Characteristic #1: Attitude

Van quotes an old saying; “There is very little difference between people, but that little difference can make a big difference. The little difference is attitude, and the big difference is whether it is positive or negative”. He emphasizes that an adjustor with a positive attitude will have increased job satisfaction and decreased stress.

How does Athens measure up?
Athens was voted one of the 125 best places to work in the Bay Area (determined by employee survey). We believe this is a direct result of the progressive and personally rewarding corporate culture we have developed over the past 30+ years. We promote healthy lifestyles (physically and mentally), personal development and provide ongoing positive reinforcement to all of our Athens team members. Our retention rate is 95% – unique (and unheard of) in the claims industry.

Characteristic #2: Time Management

The author concedes that in the claims business the work is never done. However, he says good claims professionals will not ask themselves how to handle more work, but rather what they are doing to cause more work, and how they can eliminate it. He offers the example of the “Voicemail Calculator”: if an adjustor allows 100 calls to go into voicemail in a week, he or she is actually creating 308 calls because of the required return calls and messages that have to be left again on both sides.

How does Athens measure up?
Athens promotes (and gently enforces) our “ANSWER THE RING” campaign, encouraging adjustors to answer calls as they come in whenever possible.

Characteristic #3: Interpersonal Skills

Author Van encourages gaining cooperation through use of the carrot rather than the stick. He advises avoiding the “Claims Hammer” (negative reinforcement) in favor of the word “help” (positive reinforcement). He provides a great example of what not to say: “If you don’t complete this paperwork, I cannot pay you.” Instead, he suggests: “If you fill out this paperwork I can help you by making sure you get paid.”

How does Athens Measure up?
Athens has created an internal process, AthenShare, which provides a systematic and structured methodology for employees to share customer service tips with the entire organization. Tips are sent to an inbox and the most relevant and impactful are shared with the entire Athens team via our intranet. Employees are rewarded for providing useful tips that positively impact other team members ability to provide a superior customer service experience.

Characteristic #4: Continuing Education

The author emphasizes that a primary attribute of the “Awesome Adjustor” is their desire to seek out self-improvement resources and share them with others.

How does Athens Measure up?
We are committed to promoting self-improvement among our team members. toastmasters meetings in the office and we have a library of books available to the staff to check-out. We are also committed to providing the required claims continuing education for the staff and regularly bring in speakers to the office. At times we dedicate a full day to training the staff with both internal and external educators involved.

Characteristic #5: Empathy

Van instructs that the Awesome Adjustor will recognize that he or she is in the customer service business, not just the claims business.

How does Athens Measure up?
Customer service is our first priority at Athens. We call it AthensCare: The Human Element. It represents our commitment to delivering the highest level of service and support to all customers (both clients and injured workers). Upon receipt of a claim, a Care Card is sent out to the injured worker expressing our sympathy in regards to their injury and listing the contact information for their claims team. Our adjustors recognize that the claims process can be confusing and upsetting for injured workers, and they do everything possible to explain the process and offer their sympathy and support at every step of the claims process.

Characteristic #6: Desire for Excellence

Van defines the desire for excellence as a person embracing their responsibilities as important and worthwhile.

How does Athens Measure up?
We continually remind our adjustors how crucial their role is. Every Athens adjustor is responsible for an average of $9.5 million dollars in incurred value of claims. We communicate this to our Claims Team and encourage them to take ownership of their work.

Characteristic #7: Teamwork

Van asserts that teamwork is created when there is a shared understanding that helping others in the office will create rewards for both the individual who helps, the team member receiving the help and the organization as a whole.

How does Athens Measure up?
The Athens claims process integrates team goals that encourage and reward cooperation and collaboration. These include a “buddy system” in which adjustors are partnered with another adjustor to serve as back-up for one other. Team building exercises are held on a quarterly basis, reinforcing and proactively communicating the collaborative foundation on which our organizational success is built.

Characteristic #8: Initiative

Van states that an Awesome Adjustor will ask, “What steps did I take to get the answer before going to my boss?”

How does Athens Measure up?
Athens encourages, and rewards, initiative, creativity and versatility. Performance appraisals reward staff for demonstrating resourcefulness, thinking independently, streamlining processes, seeking additional challenges and generating new ideas. We actively seek team member suggestions via an internal email address through which employees can submit ideas for improvement in workflow and efficiency.

