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You need to know the players to win the workers' comp game


There are two types of injured employees, eagles and turkeys. Eagles just want to be treated fairly and get back to work as soon as possible. Turkeys do everything they can to stay on workers' comp even when they are able to return to work. You should treat all injured employees like eagles - at least until they prove they are turkeys.

The traditional workers' comp game looks like this. The opposing team includes the injured employee, spouse, attorney, family doctor, doctor specialist, OSHA, and EEOC. In most cases, the employer team includes the insurance company adjuster... and that's it. This guarantees a huge disadvantage and a guaranteed loss for the employer. Think Golden State Warriors... and everyone else.

The key to a winning strategy is assembling a strong team with a winning game plan. The first step is to have an insurance agent who is qualified to "coach" your team. Next, you need to determine which additional players you need on your team to, hopefully, level the playing field. To do so, I suggest you recruit a physician versed in occupational medicine, an in-house agency claims adjuster, a safety professional, and a qualified workers' comp attorney.

Once the lineups are set, the only way to win the workers' comp game is by knowing your game plan. Here are seven important things business owners need to know to win the workers' comp game:

  1. Claims Management - Think of workers' comp as a tax on employee injuries. No business owners want to pay more taxes. Conduct a regular review of workers' comp losses to check on the reserves set for each claim. Be sure to review all OSHA logs for accuracy and trend analysis.
  2. Injury Management - Workers' comp claims are either medical only or indemnity (medical plus indemnity payments). Indemnity claims cost three times that of a medical only claim, therefore they need to be avoided. This can be accomplished by having an effective return-to-work process in place.
  3. Audit Process - You don't file your taxes without your CPA reviewing your tax return. The same thing goes for the work comp audit. It should be reviewed for accuracy because all errors tilt toward the benefit of the insurance company.
  4. Experience Mod - The experience mod is a multiplier that will discount or surcharge an average workers' comp premium. The actions or inactions of the players involved significantly impact the direction it takes. It is often full of errors and evidence of claim mismanagement. Since it is a lagging indicator, it also can be full of surprises.
  5. Hiring - Pre-employment physicals including drug screens and background checks are valuable tools to insure you don't hire a claim waiting to happen.
  6. Compliance - Safety and OSHA recordkeeping must be in place before an injury or an inspection. It is too late when the OSHA inspector comes knocking on your door because of an injury or because a disgruntled employee turned you in.
  7. Rating Plans - What is the best rating plan? Is it a fully-insured plan, self-funding plan, group plan, or a captive? No matter which plan you choose, finding the right insurance plan is required so that the savings you accrue after winning the workers' comp game go directly to you and not into the insurance company's pocket.

Winning the workers' comp game isn't easy, but with the right team and game plan in place you can put one in the win column.

Randy Boss is a Certified Risk Architect at Ottawa Kent in Jenison, MI. He is a Master WorkComp Advisor (MWCA).