By Donna Motley, Vice President of Claims

I think, as an insurance company, we are automatically given a bad reputation. Most people, at one time or another over the course of years, have had an experience with their insurance carrier, either vehicle or home owners. I am no exception. I would agree with most people that when dealing with a home or auto insurance carrier, there is a huge emphasis placed on damages that equates with “money”. While it is the carrier’s responsibility to make the insured whole, the dollar and cents are watched closely. And I do realize there is a lot of fraud in auto and home owners insurance make this scrutiny necessary.

In Workers’ Compensation, our responsibility is to make the “injured worker” whole. With all the possible variables surrounding a work related injury, how do you place a dollar value on that? There is a book sometimes utilized in the Workers’ Compensation industry entitled “Official Disability Guidelines” – or the ODG. Easily accessible on the Internet, the ODG categorizes by injury and provides the average number of days away from work for that injury, the estimated Indemnity and Medical costs associated with that injury, billing procedure codes, best practices for a return to work (with or without surgery) and suggested restrictions for returning to work based on job duties of the injured worker. In a perfect world, right?

While interesting reading, we at MTMIC do not utilize the ODG. Similarly, medical (treatment) decisions are not based on the “cost” of a procedure. Yes, when a claim is established in our system we have to establish a dollar figure that should cover full treatment until the injured worker is recovered and returned to work. This “reserve” is medical based description of the injury, extent of the injury, taking in to consideration the age of the injured worker, possible co-morbidities and physical skills required to return to work. It is not the decision of the Claims Department for an employee to have a CT Scan vs. MRI – that is the decision of the treating physician. We can make suggestions and ask questions, ask for an explanation and decide to dispute the requested test, but the dispute is based on medical evidence and not dollars spent or to be spent. We do make sure testing or physical therapy is not being performed because “they can”. Before authorization is extended, there has to be a medical basis and is warranted.

I can’t tell you how many times injured workers have accused us of making a decision “just to save money”. Or that we only allow injured workers to treat with a “Workers’ Compensation” doctor. It is true that we will not allow treatment with certain doctors, our decisions are not based on money, they are based on medical outcomes. We handle a lot of claims in our office and are able to witness physicians’ results. We want the best doctor for the injury. No one benefits, physically or monetarily, if the treating physician is not skilled in their practice – not the employee, employer or insurance carrier.

Adjusters are human too! Among our Claims Department staff and family members, we have experienced broken bones, trigger finger, tendinitis and carpal tunnel syndrome. And who did we seek to treat – the same physicians that we utilize for our claimants. If we are personally satisfied with the physician’s results, why wouldn’t an injured worker be satisfied? We tend to utilize physicians that are no nonsense so maybe the injured worker just doesn’t like what the doctor has to say. We are not cold or heartless, our goal is to have the injured worker recover, while at the same time keeping an eye out for fraud!

By Donna Motley, Vice President of Claims

As your Workers’ Compensation carrier, we provide a service. Hopefully, part of that service is to make your job a little easier. In today’s world, everyone is busy. We can help take some tasks off your shoulders. After a work related injury, we can contact the doctor’s office or medical facility and provide the insurance and/or claim information. Any authorization to treat, refer for testing or to another physician, should be provided by our department pursuant to the Workers’ Compensation Act and Michigan Health Care Services Rules. We can contact the injured worker and relay necessary information; and answer the employee’s questions as to “how does this (the compensation process) work”?

In order for us to help “you”, we need you to help “us”. The first and best way to aid in the Workers’ Compensation process is to promptly report the injury to us. The second best way, is to make sure we have complete and detailed information. While I realize sometimes the Employer’s Basic Report of Injury (Form 100) has to be completed in haste, the more information provided, the least likely we are to call or e-mail you with questions or requests for additional information. Please realize, when detailing “how” an injury occurred, what may make perfect sense to you may raise additional questions in our minds. We are not necessarily familiar with your facility, the employee’s work duties, work process, the machines on site or how they operate.

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By Donna Motley, Vice President of Claims

OPIoIDs – Hydrocodone (Vicodin), Oxycodone (Oxycontin, Percocet, Norco), Tramadol (Ultram). Drugs used to control “chronic” pain. Drugs used post-surgery. Drugs used to control “any” pain. Drugs that can be highly addictive. Drugs that are talked about in the news on a regular basis in relation to an epidemic of addiction in our country. CNBC has reported that approximately 80% of global opioid supply is consumed in the United States. There is much discussion going on about how to control this situation with multiple entities stepping up to the plate to do their part.

The Michigan Workers’ Compensation Agency has made changes to the Statute and Health Care Services to address the situation and save costs in the process. And it’s working!
All medications dispensed in relation to a work related injury are to be filled in the generic form if a generic form is available.

The State of Michigan has instituted a prescription drug monitoring program called MAPS that tracks and monitors controlled substance dispensing. MAPS is utilized outside of the Workers’ Compensation arena as well. If a patient “loses” his prescription, or it is “stolen” – another order cannot be written or filled until the time has expired on the original prescription.

