The Lutgert Insurance Blog

***This article is part of a series.  If you haven’t read from the beginning please start here: WC 2.0- The Work Comp Claims Managment Program.***

There are many types of claims, but for our purposes we will focus on two broad categories that constitute the vast majority of WC cases. They are Medical Only (MO) and Indemnity.

Medical Only: This type of claim is exactly as it would appear; the only payments made by the insurance company are medical bills and expenses involved in processing the claim or providing the medical treatment for the injured worker (IW). The majority of claims are medical only (MO). Employee gets hurt, claim is reported to the carrier, employee receives treatment and insurance carrier pays 100% of the bills associated with the claim.

This is a good time to introduce a couple vital points: First, it should always be the goal of the employer to obtain the very best medical treatment available for their injured worker. Medical bills are paid at 100% and are unlimited. This is NOT an area where we should attempt in any way to “save” money in the claims process. Second, our ultimate goal is to get our IW back to work as soon as possible, therefore the best medical treatment is what we want in furtherance of that goal.

Indemnity: This is the second broad category of claim and it most commonly encompasses one of three types of payment by the insurance company that result in it being categorized as an indemnity claim. There will, of course be medical bills associated with the claim as well.

Here are the three most common reasons a claim becomes indemnity:

Lost Time- In Florida, if an IW is out of work for more than 7 days, on the 8th day the insurance company will begin compensating them for lost income. They will request a wage statement from the employer showing their income for the 13 weeks prior to the injury, they will take the average for those past 13 weeks (Average Weekly Wage-AWW) and the IW will be paid 66 2/3% of that number for time missed. This is the law and insurance companies are monitored closely to assure that they are paying IW’s fairly and promptly. (There are MANY details and what if’s that surround lost time, but for now, let’s keep it simple). If even $1 of lost time is paid on a claim, it goes from MO to indemnity.

Permanent Impairment- When an injury is serious enough that it causes permanent damage to an IW, they are entitled to receive compensation for that. Frequently, this will be a result of surgery that may limit the IW in some way such as ability to lift, range of motion, etc. These impairments are measured on a percentage basis and can cover virtually any area of the body, internal or external. The percentages are dictated by tables that guide physicians in assigning the appropriate percentage of permanent disability based on the individual injury or injuries. Any payment made as a result of permanent impairment automatically moves a claim from MO to indemnity.

Settlements- The third most common way for a claim to move from MO to indemnity is through a settlement. They fall into two categories: Claims with attorney involvement and those without. If an attorney is engaged by the IW to represent them, the case almost always results in a settlement of some sort. The second category is when the insurance company feels that all has been done to help an IW and, in the interest of closing the case, offers the IW a settlement to cover any future medical or other financial costs arising from the injury. Again, if a settlement of any type is paid to an IW, the claim is moved from MO to indemnity.

This is a very cursory and uncomplicated treatment of medical only vs. indemnity, but it is vital that you understand the distinction. We will deal with each of these in detail as we build upon the knowledge required to properly manage your WC claims. Because in this, as in so many legal/financial/insurance/HR related issues, the devil is indeed in the details.

Now that you have this as a foundation, please move on to the next blog post. That is truly where the rubber meets the road when it comes to saving money on your WC costs. The MATH of this will astound you and prove to you the VALUE of developing a plan and partnering with someone who can make certain you don’t fall victim to a system designed for you to do just that.

TL;DR-Takeaways…There are two main types of WC claims- Medical Only (MO) and Indemnity. MO is when only medical bills are paid, indemnity is when other types of payments are made in addition to medical bills. In the next post you will be shown the huge financial impact the difference between these two types of claims can have on your Experience Mod and WC premiums.

Next blog post:
WC 2.3- How Indemnity Impacts Your Premiums- The Math

Please join our email list by filling out & submitting the form in the blue box on the right of this page and you will receive each blog post as it appears on our website. Feel free to call me at any time- Joe Carraher- W: 239-280-3209 or on my Cell: 239-293-7772.

