Tag Archives: workers’ compensation

COVID-19 Workers’ Comp Claim Presumption Flowchart

15 Jun

Jessica Mulholland  June 9, 2020 6  HR Watchdog – Cal Chamber

Workers Comp

In early May, Governor Gavin Newsom signed an executive order extending workers’ compensation benefits to California employees who contract COVID-19 while working outside of their homes during the state’s stay-at-home order. This workers’ compensation benefits extension is causing some confusion, but a Sacramento-based law firm recently created a flowchart to help employers.

As previously reported, the order prompted many questions about its scope, criteria and implementation — and created a “rebuttable presumption” that workers meeting certain criteria who contract COVID-19 did so during employment (which means the law automatically assumes workers’ compensation covers their claims and shifts the burden to employers, who may then present evidence to rebut the presumption).

The California Department of Industrial Relations answered some questions in its Question and Answer page, but Sacramento-based law firm Mullen & Filippi went a step further, creating a COVID Claim Presumption Flowchart to further simplify how employers can determine whether a presumption applies.

Start at the top of the chart. If you answer yes to the first seven questions — which include whether the worker received a COVID-19 diagnosis or tested positive for the virus, whether the diagnosis was from a medical doctor holding a license from the California Medical Board and whether the diagnosis was confirmed with a positive virus or antibody test within 30 days, to name a few — COVID-19 is presumed as an industrial injury. This means that, unless you can rebut the presumption by providing evidence of an alternate cause, you must provide workers’ compensation benefits. If, however, you answer no to any of the questions, no presumption exists, and the normal evidentiary rules apply.

Assuming the claim is compensable, employers can use page two of the flow chart to help determine apportionment, compensable consequences, death benefits and temporary total disability benefits.

This executive order is retroactive to March 19, 2020, and extends through July 5, 2020.

Jessica Mulholland, Managing Editor, CalChamber

For more COVID-19-related federal, state and local resources, visit the CalChamber Coronavirus (COVID-19) webpage and access additional COVID-19-related HRWatchdog blogs.

Can an employee refuse to return to work?

HR CAlif. 6/11/2020

Yes. Although you can’t force a furloughed employee to return to work, their refusal to return may disqualify them from receiving unemployment benefits.

The California Employment Development Department (EDD) has released general guidance on COVID-19-related unemployment benefits.

For example, if a business has abided by local and state guidelines and is providing adequate employee protections, an employee who refuses to return to work out of a general fear of contracting COVID-19 wouldn’t qualify to receive unemployment benefits.

If, however, the business doesn’t have proper protective measures in place, an employee can use the lack of protective measures as a valid reason for not returning to work and will thus be able to claim unemployment benefits.

An employee who earns more money on unemployment cannot use the higher pay as a valid reason for refusing to return to work; their refusal would disqualify them from receiving unemployment benefits.

If an employee doesn’t have suitable childcare and cannot return work, it would likely be good cause for not returning to work and the employee would likely be able to keep their unemployment benefits.

Read more about Unemployment Insurance in the HR Library and HRCalifornia Extra’s Unemployment Insurance: A Guide for Employers with Newly Displaced Workers.

Q&As

OSHA Issues FAQ on Face Coverings

The new guidance outlines the differences between cloth face coverings, surgical masks and respirators.

JUN 10, 2020

WASHINGTON, DC – The U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) has published a series of frequently asked questions and answers regarding the use of masks in the workplace.

“As our economy reopens for business, millions of Americans will be wearing masks in their workplace for the first time,” said Principal Deputy Assistant Secretary for Occupational Safety and Health Loren Sweatt. “OSHA is ready to help workers and employers understand how to properly use masks so they can stay safe and healthy in the workplace.”

The new guidance outlines the differences between cloth face coverings, surgical masks and respirators. It further reminds employers not to use surgical masks or cloth face coverings when respirators are needed. In addition, the guidance notes the need for social distancing measures, even when workers are wearing cloth face coverings, and recommends following the Centers for Disease Control and Prevention’s guidance on washing face coverings.

These frequently asked questions and answers mark the latest guidance from OSHA addressing protective measures for workplaces during the coronavirus pandemic. Previously, OSHA published numerous guidance documents for workers and employers, available at https://www.osha.gov/SLTC/covid-19/, including five guidance documents aimed at expanding the availability of respirators.

