When deciding on acquiring a contractor for a job, it is almost never a smooth, easy process. A contractor or specialized worker is sometimes necessary last minute. For that reason, it’s helpful to develop a plan for screening contractors and determining which one is best.
There are a few key steps to take in order to achieve the best results when acquiring a contractor.
The first, most important step, is to develop an approval process that either accepts or denies potential contractors. Only allow exceptions in very limited situations while documenting all thought processes on why the contractor should be used. Be sure to do this when it comes to making exceptions for contractors that aren’t initially accepted. Finally, it is important to gather data on what went right and wrong to further refine the approval process.
When struggling to find a contractor to fill a certain position, it is important to evaluate all choices and to have a system that selects the best available contractor.
An owner wouldn’t want an employee not doing their best work, so it doesn’t make sense to hire a contractor that isn’t best suited for the situation. Using a proper system will ease the task of finding a contractor, increase performance on the job, and boost the reputation of a company. Being diligent in the approval process is key.
Better contractor fits save a company time and money, whereas poor fits hurt the profit of a company. Poor fits can also potentially damage a company’s reputation. Successfully operating an approval plan also is a self-fulfilling prophecy. As more and more contractors are sorted, data is collected which further refines the plan, making it more effective. It’s a challenging process to come up with a solid approval plan but will be worthwhile in the long run.
For more information contact one of our Risk Advisors or call 914-357-8444
There are 3 questions every organization should put to each level within their organization to get a sense for how aligned they are as it relates to managing employee injuries, near misses and workers comp claims in general. Doing so will open up plenty of different conversation with your employees regarding their answers. Hence, why these questions must be asked. The more you understand may be a hard pill to swallow, but it usually allows for progress within the company and potentially will help lower claims and in turn, lower premiums.
When it comes to insurance claims and workers comp injuries, Mark Twain’s famous quote jumps to the fore:
” It’s not what we don’t know that hurts us…it’s what we think we absolutely know that kills us.”
Executives, HR reps, and senior management are almost always shocked when they poll the employees of their company and ask these 3 crucial questions. Though fairly straightforward, the answers they receive usually are not. The video will go through the questions, what you might expect, what the answer usually is, and how you deal with this new batch of information.
This brief video should give you some pause. We suggest you poll your own employees as soon as possible. You might be shocked at what you discover from their answers.
Do you have questions about any of the content in the video? Contact one of our professional risk advisors at 914-357-8444. Or, visit our website for more information here. We are always here to help.
You’re probably looking online for an answer on “How to Spot Workers Compensation Claims”. Well, it’s probably the most often repeated refrain when we speak to folks whose companies are suffering under the high cost of employee injuries. They feel victimized by the system, mistreated by morally challenged employees, wronged by the insurance carriers who re-enforce the false perception that there is nothing they can do. Here’s the good news that perception is not only false but can be a huge competitive advantage for you.
It’s a competitive advantage because while your competition is playing the woe is me fiddle finger ; you put forth processes and protocols that won’t eliminate fraud, but will make you much less of a target in the future sending a strong message to the rest of your employees that you take employee injuries very seriously as long as they are legit. If they are not established, it may be considered fraud by the insurance carrier, which is a felony.
The tenor of this article is not to teach you how to build systems that lower the probability of fraud, that will come later another publication or posting. We want to help you identify the red flags that may show you might be getting deceived.
Here are six red flags of a possible and potentially fraudulent workers compensation claim.
Most workers compensation claims are reported Monday morning. The reason is that the injury potentially took place over the weekend. Maybe in a softball game, maybe doing yard work. Quite often these employee lack health insurance which is why they might use the workers comp system to obtain medical treatment. If your employee reports an injury first thing Monday morning, look for some of these other signs.
The injured individual refuses diagnostic procedures like an X-ray or MRI. This might be because they really don’t want the answer. If they are truly hurt, they would want the test done to receive the correct diagnosis and treatment to get back to being functional. Let the employee know there is no cost for the test so you take money out of the equation. If they still refuse recommended diagnostic tests in poker we call that a “tell”.