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SHA is not accepting electronic submissions of injury and illness logs at this time. According to their website, they are extending the July 1, 2017 date by which certain employers are required to electronically submit the information from their completed 2016 Form 300A. Updates will be posted to the following OSHA webpage when they are available.

https://www.osha.gov/injuryreporting/index.html

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By Donna Motley, Vice President of Claims

What is entailed in processing a Workers’ Compensation injury claim? Once the claim form is submitted and set up in our system, it is more than just processing and paying the medical bills. In most cases the injured worker is treating with the employer’s Occupational Clinic. It is the Claims Adjusters’ responsibility to assure the employee is receiving proper treatment, with the appropriate medical personnel; and if necessary, have treatment of the injured worker transferred to a physician specializing in said injury. Orthopedic physicians specialize – back, shoulder, knee, foot, elbow, hands, etc. A mucular condition would be referred to a Physiatrist.
We monitor each and every doctor appointment the employee attends. If an appointment is missed or rescheduled, we want to know why. We follow up for the necessary disability slip the injured is required to submit to their employer.

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By Donna Motley, Vice President of Claims

There are a lot of advantages to have your Workers’ Compensation insurance with MTMIC, but I want to point out a few that are “hidden” advantages.

As mentioned before, our Claims staff has extensive years of experience handling Workers’ Compensation claims. I would like to say we have “seen it all”, but every once in a while a situation will occur that is a “first”, even for us. Most of the Claims staff has extensive years of service AT MTM. For many, many years our core business focused on the manufacturing and tooling industry. And because of our company’s longevity in this industry, we have some insureds that have been with us since the early days. You might wonder, where is the advantage in that? Well, the first thing we do when a claim is received in our office, is check to see whether or not the injured worker is already in our claims system. If an employee incurred an injury between 1976 and 2017, and a claim was submitted, we have record of it in our system. We ask injured workers if they sustained any previous work injuries, and if they say no, but we find them in our system, that’s a red flag that may raise the question “what are they trying to hide”? We sometimes see patterns forming – say, an injury every hunting season. Or recurrent injury to the same body part which might mean the job site or process should be adjusted.

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By Donna Motley, Vice President of Claims

Does your employee know what to do if they sustain a work related injury? Whether your employee is a new hire or has worked at your facility for many years, the procedure is the same. All employees should be briefed upon hire of the steps to be taken should a work injury occur. Employees should be reminded periodically, no less than annually, of proper procedures or any changes in said procedures, should an injury occur. All employees, not just the injured person, play a part in work safety. All employees should be diligent in keeping the work environment clean; clean up or report oil spills, report unsafe practices, report faulty equipment and safety hazards. A co-worker may be a witness to an injury.

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Donna Motley, Vice President of Claims 

Owning and operating a business is multi-faceted. Having Workers’ Compensation insurance, required by law, is one of those many facets. Hopefully, most employers rarely have to utilize their Workers’ Compensation insurance. BUT, should an employee be injured in the course of employment, you, as the employer need to be prepared.

So how far does the employer’s responsibility reach? The employer is responsible for providing a safe working environment, for training employees in the proper way to perform their job, for proper machine and facility maintenance and for properly handling a work related injury, should one occur. An employee injury is costly in many ways. An injured employee is affected professionally and socially. The employer’s production and work product is affected. A work injury has a financial impact on everyone involved. The employer has a vested interest in making the employee be the best he/she can be, as the employer will reap the rewards.

Don’t ignore the signs. If a Supervisor walks past a work station and notices an employee stretching their back, rubbing their shoulder or playing “windmill” with their arms, that should be the employers first clue that something may not be right. Ignoring “signs” rarely benefits the employer. It is doubtful the situation will resolve itself or just “go away”. On the contrary, what usually happens is the employee will start treating with their primary care physician for the medical condition. Then when it starts to cost the employee a lot of money, or the condition does not resolve, or someone tells them they should file a Workers’ Compensation claim, the employee will bring the situation to the attention of the employer. By this time, treatment has been rendered and we would have to obtain all those medical records; suspicion overshadows the entire claim because it is being reported so late and after the employee has received treatment; and we will not allow treatment until the matter has been investigated. This delay in treatment will in turn delay the employee’s recovery and impact work product and production.

While we are not suggesting that a Supervisor “suggest” to an employee that the employee has a work injury, a simple “Is everything o.k.? I noticed you rubbing your shoulder” can go a long way. At that point the employee may admit that he has an injury that occurred outside of work (make note in the personnel file if that is the case); the employee may alert the employer to a machine set up or situation that could maybe be changed to be more ergonomic; and the employee may come away feeling their employer “cares”.

