Use team approach to ID workers' comp costs

Consider yourself a member of the "workers' 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!"