You can’t grasp a clear idea of what actually happened from those involved. Lack of clarity, conflicting stories should give you pause. Separate the injured employee from the witnesses and perhaps call in a professional to execute the accident investigation.
You’ve heard gossip about the employee’s injury. Careful with this as there could be different motivations in play. All this does is confirm that you need to take a deeper dive into the claim.
There are no witnesses to the injury event.
The claim is reported more than seven days after the injury occurred. This in of itself is not a red flag as most companies don’t have a solid on-boarding process whereby the employee knows when to report an incident or injury.
One of these flags is not a conclusive way to determine a workers compensation claim is false. But if there are three or more, it’s an indication to take a closer look through a really good accident investigation process. At Metropolitan Risk we have several tools available to our clients like our Digital Surveillance Pak which is a robust tool that tracks the employee on both the internet and the streets from our partners desktop.
Before re-affirming and acting upon your suspicions on a false workers compensation claim, consider these statistics and factors.
According to the Safety and Health magazine, newer employees are more susceptible to injury due to lack of their experience. Take into account the employee’s age and sufficiency in job training when judging the validity of the workers comp claim.
Experts in the industry estimate that only 1-2% of workers compensation claims are false. When you use this as a reference you only have a maximum 2% justification on your assumptions.
It takes a lot of effort and finances to train a new employee on safety and compliance.
When an employee submits a false workers compensation claim, there are crucial steps to take to protect your business. Upon uncovering a false claim, the employer must report their findings to their claims adjuster.
The issue is: employees stay out too long on workers compensation which could be considered border line fraud.We think there is a bigger opportunity there.
If you’ve noticed multiple red flags and continuously doubted the validity of the claims, give us a call at 914.357.8444. or request a free consultation with one of our RISK ADVISORS.
Finding a witness to a worksite accident resulting in injury or property harm is of the utmost importance to contractors. A worksite accident witness is an integral component for the defense. They can discern the chain of events such as where the worker was and what they were doing or what they were working on the moment prior to the accident.
Work-site injury procedures and steps to finding a witness: take police, fire, and EMS statements and records AND:
Talk to the staff and acquire names and contact info of potential witnesses who could have been at the scene.
Ask for a complete list of all the workers on the project.
Observe the scene at the same time the incident happened. In addition, observe mailmen or delivery men who may be a witness to the case. Look at the scene at the same time the incident happened.
Find people who can give detailed information about the project, interaction between workers, and behavior of the general contractor to piece the clues together to present to a judge and jury.
A worksite incident form should have a section dedicated to identifying the witness and relaying their account of the accident. Next, statements from a witness should be taken as soon after the incident as possible. The sooner you can locate a worksite accident witness, the better for all parties involved. The clearer their memory, the more details they will be able to share regarding the incident.
Still want more info? If you would like to take a deeper dive into this issue or perhaps require assistance developing a worksite incident/day of loss reporting protocol including witness statements, contact a Risk Advisor today by Clicking Here.
Terms You Should Know When Building A Workers Compensation Cost Containment Program
There is a wide variety of workers compensation insurance terms anyone should be familiar with. Here are a few basic workers compensation claims terms to help you manage your workers compensation cost containment program.
Average Daily Wage (ADW) Average daily earnings of an employee before an injury. Use to calculate benefits payments in situations where AWW would not provide an accurate reflection of actual wages.
Average Weekly Wage (AWW) Average weekly earnings of an employee before an injury, which is used as a basis for determining weekly benefits payments.
Date of Injury (DOI) Date when injury or illness occurred or, in the case of repetitive exposure injuries or illness, when it first became apparent that symptoms were work related.
Independent Medical Examination (IME) Requested by an employer or insurer to serve as an objective evaluation of an injured employee’s condition. Use IMEs in situations where the findings of an employee’s self-selected doctor needs verification.
Maximum Medical Improvement (MMI) Point in an injured employee’s treatment when recovery has reached a plateau with no reasonable expectation of continued improvement.