For further information and resources about the coronavirus disease, please visit OSHA’s coronavirus webpage.

 

Warning Signs for Employers Red Flags of Work Comp Fraud

6 Jun

There are several “red flags” that are common in workers’ compensation claim fraud. While none on its own is necessarily cause for alarm, the presence of two or more should raise suspicions and trigger an investigation.
1) Monday morning report of injury. The alleged injury occurs first thing on Monday morning, or the injury occurs late on Friday afternoon but is not reported until Monday.
2) Employment change. The reported accident occurs immediately before or after a strike, job termination, layoff, end of a big project, or the conclusion of seasonal work.
3) Suspicious providers. An employee’s medical providers or legal consultants have a history of handling suspicious claims, or the same doctors and lawyers are used by groups of claimants.
4) No witnesses. There are no witnesses to the accident and the employee’s own description does not logically support the cause of the injury.
5) Conflicting descriptions. The employee’s description of the accident conflicts with the medical history or injury report.
6) History of claims. The claimant has a history of a number of suspicious of litigated claims.
7) Treatment is refused. The claimant refuses a diagnostic procedure to confirm the nature or extent of an injury.
8) Late reporting. The employee delays reporting the claim without a reasonable explanation.
9) Claimant is hard to reach. The allegedly disabled claimant is hard to reach at home.
10) Changes. The claimant has a history of frequently changing physicians, addresses or jobs.
We believe that vigilant employers can nip most fraud in the bud with a tight workers comp management program that focuses on preventing injury, treating employers fairly and compassionately when injuries do occur and closely monitoring the recovery process until return-to-work on full or transitional duty. By actively demonstrating vigilance repeatedly, opportunistic fraudsters may think twice and sophisticated fraudsters may choose an easier target. Here are some best practices:
• Zero tolerance message. Educate employees about their rights and responsibilities under workers comp, and be clear that your intention is to care for anyone who is injured on the job, but that you aggressively prosecute fraud as a crime.
• Publicize your return-to-work program. Establish and reinforce a goal of recovery and return-to-work for any work-related injuries.
• Train supervisors. Your supervisors should understand workers comp and their role in the process. They should understand the employer/employee rights and responsibilities and what to do if an injury occurs. They should be alert for red flags.
• Aim for same-day injury reporting. Train employees to report injuries immediately when they occur.
• Conduct accident analyses. As soon as possible after a work injury or near miss, gather facts and witnesses while things are fresh. This will also set the stage for getting to the root cause and taking any remedial actions to prevent future occurrences.
• Set the tone at point of injury. Escort an injured worker to the treating physician in your network. Remind them of rights / responsibilities and that you will be monitoring their recovery.
• Keep in close touch with out-of-work injured employees. Let the employee know how important they are to the team. Have transitional work available that conforms with any restrictions and establish a return to work date.
• Work with your insurer. Be familiar with “red flags” and report any suspicious activity immediately.

State Fund Announces Work Comp Rate Increase for 4/1/15 – Some employers up to 17.5%

4 Feb

The State Compensation Insurance Fund in California is boosting its workers’ comp rates effective April 1st and it says insured employers will be paying based upon the overall average some 9% more under the modifications. Some employers however will be hit harder than others as State Fund is boosting tier A and B rates by 5%, dropping the 6% group discounts and increasing territorial surcharges in southern California 6.5% for Los Angeles and 4.8 for the rest of the area.
That means that effectively, a tier A or B account which is currently in a group and located in Los Angeles could see an increase of 17.5%. Accounts in Los Angeles not in a group will see increases of 11.5%.
State Fund, California’s market of last resort, is also increasing its requirements for schedule credits and debits to $25,000 and increasing minimum premiums by 25%.
All this is at a time when many employers are being hit hard by dramatic increases in their experience modifications, due to changes in the rating process in California.

Thanks to the Workers’ Compensation Executive for the news flash. http://www.wcexec.com

Why should an employer take care of a worker injured on the job? Because doing so saves money, and the data proves it!

15 Mar

Hard cold numbers prove the value of taking care of an employee injured on the job.  For California, if a work injury can be treated by workers’ compensation medical care only, the average cost of a claim is $1,156. (Data is based on the latest report for complete year statistics of the Workers’ Compensation Insurance Rating Bureau.)

