“Who are all these people, and why do they all want to talk about my workers’ compensation claim?”

After filing a workers’ compensation claim, a injured employees typically aren’t surprised to hear from a claims representative at the insurance company.

What they might not expect is hearing from others too, such as medical, rehabilitation or legal professionals.

Depending on the particulars of the claim, an employee may interact with any number of the following:

• telephonic medical case managers
• vocational rehabilitation consultants
• disability case managers
• field nurse case managers
• attorneys

For someone unfamiliar with the workers’ compensation system, this can seem like an overwhelming amount of attention.

It’s important to know that everyone involved adds a significant and unique value to the process. Whatever differences exist between their job titles and training, each of them has the same goal: to make the process of returning to a normal life as quick and easy as possible.

What happens after a workers’ comp claim is filed

After a claim is filed, the employee’s first point of contact will be SFM’s claims representative, and in some cases it’s the only direct contact the employee will have with SFM.

The claims representative begins the process by learning as much as possible about the claim. This involves not only learning the details about how the injury occurred, but gaining a complete understanding of the employee’s health before and after the incident.

In addition to gathering information from the employee, the claims representative establishes a role as the employee’s primary resource for information about the claim.

Regardless of who else gets involved, this relationship continues throughout the handling of the claim. SFM’s claims representatives are always available to assist the employee, which often involves introducing other professionals into the process to provide additional expertise.

Introducing the medical case manager

When an injured worker requires medical attention, SFM frequently assigns a member of its telephonic medical case manager team to a claim to make sure that the employee has consistent access to optimal medical care throughout the recovery process.

SFM’s in-house medical case management staff consists of highly trained medical experts who evaluate and adjust the course of treatment to make sure that it’s focused on getting the employee healthy and back to work as quickly and safely as possible. This may include anything from educating the employee about procedures available to scheduling an appointment with the right specialist. Once connected with a claim, the case manager is always available to make sure that there are no unanswered questions about an employee’s recovery program.

The role of vocational rehabilitation

For claims involving more severe injuries or complications, an additional kind of professional may be brought in to facilitate the return to work. A service known as “vocational rehabilitation” comes in the form of a neutral consultant who will work as an intermediary with the employee, employer, insurer and health care system to identify and eliminate problems that may be preventing a return to full health and productivity.

A vocational rehabilitation consultant may meet with the employee in person to facilitate recovery. A vocational rehabilitation professional may go by any of a number of titles, often known as a qualified rehabilitation consultant (QRC), disability case manager (DCM) or field nurse case manager (NCM).

The specific responsibilities of the vocational rehabilitation consultant differ by job designation, and can vary greatly from state to state. For example, Minnesota statute requires that the insurer assign a QRC to any employee whose disability is expected to extend beyond 13 weeks. Once assigned to a claim, a QRC develops, administers and implements a rehabilitation plan to guide the employee back to pre-injury health and productivity. These activities are closely regulated by the state and the employee is required by statute to cooperate with the plan developed by the QRC.

A less formal option available within the realm of vocational rehabilitation comes from a DCM or NCM. Similar in training and expertise to QRCs, case managers are not regulated by any state agency. They can be called upon by either the insurer or the employer to coordinate care and pursue a safe and timely return to work.

Attorney involvement in a claim

Hearing that attorneys are involved in a claim may conjure up images of a courtroom drama involving a dispute between an injured employee and the insurance company, but that’s not usually how it plays out in reality. If a claim involves input from attorneys at all, it’s often in the form of providing legal expertise to others involved in handling the case.

Through its in-house law firm Lynn, Scharfenberg & Hollick, SFM maintains a base of specialized support for all matters related to workers’ compensation law. The attorneys are not only available to represent and defend SFM policyholders in the event of litigation, but to provide legal advice to employers whenever it’s needed.

Making it all work together

By getting the right experts involved at the right time, SFM strives to make sure that employees always have access to the resources that can help them the most. Every time that telephone rings, it means the claim handling team is working hard to get the employee healthy and back to work.