Permanent Partial Disability (PPD) Benefits paid to an employee who has suffered compensable work-related injury or illness to one or more parts of the body. Most states have a preset payment schedule (Schedule of Injuries) based on specific body parts or conditions.
Permanent Total Disability (PTD) Benefits paid to employees who face lifelong total disability from compensable work-related injury or illness.
Social Security Disability Benefits (SSDI) Benefits paid to disabled individuals through the Social Security Administration, separate from workers’ compensation. Most state workers’ compensation statutes regulate whether an individual can receive both benefits at the same time. If both benefits are awarded, there are limits in place to ensure that an individual cannot receive more money than they are entitled to from either program independently.
Statewide Average Weekly Wage (SAWW) Average wages paid to workers in a set jurisdiction for a period of time, used to set the maximum and minimum for workers’ compensation benefits paid out to injured workers.
Temporary Partial Disability (TPD) Benefits paid to an injured worker who is temporarily unable to fulfill the full requirements of their job but is able to perform at a reduced level. Benefits paid in such instances are based on possible pay differences between the regular and temporary position.
Temporary Total Disability (TTD) Benefits paid to employees who are totally unable to work for a period of time but will make a full recovery. Though TTD payments stop when the employee is cleared to return to work, they may be eligible for TPD benefits if they still face some work restrictions.
The feed back we get most is ; yes this is helpful but we just don’t have the time to follow up on all our workers compensation claims. We hear ya! Our Comp Care program will do that for you as well as more. CLICK HERE if you want to know how.
A false workers compensation claim is more common than you might think. The sooner you call the sooner we can help you work through it.
The workers’ compensation insurance system is a no-fault method, paying workers for medical expenses and wage losses from on-the-job injuries. Billions of dollars of false claims submitted each year, says The National Insurance Crime Bureau. In New York, insurance fraud looked at as a felony that most perpetrators aren’t aware of when deciding to game the system. Further, it’s the number issue most business owners raise with us when we are invited into their organization to check why their workers compensation insurance costs are so high. When business owners invite us into their organization to evaluate why their workers compensation insurance costs are so high, its typically the number issue.
Most employers face not only being vulnerable to workers compensation fraud but actually contributing to it as they don’t have the correct policies and procedures in place to help prevent fraud from starting in the first place. To help detect a possible false workers compensation claim, experience shows a claim may be fraudulent if two or more of the following factors are present:
Telltale Signs of a False Workers Compensation Claim:
Monday Morning: The alleged injury occurs either “first thing Monday morning,” or late on a Friday afternoon but not reported until Monday.
Employment Change: The reported accident occurs immediately before or after a strike, a layoff, the end of a big project or at the conclusion of seasonal work.
Workers Comp Fraud
Job Termination: If an employee files a post-termination claim:
Was this injury reported by the employee before being unemployed?
Did the employee exhaust his/her unemployment benefits prior to claiming workers’ compensation benefits?
History of Changes: The claimant has a history of frequently changing physicians, addresses and places of employment.
Medical History: The employee has a pre-existing medical condition that is similar to the alleged work injury.
No Witnesses: The accident has no witnesses, and the employee’s own description does not logically support the cause of injury.
Conflicting Descriptions: The employee’s description of the accident conflicts with the medical history or First Report of Injury.
History of Claims: The claimant has a history of numerous suspicious or litigated claims.
Treatment is Refused: The claimant refuses a diagnostic procedure to confirm the nature or extent of an injury.
Late Reporting: The employee delays reporting the claim without a reasonable explanation.
Hard to Reach: You have difficulty contacting a claimant at home, when he/she is allegedly disabled.
Moonlighting: Does the employee have another paying job or do volunteer work?
Unusual Coincidence: There is an unusual coincidence between the employee’s alleged date of injury and his/her need for personal time off.
Financial Problems: The employee has tried to borrow money from co-workers or the company, or requested pay advances.
Hobbies: The employee has a hobby that could cause an injury similar to the alleged work injury.
Suspicious about a claim possibly being an example of workers’ compensation fraud? Don’t hesitate to call us at (914) 357-8444 or CLICK HERE and run your challenge through one of our Risk Advisors. Our staff will perform digital surveillance on your case without having to spend big money on a potential stakeout.