Striving for Claims Excellence

So how did your adjustor rank? The adjustor a crucial part of a successful claims program. Hiring and retaining the most talented, motivated staff should be a top goal for any claims administrator – Athens commitment to Awesome Adjustors is the foundation for our continued success.

Related Links

www.insuranceinstitute.com/shoppingcart.html
www.claimseducationconference.com/2012/

Workers’ Compensation Pharmacy Costs

In a report issued by NCCI report August of 2011, it noted that up through 2009, the average medical cost on a medical only claim was $6000. For a lost time claim, it averaged around $25,000 with about 19% of those costs being tied to prescriptions drugs. While 19% is significant, it does appear that an employer can potentially manage these costs by aggressively handling and resolving their workers’ compensation claims in a proactive manner. We say this since the study showed that prescription costs within the first 1-2 years of the claim comprised only 3% of the total medical costs, but when the claim remained opened for more than 11 years, the costs tied to prescriptions jumped to 40%! You can view the full report here – Workers’ Compensation Prescription Drug Study: 2011 Update (PDF)

The Cost of Medical Services

NCCI also issued a report in November of 2011 which highlighted the cost-drivers of certain medical services on a workers’ compensation program. Nine areas were evaluated in their report and found that that the two highest categories were:

1. Surgery and Anesthesia
2. Prescriptions

These two categories, on lost time claims, accounted for almost 40% of medical costs. Many more significant details are noted in the report (PDF), and knowing what these cost-drivers are may help you re-evaluate what your focus will be for your 2012 managed care program.

 2011 WCIRB Report

In a very detailed report issued by the WCIRB, it was noted that claim frequency appears to be fairly consistent with the reporting levels of 2010 for the first 9 months of 2011. It also anticipates that the average cost of a 2010 indemnity claim will be approximately $65,000, which is about 40% more since the full implementation of the 2005 California workers’ compensation reforms. Of this $65,000, approximately $42,250 or 65% represents medical costs. Click HERE to view the summary reports provided by the WCIRB.

Legislative Review for 2011 – California

• AB 221 – Vetoed by the Governor and would have established a $6,000 voucher to cover retraining of an injured worker
• AB 378 – Signed on October 7th and helps lower costs by establishing guidelines for dispensing compound drugs and removes the incentives for physicians to refer patients to pharmacies where the physician has a financial interest for the referral
•  AB 397 – Requires a contractor claiming workers’ compensation exemptions to recertify their status or supply proof of insurance whenever they renew their licenses.
•  AB 584 – Also vetoed by the Governor and required Utilization Review physicians to be licensed in California.
• AB 947 – Vetoed by the Governor in October, this will would have increased the exposure for TTD benefits for California employers from 104 weeks to 240 weeks.

Other Changes for 2012

• California Office of Self Insurance Plans changes the methodology for audits
• California Temporary Disability Weekly Rate – Maximum TTD rate increases to $1010.50 and the minimum rate to $151.57
• The mileage rate for travel on or after 1/1/12 will continue to be $.55 per mile.
• Pure premium rate increase will be just over 30%.

 Related Links

 http://www.athensadmin.com

 http://www.scripnet.com/

http://www.professionaldynamics.com/ 

http://www.medexhco.com/ 

Workplace culture (the values, beliefs, attitudes and behaviors collectively shared by employees) can have a very real and powerful impact on the entire work environment. As a result, culture has a major effect on a company’s workers’ compensation experience and costs. By creating a culture focused on safety, wellness and compassion, a company can realize enormous cost savings.

A Culture of Safety

Safety programs can have a huge impact on workers’ compensation costs. According to a 2001 Liberty Mutual Insurance Company study, 61% of executives say that $3 or more is saved for every $1 invested in workplace safety.

Simple awareness of a defined safety program can markedly improve employees’ safety behavior. This phenomenon is known as the Hawthorne Effect, named for the study done by Hawthorne Works to gauge if productivity would increase in higher or lower levels of light. Surprisingly, the researchers found that workers’ productivity increased while the study was being conducted, and then slumped after the study was completed. Why? Simply because of the increased awareness on the part of employees while the study was being conducted.