Back in 2015, before opioids were regu­larly making news headlines, SFM began a concerted effort to help injured workers reduce or quit use of the addictive pain­killers.

Since then numerous individuals have thanked our claims team for helping them “get their lives back,” sometimes after years of disability. And with drug overdose deaths at an all-time high in the U.S. due primarily to the opioid epidemic, these efforts can be life-saving, too.

We’re continuing to help injured workers get off these drugs, and we’re now focus­ing more on preventing long-term use in the first place.

Long-term opioid use reduced significantly

In 2015, we hired a prescription drug clini­cal review nurse to identify high-risk cases and work with injured workers and their doctors to prevent opioid addiction.

Since then we’ve seen a reduction of 77 percent in the number of injured workers taking a higher dosage of opioid painkillers than is recommended for long-term use, said SFM Director of Medical Services, Ceil Jung, R.N., BSN, CCM.

Among a group of injured workers who were taking opioids in 2015, 87 percent have been weaned off completely, or are taking lower doses.

Our nurse sends letters to treating doctors of injured workers taking high doses of the drugs, and then works with injured workers and their doctors to provide weaning schedules that help them reduce or quit using the drugs over time.

While we’re happy with the success of these efforts, we’re not backing down. Rather, we’re now focused on making sure short-term use doesn’t evolve into long-term dependence on the drugs.

Focus shifts to early intervention

Opioids are generally recommended for short-term pain relief due to an injury or surgery.

They’re much more likely to become problematic when they are used for longer periods of time. When used long term, they can increase a patient’s sensitivity to pain, requiring higher doses for the same level of pain relief. This pattern can con­tribute to dependence.

“Our best chance of success is early inter­vention — not letting them get to 90 days of use,” Jung said.

To do this, our prescription drug clinical review nurse monitors injured workers who are undergoing surgery. If three weeks after surgery they’re still taking opioid painkillers, she will send a letter to the treating doctor.

“Doctors have been very receptive and cooperative in helping get injured workers off opioid painkillers before an addiction can develop,” Jung said. “We’re thankful for increased awareness of the dangers of these drugs.”

Injured workers also receive copies of the letters we send to their doctors. This often­times spurs them to request that their doc­tors take them off these prescriptions.

A combination of public awareness, stiffer regulations and deliberate effort has helped us improve and perhaps even save lives. We take our responsibility to injured workers seriously, and will continue to work at preventing dependence and addic­tion.

“Opioid addiction can destroy lives and tear families apart,” Jung said. “If we can help free an individual from addiction or prevent one from ever taking root, that’s something we can really feel good about.”

Claims representatives spend their days helping injured workers recover and return to work.

We asked a few claims representatives to talk more about their jobs for a recent recruiting video, and they shared how rewarding and, at times, challenging their jobs can be.

They said working closely with team members and other experts, such as in-house doctors, nurses and attorneys, helps them do their best to serve injured workers and employers.

Watch the video below to learn more about how SFM’s claim representatives view their jobs.

One of the best ways you can keep your workers’ compensation costs under control is by bringing injured employees back to work as soon as they are medically able.

Even if the employee can’t return to his or her regular job due to medical restrictions, you can bring the employee back to work in a light-duty, modified-duty or transitional role.

Because work injuries are unexpected, you might have trouble thinking of light-duty jobs for your employee to perform. That’s why SFM created a free listing of ideas — broken down by industry — of potential light-duty jobs.

Here are links to the transitional work ideas by industry:

• Bus driving/transportation industry
• Construction industry
• Grocery stores/convenience stores
• Health care
• Manufacturing
• Service industry

Transitional jobs listed include:

• Answering phones
• Completing equipment inspection logs
• Data entry
• Greeting customers
• Filing
• Shredding documents

Even if the jobs listed don’t quite fit your organization, they might help you think of other ideas.

Research shows that timely return-to-work helps speed recovery and increase the likelihood that injured workers will ultimately work again. That makes it worth the effort to bring employees back, even if at a reduced capacity.

