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Introduction to Construction Health and Safety

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					      CEE 698 – Construction Health and Safety




CHAPTER 5 – WORKERS’
COMPENSATION
                                                 Chapter 5

                                                             1
Overview of Workers’
Compensation
 The concept of workers’ compensation
  developed as a way to allow injured
  employees to be compensated without
  having to take their employer to court.
 Two aspects:
  – Fairness to injured employees, especially those
    without the resources to undertake lengthy and
    expensive legal actions.
  – Reduction of costs associated with workplace
    injuries.
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                                                              2
Overview of Workers’
Compensation
 Since its inception as a concept, workers’
  compensation has evolved into a system
  that pays out approximately $27 billion in
  benefits and medical costs annually.
 Some of the highest workers’ compensation
  insurance rates are in construction fields
  (e.g., roofers)
 Compromise between the needs of
  employees and the needs of employers.
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                                                              3
Overview of Workers’
Compensation
 Workers’ compensation laws vary from state to
  state. In fact there are extreme variations.
 Workers’ Compensation has several widely
  accepted objectives:
   – Replacement of income for injured employees
       • Current and future income at a level of two-thirds (in most states)
   – Rehabilitation of the injured employee
       • Medical care at no cost, vocational training or retraining
   – Prevention of accidents
       • Employers invest in accident prevention programs, lower premiums
   – Cost allocation
       • Spread cost of workers’ compensation appropriately and proportionately
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                                                                                   4
Who is Covered?
 Workers’ compensation laws written at state
  level
   – Much variation in laws by state
 Workers’ compensation laws are constantly
  being amended, revised and rewritten.
 Contractors/subcontractors are not covered.
  – They perform a job or service for an agreed
    amount of money in a nondirected,
    nonsupervised format
  – Therefore are viewed as being self employed
 Approximately 80% employees in US are     Chapter 5
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                                                        5
Historical Perspective
 Before workers’ compensation laws were
  enacted, injured employees had no way to
  obtain compensation for their injuries
  except to take their employer to the court.
 Proving that an injury was the result of
  employer negligence in the form of unsafe
  conditions was too costly, too difficult, and
  too time consuming
 Injured employees who hoped to return to
                                                Chapter 5
  work CEE 698 – recoveringand Safety often afraid to
        after Construction Health were                      6
Historical Perspective
 Laws at that time made it easy for
  employers to defend themselves.
 It was sufficient for the employer to show
  that at least one of the following conditions
  was existed:
  – Contributory negligence
  – Negligence on the part of a fellow worker
  – Assumption of risk on the part of the injured
    employee.
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                                                                7
Workers’ Compensation
Legislation
 Today, all 50 states, the District of
  Columbia and Puerto Rico have workers’
  compensation laws. However, these laws
  did not exist before 1948.
 The first workers’ compensation law did not
  pass until 1908 and it applied only to
  federal employees working in especially
  hazardous jobs.
 Montana was the first state to pass a
  compulsory workers’and Safety
        CEE 698 – Construction Health
                                      compensation law.
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                                                        8
Workers’ Compensation
Legislation
 The New York State legislature had passed
  a compulsory workers’ compensation law in
  1910.
 The New York Court of Appeals declared
  the law unconstitutional.
 Pressure for adequate workers’
  compensation grew, as unsafe working
  conditions continued to result in injuries,
  diseases and deaths.
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 Shortly after the New York Court of            9
Workers’ Compensation
Legislation
 On March 25, 1911, the building that housed the
  Triangle Shirtwaist Factory on its eighth floor
  caught fire and burned.
 As a result of the fire, 149 of the company’s 600
  workers were dead and another 70 were injured.
 Unsafe conditions created by the management of
  the company prevented those who died or were
  injured from escaping from the fire.
 The tragedy did focus nationwide attention on
  the need for a safe work place and adequate Chapter 5
        CEE 698 – Construction Health and Safety
  workers’ compensation.                            10
Workers’ Compensation
Legislation
 The next several years saw a flurry of legislation in
    other states relating to workers’ compensation.
   In response to demands from workers and the
    general public, several states passed limited or
    noncompulsory workers’ compensation laws.
   Many such states held back out of fear of being
    overturned by the courts.
   Others disagreed with the New York Court of
    Appeals and passed compulsory laws.
   In 1917 the U.S. Supreme Court ruled that workers’
           CEE 698 – Construction Health acceptable.
    compensation laws were and Safety             Chapter 5

