SAFe-mail 3rd Quarter

How Employers Can Focus on Getting Employees Back to Work

by Quinn Guist, on February 12, 2012

Ohio Bureau of Workers’ Compensation

Third Quarter 2012

Table of Contents

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Getting Employees Back to Work

OSHA Inspections

CompEndium: Medical Managers

Safe-mail Third Quarter 2012

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claims adjusters, employers of all sizes and industries should have at least one thing in common — workers’ compensation must be a priority. This may not be a part of your business that welcomes you warmly when you come into the office each morn-ing, but it is one that requires time and attention to keep from growing into an uncontrollable burden. One approach to handling workers’ compensation is simply to entrust your claims to your adjuster and allow them to manage them on your behalf. MCOs, claims adjusters, and workers’ com-pensation attorneys can all help administer this critical segment of your business. But most would agree a more effective ap-proach is for employers to prepare themselves well and become proactive partners in managing workplace injuries. Here are some fundamental key principles employers can utilize to gain significant return for their effort. Establish Basic Employee Guidelines A policy for workers’ compensation injury management does not have to be all-encompassing from the start, but begin by ad-dressing basic expectations for employee behavior. Why does this impact workers’ compensation? Two reasons: Basic guide-lines establish a foundation for evaluating and managing em-ployees from the beginning. Challenging employees sometimes create challenging claims. More importantly, guidelines allow you to specify employee be-havior that facilitates transparency and communication through-out the life of a workers’ compensation claim. For example, you

“Guidelines allow you to specify employee

behavior that facilitates transparency and communication

throughout the life of a workers’

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No Better Time to be Covered by SAF 5

R eturning injured work-ers to their jobs has been a high priority for Man-aged Care Organizations

(MCOs) and the workers’ compen-sation providers; however, we can always improve. MCOs, employers and providers must work collabo-ratively to advance return-to-work efforts. Regardless of the greatest intentions and efforts of MCOs and

Requirements of a Compensable Claim 7

“The injury-reporting process is an opportunity to build employee trust and confidence by demonstrating a well

thought-out game plan for injury management.”

State Accident Fund Safe-mail Third Quarter 2012

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should require that injuries and incidents be reported to a supervisor within a specified time (e.g., before the end of the shift, 24 hours, etc.). You can also re-quire employees to return medical documentation regarding their treatment and recovery to you directly (HIPAA laws do not apply to workers’ compensa-tion claims).

Transitional Work

Known by many names — modified duty, light duty, work accommodations — transitional work simply means bringing an employee back to work and ad-justing their job requirements while they recover from injury. A multitude of studies show an injured employee will recover more quickly while in their working environment. Transitional work may not be possible in every situa-tion, however, the more creativity used in identifying productive work for an injured employee, the better your chances are of avoiding one of the most costly elements of workers’ compensation claims — lost workdays.

A key point: your employee’s physician decides when they may return to work. Early return-to-work amounts to a reconciliation between the physician’s de-termination of the employee’s physical capacity and your flexibility to accom-modate the employee’s limitations while they recover. Depend heavily on your MCO to assist in informing the phy-sician of modified work options available for the injured employee. It is important for the doctor to understand the actual nature of work you have and that performing those tasks will not put your employee at risk of re-injury.

Injury Reporting Protocols

Establishing a consistent procedure for documenting work-related injuries and initiating the claim-filing process is important in a successful return-to-work program. Timing is critical, as early intervention in a claim from you and your expert resources (MCO and claim adjusters) helps bring clarity to the claim process. Having the opportunity to discuss return-to-work options with your employee and their treating physician in the early days and hours af-ter an injury helps all parties approach the claim proactively with the goal of early return-to-work.

Many employers maintain a readily available supply of injury reporting forms, contact information and a list of simple instructions. Make sure management and supervisors are familiar with these forms and are prepared to assist injured workers in completing the information and obtaining medical treatment if necessary. The injury-reporting process is an opportunity to build employee trust and confidence by demonstrating a well thought-out game plan for injury management.

