Employers Embrace Benefits of Telemedicine to Treat Work-Place Injuries

Author, Jeremy Hoolihan, Account Executive, Rancho Mesa Insurance Services, Inc.

Telemedicine is becoming prevalent in the workplace as a more efficient way to treat non-emergency type injuries. Employers, employees, and insurance companies alike are seeing the benefits of telemedicine from a convenience and efficiency standpoint. 

Telemedicine is defined as the practice of caring for patients remotely when the provider and patient are not physically present with each other. Modern technology has enabled doctors and nurses to consult patients by using HIPAA compliant audio and video conferencing tools.

Benefits of Telemedicine

• Immediate access to medical professionals is provided to injured employees and their supervisors; 24 hours a day, seven days a week. This often eliminates the need for scheduling and attending an in-person appointment and waiting room delays.

• The injured workers and supervisors avoid lost time from work driving to and from appointments.

• Employees who work remotely can quickly gain access to medical assistance.

• Minor injuries such as strains and sprains can respond favorably to appropriate on-site first aid. Often times, these types of injuries are referred to off-site clinics for care that is more expensive and more time consuming, but no more effective.

• Sound clinical decisions can be made about when first aid is appropriate and when referrals are necessary.

• When off-site referrals are necessary, doctors and nurses can direct the injured worker to pre-selected clinics within the insurance companies Medical Provider Network (MPN).

• Many telemedicine providers work directly with the employer’s insurance company to provide the first report of injury and create the claim in their system. This eliminates the need for policyholders to report the claim. This also ensures that claims are reported immediately and without delay.

• Telemedicine calls are typically recorded for future reference. The recordings are a useful tool in documenting the symptoms and injuries that are initially reported. 

How Telemedicine Works

When a workplace injury occurs and the employee requests medical treatment, a call will be placed to the predetermined telemedicine company. The triage nurse that answers will typically speak with the supervisor first, then privately with the injured employee. During the call, the nurse will provide an initial assessment of the injured worker, determine the seriousness, and evaluate the type of medical care that is appropriate. If further medical care is deemed necessary, the nurse will refer the injured employee to a certified occupational physician who can conduct a virtual appointment online via a computer, tablet, or smartphone. If the telemedicine company is not able to conduct a virtual appointment, the injured employee will be directed to a clinic within the MPN.

Once the assessment is complete, the nurse will provide a treatment plan. If the injured employee can safety return to work, the nurse will provide first aid/self-care instructions. Self-care instructions are typically accessed online or faxed. The nurse typically completes the call by speaking once again with the supervisor to ensure they are aware of the treatment plan.

Telemedicine is recognized by many as an efficient way of treating non-emergency injuries in the workplace. In fact, many insurance companies have recently partnered with telemedicine companies to help prevent a minor injury from becoming more complicated, and help the injured employee focus on returning to wellness.

If you would like to have a discussion about telemedicine and how it could be implemented into your workers’ compensation program, please feel free to reach out to me, Jeremy Hoolihan, at (619) 937-0174.

3 Benefits to Working with an Insurance Specialist vs. Generalist

Author, Jeremy Hoolihan, Account Executive, Rancho Mesa Insurance Services, Inc.

Most insurance agencies welcome any and all types of businesses, paying little attention to the type of business the prospect is running. These accommodating professionals will commit to quote virtually any person or business looking for insurance coverage. With this type of approach, inevitably the buyer will be working with a jack of all trades, but a master of none. Working at Rancho Mesa Insurance for nearly 16 years, I’ve learned the importance of focusing on a niche or vertical market, rather than attempting to write insurance for anything with a pulse. The two vertical markets I focus on are the janitorial and construction industries. Below are three reasons why I believe a business owner should consider working with a specialist rather than a generalist.

Avoid Gaps in Coverage:  

Having a trusted advisor that is a specialist in your industry can truly minimize potential gaps in coverage that otherwise might get overlooked by someone dabbling in your industry. Some examples include:

• Allowing an exclusion of coverage to a policy where the insured has exposure: Unfortunately I see this all too often when I audit a prospects policy. I once reviewed a residential general contractor’s (GC) insurance policy and found a subsidence exclusion. This posed a serious concern because the GC builds foundations. If they were ever served with a claim relating to a foundation sinking or failing, there would likely be no coverage. I’ve also seen residential GC’s who build new homes with a residential exclusion. It’s these types of errors that can put a business in tremendous jeopardy.    