According to the Department of Labor, an effective safety and health program will include:

• A clear safety policy with visible top management involvement
• Regular training for employees on how to eliminate or avoid hazards
• Employee buy-in through safety committees
• Employee participation in the assessment of  losses and job hazard analysis
• Employee accountability and reward linked to consequences for unsafe behaviors
• Proactive motivation through public, positive recognition of safe behaviors

A Culture of Wellness

According to a 2003 article in the American Journal of Health Promotion, employers can achieve a 30.1% savings in their workers’ compensation costs through workplace health promotion programs.

Such programs can take many forms, including:

• Health fairs
• Health screenings
• Healthy lifestyle coaching
• Promotion of work-life balance

Substance abuse programs should also be a key component of a company’s wellness program. Drug and alcohol abuse in the workplace causes decreased productivity and increased accidents, and its more prevalent than we think. A national survey conducted by the Hazelden Foundation found that more than 60% of adults know people who have gone to work under the influence of drugs or alcohol. The Department of Labor reports that drug-using employees are 3.6 times more likely to be involved in a workplace accident and 5 times more likely to file a workers’ compensation claim. (http://www.dol.gov/elaws/asp/drugfree/benefits.htm)

One area that should receive special attention in any Workplace Wellness Program is weight management. A John Hopkins University Medical Center study of 8 aluminum plants, found that 85% of those injured on the job were overweight or obese. A Duke University study showed that obese employees have twice the number of claims per 100 employees as non-obese employees, and lose 13 times as many work days. Indemnity costs are 11 times higher and medical costs are 7 times higher on those claims. (http://www.dukehealth.org/health_library/news/10044)

A Culture of Compassion

A positive workplace climate is key to healthy employee morale. Poor morale can manifest in many ways that negatively impact the workplace and employee productivity:

• Abuse of leave accruals
• Accidents
• Illnesses
• Litigation
• Workers’ compensation claims.

Out of frustration with high workers’ compensation costs, many managers take the view that all claims are fraudulent. This mindset can create an adversarial relationship between management and employees, leading to mistrust and the proverbial “self-fulfilling prophecy” of additional workers’ compensation claims being filed.

Our experience has shown it to be much more effective to teach managers to do performance management effectively while proactively building relationships with employees. This effort results in reduced litigation, reduced lost time from work, fewer workers’ compensation claims and faster resolution of claims that do occur.

In the book The Enthusiastic Employee: How Companies Profit by Giving Workers What They Want, David Sirota describes the three basic goals of workers as:

• Equity (being treated fairly)
• A sense of achievement (being proud of what one does)
• Camaraderie (being a part of a team)

A Company that fosters this type of environment will see an improvement in both employee morale and in the financial bottom line.

Athens Administrators – A Key Partner in Creating Workplace Wellness Programs

How can we help? Athens Administrators provides clients with comprehensive stewardship reports that help employers effectively manage and monitor their work environments.

• Provide detailed information about the causes, frequency and severity of losses
• Analyze and track trends
• Facilitate collaboration on strategic initiatives for improvement
• Benchmark against industry best practices and information
• Deliver accountability that we are performing as we promised to

Athens employs industry leading professional and personable claim staff professionals that consistently deliver:

• Prompt and meaningful communication with injured workers
• Care cards to every injured worker at the time of injury to reduce litigation
• Payment of  benefits in an appropriate and timely manner
• Thorough explanations of the workers’ compensation process to the injured workers

Related Links

Department of Labor Safety and Health Programs

The American Society of Safety Engineers

Article on how to start a wellness program

How to Boost Employee Morale on a Budget

• Unlike workers’ compensation, which is a no-fault system, in the civil arena the employer or insurer must show that the third party was at fault in order to recover claim costs.
• If the employer’s negligence is determined to be a causal factor, their rights to recovery will be reduced proportionately.