Read more on how return-to-work helps control workers’ compensation costs in our post, why early return-to-work benefits your employees and bottom line.

This is not intended to serve as legal advice for individual fact-specific legal cases or as a legal basis for your employment practices.

By Brian Bent, CPCU, ARM

With an increasingly globalized economy, more and more people are traveling overseas for their jobs. But how does overseas travel affect workers’ compensation coverage?

Employees who are working overseas temporarily are generally covered by their employers’ domestic workers’ compensation policies.

The issue is that “temporarily” is not clearly defined in the policy language or by state statute. Because of this, viewpoints differ on what constitutes a temporary work assignment. This is why it’s important to make sure your insurer knows about any foreign business travel your employees are doing.

Additional coverage might still be needed

Even if your employees are covered by your domestic policy, the countries to which they’re traveling might have additional requirements. Depending on where employees are traveling, you may also want to look at additional coverage options such as kidnap and ransom coverage or foreign voluntary workers’ compensation to cover any loss potential that might not be covered fully by your domestic policy.

This is not intended to serve as legal advice for individual fact-specific legal cases or as a legal basis for your employment practices.

Opioid painkiller misuse is now a public health emergency in the United States.

Taking opioid painkillers long term, or in high doses can have a major impact on an injured worker’s recovery and return to work.

“Well-meaning people can fall into this addiction, and into the trap of disability,” said SFM Director of Medical Services Ceil Jung. “The drugs can limit your ability to work, and then you get depressed and it’s a downward spiral.”

Opioid painkiller use tied to delayed return-to-work

Studies have shown that injured workers given high doses of opioid painkillers end up spending significantly more time off work due to their injuries than those who use other types of painkillers or lower dosages.

A 2008 California Workers’ Compensation Institute study cited by The New York Times showed that injured workers receiving high doses of opioid painkillers stayed off work three times longer than those with similar injuries taking lower doses.

A Washington State Department of Labor and Industries study cited by the National Safety Council showed that receiving a one-week supply of opioids, or two or more opioid prescriptions soon after an injury, doubles the risk that a worker will still be off work a year after the injury.

When someone becomes addicted to opioids, they develop a tolerance. This means they need higher and higher doses of the drug to get the same effect. As they take more of the drug, they become more sedated and less able to work.

How opioid painkiller use affects workers’ compensation claim costs

In part because of higher lost wages due to delayed return to work, studies have shown that claim costs for injured workers using opioid painkillers are significantly higher, on average, than those with similar injuries who aren’t using the drugs.

A Johns Hopkins University study cited by Claims Management magazine showed a nine-fold increase in average claim costs associated with long-acting opioids.

Additional claim costs could also include drug addiction and dependency treatment.

Opioid painkiller use could cause workplace safety risks

Opioids can make you less alert and slower to react.

This means employees using opioid painkillers could pose risk to themselves and coworkers if they work in safety-sensitive situations, such as operating heavy machinery, working at height or driving. This could lead to another workers’ compensation claim if an injury occurs.

For more information on opioid painkillers, see our post, Opioids and workers’ compensation: Why employers should care.

For educational and prevention-related resources on prescription drug addiction visit drugabuse.gov .

This is not intended to serve as legal advice for individual fact-specific legal cases or as a legal basis for your employment practices.

By Kathy Bray, Esq.

Based on our experience with workers’ compensation claims, many litigated cases could have been avoided if the employer had taken the time to show some concern for the employee’s welfare during the early stages of the claim.

It can be stressful for an employee to suffer an injury, and then hear nothing from his or her employer. The injured worker gets the impression that nobody cares.

Often, litigation is a reflection of feeling ignored. If the employer won’t make time to listen to an injured employee, an attorney will.

Show concern right away

As soon as you learn of an injury, have the claims coordinator, risk manager or the employee’s supervisor follow up right away. If the employee is off work, call the employee at home to see how he or she is doing or have someone see the employee in person, if appropriate.

Some supervisors avoid reaching out because they worry that they might say the wrong thing, but saying nothing is a sure way to deliver the wrong message.