Employers can provide their employees a return to work evaluation form to give to their physician when the employee suffers a work-related injury. The form can facilitate communication between the treating physician and employer as to the employee’s status and capabilities. Many employers miss this step.
We encourage employers to send the physician the employee’s current job description AND a job description for a alternative duty position for which the injured employee might be eligible.
What is the importance of a return to work evaluation form?
It’s difficult to action plan the claim and get the employee back to work when there is no clear understanding of the employee’s injury AND job duties. This form along with the job description helps establish the base line so all stakeholders can work in concert. This will get the employee back in some productive capacity.
Why should an employer provide this evaluation form?
If an employee is injured, they may not be able to perform their original duties. This return to work evaluation form helps the employer create accommodations enabling the employee to come back to work at the best of their ability.
A frequent (and very costly) mistake employers make is bringing the worker back too fast without having them medically cleared to perform their duties. We recently had an employer tell us their worker was injured playing softball for his recreational team on his own time. The employer never noted the incident formally in their employment records creating an incident. Further they never had the employee medically evaluated to see how severe the injury may have been. Nor did they have the employee medically cleared to come back in the same capacity. Instead he took a day off, came back to work too early. Sadly, he threw his back out on the job further, exacerbating the injury. Had the employer properly recorded the incident and had the employee fill out an injury form this would not have become a comp claim.
The original injury was non-compensable as it did not occur at work. It became compensable when he returned to work too early and made the injury worse. Following proper procedures and utilizing a return to work evaluation form would have gone a long way in preventing this type of situation from occurring.
What’s the impact on your workers compensation premiums by using a return to work evaluation form?
It creates a formal process around employee injuries that accomplishes several cost savings benefits:
Prevents employees from coming back to work too soon. This saves you from driving up injury rates and costs as the injuries usually become worse.
Facilitates very productive communication between treating physician, injured employee and your company’s HR staff person.
The goal after every employee injury is to get them back to work in SOME capacity as quickly as possible. This cuts down on the ultimate cost of the claim. Too often we see employers simply file the workers comp claim with their carrier then walk away and go back to their regular scheduled programming. Then their experience modification factor gets re-calculated which may result in significant workers compensation premium surcharges.
Can employees abuse the return to work evaluation form?
Employees can abuse this only if the employer allows it to happen.
If the employer:
Meets with injured employee every 10 days to check in on their healing progress
Makes it clear that the accommodations aren’t temporary
Allows open communication to provide the best accommodations and transition phase possible
Follows up with the physician
There should be no possible chance that the employee would abuse the return to work evaluation form. Truthfully, we see far more abuse when employers have no form and no process for getting the worker back on duty.
Want an example of a solid Return To Work Evaluation Form ? Click here
“Do I really need to write job descriptions?” We are asked this question constantly when we are setting up a workers compensation cost containment program. We say absolutely if you want to distinguish yourself AND save big bucks when you purchase workers compensation insurance! Job descriptions are by no means required by the Dept of Labor, but they are enormously important to smooth and successful recruiting, hiring, and workers compensation claims processes. They assist applicants in better understanding the position beyond the typical bullet points of a job posting.
Hiring & Recruiting:From the initial job post on various posting sites like www.INDEED.com, to the interview and hiring stage it’s so important to be specific and communicate to your potential new hire/employee exactly what is expected of them. Typically a business is not hiring a one off for this position as they will most certainly hire more employees for this role in the future. Rather than re-invent the wheel, spend some time and really drill into the job description. It not only helps your potential hires select right fit for them, it will also help you think though what you want in your future employee.
Employee Injuries: We did an article about the most underutilized tool to gain a competitive advantage, this post might seem familiar. It was all about setting up a Return to Work Program also know as Transitional Duty. This is an extremely effective tool in controlling workers compensation costs. One of the more important components of the Return to Work program is having a proper job description whereby your staff, the insurance carrier adjusters and the treating physicians can get a full understanding of what is entailed for your injured employee to execute their job function. In absence of a thorough job description often times the treating physician will not authorize medical clearance for the employee to return to work which drives your workers comp costs up significantly. Further your staff and the carriers adjusters if they are fuzzy on job execution they will often arrive at the wrong answer.