Recognizing Subrogation Potential

Generally there are three types of claims that could be caused by a third party:

• The action or inaction of a third party (e.g., a motor vehicle accident)
• Claims that occur on property owned by a third party (e.g., slip and fall claims)
• Claims involving machinery or equipment that is owned or maintained by a third party

Investigating Subrogation Claims

In such cases, it is critical that a thorough investigation is performed quickly in order to preserve evidence and protect the interests of the employer or insurer. Appropriate forms of investigation depend on the type of claim. They include:

• Reports – Police, CHP, OSHA, Index, et al.
• Photographs and surveillance tapes
• Environmental studies
• Product information, warranties, repair records, instruction manuals, invoices, shipping orders, maintenance logs, training records, etc.
• Witness statements and depositions
• Leases and rental agreements
• Insurance policies and indemnification agreements

Subrogation Filings

There are three ways to protect the employer’s or insurer’s subrogation interests:

• Complaint in Intervention – Employer can become a party to a civil case already filed by the injured worker
• Complaint – Primarily used when the injured worker does not file a civil complaint
• Notice of Lien – Offers the least amount of protection as the injured worker may settle without the lien claimant

Reimbursement vs. Credit

The workers’ compensation claim and a related civil action do not typically follow the same timeline. Often, the workers’ compensation claim will take longer, and may be resolved when the civil case settles.

The workers’ compensation benefits paid at the time of the civil settlement represent the employer’s claim for reimbursement. The benefits that will be paid in the future represent the employer’s potential credit. There is a strategy in asserting and settling the employer’s claim for credit that will depend on the strength of the case and the percentage of comparative negligence.

Subrogation Recoveries Directly Impact the Bottom Line

A strong workers’ compensation program ensures subrogation is not an afterthought. Claims adjusters should be actively trained, and possess the skills, to properly handle subrogation. Investigations must be thorough, going beyond determining compensability of the workers’ compensation claim. Adjusters need to quickly recognize third party negligence at the front end of a claim, aggressively pursuing recovery throughout the claim. Failure to identify potential subrogation is a missed opportunity to recover claims costs that directly impact the bottom line, and could represent millions of dollars in saving.

Related Links

National Association of Subrogation Professionals
California Workers’ Compensation Institute
California Division of Workers’ Compensation
Workers’ Compensation Insurance Rating Bureau of California

Legitimate psychiatric stress claims do exist. However, many employers find themselves faced with employee claims of mental stress that do not qualify as compensable under workers’ compensation law.

Situations that lead to questionable stress claim filings include:

• Angry employees
• Low employee morale
• Poorly performing employees on formal disciplinary plans
• Employees with attendance issues

Defending Against Stress Claims

The first step to take when a psychiatric claim is filed: conduct a thorough factual and medical based investigation of the claim.

If the investigation determines the claim has been filed following disciplinary action, the Good Faith Personnel Action Defense (GFPAD) can be argued. In order for the GFPAD to be effective, the following must occur:

• Timely identification of circumstances
• Well documented personnel actions
• Evidence of strict adherence to proper personnel procedures will be critical for success

Successfully Utilizing the Good-Faith Personnel Action Defense

The GFPAD is detailed in Labor Code §3208.1(h). A good-faith personnel action exists when a regular and routine employment decision is carried out in a reasonable manner with no hint of improper methodology. To be successful in baring a psychiatric claim based on this defense, an employer must demonstrate that the “substantial cause” of the injury was a good faith personnel action. Substantial cause is defined as 35% to 40% of the injury.

To mount a successful defense, the employer and claims administrator must conduct the investigation with the realization that if the claim were to go to trial, the judge will utilize a multi-level analysis mandated by the en banc decision in Rolda v. Pitney Bowes. The judge’s analysis will involve four steps to determine:

• Whether the psychiatric injury involved actual events of employment (factual-legal determination).
• Whether the medical evidence establishes that the events of employment was the predominant cause (greater than 50%) of the injury.
• Whether the actual employment events were personnel actions that were lawful, non-discriminatory and made in good faith.
• Whether the good faith personnel actions were a substantial cause (35% – 40%) of the injury.

In order for a successful GFPAD defense, it is imperative that the claims administrator obtain personnel records, medical records, and statements or depositions from all parties and provide this information to the evaluating doctor in order to present a competent defense before the Workers’ Compensation Appeals Board.