                                                              11
Modern Workers’ Compensation
 Since 1948, all states have had workers’
  compensation laws.
 Controversy surrounding the workers’ compensation
  continues:
   – As medical and insurance premiums have skyrocketed,
     many small businesses have found it difficult to pay the
     premiums.
   – Businesses are closing their doors in those states with
     the highest workers’ compensation rates and moving to
     states with lower rates.
   – Critics are now saying that workers’ compensation has
          CEE 698 Construction Health no longer
     gotten out –of hand and isand Safety fulfilling its Chapter 5
     intended purpose.                                             12
      Objectives of Workers’ Comp
1.   To provide an appropriate level of income and
     medical benefits to injured workers, or to provide
     income to the worker’s dependents, regardless of
     fault.
2.   To reduce the amount of personal injury litigation in
     the court system.
3.   To relieve public and private charities of the financial
     strain created by workplace injuries that go
     uncompensated.
4.   To eliminate time-consuming and expensive trials
     and appeals.
5.   To promote employer interest and involvement in
     maintaining a safe work environment through the
                CEE 698 – experience-rating
     application of anConstruction Health and Safety system.
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                                                                     13
Unexpected Factors
        Proponents of workers’ compensation did not
         anticipate the following factors:
    1.     Employees who see workers’ compensation as a
           way to ensure themselves a lifelong income without
           the necessity of working.
    2.     Enormous increases in the costs of medical care
           with corresponding increases in workers’
           compensation insurance premiums.
    3.     The radical differences among workers’
           compensation laws passed by the various states.

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                                                                    14
Modern Workers’ Compensation
 Not all employees abide by the spirit of
  workers’ compensation (e.g., rehabilitation
  in a reasonable amount of time).
 Attempted abuse of the system is perhaps
  inevitable.
 Unfortunately, such attempts result in a
  return to what workers’ compensation was
  enacted to eliminate: time-consuming,
  drawn-out, expensive legal battles and the
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  inevitable –appeals. and Safety
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                                                     15
Modern Workers’ Compensation
 Medical costs have skyrocketed in the U.S.
  since 1960s.
 Increases in medical costs can be explained,
  at least partially, as the normal cost of living
  increases experienced in other sectors of the
  economy.
 The costs associated with medical care have
  increased much faster and much more than
  the costs in these areas.
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                                                               16
Modern Workers’ Compensation
 The unprecedented increases can be attributed
  to two factors:
   1. Technological developments that have resulted in
      extraordinary but costly advances in medical care.
   2. A proliferation of litigation that has driven the cost of
      malpractice insurance steadily up
 The potential for abuse, steadily increasing
  medical costs that lead to higher insurance
  premiums, and differences among workers’
  compensation laws all contribute to
        CEE 698 – that still surrounds
  controversy Construction Health and Safety the issue.  Chapter 5

                                                                     17
Workers’ Compensation
Insurance
 Insurance rates are affected by a number of
  factors:
  –   Number of employees
  –   Risk involved in types of work performed
  –   Accident history of the employer
  –   Potential future loses
  –   Quality of the employer’s safety program
  –   Estimates by actuaries


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                                                                18
Workers’ Compensation
Insurance
        Insurance companies use one of the following
         methods in determining the insurance rates of
         employers
    1.       Schedule rating
         •     Comparison of safety conditions and evaluation against set
               baselines.
         •     Credits are awarded for conditions better than the baseline and
               debits are assessed for conditions worse than the baseline
    2.       Manual rating
         •     A manual of rates is developed that establishes rates for
               various occupations
         •     Each occupation has a different rate based on its perceived
               level of hazard
         •     The overall rate for the employer is a pro-rated combination of
               all the individual rates and Safety
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                                                                               19
Workers’ Compensation
Insurance
 3.       Experience rating
      •     Premium rates are assigned based on predictions of average
            losses for a given type of employer
      •     Rates are then adjusted either up or down according to
            employers actual experience over the past 3 years.
 4.       Retrospective rating
      •     Employees pay an established rate for a set period
      •     At the end of the period, the actual experience is assessed and
            an appropriate monetary adjustment is made at the end of a
            period
 5.       Premium discounting
      •     Large employers receive discounts on their premiums based
            on their size
 6.       Combination rating
      •     Combining two or more methods
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                                                                               20
Resolution of Workers’
Compensation Disputes
 When an injured employee and the employer’s
  insurance company disagree on some aspect of the
  compensation owed (e.g., weekly pay, length of
  benefits, degree of disability), the disagreement
  must be resolved.
 Most states have an arbitration board for this
  purpose.
 Workers’ compensation litigation is very common
  and expensive.
 Neither the insurance company nor the injured
             is Construction to hire an
  employee698 –requiredHealth and Safety attorney. However
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  many employees do.                                             21
Injuries and Workers’ Comp
 Accidents traditionally viewed as sudden and
  unexpected. Now, gradual onset of a disease as
  result of prolonged exposure to harmful
  substances or a harmful environment can also be
  considered as an accident.
 The harmfulness of an environment does not
  have to be limited to its physical components.
  Psychological factors can also be considered.
 The highest rate of growth in workers’
  compensation claims over the past two decades
                                                 Chapter 5
  has been 698 –the areaHealthstress related injuries.
         CEE
             in Construction of and Safety             22
Injuries and Workers’
Compensation
 AOE: Injuries arising out of employment
 COE: Injuries occurred in the course of employment
 Workers’ compensation benefits are owed only when
  the injury arises out of employment or occurs in the
  course of employment.
 When employees are injured undertaking work
  prescribed in their job description, work assigned by a
  supervisor, or work normally expected of employees,
  they fall into AOE category.
 Employee: may be defined as a person who is on a
  company’s payroll, receives benefits, has a supervisor.
 Supervision and direction are Safetyfactors that set
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                                                                23
Disabilities and Workers’ Comp