Next Article »

***This article is part of a series.  If you haven’t read from the beginning please start here: WC 2.0- The Work Comp Claims Managment Program.***

The Work Comp world has changed. For decades WC was sold on the basis of who had the best dividends. When rates were more than double what they are now, not reporting claims and maximizing dividends just made sense.

Not anymore. Now the most critical objective is to KEEP YOUR EXPERIENCE MOD AS LOW AS POSSIBLE. New mantra: Take care of your Mod and the dividends with take care of themselves.

This blog is dedicated to those concepts, tools and strategies that will directly contribute to minimizing your Mod. This is Work Comp 2.0. I will not bother you with the basics of WC as that information is available anywhere. Everything I put in this blog will be something you should know regarding how to manage your WC costs and will have a direct and measurable impact. No bologna.

It is not about safety, although we believe very strongly in the value of safety training and the multitude of efforts that can be made to reduce accidents. Scott Bills, our Director of Loss Control Services, has built the best loss prevention department of any agency I’ve ever seen. Avoiding a claim in the first place is always the best option. But this blog is about doing all those things that can drastically reduce your costs after an accident and they have to be put in place before the injury occurs.

The outline is simple:

  • Education- Owners, HR professionals, CPA’s and Supervisors need to know the information contained in this blog
  • Policy/Procedure Changes- Basic amendments to your employee manual that allow you to implement the tools that can save you money
  • Hands-On management and consultation on every WC claim

I promise you will learn more about WC and more about what truly affects your WC premiums than you ever have before. I have met with hundreds of employers and the reaction is always the same: stunned amazement that they have never been told these things…ever.

Sales Moment: I won’t do this very often, but when you learn about these simple but important WC tenets, you will ask yourself, “Why hasn’t my current agent ever told me about this?” The answer is they don’t know it. Sure they know indemnity claims are bad for your Mod and they will tell you “We can do all this for you”. But the truth is, if they could, they would already be doing it. This requires a full time COMMITMENT on the part of the agent and agency. Few agents are willing to make that commitment.

Ok, enough of the sales talk. You should also know that I believe in this. I believe it is our duty as agents to inform our clients about this, if for no other reason than NO ONE ELSE WILL DO IT. I think every employer deserves to know exactly HOW this system is rigged.

If you take the time to read this blog regularly or, better yet, allow me to speak to you directly, you will see that implementing this WC program will reduce your Mod to its’ lowest level possible, given the injuries that occur. NOT implementing it will result in the highest Mod, given the injuries that occur. I don’t know about you, but I’ll take the former outcome, please.

Finally, and this is the best part, I and my agency don’t charge a dime extra for providing this service. You will see when you read this or if we speak in person that I truly believe every employer in the state of Florida should know this and Lutgert Insurance agrees.

BTW, be sure to read the next two posts, as they give information you must have.

WC 2.2- Types of Claims- Medical Only vs. Indemnity- Must Read!!
WC 2.3- How Indemnity Impacts Your Premiums-The Math- Must Read!!

TL;DR (Too Long: Didn’t Read) Takeaways- There are simple, proven tools that will allow you to minimize your Experience Mod and consequently your WC premiums. Every employer should know this, but only the largest with full-time risk managers do. This blog will give you concrete information on how to accomplish that goal.

Please join our email list by filling out & submitting the form in the blue box on the right of this page and you will receive each blog post as it appears on our website. Feel free to call me at any time- Joe Carraher- W:239-280-3209 or on my Cell: 239-293-7772.

Next Article »

The U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) has issued a final rule to improve tracking of workplace injuries and illnesses. The new rule requires certain employers to electronically submit to OSHA injury and illness data that they are already required to keep under existing regulations. The final rule also includes provisions regarding employee rights to report work-related injuries and illnesses free from retaliation.

