees. It may not be their same old job, but you should have work available for all comp cases. Maybe sweeping the floor, or filing in the office. This is the number one way to get employees back to full-time productive work. Pay Joe his normal wage, even if he were a glazier, pay that wage as he sweeps the floor. Get him back involved in your company, and he will want to go back to his regular job!

Create a menu of every job that can be done by someone on light duty. Every company can come up with dozens of items:

• Taking your trucks to the fleet wash


• Doing inventory


• Sweeping the plant


• Painting


• Teaching other employees


• Learn how to use your computers


• Learn another language


• Doing simple work like putting logos on tempered glass or operating a spacer bender


• Audits of parts and supplies room


• Filing


• Following up on old quotes


• Answering the phone

You are paying Joe's salary while he is on comp, so you might as well get some work out of it. Even if it is only a half-day, that is good. Keep people in the habit of coming to work. Even someone can only work for twenty minutes, have them work twenty on, and twenty off. It is still better than paying them to stay home and watch the commercials from the ambulance chasers.

Other things to look out for:

• Joe changes his doctor's a couple of times. All this does is continue to delay a finding that he could come back to work.


• Joe goes for an Independent Medical Examination (IME) and gets a different report than by going to his own doctor. Or, Joe cancels more than one appointment with for the IME...this shows he doesn't want to be seen by the impartial doctor.


• Watch for a claim of disability that doesn't fit the injury. In Joe's case he has a bad shoulder, and puts in for disability on his shoulder and knee.


• Watch out for the time that Joe says he wants to come back to work, but suddenly you get a lawyer's letter asking for more info. Joe watched too much TV.


• You ask Joe to come into the office for a follow-up, and he is wearing work clothes, or has grease on his hands or fresh mud on his shoes, or if you can see his car or truck, and there is a tool box.

Next week we will discuss employee surveillance, working with your insurance carriers fraud unit, your own investigator and other warning signs of fraud.