It’s helpful if you have job descriptions already built for your potential alternative duty position too so the treating physician might consider this alternative duty job in lieu of their present job. If you want to know more about building out your own Return To Work Program CLICK HERE
Defining exempt vs. non-exempt: Job descriptions are key to determining if a position qualifies as exempt (a.k.a. salaried without overtime) under the law. Actual duties, not titles, drive this determination. A job description that accurately reflects the realities of the day-to-day functions of a role can help you defend against any claims that an employee is being improperly denied overtime.
Identifying “essential functions”: The Americans with Disabilities Act (ADA), as well as many state anti-discrimination laws, requires employers to provide reasonable accommodation to employees with covered disabilities, provided the employee can perform the essential functions of the job. A well-written job description is key for identifying those functions that are essential versus those that are marginal, incidental, etc.
Protecting against discrimination claims: Using job descriptions to compare an applicant’s experience, skills and credentials to the minimum qualifications of the job can aid in protecting an organization against claims that it excluded someone based on race, age or other protected class. Skills and requirements should be identified as minimally required or preferred so it’s clear who meets the bona fide job criteria and who doesn’t.
Need more information on job descriptions? We have a job description tool builder as part of our THINK HR platform which is free to customers of Metropolitan Risk. We would love to answer any questions you have and assist you in developing them for your organization. Contact Metropolitan Risk today at (914) 357-8444 or click here!
Remember when your kids annoyed you by responding to everything you said with “Why?” Well, there was a genius to that tactic only children can impart. The 5-Why Analysis is a method used to determine and understand the root cause of a problem by repeating the question “why?” five times. Each answer forms the basis of the next question.
There are no hard and fast rules about what questions to explore, or how long to continue the search for additional root causes (e.g. asking “why?” seven or eight times instead). Therefore, the outcome of the analysis will always depend upon the knowledge and persistence of the people involved.
Here is a relatively simple example of Why Analysis:
Problem: The car will not start!
Why? – The battery is dead. (First why)
Why? – The alternator is not functioning. (Second why)
Why? – The alternator belt has broken. (Third why)
Why? – The alternator belt was well beyond its useful service life and not replaced. (Fourth why)
Why? – The vehicle was not maintained according to the recommended service schedule. (Fifth why, a root cause)
Just as annoying children so often do, it would be easy to continue asking “why?” in order to delve even deeper into the problem. However, five repetitions will generally suffice in leading to a root cause.
About Why Analysis
It is important to note that the determined root cause should almost always point toward a process that is not working well or does not exist, rather than something simple and generally uncontrollable such as “There wasn’t enough time.” Answers that are out of our control are not helpful; further in most cases what you will discover in your 5 Why Root Cause Analysis is a failure of process, which is the ultimate goal. You can’t manage and improve what you don’t know.
The developer of the 5-Why Analysis method Sakichi Toyoda was head of the Toyota Motor Corp who used this method to great effect. Toyoda has some helpful tips and strategies to think about when performing “ Why Analysis”:
Use paper or whiteboard instead of computers
Writing the issue helps you formalize the problem and describe it completely. It also helps a team focus on the same problem
Look for the cause step by step. Don’t jump to conclusions.
Base our statements on facts and knowledge; not conjecture.
A root cause should never be something as simple as “human error” or “workers’ inattention”
The Why Analysis can be used in day to day business life, and is especially helpful when dealing with persistent problems that never seem to go away. Stubborn and recurrent problems are often so because they contain deeper issues, and “quick fixes” only solve the surface issues.
Need help dissecting and solving a recurring problem safety or employee injury problem? Don’t hesitate to call us at (914) 357-8444. We have been invited into thousands of businesses to break down their challenges and help solve for “x” , usually high insurance costs driven by claims. We will help you get to the why that much quicker. Time is money, gives us a call.