Click on the link below for a recent example of a good faith personnel defense case:
County of Sacramento v. Workers’ Compensation Appeals Board (Michael Brooks) (2011)

Increasing the Chances for a Positive Stress Claim Outcome

Defending stress claims can be extremely challenging for employers. By understanding the process and having solid personnel performance documentation and procedures in place within your organization, the potential for a positive claims defense outcome will be greatly enhanced. It is also critical to provide your claims administrator with as much information as possible, and to maintain constant communication with them regarding the investigative process.

What does Auto Liability cover?

The liability portion of a business auto policy covers all damages that a business becomes legally obligated to pay as a result of bodily injury or property damage caused by a covered vehicle, up to the policy limits. When there is an auto liability lawsuit against the insured business, where the loss is covered by the policy, the insurer is obligated to defend the business or settle the lawsuit. The decision whether to contest or settle the case is entirely at the insurer’s discretion.

How much Auto Liability coverage is needed?

Many insurers recommend a business auto coverage limit of $1,000,000, with $500,000 as the minimum. Considering the amount of additional protection that the higher limit it provides you and your business, the higher limit is generally a wise investment.

Does Auto Liability cover employees who use company vehicles for personal business?

It is not uncommon for businesses to allow employees to utilize company vehicles for personal purposes. As long as these vehicles are scheduled on your business auto policy and the appropriate “coverage auto symbols” are shown on the policy page, you have coverage for business owned autos taken home by employees.

Employees’ own personal auto policies will usually not cover their use of a company car unless the car has been specifically borrowed as a temporary replacement for the employee’s own car while it is unavailable.

What vehicles are covered?

The scope of coverage in the business auto policy varies. In general, you have three options for which vehicles you choose to cover:

1. Autos your business owns.
2. All autos your business owns, hires or leases.
3. All autos used for the business, including those that your business does not own, hire or lease.

Generally, businesses purchase the third type, since it is the only coverage that protects the business from liability in almost all circumstances, even when an employee or owner is driving a personal vehicle on business.

What names need to be on the Auto policy?

An insurance contract usually requires that the owner of a vehicle be named in the policy “Declarations” as the “named insured.” If you drive any of the same vehicles for business and pleasure, make sure you tell your agent who holds the vehicle’s title, you personally or your company. This will avoid problems if you need to file a claim or a claim is filed against you.

What happens when I have a claim? Athens can help:

It’s imperative to have the best possible partner to handle your claims when they occur. Fast, effective, and fair are just some of the important factors to consider when managing the exposure or liabilities to your organization.

Before a claim

• Our experienced claim examiners can answer informational questions on what auto policy language means and what coverage will respond to special claims situations.
• Athens can help by consulting with the employer and/or your broker on the best practices for employees that drive business vehicles.
• Provide superior access to information for the policy holders.

During the claim

• Continue to communicate to all affected parties.
• Be reachable and responsible during the process so that there is no mystery.

After the claim

• Be proactive to get the claim investigated, evaluated and resolved as soon as possible to end any exposure to your business.
• We strive to educate our insureds throughout the claim process, so their businesses benefit from experience of a claim.

Related Links

Business Automobile Policy
Commercial Automobile
Trucking Statistics

Athens Administrators is extremely proud and gratified to have been voted one the Best Places to Work in the Bay Area by the San Francisco Business Times for the third consecutive year. Athens was ranked the 12th best place to work in the 2011 mid-size business category (100-500 employees), our highest ranking to date. In 2010 we ranked 19th and in 2009 we were 36th.

Athens continued recognition, as a “Best Place to Work” in the San Francisco Bay Area, is an important by-product of our ongoing commitment to the personal and professional well being of our employees. Our business success is based upon cultivating and maintaining a supportive environment for employees to grow and succeed. This commitment to our employees is the foundation of Athens’ ability to deliver superior service and results for our clients. Simply put, taking care of our employees enables us to take care of our clients.

Recognition as one of “the best” in the extremely dynamic, competitive Bay Area business region is truly meaningful. As we look forward to continued growth and future success, Athens is committed to providing a respectful, fulfilling and rewarding place to work for all of our valued team members. This ongoing dedication will ensure our place on the leading edge of our industry.

