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Insurance - Strong return to work strategy; key to good Workers’ Comp experience

image Wes Pitts, Sr. V.P. and Southwest Regional Construction Practice Leader for USI Southwest USI Southwest, Austin, TX

AUSTIN - I’d like to share a best-practice strategy that can change your Workers’ Comp. experience for the better. Strongly consider a dedicated person to manage your Workers’ Comp. claims. This person needs to be genuinely caring for the welfare of your employees, but also a tough “bull dog” personality type. You want to be prepared with a strategy of using Return to Work and a Bona Fide Offer of Employment Letter (get sample from your agent and put on your letterhead) on all cases of an injured employee getting hurt, going to get checked out by the treating doctor and the doctor releasing them to light or modified duty, which is always what you want as an alternative to just sending them home off work.


    A full release with no restrictions is ideal, but this is the next best strategy if released by the doctor with restrictions.  Establish relationship with occ. med. clinic (in-network with carrier if elected) that supports your goals of returning employees to work. Your claims manager should constantly be on the doctor to see your employee, and constantly on the employee to get in to the doctor.  Call and press the doctor prior to seeing your injured employee how important this is, and that you have light and/or modified duty positions for the injured employee available either at your job site, your office, or in your yard/shop, and may be as restrictive as just sitting watching safety videos– need to be able to accommodate the restrictions the doctor sets per his release with the DWC-73 work status form. As soon as the doctor sees your injured employee and assuming they are released to return to work with restrictions, that same day you want to provide to your injured employee your bona fide offer letter (with copy of DWC-73 attached) and ask for their written acceptance or declination by a reasonable time that same day (we actually amend the typical bona fide offer letter by adding two signature options at the bottom: Injured Employee Name, I accept the offer of temporary, modified-duty job assignment; and Injured Employee Name, I decline the offer of temporary, modified-duty job assignment). If they accept and don’t show up they may eventually be subject to termination just like any other employee that doesn’t show up (not that that removes the WC claim), and if they decline in writing, that could be same as their willingly terminating their employment and you might just write them a letter back acknowledging their desire to terminate employment with you.  The main goal is to try to mitigate your Workers’ Comp. claim (have better experience on your Workers’ Comp., which is going to translate into a better modifier and better rates versus your peers) while positively bringing your injured employee back to their full duty, and often the dynamic of using this bona fide offer letter and bringing them back in on light/modified duty at same pay will motive them to want to get back to full duty.  Same pay is recommended because you want to try to keep the claim medical only, no lost time–important because if the claim is medical only and coded this way by your carrier then NCCI for purposes of your experience modifier calculation will discount the claim by 70%. If the injured employee resigns or you terminate them that does not mean the WC claim just goes away, but it does often put you in a better position in ability to potentially remove a “bad apple” from your workforce. The most important thing this strategy accomplishes is the perception among your workforce that, “when you’re employed here you won’t just get off work with a WC claim.” They are expected to return to modified/light duty immediately! This strategy begins to make a difference because they all talk to each other.
    To run with this on Workers’ Comp. claims need to:  1. Get employee to treating doctor asap, reach out to employee and doctor, discuss game plan, your desire to get them back to work, was he released to full or restricted duty?  You are seeking a Work Status Report (DWC-73).   2. Clinic needs to follow any post-accident drug and alcohol screen requirement.    3. Get claim form DWC-1 filed with carrier as first notice.   4. Place bona fide offer letter on letterhead and send to the individual consistent with restrictions in DWC-73 (attach it to letter), and get this to the employee immediately after being seen and released.   5. A new bona fide offer of modified duty must be executed every time a worker’s restrictions change (after each follow up doctor appt.-attach the latest DWC-73 from doctor), accommodate updated restrictions (hopefully, able to perform more duties each time)...until released to full duty.   6. Work closely and weekly with carrier assigned adjuster on the claim with goal of getting it brought to a close.   
    Involve your agent’s claims manager or your producer as needed anytime and keep us updated of status or any questions with the claim.
    Wes Pitts is a Sr. Vice President and Southwest Regional Construction Practice Leader for USI Southwest - Austin, TX.  512-651-4107, or Wesley.pitts@usi.com

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