Simplifying Workers' Compensation System Involves Simple Concepts

Sarasota, FL (WorkersCompensation.com) – Here’s a thought: what if benefit notices were printed on a particular color of paper each year. Say this year’s would be on salmon colored paper, next year’s would be on light green and the following year would be on light blue.

“That way when anybody from the insurance company or the TPA walks in they can just glance, or the safety people within that organization can glance at the board and know whether that particular location is up to date on all the posting notices,” said William M. Zachry, board member of the California State Compensation Insurance Fund. “In some jurisdictions they want everything in a certain color, but generally speaking this is the kind of idea you can put out there that makes it easier for other people.”

Zachry, widely known in the workers’ compensation industry, has a number of ideas he believes would help simplify – and improve – the workers’ compensation system. He shared many of them  and discussed them with other industry experts during Simple Concepts For The Complex World Of Workers’ Compensation, the most recent Hot Seat webinar produced by the WorkersCompensation.com  

Simple Concepts

Simplifying the workers’ compensation system may sound like a mammoth undertaking. But there are a number of small steps people can apply to what they do on a daily basis that can go a long way toward un-complicating the system.

“There are a lot of little things,” Zachry said. “If you do things well on the front lines, on little things, it all adds up to big stuff. So it’s an opportunity.”

One such idea is getting detailed job descriptions into the hands of medical providers, especially physical therapists.

“It makes a huge difference,” said Beth Harkins, commissioner of the Mississippi Workers’ Compensation Commission and a former physical therapist. “There’s tremendous value in functional capacity evaluation (FCE), because whether it’s a back injury or a shoulder injury, having an accurate job description that accurately and thoroughly describes the type of work that the employee is doing, that makes a huge benefit. So not only in their treatment can you practice doing activities that are functional, that are similar to what they will be doing to return to work, also, having that information is key to knowing what it is that, ‘well sure, you can lift a weight, but can you actually put it on the shelf the same way you have to do it at work?’ That’s a huge component.”

Zachry related the story of a large male worker with a strained back who told his provider that he was a cement mixer. The physician kept him off work for several weeks, believing the worker would not be able to do his job with his continued strained back. When the employer asked why the worker was continuing to be out of work, he clarified to the physician that the employee’s work was not physically taxing because he actually mixed amalgam for dental fillings.

“I think that’s one of those simple ideas that is so important,” Zachry said. “You have to have that understanding, the doctor and the physical therapist, what the job is and work on getting the person back to that job.”

In addition to medical providers, claims examiners could also do their jobs more effectively with more information. Risk factors about the injured worker, for example, could go a long way to helping the employee.

“Obese injured workers, according to the Rating Bureau, according to the CWCI, according to the WCRI, are 20 percent more expensive in their claims. And yet doctors’ first reports in most jurisdictions do not tell you the height and weight of the injured worker. So you don’t know, as a claims examiner, that this person is more at risk because of their weight and height and needs more intervention and a different kind of treatment,” Zachry said. “The idea behind this is let’s get the right information in the right place at the right time so that the claims adjusters can appropriately intervene and help out when the person really needs help to recover.”

Changing Culture

Why such ‘simple’ concepts are not adopted has varying reasons. One is because they require a change in mindset.

“It seems like we are talking about culture change here,” said David Langham, deputy chief judge of Compensation Claims for the Florida Office of Judges of Compensation Claims at the Division of Administrative Hearings, and co-host of the Hot Seat series. “These ideas, as simple as they may be to implement, it seems to me one of our challenges is to maintain them past implementation and actually change the way we move forward. How do we go about that? Is there a way we can build this into culture at commissions, at companies, at carriers?”

Cultures can change if those involved have the financial incentives to do so. Demonstrating that a focus on returning the employee to function and work and minimizing disability through quality treatment, is one example.

“It’s amazing how, if you do the right things for the injured worker, how much less expensive it is,” Zachry said. “At Albertson’s we were able to take $100 million off our annual workers’ compensation budget by focusing in on return to work and focusing in on safety, vs. fighting everybody as if they were the enemy.”

The adversarial nature of the workers’ compensation system is a major obstacle to simplification, the speakers agreed. A culture in which employers and employees work together would go a long way to improving outcomes for all concerned.

“There’s an incorrect thought process where [employers think] ‘well, you’re not really hurt,’” Harkins said. “If you can change the culture to think ‘OK we’re working together; you’ve had an injury; we’re going to help you get access to medical care.’ The faster you can get access to medical care for treatment the faster you can, hopefully, return to work.”

Communication and education are key to improving the system, for both employees and employers. Both groups should understand the steps that will occur and their responsibilities. One of the biggest issues that can be addressed, for example, is fear.

“That’s an extraordinary piece,” Zachry said. “Fear of reinjury is one of the biggest barriers [to return-to-work].”

Employers’ fear of reinjury may prevent them from allowing the worker to return until he is fully recovered; while employees themselves fear getting reinjured.

“I’ve seen similar, where it’s not about fear of injury getting back to work, but I’ve had injured workers back in my practice days that were afraid to go to the physical therapist, to go back to the physical therapist because, quote, ‘she hurt me;’ ‘he hurt me,’ and ‘it’s not pleasant.’ Physical therapy is not pleasant,” Langham said. “Does that initial experience play into this?”

“Probably,” Harkins said. “There’s the old nickname that they’re ‘physical terrorists.’ I tell people when they start therapy it’s kind of like tangled hair. When you first start brushing out the knots it hurts, it’s tangled, and it’s caught in there. But once you keep combing through it gets smoother and easier and easier and easier. When you have an injury there’s a lot of things you’ve got to do in there for recovery, to regain range of motion and strength, and it may be uncomfortable but eventually it's going to get better.”

“What I hear you saying is setting expectations will help you with the outcomes,” Zachry said. “It’s amazing how that concept permeates through the entire comp system. In terms of, if you set expectations for return-to-work, they will return-to-work. If you set expectations for ‘you’re going to be uncomfortable – not in pain – uncomfortable when doing those last two inches to get the final range of motion,’ you set that expectation and they’ll go through it ... But if you don’t’ set the expectations it’s astonishing how that concept of setting expectations is so important for positive outcomes.”

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