About the Best Places to Work Survey

This year 301 companies, located in 12 Northern California counties competed for 125 spots on the Best Places to Work list. Our position was based on the anonymous surveys that were distributed to 100% of our staff. The survey focused on locating the companies that were ranked the highest by their employees based on internal policies, culture, compensation and general business practices.

Our Values: The Key Beliefs That Drive Us

Our inclusion on the 2011 Best Places to Work list is a direct reflection of the values at the heart of Athens Administrators. These beliefs drive us to both deliver world-class service to our clients and maintain a great place to work for every Athens team member. learn more »

Results Matter
Deliver superior results for every client.

Customers Count
Customers are people, not just accounts, we solve their problems.

Always Excellent
The highest level of service at all levels, all the time.

Knowledge is Power
Continual learning, curiosity and a desire to know more.

Lead, Don’t Follow
Commitment to technological innovation and thought leadership.

Our People Are The Business
The commitment of the people in our company drives our success.

Genuine Involvement
Make a positive impact on our industry, employees and community.

Related Links

San Francisco Times
Join The Athens Team

According to a recent study completed by the California Commission on Health and Safety and Workers’ Compensation (CHSWC), liens are one of the largest cost drivers in California workers’ compensation system. California employers and insurers are spending roughly $200 million per year on loss adjustment expense to handle medical lien claims.

Liens are also bogging down the courts. According to the CHSWC report, liens consume about 35% of the court’s calendar. Over 450,000 liens are expected to be filed in 2011. Since files cannot be settled via Compromise and Release until all liens are adjusted, this situation prolongs the settlement process and keeps files open. The result? Dollars stay on the books, claims remain open, and timely, efficient, cost-effective resolution is compromised.

Why Are Liens Filed?

• One-third of medical liens involve disputes over the application of the Official Medical Fee Schedule (according to CHSWC).
• A claim has been denied but the provider continues to provide treatment on a lien basis, attempting to collect a portion of the charges.
• The provider is not authorized to provide treatment (not in the Medical Provider Network) and bills are disputed as a result.
• Treatment is provided despite utilization review deeming it non-certified.
• The body part receiving treatment is contested.

What Is Being Done About It?

• In 2010 the WCAB held “lien fiestas” in order to attempt to resolve large numbers of liens at once.
• CHSWC made several lien-related recommendations, including:
  • Reinstatement of the $100 filing fee on medical liens to discourage frivolous claims.
  • Adoption of a more explicit fee schedule.
  • Enactment of a statute of limitations of 18 months from the date of service.

How Can Athens Help?

In-House Bill Review:
Athens employs experts in the Official Medical Fee Schedule and has access to all current updates. Because Bill Reviewers are on-site at Athens, the claims staff can collaborate with them in order to effectively resolve liens. Bill Review professionals may also serve as trial witnesses if required.

Medical Provider Network:
Athens MPN, administered by MedEx, affords our clients a strong defense on the issue of providers not authorized to treat. This allows us to object to treatment rendered outside of the provider network and successfully dispute any liens that may result.

Utilization Review:
Athens has a proven utilization review process in place through our partner, Professional Dynamics, to assess whether treatment is appropriate. A utilization review decision is a robust defense against a lien for treatment not appropriate under the relevant guidelines.

Seasoned, well-trained and incentivized claims professionals:
Athens Senior Claims Examiners receive on-going continuation education, including lien resolution instruction. We also have several programs in place which reward the staff for resolving and closing claims quickly and efficiently.

Related Links

California Commission on Health and Safety in Workers’ Compensation Lien Report 2011:
Click here to download

Today is the perfect time to assess your workers’ compensation program – What is working? What is not? What would an ideal program look like? Most likely, several thoughts quickly came to mind. Following is a list of challenges we have found that workers’ compensation program managers often encounter, along with potential solutions.

2011 is the year to explore alternatives, make informed decisions about your workers’ compensation program, and become a hero within your organization!

Challenge

“I’m tired of the constant staff turnover at my current TPA. It is detrimental to the momentum towards resolution of our claims. Plus, I don’t even know who my contact person is anymore.”

