Pro Group Management, Inc. - News for Self Insured Members
The Value of Knowing Who You Are Hiring
Many Self Insured Group Members sometimes forget the importance of knowing the full story of the person they plan on hiring. Often these prospective employees bring added baggage with them, including a previous workers’ compensation injury or claim. By taking the right steps you can protect your business from a workers’ compensation claim that should not be the self insured group’s responsibility.
Many years ago the State of Nevada put in place the “Subsequent Injury Account” (SIA). The primary purpose of the Subsequent Injury Account(s) is to encourage employers to hire workers who have suffered a permanent physical impairment. The impairment is any permanent condition, whether congenital or caused by injury or disease (diabetes), that is serious enough to cause a hindrance or obstacle to obtaining employment or to obtaining re-employment, if the employee is unemployed. The costs of the subsequent injury are paid from a designated “subsequent injury account” (SIA) which is supported by assessments received from workers’ compensation insurers rather than having the current insurer pay the entire costs of a qualifying claim.
The ability to submit a claim to the SIA for recovery is first researched by Claims Staff at ARMI as well as Kris Louisiana of Pro Group Management.
Key components of the SIA accepting a claim are:
Verification of the employer’s knowledge of impairment at the time of hire (a note or letter to personnel file upon learning of impairment) or retention in employment after obtaining knowledge of the impairment (payroll records)
The job has to be physically appropriate for the worker and the employer must accommodate any restrictions the worker may have.
The makings of a successful SIA claim are outlined below.
The fan belt broke on his truck so the IW decided he should take a quick look under the hood. In doing so he injured his back. The IW followed protocol for reporting his injury, received treatment and was released to return to work and the claim was closed. The IW appealed claim closure and the Hearing Officer ordered the claim to be reopened. The IW went on to receive back surgery. Fortunately, his employer had knowledge that his employee had a pre-existing back injury from several years earlier and the employer had properly documented this knowledge in their file. Associated Risk Management, Inc. (ARMI), the third party claims administrator, obtained the IW’s prior medical records with the IW’s approval and upon review of these records it was determined that the compensation for disability on the subsequent injury was substantially greater due to the combined effects of the preexisting impairment than that which would have resulted from the subsequent injury alone. Pro Group Management, Inc., on behalf of this member, was able to qualify this claim for relief from the Subsequent Injury Account. Had the employer not documented their file about their knowledge of their employee’s preexisting condition, relief would not have been found on this claim and claims costs would not have been reduced.
Since 2003 Pro Group’s Subrogation Analyst, Kris Louisiana has recovered over $300,000 in subsequent injury reimbursements. However, over $450,000 in subsequent injury reimbursements was denied because the employer did not document pre-existing conditions appropriately and/or did not retain the employee after the subsequent injury.
A tool available to all members involved in self insured groups administered by Pro Group Management is employee background checks offered by Employer Lynx. These background checks offer the group member the opportunity to learn more about their potential hire, including a record of previous workers’ compensation claims. And, as we have learned “Knowing and Documenting” a previous disability can help keep claims costs down and help the group continue to perform successfully. We encourage you to utilize the employee background checks offered through your SIG. By doing so you will protect both your company and your self insured group.
For more information on handling the documentation process or to discuss a potential SIA claim contact Kris Louisiana of Pro Group management at (800) 859-3177.
Many Self Insured Group Members sometimes forget the importance of knowing the full story of the person they plan on hiring. Often these prospective employees bring added baggage with them, including a previous workers’ compensation injury or claim. By taking the right steps you can protect your business from a workers’ compensation claim that should not be the self insured group’s responsibility.
The fan belt broke on his truck so the IW decided he should take a quick look under the hood. In doing so he injured his back. The IW followed protocol for reporting his injury, received treatment and was released to return to work and the claim was closed. The IW appealed claim closure and the Hearing Officer ordered the claim to be reopened. The IW went on to receive back surgery. Fortunately, his employer had knowledge that his employee had a pre-existing back injury from several years earlier and the employer had properly documented this knowledge in their file. Associated Risk Management, Inc. (ARMI), the third party claims administrator, obtained the IW’s prior medical records with the IW’s approval and upon review of these records it was determined that the compensation for disability on the subsequent injury was substantially greater due to the combined effects of the preexisting impairment than that which would have resulted from the subsequent injury alone. Pro Group Management, Inc., on behalf of this member, was able to qualify this claim for relief from the Subsequent Injury Account. Had the employer not documented their file about their knowledge of their employee’s preexisting condition, relief would not have been found on this claim and claims costs would not have been reduced. 
A tool available to all members involved in self insured groups administered by Pro Group Management is employee background checks offered by Employer Lynx. These background checks offer the group member the opportunity to learn more about their potential hire, including a record of previous workers’ compensation claims. And, as we have learned “Knowing and Documenting” a previous disability can help keep claims costs down and help the group continue to perform successfully. We encourage you to utilize the employee background checks offered through your SIG. By doing so you will protect both your company and your self insured group.