Arrange with the employee to maintain contact. For example, maybe you agree to check in weekly.

What to say when you reach out to injured workers

Injured workers might be worried about their jobs and livelihood, so it’s really important to reassure injured workers that you’re looking forward to their return and you’ll have a job for them when they’ve recovered enough to return to work.

Make sure employees know you’ll provide light-duty work or needed accommodations so they can return to work as soon as medically possible. Help them understand that they might end up doing an entirely different job than what they’re used to depending on their medical restrictions.

Knowing that you’re committed to bringing them back to work can help quell any anxiety or uncertainty injured workers face over what will happen financially to them or their families. SFM’s experience is that the number one reason injured employees seek representation from an attorney is fear of losing their jobs and incomes.

Maintain good relationships, even if there’s a dispute

If representatives of the employer attend hearings or other proceedings related to a disputed benefit, they should remain civil and respectful to the employee even if relations are strained. If the employee remains actively employed, walking over to the employee and his or her spouse at a hearing to greet them is a nice gesture, and lets them know the dispute is a separate matter — “just business” — rather than something the employer is taking personally.

Educate your supervisors and help them separate personal feelings from any disputes that arise along the way.

Anticipate questions from the injured employee

Injured employees will likely have questions about workers’ compensation benefits and employee benefits. Be ready to review the company’s policies regarding workers’ compensation benefits and direct them to their workers’ compensation claims representative for more detailed questions. If the injury is denied, or there is some dispute related to the availability of workers’ compensation benefits, talk with them about other benefits they may be eligible for such as short-term disability, long-term disability, or paid or unpaid leave benefits.

Explain whether any FMLA (Family and Medical Leave Act) benefits will run concurrently with workers’ compensation leave, or separate from it if the workers’ compensation claim is denied.

Also review policies regarding continuation of health insurance benefits. Reassure the employee that you are there to answer any questions regarding employment or benefits, again minimizing the need for the employee to unnecessarily or prematurely consult outside sources.

Take concerns about work restrictions and retaliation seriously

Staying in contact with the injured employee remains important even after he or she is back at work.

If the employee or coworkers raise concerns about return-to-work issues, take them seriously. Be on alert if an injured employee feels like he or she is experiencing retaliation or being discriminated against in some way. Respond promptly to the concerns. Don’t ignore them.

If the supervisor or coworkers express concerns about the employee working outside of medical restrictions, talk with the employee right away. Emphasize the need to work safely and within restrictions. If the employee disregards that instruction, and continues to work beyond restrictions (for example, not asking for assistance with moving or lifting heavy objects despite the employer instructing him or her to do so), the employer may want to consider treating the disregard for restrictions as a performance issue or safety violation, and write up the employee or discipline the employee accordingly. While an employer cannot punish or retaliate against an employee for having a work injury, an employer can enforce reasonable performance and safety expectations such as working safely within restrictions.

If the employee complains that the supervisors or coworkers require the employee to work outside of restrictions, or retaliate when he or she declines to perform duties outside of restrictions, investigate those concerns. If the investigation suggests this is occurring, discipline or write up the supervisor or coworker if the behavior continues.

Work injuries can open up a host of opportunities for bad feelings, as well as goodwill. Your care, concern and attention throughout your injured worker’s recovery can play a big role in preventing unnecessary conflict.

For more information on what to do after an employee is injured, see these additional SFM resources:

• Your work injury checklist
• After reporting an injury

This is not intended to serve as legal advice for individual fact-specific legal cases or as a legal basis for your employment practices.

Employees with poor performance often have more costly and challenging workers’ compensation claims than the average employee.

These typically are employees with:

• Histories of attendance problems
• Low productivity
• Quality issues
• Difficulty relating to others.

Many times, these employees should have been disciplined or even fired before they reported work injuries. But once a workers’ compensation claim has been filed, disciplining or firing an employee can become much more complicated, and costly.

For example, you may still be required to pay injured workers benefits for lost wages, even if you fire them. These wage-replacement benefits get expensive fast, ultimately impacting your workers’ compensation premium. If you’ve fired the employee, you no longer have access to an important tool to control these costs — offering light-duty transitional work.