If the employee advises that something he did at work has caused an injury, the employee should be immediately sent to the clinic. Remember, it is not up to the employee to decide whether or not they “want” to go to the clinic if they have reported a work injury. Whether the employee alleges nothing is wrong, an injury occurred outside of work (i.e. they just slept wrong) or there was a work incident, the Supervisor should follow up with the employee later that day, the next day and the next week, and ask if everything is o.k. or if they are having any other issues. Again, ignoring these situations do not make them go away – instead, they tend to “fester”.

As an employer, you should review all employee injuries, your injury logs and/or loss runs to determine how many and what kind of injuries are occurring and where they occur. Then review to see if there are any changes that could be made so injuries do not continue. Your Loss Control Consultant can be a tremendous help in this regard. Remember, we are a team, all working toward the same goal – a safe and productive work environment! We all benefit!

By Donna Motley, Vice President of Claims

An injury occurs at your facility. The incident is reported through the proper channels – this could be a report to the immediate Supervisor, Plant Manager, Safety Director, or Human Resource Department. If immediate medical attention is required (i.e. blood is involved, a head injury, EMS needs to be called) the next step would be to make sure the injured employee receives the proper medical attention. Then, notify the MTMIC Claims Department of the incident – even if notification is without benefit of the Form 100 (Employer’s Basic Report of Injury). In an emergent situation, you may not know all the facts at that point in time, but should medical personnel contact our department for some sort of verification or authorization, we would at least be aware of the situation and able to take appropriate measures to manage the pending claim. Following said notification, the employer should then start their investigation as to the facts and circumstances surrounding the incident. If a serious injury has occurred, the Claims Department will also notify your MTMIC Loss Control Consultant, who will contact you and aid in an investigation and/or schedule to do an investigation on our behalf.

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By Donna Motley, Vice President of Claims

One of the distinct advantages to having your Workers’ Compensation insurance coverage with Manufacturing Technology Mutual Insurance Company is our collective years of experience. As you are aware, we are celebrating our 40th year in this industry. The Claims Department has more than 100 years of experience in adjusting workers’ compensation claims. And just about when we think we have seen everything, and we have seen A LOT, an incident will occur that may surprise even us. Our experience and longevity provide us with certain insights a novice in this business will not have. We also have extensive experience, based on our longevity, in the tooling industry which is not something other insurers can claim. One may think a back injury is simply a “back injury”. But there would be a world of difference in processing the back injury claim of a machinist as opposed to a school teacher.

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MIOSHA has reported 9 fatalities that have occurred in 2016 so far, 7 of them were from a “fall”. That would equate to approximately one fatality per month. I know we are a good sized state, but I think that is a high number, particularly in this day and age when we are so much more aware, informed and safety conscious.

MIOSHA reported 29 fatalities for the year 2015. That would equate to more than two per month. In looking at the statistics provided by MIOSHA, age does not appear to be a factor, nor does industry. Of the 29 cases reported, 7 cases involved the employee being “struck by” something, 11 cases involved the employee being “crushed” by something, 6 cases involved the employee “falling” and 3 cases involved inhalation and/or burns.

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By Megan Brown, Vice President of Sales & Marketing

Effective July 1st, all MTMIC customers will have the ability to submit the required Form 100 through the customer portal. Once all of the fields are completed and the submit button is clicked, the Claims Department receives an email notification that a claim has been submitted. Medical documentation, notes and bills will still need to be submitted as they are currently (via fax, email or mail). We anticipate that MTMIC will have the functionality in place to accept all associated claim paperwork through the portal by the beginning of Fall. If you are interested in submitting the Form 100 through the Portal or have questions, contact Patty Allen at patricia.allen@mtmic.com/blog or (248) 488-1172, ext 1010.

By Donna Motley, Vice President of Claims

The basic premise of Workers’ Compensation is simple – if an employee sustains an injury at work, medical treatment and when applicable, wage loss benefits, are paid. In exchange for that benefit, the injured worker gives up the right to “sue” the employer. Following are some facts you may not know:

Michigan is a “no fault” state. Translated, that means it does not matter whether or not an employee followed proper procedures, took a short cut or made an unwise decision – they would still be entitled to Workers’ Compensation benefits. However, if an employee had been trained and did not follow proper procedures, or took it upon themselves to take a short cut and an injury resulted, disciplinary action should be taken by the employer. If the same employee is repeatedly injured in the same manner, even after being disciplined for the initial act, we would have a basis on which to deny the claim.

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By Donna Motley, Vice President of Claims

What is meant by “late reporting”? Typically, we like to receive notice of injuries (via the Form 100 – Employers Basic Report of Injury) within a week of the occurrence. The earlier a report is submitted, the earlier we can set the claim up in our system. Then, if there are telephone calls regarding medical treatment, we will at least have the basic information. The “basic” information required to set up a claim is the employee’s name, address, social security number and date of birth. Obviously, we need to know the type of injury and body part involved. We also require the employee’s date of hire, occupation and the date the employer was notified of the injury. These are mandatory fields to obtain a claim number. You can submit an injury report without knowing the current medical status, treatment plan or whether or not the employee will be losing time from work. We can obtain that information once the claim has been established.

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