Detecting patterns

Patterns of reoccuring claims can be seen with certain employees or in particularly hazardous industries. For example, says Becki Shafer, president of Amaxx Risk Solutions, Inc. and a workers' compensation expert, if forklift operators or other drivers are not given eye screening, they may have more injuries.

Of course, there are patterns of fraudulent claims made by individuals who have "accidents" repeatedly, Shafer says.

Also, employees who are overweight tend to have more injuries, and people with diabetes tend to take longer to heal from injuries than other people—"co-morbid" conditions which complicate healing and recovery.  

Pennachio says that most of the strain and sprain injuries are a result of overexertion. "Employees ask their body to do more than their bodies can do. This is a challenging area to address," because it's more about human behavior, he says. Almost all injuries are a result of unsafe acts, not unsafe conditions, and even if all workplace hazards are eliminated, injuries will still happen.

Preventing false or exaggerated claims?

Pennachio says that false (did not occur, or occurred outside of the workplace) claims actually represent a small percentage of injuries, but that a much larger number of injuries are "exaggerated" or the recovery process is delayed. Pennachio says employers should address exaggerated claims by:

• Ensuring the injured employee is getting the right medical treatment;
• Returning the injured employee to work as soon as possible, even if their duties need to be modified during their recovery;
• Supervisors staying close and communicating their concern and support for the employee;
• Reducing the disruption to the employee's life as much as possible during recovery;
• Addressing behavioral issues that may be driving disability.

Shafer says employers can reduce false claims by using a number of techniques: video-surveillance in retail stores and parking lots, implementing pre-employment and post-accident drug screening, and anonymous tip lines where other employees and relatives (such as ex-spouses) can report exaggerated or fraudulent claims.

Reducing claims

The first step in reducing claims begins with the hiring process. It's important to hire employees who are mentally and physically fit for the job, Shafer says. Having accurate job descriptions which list the physical demands of the job are crucial. Shafer also suggests the following:

• Having tight post-injury response procedures in place where all injuries are reported to triage nurses immediately after an injury;
• Implementing top-notch workplace safety programs;
• Having injured employees go to select medical providers who specialize in occupational injuries;
• Implementing effective communication programs to enable employees insurance adjusters and employers to speak with each other often and easily, and be on the same page with regard to treatment;

Pennachio is of the same mind and stresses the importance of prompt reporting and routing the employee to the best medical provider. Employers should also stay in touch with the employee and the doctor, and accommodate their physical restrictions so they can recover while still at work. Employers need to communicate concern and empathy during the recovery process too, he says.

Leadership and injury prevention go hand-in-hand. Pennachio says that "corporate culture must embrace injury prevention from the leadership level." Because employees who think management does not care about them will have more injuries, he says.

Mitigating the cost impact

After a claim has been made, what can employers do to minimize the cost impact?

One way is through "transitional duty programs." Shafer says that currently only 60 percent of employers require having transitional duty programs, which allow an injured worker to remain working in some capacity while they get better. "This leaves 40 percent [of employers] that have an opportunity to reduce their exposure simply by implementing transitional duty programs," she said.

There are also treatment "guidelines" employers can reference that indicate how long it should take a person to recover from a certain injury and how it should be treated. Also, companies who partner with physical therapy networks can have more control over their claims and their employees will recover and return to full employment up to 30 percent faster than companies which do not have affiliations with such networks.

Another option is implementing a workplace clinic. Ken Knuth, vice president of Administration at Encore Wire, a wire manufacturing company, said says the most common injuries he sees are strains and sprains. Since implementing an on-site clinic sponsored by Medcor, the company has saved about $1 million a year in workers compensation claims. "It has been a great addition to our facility," he says.

The on-site clinic is not just for injuries, though. Employees can be seen for day-to-day health issues, and their families can be seen there too.

The wellness tie-in

Leslie Morse, director of claims management for Alper Services LLC in Chicago, says that employers have traditionally been skittish about implementing wellness programs, because they are worried about injuries occurring from participation. But, she says, there is clearly a benefit. "Employees are quicker to heal, and quicker to go back to work," when they take part in wellness programs.

To be successful with wellness programs, employers should create a wellness committee, and it should be embraced from the top down, starting with the CEO, says Cindi Elstien, director of human resources for Alper. "With a committee, everyone can give their buy-in, and act as sort of an advocate," says Elstien.