• Missing key coverage’s to plug gaps in coverage: Most contractors are required to carry workers’ compensation and general liability insurances. However there are many exposures that a contractor has in their operations that would be excluded without additional coverage’s in place. One example is pollution liability. If a plumber installs a faucet that leaks over time, undetected, and causes mold or fungus to develop, you will likely run into a pollution liability claim for bodily injury and/or property damage. Most general liability policies have a pollution exclusion. Without the knowledge of placing a separate pollution liability policy in place, the plumbing contractor would be faced with a gap in coverage.

Knowledge of Specialty Coverage’s and Markets:    

Brokers who understand the operations and challenges faced by a particular vertical market have an opportunity to position themselves as risk management and coverage expert in that field. Specialization can also lead to specialty markets seeking brokers out to work with. Specialty markets seek brokers with expertise in their specific niche because they know the marketplace, and proper coverages can provide a steady flow of business. These relationships often lead to a much more comprehensive policy at an aggressive price. In addition, these programs include coverages that you would normally purchase individually that come standard to the program.

In the janitorial industry, one example is 3rd party crime coverage. Many of your standard market package policies will include 1st party crime coverage for employee theft. While this coverage is very important against an employee stealing from an employer, it does not cover theft of a client’s property from an employee. In order to cover this exposure, a policy needs to have 3rd party crime coverage.

Industry Specific Resources:

Partnering with a broker and agency, like Rancho Mesa Insurance, will also provide industry specific resources that generalist agencies will not. Below are a few examples of what you should expect when working with a specialist like Rancho Mesa.

• Industry Specific Workshops – such as OSHA 10 Certification, Mobility & Stretch, Heat Illness Prevention, Fleet Safety, Fighting Fraud in CA Workers’ Compensation, etc.

• Industry Specific Training Materials – extensive training library of over 3,000 titles in both online and in-person formats, available in English and Spanish

• A dedicated Workers’ Compensation Claims Advocate to aggressively work on a client’s existing claims.

• HR Benefits – rely on a team of HR experts who can quickly answer complex human resource and compliance questions over the phone or via email. 

• Comprehensive Living Employee Handbook – create and maintain your customizable employee handbook plus receive suggested updates when laws change.

• Client Services Advocacy – In house dedicated client services coordinator to assist with implementation of risk management services.

Rancho Mesa Insurance is dedicated to becoming a trusted advisor to their clients by providing a 365 day approach to Risk Management. Our laser focus on specific industries has allowed us to build comprehensive programs that our clients are able to benefit from. If anything in this article resonates with you, please feel free to reach out to Rancho Mesa Insurance at (619) 937-0164.

Promoting Safe Behaviors in the Workplace

Author, Jeremy Hoolihan, Account Executive, Rancho Mesa Insurance Services, Inc.

Safety awareness is one of the most important factors in reducing workplace injuries. There are approximately three million workplace injuries, every year. This amounts to roughly 8,000 injuries per day, 350 per hour, or 6 injuries per minute. Many of these injuries are preventable. Unsafe behaviors or decisions are usually the most common contributing factors. If employees are unaware of hazards or not motivated to follow safety protocol, their behavior will expose them even more.

Promoting safe behavior in the workplace can be one of the most impactful ways of reducing injuries. I encourage business owners to go above and beyond the required controls and measures such as engineering, administrative, and personal protective equipment (PPE) and promote safe behaviors and a safe work environment. Below are examples of ways ownership and management can promote safe behaviors.

• Conduct frequent safety meetings with employees and encourage participation. Discuss previous injuries or near misses with your employees to identify the root cause and any corrective actions that are necessary. Be aware that not all corrective actions are readily accepted by employees, especially those seasoned employees that are set in their ways. It is important to listen to their concerns, analyze and modify the procedure or task so that the employee will buy into the changes and not be tempted to break the rules and work unsafely.

• Give recognition to employees who are performing tasks safely and demonstrate proper behaviors. A little bit of recognition amongst your peers can be extremely influential and can further promote safety in the workplace.

• Involve the employees in identifying and correcting hazards in the workplace. This can promote self-worth in an employee. Your employees are your eyes and ears in the field and they may identify an overlooked workplace hazard. It is especially impactful when the corrective action was a hazard they identified on their own.  

• Perform safety observations to encourage safe behaviors. While supervisory observations are important, business owners should also consider peer to peer safety observations. By collaborating with employees and involving them in the safety program, it will help them buy into any changes that are necessary further promoting workplace safety. 