In addition, it is not uncommon for an injured employee who is fired to sue an employer for retaliatory discharge.

What employers can do to prevent problems with poor performers

There are a number of things employers can do to avoid these types of challenges, including:

• Deal with performance issues early. 
  This is the first and most important step you can take. This helps you avoid a situation where an employee has both ongoing performance problems and a workers’ compensation injury. The workers’ compensation claim undoubtedly will complicate your ability to manage this employee. Work with your supervisors to address performance situations. If termination is necessary, do it without delay to lessen the risk that it becomes entwined in the legalities of a workers’ compensation case.
• Follow written policies and procedures. 
  Have a written and well-documented performance management plan that includes disciplinary steps to be taken in cases of misconduct. Follow your policy to the letter.
• Document everything. 
  It can save you from expensive litigation. For example, document contacts with the employee, employee performance issues and remedial actions taken.
• Think before you fire, especially when workers’ comp is involved. 
  You may be faced with a frustrating situation, but an impulsive decision could make the problem drag out longer and become more costly in the end. Discuss your options with your claims representative and your employment law attorney for assistance making the best business decision possible.

More information on dealing with problem employees

For more information on dealing with problem employees, see our:

• Problem employees, situations CompTalk
• How to discipline employees who’ve experienced work injuries blog post
• The four most effective tactics to avoid workers’ compensation litigation blog post

This is not intended to serve as legal advice for individual fact-specific legal cases or as a legal basis for your employment practices.

As America grapples with the consequences of opioid painkiller addiction, the medical community is finding other ways to help individuals with chronic pain — both chemical and non-chemical.

Exercise is one of the most simple, yet promising alternatives.

“Exercise not only promotes healing because it increases circulation, but it also has been shown to reduce your pain level,” said SFM Director of Medical Services Ceil Jung, RN, BSN, CCM. “Studies have shown that exercise is the best way to treat your pain in many cases.”

The idea can seem counterintuitive at first, as it seems like exercising will make pain worse, Jung said, but studies have shown the opposite.

A study published in the journal Clinical Rheumatology showed that programs including aerobic, resistance and flexibility exercises significantly reduced pain in those with chronic pain conditions.

Another study published in the Annals of Internal Medicine showed that a weekly yoga class increased mobility for chronic low back pain sufferers more than other common types of treatment, according to Harvard Medical School .

In some cases, doctors might inject pain relief medication in the area that’s hurting to help patients get to the point where they feel they can exercise, Jung said.

Other chronic pain treatment options

In addition to exercise, doctors are turning to a number of other options to treat chronic pain, including:

• Other medications and supplements
  The Centers for Disease Control and Prevention recommends acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (aspirin, ibuprofen) as first-line treatment for low back and other types of chronic pain. Turmeric is a natural anti-inflammatory that’s easier on the stomach than pills.
• Acupuncture
  This traditional practice, which originated in Asia, of inserting hair-thin needles into the skin at certain points of the body is now an accepted, mainstream practice for treating chronic pain.
• Lifestyle changes
  Getting enough sleep, eating healthy, quitting smoking and losing weight can all be effective in reducing chronic pain.
• Cognitive behavioral therapy
  This form of talk therapy helps people learn to change negative thoughts and behaviors and improve coping skills so that they can regain function and change their perception of pain.
• Addressing psychological and social contributors
  Pain may originate from a biological source, but psychological and social factors influence how an individual experiences it. Because of this, treating those other contributing factors, such as anxiety or depression, is sometimes used to treat chronic pain.
• Virtual reality
  Studies show that virtual reality technology can be used to reduce all types of pain. 

These represent just a small sampling of the many treatments available. While treating chronic pain can be complex, it can make a huge difference in people’s lives.

“It’s all about helping people regain function so they can do the things they want to do,” Jung said. “Finding solutions to treat chronic pain really gives people their lives back.”

Few employers realize just how costly a work injury can be until they experience one at their organization.

