Use team approach to ID worker's comp costs

Consider yourself a member of the "worker's compensation team" as a strategy to reduce costs, says Mary (Penny) B. Nicholls, RN, CCM, COHN-S, a disability consultant with Alabama Power Company in Birmingham and a member of the advisory board for the Deep South Center for Occupational Health & Safety at the University of Alabama at Birmingham.

In addition to the occupational health professional, other "players" may include the injured worker, employer, safety professional, health care provider, case manager, insurance adjusters, attorneys and vocational rehabilitation specialist. She gives these recommendations:

1. Work with safety professionals to investigate early and thoroughly.

"Tie the facts down early, as it may take years to come to court," says Nicholls. She says you should:

• Identify mechanisms of injury, and relate this information to the health care provider;

• Determine whether the condition was causally related to the work or job;

• Determine whether the injuries were sustained during an unreasonable or substantial deviation from employment and not compensable.

2. Work collaboratively with health care providers to assess causality, provide physical capacities, expedite care, communicate with patient, family, and company and coordinate care with other health care providers.

"The health care provider must ask whether there was a clear, probably traumatic event, to assess the mechanism of injury. Are the symptoms consistent with the source of injury, or are they due to repetitive stress which is more difficult to identify?" asks Nicholls. "They must also determine if it is pre-existing, a reoccurrence, acceleration, an exacerbation, or an aggravation This determination is a cost driver within itself."

3. Convey to injured workers that you care about them.

"A trust begins to build and the results will be greatly improved," says Nicholls. "History shows that injured workers who feel truly cared for do not sue their companies. This will result in cost control, even though it is not disease-specific!"

Rewarding workers for lack of injuries is risky

Have you learned that back injuries are the top cost drivers in workers' compensation cases at your workplace? Imagine the impact of giving incentives to various departments if zero injuries are reported within a certain time period. Or then again, maybe not.

"Not reporting injuries, especially cumulative trauma injuries, is not a good approach. If workers are pressured not to report injuries, they may defer reporting until the pain is so bad that treatment ends up being more involved," says Eileen Lukes, PhD, RN, COHN-S, CCM, FAAOHN, a Mesa, AZ-based member of the American Association of Occupational Health Nurses' board of directors. "A simple first aid injury could instead become recordable and maybe even a lost-time case." This is particularly dangerous for cumulative trauma injuries, she adds.

Incentive programs for decreased reporting of injuries are counterproductive, since these don't address unsafe working conditions, says Kathy Dayvault, RN, MPH, COHN-S/CM, an Occupational Health Nurse at PureSafety. "Be careful when instituting incentive programs such as these. It can appear that the responsibility of injury prevention belongs to employees, not employers," warns Dayvault. Use these approaches instead:

• Make minor, low-cost changes.

For example, if items are raised off the floor so they can be lifted from an easier working height, back injuries may be reduced. "Methods such as these are simple and do not cost a lot of money," says Dayvault.

• Reward employees for reporting unsafe work practices.

"This is much more effective at improving injury/incidence rates than rewarding decreased reporting of injuries," says Dayvault. Employees could be given incentives for calling attention to a coworker performing an unsafe act, such as driving a forklift too fast or turning blind corners and not blowing the horn, for example.

"Reward employees for following safety rules, or for giving suggestions to make a task or process safer," says Dayvault. "Spotlight employees in a company newsletter for raising safety awareness."

Lukes recommends insisting that managers be evaluated on incorporating safety and prevention in their annual business goals. "Reward safe behaviors like pre-workday stretching," she says.

• Use a team approach.

"This is more effective than trying to make changes independently," says Lukes. "Sitting down with management and safety to discuss trends and costs will increase buy-in from others. When the nurse presents the data, the solution may be self-evident."

Meeting with teams of employees is another way to come up with effective solutions. "After all, they're the ones doing the work, so they may be in the best position to figure out what needs to be changed," says Lukes.

• Implement an ergonomic program which addresses cumulative trauma injuries.

"When partnered with design change and ergonomically correct tools, not only can ergonomic injuries be reduced, but eradication can occur as well," says Dayvault.