However, if the employee can’t return to work the next day, and receives “temporary disability” payments, the average cost per claim jumps to $15,041. This increase in costs clearly shows the value of an aggressive return to work program, and a “day of injury” protocol in taking care of the physical and emotional needs of an injured employee.

If an injured employee experiences any, even minor, permanent disability, the average cost per claim triples to $41,313.  Major permanent disability claims average $140,021 per claim and permanent total disability claim costs soar to an average of $109,922,270 per claim – yes that is $109 million per claim on average.  Death claims only average a cost of $43 million each.  

Contact Don Dressler Consulting and CalWorkSafety for help in keeping injured workers on the job.  Our Nurse Consultant is doing great work in this area and our experience consulting staff can help with safety programs to prevent the injuries in the first place.

Visit our websites at www.DonDressler.com and www.CalWorkSafety.com

Even One Injury Can Raise Your Ex Mod

14 Apr

It is becoming increasingly clear in 2013 that recent changes in the California workers’ compensation experience modification process are severely hurting small employers, who have even 1 work injury reported. A single claim can push an employer’s experience mod up by 15 to 25 %, or more. Now that the first $7,000 of each claim are used in the “primary” loss portion of the experience modification, up from just $2,000 in past years, a single work injury can increase future workers’ compensation premiums by 3 to 4 times the dollar cost of the claim, according to UC Berkeley researcher Frank Neuhasuer and others.
And experience mods being reported in 2013 are showing this impact. The increases are so high that the Workers’ Compensation Insurance Rating Bureau has met recently to consider limiting the impact of one claim. The problem, however, is that many times, what appears to be multiple claims really is just an attorney for an injured worker taking advantage of filing two different claims, one for a “specific’ injury such as an injured shoulder, and a second claim for “cumulative trauma” over the work life of the employee. In truth, these are not two claims, but the lawyer’s effort to magnify injuries to obtain more money for himself and the worker.
Employers, in self-defense, need to consider “post offer pre employment physical exams”, immediate and through accident investigations, and full cooperation with their workers’ compensation claims personnel.

How to Save Money from the 2013 California Workers’ Compensation Reform

2 Apr

The California Legislature passed SB 863 in September of last year, with most of the provisions taking effect January 2013. “Permanent Disability” benefits were increased by 40% at a cost to employers of over $1.2 billion in new or added costs per year. There were a number of other changes, some good for employers, others very technical. One of the most effective tools employers were given to save money to offset the cost increases of the law are “return to work” programs. This means it pays for every injured worker, who is not in the hospital, to be back on the job doing something within the limits of their ability, the day after their injury. It might be better to call this a “stay at work” rather than a “return to work” policy.
California employers can save over $400 million a year in workers’ compensation cost by using this “stay at work” approach. But the savings are even larger in future premiums! When an injured worker is off duty due to a work injury, and he qualifies for “temporary disability benefits” under a workers’ compensation policy, he receives only 2/3rd of his pre-injury wage. BUT, this same temporary disability benefit costs almost all employers 2 times or more the lost wages – because these claim costs are used to set their “experience modification, not for one, but for 3 years in a row!. SO- the employee loses money by being off work and his employer pays more than twice as much as if the worker were to come back – even if the worker was just putting in time.
But of course a good return to work program is much more effective than just wasting an employee’s time. Every company I know has some work that they just have not gotten around to, but need to do “someday”. Such activities are always a place to look for “modified work” within the physical limits of a recovering employee.
If you would like to learn more about the return on investment or economic value of “stay at work” or “return to work” programs, just email me at DonDressler1@hotmail.com

The Most Important 2 days in Controlling Workers’ Compensation Costs

16 Mar

When an employee reports an injury, often that he or she is experiencing pain from lifting or a slip or fall, many employers direct the employee to a medical provider, file a report with their workers’ compensation insurer, and hope for the best. But they have wasted the 2 most important days they ever will have in controlling workers’ compensation costs.
Day 1- when the worker reports an injury- which may or may not even be an injury. Unless there is a medical emergency, bleeding, apparent broken bones, burns, etc. Take 15 seconds to do an assessment, just as any first responder would.-ABCD
A- Airways – is the person breathing
B- Bleeding –
C- Conscious-
D- Other apparent Disability
Treat the medical emergency with appropriate first aid with trained personnel, call for medical first response. After the emergency is handled, direct the employee to the appropriate medical care, if work related, provide workers’ compensation claims forms and notify your workers’ compensation claims office. All this SHOULD happen on Day 1. Case after case has shown that costs increase for every day of delay in any of these steps.

