Storm Clouds Ahead For Your Workers Comp Insurance

It has never been more important for you to control your workplace injuries and the reasons aren’t even your fault.

A very good article by Steve Doss of CCIG looks at three signs of trouble for workers comp rates.  They all have to do with national trends.

  1. Obama Care (the Affordable Care Act) – The Affordable Care Act and workers comp are supposed to be two separate programs with two separate purposes.  The problem is that doctors may “leak” cases that should be covered by health insurance into worker’s comp.  Why?  Patients  can avoid high deductibles by going through worker’s comp and doctors can charge more for workers comp treatment than they can under group policies.  So there is an incentive for both to classify things as work-related.
  2. Accident Frequency – As the economy has improved since 2012, accidents have gone up, especially in construction and transportation.  Two distinct problem there – more inexperienced workers entering the workforce and an aging demographic as more people delay retirement.  According to Doss, “non-fatal work-related construction injuries jumped 9.5 percent from 2012 to 2013. Also, as older employees work longer, the number of accidents among those 65 and older rose 18.5 percent from 2012 to 2013.”
  3. Accident  Severity – Fatalities are going up.  For example, the government says that between 2013 to 2015, construction fatalities rose 5.6 percent and manufacturing fatalities rose 9.3 percent from 2013 to 2014.   At the same time, hospital and drug costs are rising faster than inflation and those are the biggest expenses impacting workers comp.

What should you do about it?  Doss says prevention is the best investment you can make; every dollar spent on prevention saves two-to-six dollars in savings.

At CORE Health Network, a leader in integrated occupational health management, the four keys to prevention are:

  1. Documentation – Companies that don’t monitor worker health and on-the-job injuries may have no way to determine whether an injury was really work-related and they have limited options on getting workers back to work quickly.
  2. Make sure the people you hire can perform their job duties safely – That is done through a network of 1300 clinics around the country that can perform drug and alcohol testing, compliance testing and functional assessments during the onboarding process.
  3. Keep track of worker medical conditions as their careers progress – Return-to-work assessments are a critical to preventing re-injury and helping workers return to work.
  4. Post-incident case management – The first minutes after an injury are critical to determining injury severity and the right level of treatment.  They are also important in re-assuring workers that they will receive the proper care and that company wants them to return to work healthy.  CORE’s TimeZero service addresses those concerns.

Let us know if we can help you manage your worker health needs.


Workplace injuries: And the winner is….

Safety programs are naturally focused around hazards.  We identify job site hazards and implement policies to control or eliminate those risks.  But what if we went at it from the other direction – identify the types of injuries that occur and focus on preventing those classifications?

I wondered about this when I saw a listing of types of injuries both as a percentage of total injuries and direct cost.  It comes from the Liberty Mutual Research Institute for Safety, which has long been a leader in safety research.  Every year, the group puts together a list of injuries based on the latest data.   Here’s what the 2016 report looks like:

injuries list

In total, Liberty Mutual found that businesses spend more than $one-billion a week on nonfatal injuries, for a total of almost $62-billion a year.  The 80-20 rule also applies – eighty percent of the injuries come from the top categories of injury types.    By far, the top cause is overexertion involving outside sources, meaning injuries related to lifting, pushing, pulling, holding, carrying or throwing objects.   Those types of injuries make up a quarter of the total.

We should never turn away from hazard identification as a foundation of safety, but can we also focus on injury types.  To some extent that is the health part of  Health, Safety and the Environment.  Some companies are having a great deal of success in reducing musculature injuries by training workers on avoidance skills – stretching, proper lifting techniques and awareness.  For many companies, that involves a cultural shift.

The other piece involves occupational health.  Knowing that certain injuries are more likely to occur, focus on ensuring that new hires are capable of performing their specific job duties.  If an injury does occur, ensure that appropriate treatment is used to reduce the long-term impact, find light duty work that can be performed while the worker heals and use a case management process get workers back to work as soon as is practical.

Are you still taking workers to the ER?

EREmergency rooms are for emergencies. A worker who experiences a life-threatening injury needs to go to the emergency room.  The problem is that too many companies consider the emergency room as their first option.  Research shows companies may not be getting their employees the right level of care and it carries a tremendous cost.