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                                                            24
Temporary Disability
 When it is probable that an injured worker
  will be able to return to work with no or
  only partial disability
 Temporary disability assumes that the
  employee’s condition will substantially
  improve.
 The ability to return to work relates only to
  work with the company that employed the
  worker at the time of the accident.
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                                                              25
Temporary Disability
 Temporary total disability: Injured worker is
  incapable of any work for a period of time but
  is expected to fully recover.
   – Most workers’ compensation cases fall into this
     classification.
   – Most states prescribe in law the benefits owed to the
     employee. Factors prescribed typically include a set
     percentage of an employee’s wage that must be paid
     and a maximum period during which benefits can be
     collected.


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                                                                26
Temporary Disability
 Temporary partial disability: Injured worker is
  capable of light or part-time duties.
   – Depending on the extent of the injury, temporary
     partial disabilities sometimes go unreported.
   – This practice is allowable in some states. It helps
     employers hold down the cost of their workers’
     compensation premium.
   – This is similar to not reporting a fender-bender to
     your automobile insurance agent.


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                                                                 27
Permanent Partial Disability
 Condition that exists when an injured
  employee is not expected to recover fully.
 In such cases, the employee will be able to
  work again but not at full capacity.
 Often employees who are partially disabled
  must be retrained for another occupation.




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                                                               28
Permanent Partial Disability
 Permanent partial disabilities can be classified as
  schedule or nonschedule disabilities.
   – Schedule disabilities are typically result of nonambiguous injuries,
     such as the loss of a critical but duplicated body part (e.g., arm,
     ear, hand, finger, or toe). Because injuries are relatively
     straightforward, the amount of compensation that they generate,
     and the period of time that it will be paid, can be set forth in a
     standard schedule.
   – Nonschedule injuries are less straightforward and must be dealt
     with on a case-by-case basis. Disabilities in this category tend to be
     the result of head injuries, the effects of which can be difficult to
     determine. The amount of compensation awarded, and the period
     over which it is awarded, must be determined by studying the
     evidence. Awards are typically made based on a determination of
          CEE 698 – disability.
     percentage of Construction Health and Safety                   Chapter 5

                                                                            29
Permanent Partial Disability
 Four approaches to handling permanent
  partial disability cases have evolved.
 Three of these are based on specific theories
  , and the fourth is based on a combination
  of two or more of these theories. The three
  theories are:
  – Whole-person theory
  – Wage-loss theory
  – Loss of wage-earning capacity theory.
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                                                              30
Whole-Person Theory
 Simplest and most straightforward of the
  theories.
 This theory is applied like a subtraction
  problem
 What the worker can do after recuperating
  from the injury is determined and subtracted
  from what he or she could do before the
  accident
 Factors such as age, education, and occupation
  are not considered.

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                                                              31
Wage-Loss Theory
 Determines the amount of wages the employee
  could have earned if the injury did not occur.
 The wages actually being earned are subtracted
  from what could have been earned, and the
  employee is awarded a percentage of
  difference.
 No consideration is given to the extent or
  degree of disability. The only consideration is
  loss of actual wages.