Relationships with Local Medical Providers

Remember, the physician has final say regarding return-to-work timing for an injured employee, and your MCO serves all parties by ensuring the physician is as informed as possible when making decisions about your employ-ees’ return-to-work status. Take notice of the medical treatment options available in

Getting Employees Back to Work … continued from page 1…

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OSHA Inspections

Guidelines by:


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employees. 2. Fatalities and catastrophes—incidents that involve a death or the hospitalization of three or more employ-ees—come next. Employers must report such catastrophes to OSHA within 8 hours. 3. Complaints—allegations of hazards or violations also receive a high priority. Employees may request ano-nymity when they file complaints. 4. Referrals of hazard information from other federal, state or local agencies, individuals, organizations or the media receive consideration for inspection. 5. Follow-ups—checks for abatement of violations cited during previous inspections—are also conducted by the agency in certain circumstances. 6. Planned or programmed investigations—inspections aimed at specific high-hazard industries or individual workplaces that have experienced high rates of injuries and illnesses—also receive priority.

Phone/Fax Investigations

OSHA carefully prioritizes all complaints it receives based on their severity. For lower-priority hazards, with permission of a complainant, OSHA may telephone the employer to describe safety and health concerns, follow-ing up with a fax providing details on alleged safety and health hazards. The employer must respond in writing within five working days, identifying any problems found and noting corrective actions taken or planned. If the response is adequate and the complainant satisfied with the response, OSHA generally will not conduct an on-site inspection.

Onsite Inspections

Preparation—Before conducting an inspection, OSHA compliance officers research the inspection history of a worksite using various data sources, re-view the operations and processes in use and the standards most likely to apply. They gather appropri-

“Help employers and workers reduce on-the-job

hazards and prevent injuries.”

The Occupational Safety and Health Administration is committed to strong, fair and effective enforce-ment of safety and health requirements in the workplace. OSHA inspectors, called compliance safety and health officers, are experienced, well-trained industrial hygienists and safety profession-als whose goal is to assure compliance with OSHA requirements and help employers and workers re-duce on-the-job hazards and prevent injuries, ill-nesses and deaths in the workplace. Normally, OSHA conducts inspections without advance notice. Employers have the right to require compliance officers to obtain an inspection warrant before en-tering the worksite.

Inspection Priorities

OSHA cannot inspect all 7 million workplaces it covers each year. The agency seeks to focus its inspection re-sources on the most hazardous workplaces in the fol-lowing order of priority: 1. Imminent danger situations—hazards that could cause death or serious physical harm—receive top pri-ority. Compliance officers will ask employers to correct these hazards immediately—or remove endangered

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ate personal protective equipment and testing instruments to measure potential hazards. Presentation of credentials—The onsite inspection begins with the presentation of the compliance officer’s cre-dentials, which include both a photograph and a serial number. Opening Conference—The compliance officer will explain why OSHA selected the workplace for inspection and describe the scope of the inspection, walk-around procedures, employee representation and employee inter-views. The employer then selects a representative to accompany the compliance officer during the inspection. An authorized representative of the employees, if any, also has the right to go along. In any case, the compliance offi-cer will consult privately with a reasonable number of employees during the inspection.

Walk-around—Following the opening conference, the compliance officer and the representatives will walk through the portions of the workplace covered by the inspection, inspecting for hazards that could lead to em-ployee injury or illness. The compliance officer will also review worksite injury and illness records and posting of the official OSHA poster. During the walkaround, compliance officers may point out some apparent violations that can be corrected immediately. While the law requires that these hazards must still be cited, prompt correc-tion is a sign of good faith on the part of the employer. Compliance officers try to minimize work interruptions during the inspection and will keep confidential any trade secrets they observe. Closing Conference—After the walk-around, the compliance officer holds a closing conference with the em-ployer and the employee representatives to discuss the findings. The compliance officer discusses possible courses of action an employer may take following an inspection, which could include an informal conference with OSHA or contesting citations and proposed penalties. The compliance officer also discusses consultation and employee rights.