According to a study by the New England Healthcare Institute,  overuse of emergency room visits costs Americans  $38 billion a year.    The study found that more than 50 percent of all emergency room visits area avoidable.

When you look at workplace injuries, the number may be even higher.   According to Dr. Bradley Kenny, who specializes in occupational healthcare, “75 percent of all work-related injuries that go to the emergency room are non-emergencies.”

And there are indications that emergency room visits don’t offer advantages to workers.  A study by the American College of Emergency Physicians (ACEP) found that the median wait for patients was a shocking 4.5 hours.  That is four-and-a-half-hours for a worker to be in pain, frustrated and, ultimately, angry about their care.   So companies are wasting millions or even billions of dollars to almost guarantee that workers have a bad experience.

So what should companies do?   The two biggest solutions appear to be appropriate use of telemedicine to put workers on the phone with trained medical personnel who can do a preliminary assessment of the level of care that is necessary.  That was one of the findings of the New England Healthcare Institute study.   The second is to understand the capabilities of nearby occupational clinics.  It is important to work with staff who can provide the appropriate levels of treatment and also understand the nuances of the OSHA recordkeeping rules.

CORE Health Networks has built its integrated approach to occupational health around those two principals.  CORE has build relationships with more than 1300 clinics around the country to help serve clients anywhere their crews are working.  Through its Time-Zero intervention and case management, CORE puts RNs with experience in injury care, OSHA recordkeeping and workers comp laws into immediate communication with workers and supervisors to make sure they receive the right treatment at the right time.    The emergency room will still be there for emergencies, but there is no reason to use them unnecessarily.

For more information on CORE’s services email me at


Occupational Health – Knee ACL Reconstruction Has High Rate of Re-injury

Credit:  St. Louis Children's Hospital
Credit: St. Louis Children’s Hospital

The goals of a good workplace health management program are to make sure that workers are not assigned to job duties where the risk of injury is high and to make sure they have timely and proper treatment if there is an injury.

New research shows there is good statistical reason to take a close look at new employees who have had Anterior Cruciate Ligament Reconstruction (ACLR) surgery on a knee or at employees returning to work after that injury. A new study of soldiers in the British Army has just been released.    Apparently, prior to 2005,  ACL surgery was a cause for discharge or rejection, but after 2005, the Brits changed their recruitment policies to allow enlistees who had previously undergone ACL surgery.   As a followup, they wanted to find out whether those recruits went on to experience additional knee problems.   The study compared recruits who had ACL surgery with a control group who had not had the surgery (and we assume, had not had knee problems).  It found that “Sixty-one per cent of cases experienced complications linked to their previous surgery.”

Another, earlier study had looked at young athletes who had ACLR surgery.  It found that about 69% of them experienced a re-injury.

What does this mean to employers?  Well, first you need to recognize that military surgery and sports are likely to place special stress on knees.  Most jobs don’t create that kind of physical stress.   But some do.  There are two lessons here:

  1. It is important to understand job duties and make sure new hires or employees returning to work can perform those duties without risking additional injury.
  2. It is important to document pre-existing conditions or surgeries.   Depending on the severity and where the operation takes place, an ACL operation can cost $20,000-50,000.

If you want to learn more about the onboarding process as practiced by CORE Health Networks, contact me at


Worker injuries and mistrust: Why the first few minutes after an incident are so important.

taller de ilustracion digital - 212Near the end of his shift, a warehouse worker lifts a box while talking to a co-worker.  He’s distracted and doesn’t remember to lift with his legs.  He feels a twinge in his back and by 10 o’clock that night, the pain is so bad he can’t sleep.

Want to know one of the top factors that will determine how soon he is back on the job?   Whether he is afraid of losing his job.

The Workers Compensation Research Institute (WCRI) surveyed injured workers in 12 states.  It found that trust, or rather mistrust, of the company and fear of losing their jobs was strongly related to workers staying off the job longer.  In fact, the study found that “concerns about being fired were associated with a four-week increase in the average duration of disability.”  Workers who were afraid of being fired also were much more dissatisfied with the care they received and had more problems with access to care.

There is a very good recap of the study here in CFO Magazine.