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                                                               32
Loss of Wage-Earning Capacity
Theory
 The most complex of the theories for handling
  partial disability cases.
 It is based on not just what the employee was
  earning at the time of accident, but also on what
  the employee might have earned in the future.
  Making such a determination is a subjective
  undertaking.
 Factors considered include past job performance,
  education, age, gender, and advancement
  potential at the time of the accident, among
  others.
 Once future earning capacity has been
         CEE 698 – the extent and Safety
  determined, Construction Healthto which it has been
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  impaired is estimated, and the employee is          33
Use of Schedules
 The use of schedules has reduced the
  amount of litigation and controversy
  surrounding partial disability cases.
 However, they may be inherently unfair:
  – A surgeon who loses his hand would receive the
    same compensation as a laborer with the same
    injury, if the loss of a hand is scheduled.



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                                                              34
Permanent Total Disability
 When an injured employee’s disability means they cannot compete
    in the job market.
   This does not mean that the employee is helpless. Rather, it means
    an inability to compete reasonably.
   Handling permanent total disability cases is similar to handling
    permanent partial disability cases except that certain injuries
    simplify the process.
   In most states, permanent total disability can be assumed if certain
    specified injuries have been sustained. (e.g., loss of both eyes or
    both arms).
   In some states, compensation is awarded for life. In others, a time
    period is specified.

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                                                                              35
Monetary Benefits of Workers’
Compensation
 The monetary benefits vary markedly from
  state to state.
 The actual amounts are of less importance than
  the differences among them.
 The amounts set forth in schedules change
  frequently.




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                                                              36
Monetary Benefits of Workers’
Compensation
 Death and burial benefits:
   – Benefits accrue to the families and dependents of
     workers who are fatally injured.
   – The remaining spouse receives benefits for life or until
     remarriage. However, in some cases, a time period is
     specified.
   – Dependents typically receive benefits until they reach
     the legal age of maturity unless they have a condition or
     circumstance that makes them unable to support
     themselves even after attaining that age.
   – Further expenses are provided in addition to death
              in Construction except Safety
     benefits698 –all states Health and Oklahoma.
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                                                                   37
Medical Treatment and Rehab
 All workers’ compensation laws provide for
  payment of the medical costs associated with
  injuries.
 Most states provide full coverage, but some limit the
  amount and duration of coverage.
 State laws specify the following options:
   – Employee selects physician of choice (Applicable in Ohio)
   – Employee selects physician from a list provided by the state
     agency
   – Employee selects physician from a list provided by the employer
   – Employer selects the physician
   – Employer selects the physician, but the selection may be changed
     by the state agency
   – Employer selects the physician, but after a specified periodChapter 5
          CEE 698 – Construction Health and Safety               of time,
     the employee may chose another                                        38
Rehabilitation and Workers’
Compensation
 Occasionally an injured worker needs rehabilitation
  before he or she can return to work.
 Goal of rehabilitation is to restore the injured workers’
  capabilities to the level that exited before the accident
 There are two types of rehabilitation:
   – Medical rehabilitation: Consists of providing whatever
     treatment is required to restore, to the extent possible, any
     lost ability to function normally. This may include such
     services as physical therapy or the provision of prosthethic
     devices.
   – Vocational rehabilitation: Involves providing the education
     and training needed to prepare the worker for a new
     occupation.– Construction Health and Safety
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                                                                          39
Medical Management of
Workplace Injuries
 Out-of-control workers’ compensation cases
 led to the concept of medical management
 of workplace injuries.
 The goals of these state-level efforts are:
  – Speed up the processing of workers’ compensation
    claims
  – Reduce costs
  – Reduce fraud and abuse
  – Improve medical management of workplace
    injuries                                      Chapter 5
       CEE 698 – Construction Health and Safety
                                                              40
Medical Management of
Workplace Injuries
 Workers’ compensation and managed care
  have been merged through the creation of
  Health Partnership Programs (HPP).
 HPPs are partnerships between employers
  and their state’s Bureau of Workers’
  Compensation.
 Employers who choose to participate are
  required to have a managed care
  organization that provides medical
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        CEE 698 – Construction Health and Safety
  management of workplace injuries and                   41
HPP Example - Ohio
 According to Clairmonte Cappelle,
   – “When a workplace injury occurs or an illness manifests itself, the
     employee reports it to the employer and seeks initial medical
     treatment. At this early stage, the employer or health care provider
     informs the MCO, which files a first report of injury electronically
     with the state and beings medical management of the case. The
     MCO prefers that an injured worker stay within its healthcare
     provider network for care. However, injured workers may choose
     their own doctors and hospitals from the list of 100,000 BWC-
     certified providers. Except for emergency situations, workers who
     select non-BWC-certified health care providers will not have their
     workers’ compensation medical costs covered by the state. Once a
     claim is filed, MCOs work with employers, injured workers, health
     care providers, third-party administrators and BWC. This includes
     authorizing certain medical procedures, processing providers’ bills
                                                                     Chapter 5
     for payment – Construction Health and Safety return-to-work process.”
           CEE 698 by BWC, and driving the
                                                                             42
Health Partnership Programs
(HPP)
 The HPPs are effective because an MCO coordinates the
  paperwork generated by the injured employee, the employer,
  health care providers, and the BWC.
 The average time required to process an injury report before
  implementation of the HPP was more than 66 days. The HPP
  reduced this to approximately 33 days.
 States that have implemented HPPs have learned the
  following lessons:
   – It is better to mandate HPPs than to make them optional
   – Cost containment is only part of the goal. Managed care programs must
     also include criteria such as lost wages, ability to return to work, and
     administrative costs to the employer.
   – Employees want choice in selecting healthcare providers.
   – SmartCEE 698 – Construction Health and Safety
             return-to-work programs are critical.                         Chapter 5

