The ProblemThis paper covers many issues surrounding misdiagnosis in workers' compensation. It was written to start an industry-wide discussion on the issue. The ideal goal in workers’ compensation is to “provide the right care at the right time” to maximize recovery and return to work. Workers' compensation often deals with a range of injuries and conditions that can be difficult to diagnose accurately, especially early in the claim. The increasing use of…
This article was cowritten by Bill Zachry and Timothy Hui, PT, DPT. I. Restoring Function Quality physical therapy restores function and mobility, enabling a faster return to work and daily activities. Early intervention using physical therapy prevents long-term disability and chronic pain. Quality-focused physical therapy with patient engagement results in shorter disability durations, better mobility, and lower claims costs. Patients who do not adhere to their physical therapy regimen are more…
There are many different life situations facing parents. One of the most rewarding and challenging is the balancing act of raising children while meeting work responsibilities. The fundamental obligation of a parent is to make sure that their children obtain the necessary education to be successful in life. Children who are engaged and supported at school usually become successful adults. Many times employers ignorantly create work situations that do not…
Introduction Employers have a moral and legal obligation to support their employees who have parental and family obligations. One of the most emotionally challenging aspects of life is balancing caring for aging parents while meeting work responsibilities. Adult children feel the obligation to ensure their aging parents receive the necessary care to live comfortably and with dignity. Employers should recognize that caregiving obligations extend beyond those who are parents; sometimes,…
Introduction Font-line treating physicians need a good physical job description to target the patient’s recovery and return to work. Having a good physical job description also helps the doctor better understand the mechanics of injury to help improve the accuracy of diagnosis. A good physical job description helps the patient and the doctor agree on the recovery return to work goals. When the front-line clinics that treat injured workers do…
The workers’ compensation system is often seen as a fossilized benefit delivery system, with medical care provided by the lowest bidder, administered by Luddites, and adjusted by overwhelmed claims adjusters, all driven by ’attorneys' misplaced incentives. On the other hand, I see extraordinary people doing what they can to make the system work, focusing on what they can do to ensure injured workers are properly taken care of. An excellent…
Introduction Distractions in the workplace pose a significant challenge to risk managers focused on preventing accidents and ensuring safety. Distractions can be visual, manual, or cognitive, each type posing unique risks to individuals and organizations. This paper explores the nature of these distractions, provides real-world examples, and offers practical solutions to mitigate their impact. Types of Distractions Visual Distraction: Involves taking one's eyes off the task at hand. Manual Distraction:…
Defense attorneys have traditionally focused on individual claims management in workers' compensation, primarily centered around injury, compensability, permanent disability, and future medical care. However, with artificial intelligence and data analytics, there is an opportunity to refocus defense attorneys' role to address broader systemic issues and achieve improved claims outcomes, including injury prevention. Artificial Intelligence and Data Analytics Artificial intelligence and data analytics offer new opportunities to gather insights from deposition…
The workers’ compensation claims settlement philosophy has a significant financial impact on injured workers and their employers. In addition to the economic issues, the nature of the workers' compensation settlement with an injured worker can also significantly impact the worker's success in moving beyond the injury and productively returning to work. For the past four decades, employers have been subject to a de facto settlement philosophy without fully understanding all…
Uses of Claims Reserving The rating bureaus use case reserves to help determine the pricing of workers' compensation insurance. This calculation uses the case reserves on the claim files 18 months after the insurance policy's inception. Actuaries rely on claims reserves to help determine the projected ultimate cost of the claims. They calculate a reserve loss development factor applied to the cash reserves. Their calculations use industry trends, paid losses,…