Why is this important?  Time off the job is a cost to the company and shows up as OSHA recordables. Workers who don’t trust their employers may also be more likely to sue.  More importantly however, getting workers back to where they can earn a living is a priority.  Good companies understand the value of keeping a productive, engaged workforce.  A high level of distrust and workers feeling like the company doesn’t support them if they are injured can destroy a company culture.

What you can do about it.  The article gives a number of valuable tips.  On the front end, companies should engage workers in identifying hazards and avoiding them as a part of their overall safety program.   They should also plan ahead by identifying transitional jobs that allow workers to return to work without risking their recovery.

One of the biggest recommendations is something that is at the heart of CORE Health Network’s approach – Early intervention by trained professionals who can make sure that worker know they will be taken care of with appropriate, timely treatment.  Here is what the article on the study says:

Providing a 24/7 nurse triage program to speed treatment for injured employees so they get the care they need as soon as possible. The employee can contact the nurse triage line immediately after feeling a twinge of pain or sustaining an injury that doesn’t require emergency treatment. This service not only ensures the employee gets the right care immediately, it also cuts down on unnecessary visits to the physician when the employee can use such self-care treatments as ice, rest, elevation, or (over the counter Ibuprofen).

If you need more information on the early intervention offered by Core Health Network, contact us at

New OSHA Target: Midwest Manufacturers

OSHA has a new focus areaosha_logo_pub for targeted inspections – Manufacturing industries in Iowa, Kansas, Missouri, and Nebraska (OSHA Region 7).   The safety agency has what it calls regional emphasis programs that identify industries with injury and illness rates that are above national averages.

When OSHA adds an industry to its regional emphasis program, companies in that industry are more likely to receive inspections and those inspections tend to be much more detailed.  One of the main criteria OSHA uses in placing an industry on the emphasis program is its Days Away, Restricted or Transferred (DART) rate.  The national DART rate for private industry is 3.3.  The other criteria is what is called serious violation rate per inspection (SVPI).

Five Things Companies Should To to Prepare for OSHA

  1. Aggressive Occupational Health Management – Research has shown that one of the most cost-effective ways to reduce OSHA recordables, like DART, and lower workers comp costs is to help workers stay healthy.  That means strength and functional assessments on the front end to make sure workers aren’t assigned duties that exacerbate pre-existing conditions.  It also means that, if there is an incident, the company helps get workers the right treatment at the right time.  Many incidents are mis-characterized as OSHA recordables because the worker was not given the right level of treatment immediately after the incident occurs.   Lifeline Strategies is working with one of the leaders in integrated occupational health, CORE Health Networks.
  2. Safety Program Management – Start by looking at your overall safety and training, because that is the first thing OSHA will look at.   Many companies that think they have safety programs really just have a bunch of policies gathering dust on the shelf.   Make sure your program is up-to-date and addresses the actual risks that workers face on the job.
  3. Communicate and Train to Your Safety Program – Safety programs are useless if the workers who need to rely on them don’t understand them and follow them every day.  OSHA has realized that and is increasingly looking at management commitment and worker engagement on safety.
  4. Prep For OSHA Inspections – Some companies with great safety records can look very bad in an OSHA inspection if they don’t know what to expect.  Make sure safety professionals and management know what takes place during an OSHA inspection, what inspectors will want to see and management’s responsibilities under the law.  It may be worth holding a surprise inspection drill.
  5. Understand Changing OSHA Requirements – The rules on what needs to be reported, when and how to follow-up have changed and will change again in the next few months.  Companies that didn’t know about the changes or ignored them have been hit with thousands of dollars of fines.

If you need help with any of these recommendations, contact us at

According to its criteria, OSHA will target the following industries in those states:

For DART rates

  • food
  • nonmetallic mineral products
  • fabricated metal products
  • machinery
  • computer and electronic products
  • furniture and related products (337).

For SVPI data

  • beverage and tobacco products
  • wood products
  • printing and related support
  • primary metal
  • miscellaneous


Weird Workers Comp Claim: Shot at the Shooting Range

Law enforcement officers regular face dangerous situations, but Dalworthington Gardens Police Chief Bill Waybourn didn’t expect the shooting range to be one of them.  The chief was teaching a concealed handgun class when one of his students shot him in the hand.  Officials in the town of 2200 agreed that the shooting came in the line of duty and OK’d workers comp.  Although the class wasn’t officially a city-authorized function, town fathers decided it helped with public awareness.

