At the recent California Coalition on Workers’ Compensation 11th Annual Conference in Anaheim, CA, industry bloggers Mark Walls (Work Comp Analysis Group on LinkedIn), Robert Rassp (The Rassp Report), Rebecca Shafer (ReduceYourWorkersComp), David DePaolo (DePaolo’s Work Comp World), and Roberto Ceniceros (Comp Time) participated in a spirited debate on how we can improve the workers’ compensation, what needs to be changed, and how to achieve those goals.
The “Bloggers' View of the Workers’ Comp World” consisted of about 55 minutes of the panel interacting at the prompting of Mark Walls. Mark started by asking Roberto Ceniceros about the hottest issue in workers’ comp today, and Ceniceros responded by saying the op-out program in Oklahoma is being watched by other states.
Rebecca pointed that opt-outs will give the employers much needed control with regard to which medical provider to use, benefit levels (employer can pay higher if they wish) and which claims to pay lump sum settlements.
After a brief discussion of opt outs, the bloggers then focused on California.
Robert Rassp talked about his theme of being the only applicant's attorney there. He addressed the "experiment" of Independent Medical Review (IMR) in California workers' comp and how adjusters need to adjust and how we shouldn't need all of the vendors in the Exhibit Hall to do their jobs for them.
According to Rassp, the outsourcing of adjusting duties is a bad sign no matter what state you talk about. Rassp said most injured workers in fact want to return to work and there is a huge disconnect between employers and their own claims examiners - California has one of the worse return to work records in the country.
Rassp observed that if claims adjusters do their job, then he doesn’t have to do his.
DePaolo explained that IMR may very well work out to reduce the number of treatment disputes, and may very well improve treatment outcomes.
But DePaolo warned that behavior of those of us on the front lines must change, and that the information that comes out of IMR needs to be utilized properly by the payer community and the state to improve rules, regulations and procedures. Otherwise, IMR just becomes yet another part of "cost containment" bloat.
Rebecca Shafer told the audience that companies in every state, including California, can implement workers’ comp cost containment programs. Some steps they can take include more communication such as a brochure for employees, providing proper forms so employees get medical restrictions on the FIRST medical visit, having injured employees attend weekly meetings to determine what obstacles they may be experiencing and showing them potential modified duty jobs. Shafer highlighted that only 59% of employers have return to work programs across all business units, according to the 2009 RIMS Benchmark Survey, so there is much room for improvement as employers begin to “look in the mirror” for the cause of their high workers comp costs.
Shafer also pointed out that an employer can request more services from their insurance carrier or third-party administrator than just a bare minimum. The same goes for a TPA, employers can retain control over claims overseeing a TPA IF they know what to ask for. Companies with higher retention insurance policies have more control, but they need to know what to ask for from the insurance companies.
Several things companies can ask for are “chairside visits” to their adjusters to learn how their claims are processed. Brokers must provide services more proactively, introducing their clients to potential services that would be useful; they cannot simply wait for employers to ask for a service because employers cannot ask for what they do not know exists.
DePaolo said that comp changes with the economy - we are now a service society and no longer a manufacturing or agriculture society so things have changed in our system in the last 100 years and will continue to evolve and the law and claims need to evolve with it.
Rebecca Shafer brought up the possibility of using integrated occupational and non-occupational wellness programs more effectively with the Affordable Care Act coming into play soon and increasing use of medical doctors as medical directors to gain greater control over workforce safety and health both on and off the job. All bloggers thought this type of program could be widespread in the future.
At the end of the session, Mark asked the panel if our workers’ comp system is fair. Rassp quipped that if anyone in the room thinks the workers’ comp system is fair, then they belong "out there in Fantasy Land."
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