Solution:

Athens Administrators is a TPA that understands the importance of examiner continuity on a claim file. During 2010 our staff retention rates were greater than 95%. We are also regularly recognized as a “Best Place to Work” in the industry. At Athens you will have a designated team that will be involved with your program for the long haul. www.athensadmin.com

Challenge

“I have a handful of claims where prescription drug costs are out of control. This year I am going to do something about it.”

Solution(s):

Professional Dynamics, Inc. (PDI) offers a unique and successful chemical dependency program that is designed to impact those cases that show patterns of chronic or emerging pain medication usage and dependencies. http://www.professionaldynamics.com/chemical-dependency.aspx

ScripNet offers an industry leading Pharmacy Benefit Management (PBM) program. Their program has proven to deliver cost savings and improved pharmacy related results for many years. Upon implementation (PBM) programs can deliver immediate positive relief for a program. http://www.scripnet.com/services/

Challenge

“I don’t love the occupational health clinic that my company is using. They are not conveniently located and their results have been sub-par for my employees and for my company.”

Solution:

Kaiser on the Job (KOJ) provides exceptional Occupational Health Services. They have over (50) locations throughout California. Also, over time their approach has proven to produce significantly better than average results from a cost perspective. If you have not explored (KOJ) recently, now is the time:
https://businessnet.kp.org/health/plans/ca/plans/otherproducts/occupationalhealth

Challenge

“I’m not happy with the network of physicians that our employees have access to through our MPN. There must be a better solution and I’m going to find it this year.”

Solution:

Medex offers a unique Medical Provider Network (MPN). The number of participating physicians is limited. All participating providers have been nominated by employers and/or their professional claim administrators. The MEDEX MPN network is based on providers who offer quality medical care and have the ability to write quality and ratable medical reports. This is a great MPN solution for the State of California. http://www.medexhco.com/serv_mpn.php

Conclusion

These examples represent a handful of potential challenges and solutions that employers throughout California may encounter within their workers’ compensation program. When assessing your program you may find it challenging to determine where to begin. Hopefully these scenarios will provide a basic framework for determining where to start your review and assessment process.

Athens Administrators is available to help navigate the assessment of your total workers’ compensation program. We can work with you to identify issues and implement solutions.

The benefits of this approach include:

1. Fresh, new perspectives and ideas
2. Questioning and the testing of the “status quo” of your program
3. Assistance with the development and plan for your workers’ compensation program
4. Overall cost savings

To discuss the assessment of your workers’ compensation program and to learn how we can increase efficiency while saving costs, please contact us at:

A brief recap of some of the important industry-related events in 2010:

Legislative Bills Approved in 2010

• AB 933 – Physicians who perform utilization review must be licensed in California
• AB 1696 – Continues payment of death benefits for children of certain public safety workers up to 19 years of age while still in high school
• AB 2253 – Extends the current cancer presumption for certain public safety workers up to
  10 years

Industry Newsworthy Events

• Continued implementation of the Division of Workers’ Compensation (DWC) 12-Point Plan
• Ongoing dispute over Governor Schwarzenegger’s furlough program that includes state employees working for the DWC
• In an effort to reduce the backlog of cases at the WCAB, the DWC expanded the use of its Electronic Adjudication Management System (EAMS)
• Los Angeles WCAB held “Lien Fiestas” in an effort to reduce the backlog of medical liens
• Debate over failure to amend the Permanent Disability Rating Schedule as required by 1/1/10
• New Posting Notices went into effect 10/8/10
  (http://www.athensadmin.com/athensnews/news/new-dwc-regulations/)
• California Supreme Court declined to review the Almaraz/Guzman II decision. The WCIRB estimates this will increase claim costs by 5.8%
• New Democratic governor elected – Jerry Brown

Benefit Rate Changes for 2011

• Temporary Disability Weekly Rate – No change due to a decline in the State Average Weekly Wage (SAWW) of .5%. The maximum TD rate will remain at $986.69 per week
• Cost of Living Adjustments (COLA) – No change
• Medical Mileage Reimbursement Rate – Increases $.50 per mile. New rate will be $.51 per mile
• Pure Premium Rates – No change

What’s Ahead for 2011

• Medicare Reporting begins 1/1/11
• Watch out for a new round of reform legislation that may drive up costs
• Expect changes and new dynamics in Sacramento with the arrival of the new governor