That would have been the end of it, except that Waybourn is now running for sheriff and it has turned into a bit of a campaign issue.   The chief had made headlines by offering free classes to teachers after a school shooting and to military personnel after an attack on service personnel in Tennessee last year.   This time, though, the student was a doctor and the shooting occurred after the gun jammed.  In the campaign, there were questions whether the injury was truly work-related.

No word on whether the student got a failing grade, but we can only assume.



Oh, My Aching Back!

ferrari-1111580_1280Companies that want to hold down workers comp and other occupational health costs should take a hard look at how they are addressing back problems.   OSHA says one-in-five workplace injuries is are back-related.  It causes untold misery for employees and limits their on-the-job ability.  For employers it is a nightmare.  According to the Integrated Benefits Institute, low-back pain costs employers $51,400 annually per 100 employees in lost productivity and medical treatments.

What can employers do to reduce painful back injuries and the related costs in the workplace?  CORE Health Networks, a leading provider of integrated occupational health, practices a three-pronged approach:

  1. Make sure new hires are fit for their new job duties – CORE arranges and reviews simple exams or more involved functional assessments from more than 1300 occupational clinics to make sure new hires do not have congenital or existing conditions that could put them at risk for particular duties.
  2. Medical surveillance – Some of our most experienced, valuable workers are the most at risk because of the potential for injury in an aging workforce.  If an employee’s health or medical conditions change, CORE can review the change to help determine if they are fit for their current duties and what alternative duties may allow them to return to work without increasing the risk of injury.
  3. Post-incident intervention – The company provides a hotline to RNs with experience in injury care, workers comp and OSHA recordkeeping requirements.  Medical studies have shown that early intervention and ongoing communication with workers is effective in getting them the right care at the right time and allowing them to return to work sooner.  Under one study, early intervention was shown to reduce time away from the job for back injuries in half.

What else works?   Certainly it is important to train workers on proper techniques for lifting object.  It is more important to analyze whether there are alternatives to lifting those objects at all.  Some companies have even started stretching exercises with their workers and reporting surprisingly good result.

If you would like more information on back injuries and prevention techniques, OSHA has a good resource here. 

If you would like to learn more about CORE Health Networks, feel free to contact me at

Occupational Medicine: Right Care/Right Now

COREHEALTHlogoI am pleased to announce that I have taken on CORE Health Networks as a client.   If you are not familiar with CORE, it is one of the leading providers of integrated occupational medicine.

Maintaining a healthy workforce is one key to  managing bottom line costs and to ensuring both productivity and employee engagement.   Unfortunately, businesses that try to tackle management of worker occupational health on their own can find that it eats up their time and the potential savings.   A high level of expertise and administrative support that is required to handle:

  • Substance abuse testing, compliance and medical screening and other steps that may be involved in bringing on new employees,
  • Ongoing medical surveillance during a worker’s career, and
  • The potential for injury, OSHA recordables and worker’s comp expense if there is a workplace incident.

How important is it to have a handle on workplace health and injuries?  CORE did a case study of one client’s major projects.   More than 1500 employees were given functional assessment exams before they were cleared to work the project.   Some 17% were found to have existing conditions that could have resulted in injuries or health problems given the nature of the work.  In five of those cases, the employees were found to have serious medical conditions that required immediate attention and most had been unaware of their condition.  In the end, the test potentially saved the company an estimated $2.5 million.

What attracted me to CORE was its hands-on approach to employee occupational health and the medical recordkeeping that it requires.  Their approach includes:

  • Building a coast-to-coast network of 1300 clinics so that clients can find convenient locations, know that the right tests and paperwork will be in place and benefit from negotiated pricing.
  • Hands-on management of medical clearances to get qualified workers on the job as efficiently as possible.
  • In the event of an incident, an employee or supervisor can be on the phone immediately with an RN with experience in patient care, OSHA recordkeeping and local Workers Comp laws.  This early intervention and follow-up case management means employees get the right care at the right time.
  • Maintaining an electronic medical records system to meet HPAA requirements and store records for OSHA’s mandatory 30-year period.

Please contact me if you want more information at