                                                                                       43
Administration and Case
Management
 If an accident results in a serious injury, several
      agencies must be notified.
  –     As a general rule an injury is serious if it requires more than
        24 hours of active medical treatment.
 The company’s insurer, the state agency, and the
      state’s federal counterpart must be notified at
      minimum
  –     Individual states may require additional agencies be notified
 Once the notice of injury has been filed, there is
  typically a short period before the victim or
  dependents can begin to receive compensation
  unless impatient hospital care is required.
  However, when payments do begin to flow, they
  are typically retroactive to the date of injury.
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        CEE 698 – Construction Health and Safety
 State statutes also provide a maximum time period                          44
Administration and Case
Management
 All such activities – filing injury notices,
  filing claim notices, arriving at settlements,
  and handling disputes – fall under the
  collective heading of administration and
  case management.
 Most states have a designated agency that is
  responsible for administration and case
  management.
 In addition, some states have independent
                                            Chapter 5
        CEE 698 –
                  conducts hearings or hear
  boards thatConstruction Health and Safety      45
Administration and Case
Management
 Once the claim has been filed for workers’
   compensation, three approaches are used to
   settle claims
  1. Direct settlement
    •   Employer or insurance company begins making what it thinks are the
        prescribed payments. The insurer also sets the period over which
        payments will be made.
  2. Agreement settlement
    •   Employee and employer or its insurance company work on
        agreement on how much compensation will be paid and for how long.
        Such an agreement must be reached before compensation payments
        begin.
  3. Public hearing
    •   If an injured worker feels he or she has been inadequately
        compensated or unfairly treated, a hearing can be requested. Such
        cases are known as contested cases.
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                                                                                46
Problems With Workers’
Compensation
 There are serious problems with workers’ compensation in
  the U.S.
   – There is evidence of abuse of the system
   – Many injured workers who are legitimately collecting benefits suffer a
     substantial loss of income.
 Stress claims in 1980 were almost non-existent, but now
  represent a major and costly category
 Of the $27 billion spent on workers’ compensation, only $17
  billion goes to the worker
   – $10 billion alone goes to medical expenses
 “Almost one-half million families each year are faced with
  getting by on a drastically reduced income because of a
  disabling injury suffered by the principal income earner. On-
  the-job accidents are supposed to be covered by workers’
  compensation and all states have compensation systems.
  However, the injured worker rarely receives an income that
          CEE 698 – Construction Health was earning before the Chapter 5
  comes close to what he or sheand Safety
  accident.”                                                             47
Spotting Workers’ Compensation
Fraud or Abuse
 Public outcry against fraudulent claims is
  making states much less tolerant against abuse.
 Ohio legislature passes a statute that allows
  criminal charges to be brought against
  employees, physicians and lawyers who give
  false information in a workers’ compensation
  case.
 The following factors should raise cautionary
  flags:
   – The person filing the claim is never home or available
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     by telephone or has an unlisted phone number                 48
Spotting Workers’ Compensation
Fraud or Abuse
 –   The person filing the claim is active in sports
 –   The person filing the claim has another job
 –   The person filing the claim is in line for early retirement
 –   The rehabilitation report contains evidence that the person filing the claim
     is maintaining an active lifestyle
 –   No organic basis exists for disability. The person filing the claim appears
     to have made a full recovery.
 –   The person filing the claim receives all mail at a post office box and will
     not divulge a home address.
 –   The person filing the claim is known to have skills, such as carpentry,
     plumbing, or electrical skills, that could be used to work on a cash basis
     while feigning a disability.
 –   There are no witnesses to the accident in question.
 –   The person filing the claim has relocated out of state or our of the country.