• Having ownership and management consistently express their concerns for their employees well-being and safety is another way to promote safe behaviors. As a business owner, communicating to your employees that your main concern is their safety can drastically change the culture of a business. Reminding your employees that you want them to go home safely each day, goes a long way.  

Promoting safe behaviors in the workplace starts with ownership and management, but is executed daily by the workforce. Providing sound policies and procedures relating to safety, along with a strong collaboration between ownership, management, and staff can drastically improve safety in the workplace and promote a safety culture.

Rancho Mesa Insurance Services, Inc. is a strong advocate for workplace safety. We like to take a risk management approach with our clients and prospects to develop a program that fits their needs. Please feel free to reach out to me, Jeremy Hoolihan, at (619) 937-0174 to see how Rancho Mesa can improve your risk profile.

Optimizing Risk Management While Reducing Gaps in Coverage

Author, Jeremy Hoolihan, Account Executive, Rancho Mesa Insurance Services, Inc.

Working within the construction unit at Rancho Mesa for over 15 years, I have developed strong long-term business relationships with my clients. As an insurance advisor, I have an obligation to insulate clients from exposures and liabilities. Many of which may remain the same from year to year. However, it is vital that business owners meet with their insurance advisor frequently, especially prior to an insurance renewal, to avoid potential gaps in coverage.  Below are a few key topics that should be reviewed on a regular basis by a company’s insurance advisor. 

Review and Discuss Business Operations

It’s always a good business practice to have the insurance advisor review the business’s operations to see if there have been any changes that could affect its risk profile.  For example, I once had a client in the construction industry that specialized in commercial tenant improvement work. The company wanted to start a residential construction division. By understanding this change before it actually took place it provided us the time to adequately access the differences in the insurance exposures between the commercial and residential marketplace.  As a result, we were able to proactively and affordably place their coverage with an insurance carrier that was comfortable with both exposures.

Review Financial Projections

With the economy fluctuating year to year, it is vital that you meet with your insurance advisor and go over your financial projections for the coming policy term.  These items should include projected; annual sales, payrolls, subcontract costs and any changes in your surety requirements. These factors will help in not only negotiating the most favorable renewal terms for you but help to avoid any unforeseen expenses like a large final audit

Discuss Business Assets

Businesses routinely buy, sell, and upgrade their tools, equipment, and vehicles. While most are conditioned to notify their insurance advisor of any changes, it is always a good business practice to review assets with the insurance advisor at each pre-renewal meeting. It is common that there are items that were either sold (that need to be removed) or new (that need to be added to policies). By reviewing the assets on a regular basis, it minimizes the chance that items are missed and you either are paying premium on an item you no longer have or have an uninsured loss.

Discuss and Revisit Recommended Coverages

Recommended coverages may include an Umbrella, Pollution Liability, Professional Liability, Employment Practices Liability, and Cyber Liability policies. Even if you have discussed these coverages in the past with your insurance advisor and have declined them, they should not assume you will do so again in the future. The business climate is constantly changing; therefore, so are the risks you are facing.  Understanding where you have gaps  in your risk management profile and making informed decisions to either transfer the risk to an insurance carrier (purchase insurance) or retain the risk yourself (don’t purchase insurance) is always a Best Practices standard.

If you would like to discuss and learn more about Rancho Mesa’s proprietary risk management tools and explore our help in developing a Risk Management program based on your specific business needs, you can reach out to me at 619-937-0174.

Six Reasons for Promptly Reporting a Workers’ Compensation Claim

Author, Jeremy Hoolihan, Account Executive, Rancho Mesa Insurance Services, Inc.

Reporting workers’ compensation claims in a timely manner can have a huge impact on the severity of the claim. Some policyholders believe the practice of not reporting employee injuries early is a good business practice. This could not be further from the truth. Below are six reasons why reporting claims early can reduce the overall impact of a claim on an employer’s insurance premiums:

1. Lowers the cost of a claim – The cost of a claim gets higher and higher for each day it is not reported. Claims reported after 30 days of the injury on average cost 30% more than those reported right away.

2. Ensures that key evidence is secured – The prompt reporting of a claim allows the claims adjuster to ensure key evidence is preserved. It also ensures that the supervisor’s accident report and witness statements are taken while things are still fresh in their minds.