Continue reading »

 

 

Alcohol affects every organ in the body. Take a minute to rethink your drink.

  • Know your limits. Drinking in moderation is defined as having no more than 1 alcoholic drink per day for women and no more than 2 alcoholic drinks per day for men.
  • Choose nonalcoholic beverages if you:
    • Are recovering from alcoholism or are unable to control the amount you drink
    • May become pregnant or are pregnant
    • Plan to drive, operate machinery, or take part in other activities that require attention, skill, alertness, and coordination
    • Are taking prescription or over-the-counter medications that can interact with alcohol
    • Have certain medical conditions
    • Are younger than 21

Every day in the United States, 120 people die as a result of drug overdose, and another 6,748 are treated in emergency departments for the misuse or abuse of drugs. Nearly 9 out of 10 poisoning deaths are caused by drugs. Take a few minutes to:

    image002

  • Discuss all medications you are taking (including over-the-counter) with your health provider.
  • Use prescription drugs only as directed by a health care provider, and store them in a secure place.
  • Dispose of medications properly, as soon as the course of treatment is done. Do not keep prescription medications around “just in case.”
  • Help prevent misuse and abuse by not selling or sharing prescription drugs. Never use another person’s prescription drugs.
  • Discuss pregnancy plans with your health provider before taking prescription painkillers.
  • Follow directions on the label when you give or take medicines.
  • Get help for substance abuse problems (1-800- 662-HELP); call Poison Help (1-800-222-1222) for questions about medicines.

Sourced from Centers for Disease Control & Prevention

image001Five Minutes or Less for Health Weekly Tip: Prevent Colon Cancer

Colorectal cancer (cancer of the colon or rectum) affects both men and women, and is the second leading cause of cancer deaths in the United States. Colorectal cancer can be prevented by getting screened for the disease beginning at age 50. Screening tests help prevent colorectal cancer by finding and removing precancerous polyps (abnormal growths). Screening also finds this cancer early, when treatment can be most effective.

Take these steps to help lower your risk for colon cancer.

  • Talk to your doctor or nurse about colon cancer screening, especially if you are age 50 or older, you or a close relative has had colon cancer or polyps, or if you have inflammatory bowel disease.
  • Call 1-800-4-CANCER or 1-800-ACS-2345 to learn more about screening options in your community.
  • Be physically active and maintain a healthy weight.
  • Choose more fruits and vegetables for meals and snacks.
  • Limit alcohol.
  • Quit Smoking. Call 1-800-QUIT-NOW to help you quit.

Sourced from Centers for Disease Control & Prevention

Heart HealthUse these tips to take action in lowering your risk for heart disease and heart attack.

  • Ask your doctor or nurse how to maintain a healthy weight and how to prevent and control high blood cholesterol, high blood pressure, and diabetes.
  • If you smoke, call 1-800-QUIT-NOW to help you quit.
  • Limit alcohol.
  • Make healthy food choices for meals and snacks. Grab a healthy snack on the go.
  • Be active. Take the stairs instead of the elevator. Park farther away and walk.
  • Know the symptoms of a heart attack.

Sourced from Centers for Disease Control & Prevention

heart-attack-signsA person’s chances of surviving a heart attack increase if he/she gets emergency treatment as soon as possible. It’s important to recognize the signs and symptoms of a heart attack and act quickly. If you think that you or someone else is having a heart attack, call 9-1-1 immediately.

Take a few minutes to learn the major signs and symptoms of a heart attack:

  • Chest pain or discomfort
  • Pain or discomfort in the jaw, neck, back, arms, shoulders, or stomach
  • Feeling weak, light-headed, or faint
  • Shortness of breath. May occur with or without chest discomfort.

Other signs and symptoms that a person may have during a heart attack include:

  • Nausea (feeling sick to your stomach) or vomiting
  • Breaking out in a cold sweat
  • Sourced from Centers for Disease Control & Prevention