Day 2- and just a critical. If the employee involved returns to work, welcome them back, be supportive and ask how you can assist them. IF THEY DO NOT RETURN TO WORK their next assigned, day, they employer or someone on their behalf needs to immediately contact the worker, verify how they are doing, express support, answer questions, and urge them to return as soon as possible. Identify any work restrictions needed to accommodate their return to work.

The average cost of an injury of where the worker returns to work the next day is $700, and when the worker does not return is $13,000.

For help in managing your work injuries, contact Don Dressler Consulting at DonDressler1@hotmail.com

New Resource for California Employers – WCIRB.com Website Launched

23 Feb

The Workers’ Compensation Insurance Rating Bureau has launched a completely redesigned website to provide more in-depth information relevant to employers, insurers and agents, and anyone interested in learning more about the WCIRB and California’s workers’ compensation system. The website has a new online address: http://www.wcirb.com

What’s Available- Visitors to the website will find information and resources specifically tailored to their needs.

• Publications and Filings
Locate and access California manuals and plans, WCIRB Bulletins, regulatory filings and more.
• Research and Analysis
Search for and find current data, reports and analyses about the workers’ compensation system.
• Learning Center
Access online educational tools on a variety of topics including the standard classification system, payroll auditing, experience rating and more.
• About
Learn about the WCIRB Click: http://vimeo.com/60274101 for a video tour.

If you would like to learn about your own company’s experience modification or how to control it, please contact Don Dressler Consulting by our email: DonDressler1@hotmail.com or view our website at http://www.DonDressler.com

When A Work Related Injury Occurs

25 Oct

REPORT ALL INJURIES – TO YOUR WORKERS’ COMPENSATION INSURER. IF THE INJURY IS LIFE THREATENING – CALL 911
Once the injured worker is stabilized and sent to an MPN (Medical Provider Network) doctor, immediately call your Insurance Company to report the injury.
THE FIRST 24 HOURS ARE IMPORTANT
There are two key steps that must be followed once the injury is reported and treatment initiated.
1. EMPLOYEE CLAIM FORM (DWC-1)
You must provide the injured worker with the Employee Claim Form (DWC-1) within 24 hours of being notified of the injury. You must also provide the Medical Provider Network Notice (MPN Notice For Employees) within 24 hours of claim notification to the injured worker. MPN Notice For Employees
2. LOG OF WORK-RELATED INJURIES AND ILLNESSES
Employers with 11 or more employees, except those industries classified as retail, service, finance and real estate are required to track records of work related injuries using the Cal/Osha Form 300.
RETURN TO WORK
Almost all injured workers can return to work the next day after an injury and do some type of activity. The difference to you as an employer is claims costs is tremendous. The average cost of a workers’ compensation claim, IF the worker comes back the next day is about $700. IF THE WORKER DOES NOT RETURN THE NEXT DAY COSTS AN AVERAGE OF $11,000!

How To Cope With a Rising Cost Workers’ Compensation Inurance Market?

8 Oct

1. It all starts with an effective safety plan. A plan is required by Cal/OSHA, helps prevent injuries and serves as guide for the whole process.
2. Get injured workers back on the job the very next day after an injury. The latest WCIRB tells us the average total cost of a lost time injury now is $70,179. You can get almost every injured person back to work doing something productive. Can you afford the impact on your experience modification and your claims history of doing nothing?
3. Conduct a thorough accident investigation.. In the past week alone, in two investigations, I learned that one injury did not occur on the job, and the second injury was a re-injury from 5 years ago (when this employee did not work for us – and any permanent disability needs to be properly apportioned to the prior employer and old claim.)
4. Now we have better rules to work with, use the Medical Provider Network to gain “life of claim” medical control. One part of the reform limits the ability of chiropractors to be “treating physicians” and giving medical opinions after their limited course of treatment is over.
5. There will be more tools for you from this reform. Stay tuned!
Helping you save money on workers’ compensation claims and keep or obtain a low experience modification is what I do for you. Just as important is compliance with OSHA recordkeeping, reporting and safety standards. Call me for a FREE, no obligation conference.
Don Dressler: Ph.: 949-533-2742; E-mail: DonDressler1@hotmail.com; Websites: http://www.DonDressler.com and http://www.CalWorkSafety.com