Dear Nicole,
I have been injured on the job and I would really like to treat with my family physician. However, I was told by Associated Risk Management that I would have to choose a physician off of the provider panel. I don’t understand! My family physician knows me so well that he would probably treat my industrial injury better than anyone on your panel.
Signed, Wanted
Dear Wanted,
Associated Risk Management was correct in telling you that you need to treat with a physician on the contracted provider panel. Although it is understandable that you feel more comfortable treating with your personal physician, please rest assured that there are many benefits to treating with physicians that are on the panel. These physicians specialize in workers’ compensation injuries and they are the most equipped to provide you with the care that you need. They are more familiar with the required documentation and proper ways to request medical treatment.Sometimes family physicians are unaware of how to handle workers’ compensation claims as unlike the panel physicians, they do not handle these types of claims on a daily basis. This can lead to steps being missed and ultimately you may not receive the care that you need. You must keep in mind that a workers’ compensation claim is not processed in the same way a sickness would be processed through your normal health care insurance. There are different laws and regulations that need to be followed for workers’ compensation claims. If these procedures are handled incorrectly, treatment and benefits can be denied. A provider panel is put in place to ensure that the injured employee’s care is handled properly and timely.
Signed, Nicole
Dear Nicole,
I have a very hard working and dedicated employee who was recently involved in an accident at work which resulted in a very serious injury. Following the accident, she was immediately taken to the emergency room, and was diagnosed with a fractured skull. The problem is that although this employee was doing her job when the accident occurred, another employee was also involved, HER MOTHER. The two of them were engaged in conversation while working and evidently the mother was angered by something her daughter had said. The mother then picked up a 2 x 4 piece of lumbar and hit the daughter over the head with great force. Because this seemed to be a personal dispute and these employees are related, does this qualify to be a workers’ compensation claim or is it simply a domestic dispute?
Signed, Stumped
Dear Stumped,
This is an interesting one! First of all, this should be a lesson to everyone as to why hiring family members is not always a good idea; you never know what domestic issues may be brought into the workplace. If these two employees were fighting over something that was not work related, this claim would most certainly be denied. However, let’s change the scenario a bit. Let’s say that these 2 women were arguing over the 2 x 4 with regard to who should be working on it. During the argument, it slips out of one of the employee’s hands and hits one of the women in the head. This scenario would be compensable! Ironically enough, if an employee is injured at work during an argument about something related to work, it is a compensable claim. However, as illustrated above, if the argument is not work related, the claim is not compensable. It is very important to take note of the employees you may have that are quick with their tempers; this is almost always a recipe for disaster!
Signed, Nicole |
As the economy suffers there is potential for an increase in fraudulent workers’ compensation claim reporting. When an employee feels there may be a downsizing effort coming up they are often tempted to file a workers’ compensation claim to limit the impact of a possible loss of income. As these types of claims may be less than legitimate we are providing a reminder of “Red Flag” or “Fraud Indicators” to help all SIG Members learn more about identifying those questionable accidents or fraudulent workers’ compensation claims.
As you can see the signs of fraud are apparent when you consider the facts as a whole. It is important to document your claim files, including all phone calls, letters, comments made, appointments missed and light-duty job offers made. You will find that by having an appropriately documented file questions that need asking will be more apparent and claim legitimacy will be more easily addressed.
As we work in our office settings, we often forget the strain we put on our bodies. Try these easy office stretches during your working day…
UPPER BACK & SHOULDERS
Experts in the field agree that even the strongest safety program will not help reduce workers’ compensation costs if management and employees don’t support the program. Having a good written safety program on the shelf won’t necessarily result in good loss control. Implementation is the key to positive results and your managers and employees are the key to implementation. 
To gain the support of your safety program by your employees you may want to look at adapting a safe-behavior management approach. This gives employees ownership of the safety program and is more likely to motivate employees to follow safety rules than the traditional management-developed safety programs.
It is hard to argue against the importance of the need for eyewashes and showers in the workplace, given the reported injuries to and incident statistics of workers who require medical treatment of some kind. Take eye injuries, for example – there are 800,000 reported eye injuries in the American workforce each year, many of which are caused by exposure to chemical hazards. Factoring in direct costs of the injuries covered by worker’s compensation, disability benefits, and indirect costs ranging from lost work time and productivity to potential litigation expenses to reduced employee morale after an incident, the costs of an eye injury can reach more than $30,000. 
Even though emergency eyewash and shower equipment has been in use for more than 80 years, not until 1981 was a voluntary standard covering this type of equipment established in the United States. For nearly 35 years, the ANSI/ISEA Z358.1 standard has been the authoritative document for equipment manufacturers because it specifies minimum performance criteria for flow rates, temperature, and drenching patterns – all characteristics that are important for a user to receive adequate rinsing of a contaminant in an emergency situation. Equally important are the requirements and maintenance directives for the installer to ensure the equipment is available in proper working condition, should the need for the use of the equipment arise.