Results

OSHA must issue a citation and proposed penalty within six months of the violation’s occurrence. Citations de-scribe OSHA requirements allegedly violated, list any proposed penalties and give a deadline for correcting the alleged hazards. Violations are categorized as other-than-serious, serious, willful, repeated and failure to abate. Penalties may range up to $7,000 for each serious violation and up to $70,000 for each willful or repeated viola-tion. Penalties may be reduced based on an employer’s good faith, inspection history, and size of business. For serious violations, OSHA may also reduce the proposed penalty based on the gravity of the alleged violation. No good faith adjustment will be made for alleged willful violations.

Appeals

When OSHA issues a citation to an employer, it also offers the employer an op-portunity for an informal conference with the OSHA Area Director to dis-cuss citations, penalties, abatement dates or any other information perti-nent to the inspection. The agency and the employer may work out a set-tlement agreement to resolve the matter and to eliminate the hazard. OSHA’s primary goal is correcting hazards and maintaining compliance rather than issuing citations or collecting penalties. Alternatively, em-ployers have 15 working days after receipt of citations and proposed penalties to formally contest the alleged violations and/or penalties by sending a written notice to the Area Director. OSHA forwards the contest to the Occupational Safety and Health Review Commission for independ-ent review. Alternatively, citations, penalties and abatement dates that are not challenged by the employer or settled become a final order of the Occupational Safety and Health Review Commission.

For more details on these exposure risks or other safety questions, you may go to www.osha.gov or contact the State Accident Fund and ask for Barney Derrick 803-896-5935 or Ray Coleman at 803-896-5855.

OSHA Inspections, continued from page 3 …

http://www.osha.gov


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The State Accident Fund has been at work since 1943 and there’s no better time to take advantage of our expertise, competitive rates and superb service. Our safety consultants will tailor a safety plan for your business to insure compliance with OSHA and to help prevent on-the-job accidents. But if an accident does occur, our caring, attentive claim adjustors will be there every step of the way to assist the injured worker and you, the employer, through the process. Our premium auditors make sure you get maximum benefit for your premium dollars through proper pay-roll classifications and annual audits. We serve South Carolina state governmental and local governmental agencies including, but not limited to, local towns & cities, county government operations, local police, fire fighting and EMS operations, water-works operations, school districts, colleges and universities. We’re not a huge insurance company that only cares about the bottom line. We are here to provide the best coverage at the most reasonable cost. When you call us, you will speak with a person. If the person you need isn’t readily available, you will receive a return phone call within 24 hours – but probably much sooner! All our employees are located in South Carolina and live in South Carolina. We are familiar with the specific laws and guidelines that apply to South Carolina and well as a familiarity with issues that impact all of peo-ple living in South Carolina. Employees from other insurers are likely to be located outside of South Caro-lina with no local knowledge whatsoever! Workers compensation is what we do; it’s all we do and we do it well. Already a customer? Great! You could save money on your policy by introducing others to SAF! You could receive up to a 1% schedule credit based upon the premium of a new policyholder that you refer to us! You could receive a one-time credit applied to the following policy year premium. Minimum $250.00 credit, up to a maximum 1% sched-ule credit based upon premium of new policyholder. To find out more about this incentive, please speak with your auditor.

Check out our website at www.saf.sc.gov for more available programs, forms, claims reports and more! You can also contact one of our premium auditors by calling 803.896.5856 (Kirk Adair) or 803.896.5857 (Theresa Simmons).

There is no Better Time to be Covered

By the State Accident Fund

Theresa Simmons, Premium Auditor

Kirk Adair, Premium Auditor

“We are here to provide the best

coverage at the most reasonable cost.”

http://www.saf.sc.gov

“To ensure the proper medical treatment

is administered and followed to allow a speedy recovery

and return to work status.”


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C ompEndium Services continues to be a proac-tive component of the South Carolina State Acci-dent Fund (SAF) policyholders’ workers compensa-tion cost control program. CompEndium Services provides a Nurse Consultant (Medical Manager) to every injured worker in order to ensure the proper medical treatment is administered and followed to allow a speedy recovery and return to work status. This is done through timely coordination of com-munication, continuous review of medical status and promotion of return to work capabilities.

