Who Wins and When?
“Win” does the case end? Physician: Case ends when all is done that can be; patient lost to follow-up; patient is on autopilot to a determined outcome Worker: When wholeness is achieved both economically and physically. Missouri: 2 years after last visit to w/c provider Employer: When productivity, moral, and workforce is restored Insurers: Motivated to get off books; limit long term liability; case closure; do the right thing; “Pay what we owe.” Attorney: ? System: W/C Case ends at point after which minimal change over course of the following year is expected
“Win” does the case end? Physician: Case ends when all is done that can be; patient lost to follow-up; patient is on autopilot to a determined outcome Worker: When wholeness is achieved both economically and physically. Missouri: 2 years after last visit to w/c provider Employer: When productivity, moral, and workforce is restored Insurers: Motivated to get off books; limit long term liability; case closure; do the right thing; “Pay what we owe.” Attorney: $ System: W/C Case ends at point after which minimal change over course of the following year is expected
“Win” does the case end? Physician: Case ends when all is done that can be; patient lost to follow-up; patient is on autopilot to a determined outcome Worker: When wholeness is achieved both economically and physically. Missouri: 2 years after last visit to w/c provider Employer: When productivity, moral, and workforce is restored Insurers: Motivated to get off books; limit long term liability; case closure; do the right thing; “Pay what we owe.” Attorney: ? System: W/C Case ends at point after which minimal change over course of the following year is expected
Cost of worker’s comp Insurance premium Lower employee moral/presenteeism Loss of productivity of “green” temp worker Increase in “mod” rate OSHA fines
Case closure begins… Application for employment Hire strong young men? Hire healthy workers –Smokers –Obesity –Chronic disease
Case closure begins… Application for employment Hire strong young men? Hire healthy workers –Smokers –Obesity –Chronic disease
TABLE 3. Injury rate ratios and 95% confidence intervals (Cl) by part of body classification among Southern Califomia Edison electric utility workers, adjusted for occupation, age, and Job experience, InjuryRatio of rate ratioFemale Number Of InjuriesNumber of Days Lost(females/ Lost Days Part of BodyMalesFemalesMalesFemalesmales)95% Clto Male All head and neck5, ,6074, Neck ,3992, All upper extremities7,1781,20512,9437, Hand/wrist2, ,6435, Shoulder ,7061, Back4, ,7059, All lower extremities6,3421,39634,2479, Hip304893, Knee1, ,2005, Ankle1, ,1351, Body systems ,0812, All Injuries31, ,01450, Sex Differences in Work-related Injury Rates among Electric Utility Workers Michael A. Kelsh and Jack D. Sahl
Sex Differences in Work-related Injury Rates among Electric Utility Workers Michael A. Kelsh and Jack D. Sahl TABLE 4. Injury rate ratios and 95% confidence Intervals (Cl) by selected type of Injury among Southern California Edison electric utility workers, adjusted for occupation, age, and Job experience,Ratio of Female Number of InjuriesNumber of Lost DaysInjuryLost Days Type of InjuryMalesFemalesMalesFemales Ratio F/M96% Clto Male Fractures ,9431, Surface wounds8,5861,67612,5363, Bums974927, Object in orifice2, Sprains/strains10,4671,80598,92822, Cumulative trauma139961,9514, Mental stress78482,4101, Poisoning
Case closure begins… Application for employment Hire strong young men? Hire healthy workers –Smokers –Obesity –Chronic disease
Case closure begins… Pre-placement –Job matching –Strength testing –Culture of collaboration Pre-placement and post accident drug testing Accepting that complaint is legitimate then verify! Transparency in seeking the underlying problem
Case closure begins… Pre-placement –Job matching –Strength testing –Relationship building Pre-placement and post accident drug testing Accepting that complaint is legitimate then verify! Transparency in seeking the underlying problem
Case closure begins… Pre-placement –Job matching –Strength testing –Relationship building Pre-placement and post accident drug testing Accepting that complaint is legitimate then verify! Transparency in seeking the underlying problem
Case closure begins… Pre-placement –Job matching –Strength testing –Relationship building Pre-placement and post accident drug testing Accepting that complaint is legitimate then verify! Transparency in seeking the underlying problem
Reasons for hiring attorney Employee does not know what to expect Fearful for themselves and families Controversy develops between employee/employer or employee/adjuster
Keys to Closure Case management intervention before expectations and patterns have developed Early diagnosis/aggressive diagnostics including MRI (careful!)
Keys to Closure Maintain communication with employee even if off work Identify and alleviate employee’s concerns Move quickly towards normalcy by closing case, settling, and moving on.
Avoid These Mistakes! Provide immediate care Late reporting Ignoring the employee Under reporting compensation Not complying with restrictions
Summary Hire right demographics Hire healthy workers Pre placement drug testing Pre placement job matching and strength testing Post accident drug testing Early diagnosis; set expectations Early closure and move on!