That’s because there are so many hidden costs of work injuries that aren’t covered by workers’ compensation benefits, such as lost productivity, overtime costs, and lowered morale among the remaining employees, among others. Not to mention the impact on the injured worker.

When you’re thinking about the impact of work injuries on your organization, and the value of preventing them, the following not-so-obvious costs are worth taking into account.

Overtime and lost productivity

While an injured employee is out with an injury, you may have to hire and train a temporary replacement who is less experienced and efficient at the job. Alternatively, if you choose not to hire a replacement, you may have to pay your existing workers overtime as they cover the injured employee’s responsibilities.

These costs increase when the injured employee has a specialized or unique skill set. It is much harder to find replacements for employees with advanced degrees or the technical ability to run specialized machines.

Increased injury risk for other employees

Employees who cover for the injured worker can increase their own risk of injury due to rushing and fatigue. As a result, one workplace accident could cause a domino effect that leads to injuries among remaining workers.

Supervisors’ time

Work injuries also cost supervisors time. They may have to spend time investigating the accident, reporting the claim, working with their claims representative, implementing corrective action and checking in with the injured worker. They may also have to spend time finding light-duty jobs for your injured employees.

Disruption in the workplace

Immediately following a work injury, there can be a lot of lost time and productivity. Employees may need to stop working to try to help the injured worker, get the attention of supervisors, or get the injured worker medical attention.

Depending on the severity of the accident, you may have to stop work for a few hours or even a few days. This might affect just a few people or possibly your entire com­pany. You may receive visits from outside individuals such as attorneys, the Occupational Safety and Health Adminis­tration, or even the police following an incident, which can further disrupt your work environment.

Equipment losses

Tools or equipment that were directly involved in the accident may have to be taken out of service until investigation and litigation is over. This could mean buying or renting replacements.

Low morale

Following an injury, other employees may become distracted and uneasy as they worry about their own safety and risk of being injured. Employees who witnessed the accident, or who may feel somewhat to blame, might also be dealing with lingering trauma. They might also feel less confident in their supervisors or the company.

An injury can also disrupt the dynamic between your workers. Other employees may be resentful toward an injured worker who is off work or on light-duty, or they may doubt that the employee is actually injured.

Harm to company reputation

If word gets out about a workplace injury, it could harm your company’s reputation. Customers and prospects could get the impression that your company doesn’t take care of its workers. Additionally, your employees may have to field questions or opinions from people outside the company about the accident.

Financial costs to injured workers

Injured workers who, prior to the injury, made more than the maximum compensation rate allowed by their state will take a pay cut if they can’t immediately return to their regular work. Employees who can’t ever work again could miss out on the future wage increases they thought would secure their financial stability. Being injured at work can continue to impact employees financially for years to come.

Costs to injured workers’ families

The families of injured workers often suffer from the same financial losses as the employee, and family expenses can increase, too. They may have to pay for services the injured employee can no longer perform, such as snow removal, lawn mowing and house cleaning.

There are many good reasons to do everything you can to prevent work injuries. Knowing the hidden costs provides you with a fuller picture of all that’s at stake.

Mitigating costs

The best way to avoid the hidden costs of work injuries is to focus on workplace safety and prevent accidents before they happen.

But if an injury does occur, here are a few things you can do to help your injured worker recover and avoid unnecessary costs.

• Stay in contact with your claims representative

  They can help you take a proactive approach in preventing some of these hidden costs.

• Encourage return-to-work

  Getting your injured employees back to work quickly in light-duty positions lowers your claim costs and helps prevent re-injury.

• Check in with injured employees

  Contact your workers regularly to check on their well-being and recovery.

• Communicate with all your employees

  Being open with your employees about protocol following work injuries and offering them support can boost morale. Let them know what your expectations are following a claim.

• Communicate with the medical provider

  Working with your injured employee’s medical provider can help facilitate return-to-work. See our past post on why employers should get to know medical providers to learn more.

Focusing on workplace safety and preventing injuries before they happen will go far to protect your employees and your organization from harm.