With continuous education, review of claim medi-cal direction, and return to work policies, your dedicated Medical Managers are committed to cus-tomer service. CompEndium is able to provide 24 hour telephonic assistance to injured workers, poli-cyholders and providers throughout the treatment cycle. This enables all parties to request assistance

when help is needed. Coupled with our special instructions manual and current medical guidelines, CompEndium is able to ensure your Medical Managers provide proper guidance to all injured workers throughout the claims process. Feel free to contact your dedicated Medical Manager to ensure your contact information, return to work policies, preferred providers or any other special notes are cur-rent. CompEndium is also able to provide policyholders access to our website to follow their claims medical progress. With an established account, the CompEndium website at CompEndiumusa.net offers policy-holders the ability to see the latest medical direction for their injured workers. Many of you have util-ized this site in the past and feel this is a valuable tool for up to date information regarding your in-jured workers. We are currently reviewing the site and hope to bring you a new more active site with the new year to allow for a smoother flow through site navigation. Again, we are here to assist the South Carolina employers with their cost management goals. Feel free to contact us to schedule a training session, review of return to work program or any opportunities we may have to better meet your needs. We can be contact at 877-709-2667 or [email protected] .

Bobby Collins President/Chief Executive Officer

CompEndium Services, Inc.

CompEndium: Medical Managers

mailto:[email protected]


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“At Work Since 1943.”

your area and ask your MCO for recommendations and advice. Build relationships with key physicians. Invite them to tour your facility so they can personally see the types of job duties your em-ployees perform. Their understanding of your business contrib-utes to their decision-making process regarding return-to-work.

Consider other medical services you may need as an organization (pre-employment physicals, drug testing, etc.) and position your organization as a wise consumer. You can certainly recommend excellent options and establish relationships with service provid-ers to foster communication and trust.

Culture of Health with Your Employees

It only makes sense that a healthier work force tends to have fewer injuries or, once injured, employees who return to work more quickly. Create your own healthier work force and posi-tively impact your workers’ compensation experience.

Putting all the pieces together in your workers’ compensation puzzle will optimize a safe and efficient return-to-work program that ultimately benefits all parties.

Requirements of a Compensable Claim: Injury by Accident

The South Carolina Workers Compensation Act requires that a worker undergo an injury by accident in the course and scope of employment in order to establish a compensable claim. S.C. Code Ann. § 42-1-160. The term “accident”, however, is not defined in the Code. Beard, et al, The Law of Workers’ Compensation Insurance in South Carolina, 5th Ed., p. 74. Case law has defined “accident” as an unlooked for and unto-ward event which is not expected or designed by the person who suf-fers the injury. Lanford v. Clinton Cotton Mills, 204 S.C. 423, 30 S.E.2d 35 (1944). While it is logical for one to expect “an external act or oc-currence which causes the injury or death,” an accident can also in-clude “not only an injury, the means or cause of which is an accident, but also an injury which is itself the accident, that is an injury occur-ring unexpectedly from the operation of internal or subjective conditions, without the prior occurrence of any external event of an accident nature.” Sharpe v. Case Produce Co., 329 S.C. 534, 495 S.E.2d 790 (Ct. App. 1997), rev’d on other grounds, 336 S.C. 154, 519 S.E.2d 102 (1999). In other words, the injury is itself the accident. An illustration of this principle is the case of Creech v. Ducane, 320 S.C. 559, 467 S.E.2d 114 (Ct. App. 1995), in which the claimant merely bent to pick up a rack, weighing less than a pound, off the floor and injured his back. See also, Sigmon v. Dayco, 316 S.C. 260, 449 S.E.2d 497 (Ct. App. 1995)(employee suffered compensable injury when he stood and his knee locked). Even with such a brod definition of accident, there are still exceptions, such as inter-nal breakdowns or expected injuries, that are not compensable.

Back to Work, continued from page 2 …

by Ellen Goodwin

Safe-mail Third Quarter 2012

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