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                                                                                     49
Spotting Workers’ Compensation
Fraud or Abuse
 – Demands for compensation are excessive
 – The person filing the claim has a history of filing
 – Doctor’s reports are contradictory in nature
 – A soft-tissue injury is claimed to have produced a
   long-term disability.
 – The injury in question occurred during hunting
   season.




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                                                              50
Future of Workers’ Comp
 REFORM is the key!
 California is the leader in the reform movement with
  its Workers’ Compensation Improvement Act
   – Key elements of the act include:
       •   Stabilizing workers’ compensation costs over the long term
       •   Streamlining administration of the system
       •   Reducing the costs associated with the resolution of medical issues
       •   Limiting stress-related claims
       •   Limiting vocational rehabilitation benefits
       •   Increasing benefits paid for temporary and permanent disabilities
       •   Reducing the amount that insurers may charge for overhead
       •   Providing more public input into the setting of rates


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                                                                                    51
Cost Reduction Strategies
 Construction professionals are responsible
  for helping their companies hold down
  workers’ compensation costs.
 The best way to accomplish this goal
  outside of the legislation process is to
  maintain a safe and healthy workplace,
  thereby preventing the injuries that drive
  the costs up.

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                                                              52
General Strategies
1.       Stay in touch with the injured employee
     –     Let injured employees know that they have not been
           forgotten and that they have not been isolated.
2.       Have a return-to-work program and use it
     –     The sooner an injured employee returns to work, even
           with a reduced workload, the lower workers’
           compensation costs will be.
3.       Determine the cause of the accident
     –     The key to preventing future accidents and incidents
           is determining the cause of the accident in question.
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             CEE 698 – Construction Health and Safety
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General Strategies
 Colledge and Johnson recommend using the SPICE
  model for improving the effectiveness of return-to-
  work programs:
  – Simplicity: Medical professionals who treat injured employees
    should work closely with employers to prevent system-induced
    complications. Such complications occur when employees become
    convinced their injuries are more serious than they really are.
  – Proximity, means keeping the injured employee as close to the job
    as possible.
  – Immediacy, means that the faster an employee’s injury claims can
    be handled, the less likely he or she is to develop psychosocial
    issues.
  – Centrality, mans ensuring the employees and their families that
                                                                 achieve
    everyone has the same goal and is working in good faith to Chapter 5
    that goal.698 – Construction Health and Safety
          CEE
                                                                         54
Specific Strategies
1.       Cultivate job satisfaction
     •     Recognize and reward employees
     •     Communicate frequently and openly with employees
           about job-related problems
     •     Give employees as much control over their work as
           possible
     •     Encourage employees to talk freely themselves
     •     Practice conflict management
     •     Provide adequate staffing and expense budgets
     •     Encourage employees to use employee assistance
           programs

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             CEE 698 – Construction Health and Safety
                                                                    55
Specific Strategies
2.       Make safety part of the culture
     •     Ensure the visible, active leadership, involvement, and
           commitment of senior management
     •     Involve employees at all levels in the safety program and
           recognize them for their efforts
     •     Provide comprehensive medical care, part of which is a return-
           to-work program
     •     Ensure effective communication throughout the organization
     •     Coordinate all safety and health processes
     •     Provide orientation and training for all employees
     •     Have written safety practices and procedures and distribute them
           to all employees
     •     Have a comprehensive written safety policy
     •     Keep comprehensive safety records and analyze the data
           contained in those records

                                                                  Chapter 5
             CEE 698 – Construction Health and Safety
                                                                              56
Specific Strategies
3.       Have a systematic cost-reduction program
     •     Insert safety notes and reminders in employee’s paycheck
           envelopes
     •     Call injured employees at home to reassure them that they will
           have a job when they return
     •     Keep supervisors trained on all applicable safety and health
           issues, procedures, and rules
     •     Hold monthly meetings to review safety procedures, strategies,
           and techniques
     •     Reward employees who give suggestions for making the
           workplace safer
     •     Make safety part of every employee’s job description and
           performance appraisal
4. Use integrated managed care
                                                                  Chapter 5
             CEE 698 – Construction Health and Safety
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