3. Potential hazards are identified as early as possible – When an injury or near miss occurs, there should be an accident investigation completed to find out the root cause of the injury. Identifying the cause or potential hazard will reduce the likelihood of a similar claim from occurring in the future. It can also be useful as a training topic during safety-related meetings.

4. Could identify “red flags” for fraud – It is very important to understand that an insurance company only has 90 days from the employer’s (or their management or supervisors) date of knowledge to accept or deny a claim. If the claim is reported late, it leaves the adjuster little time to investigate the validity of a claim, which might force them to accept it. If the claim is reported 90 or more days after the date of knowledge, the adjuster has no choice but to accept the claim. The impact of a fraudulent claim can have a significant effect on future workers’ compensation pricing.

5. Reduces litigation – When an injury claim is not reported in a timely manner by the employer, it can make the injured employee feel neglected or disgruntled. Reporting the claim early, showing compassion towards the employee, and keeping the lines of communication open will significantly reduce the likelihood of a litigated claim. Employees need to feel they are going to be taken care of medically and still have a job at the company. Employees are more likely to hire an attorney when they feel uneasy about their job security or they are not receiving proper treatment. When a claim becomes litigated, it typically prolongs the time it takes to close the claim and increases the cost by an average of 30%.

6. Untreated medical only injuries could develop into indemnity claims – A small percentage of medical only claims can turn into indemnity claims as a result of unforeseen complications. For example, if an employee has a small metal shard stuck in their finger and chooses not to receive treatment, the finger could become infected, require surgery, and ultimately cause nerve damage. Had this injury been properly treated from the beginning, it likely would have simply been a first aid claim. Early treatment is key to minimizing indemnity claims.

Quickly reporting claims is simply one risk management strategy to controlling a business’s insurance costs. To discuss this strategy and others please feel free to contact Rancho Mesa Insurance at 619-937-0174.

Six Reasons a Company’s Experience Modification Could be Recalculated

Author, Jeremy Hoolihan, Account Executive, Rancho Mesa Insurance Services, Inc.

Workers’ Compensation costs continue to be one of the most costly expenses for business owners in California. With recent reform, California has maintained steady rate decreases in the workers’ compensation marketplace. Unfortunately, California still maintains some of the highest rates in the country, often times two to three times the nations average.

Controlling insurance costs is vital to staying profitable and often times, staying in business.  An important way business owners can control their insurance costs is by controlling their Experience Modification or X-MOD. An X-MOD is a benchmark of an individual employer against others in its industry, based on that employer's historical claim experience. This comparison is expressed as a percentage which is applied to an employer's workers' compensation premium.

The premium impact of a credit X-MOD (less than 1) vs a debit X-MOD (more than 1) can be significant. Business owners budget around their insurance costs. When there are unforeseen changes to their insurance costs it can have a dramatic effect. While it is rare, there are situations when an X-MOD can change in the middle of a policy term.  Below are six circumstances when this could happen:

1. If a claim that has been used in an X-MOD calculation is subsequently reported as closed mid policy term AND closed for less than 60% of the aggregate of the highest value, then the X-MOD is eligible for recalculation.  
2. In cases where loss values are included or excluded through mistake other than error of judgement. Basically, this rule takes into consideration the element of human error.
3. Where a claim is determined non-compensable. Meaning the injury was determined to be non-work related.
4. Where the insurance company has received a subrogation recovery or a portion of the claim cost is declared fraudulent.
5. Where a closed death claim has been compromised over the sole issue of applicability of the workers’ compensation laws of California.  Basically, if a person passes away at work but it was determined that the person had a pre-existing condition which caused the death, not work itself.
6. Where a claim has been determined to be a joint coverage claim.  This occurs mainly with cumulative trauma claims where there was no specific incident that caused an injury, but an injury that developed over time (i.e., wear and tear).

If any of the circumstances above have occurred, than a revised reporting shall be filed with the Workers’ Compensation Insurance Rating Bureau (WCIRB) and it shall be used to adjust the current and two immediately preceding experience ratings. 

If you would like to discuss this topic in further detail, and learn how Rancho Mesa Insurance can audit your X-MOD worksheet for potential recalculations, please contact us at (619) 937-0164. 

Simple Steps to Developing a Personal Protective Equipment Program

Author, Jeremy Hoolihan, Account Executive, Rancho Mesa Insurance Services, Inc.

In the workplace, employees can be exposed to potentially harmful hazards. Identifying these hazards and using precautionary measures such as personal protective equipment (PPE) can mean the difference between a safe jobsite and an injury.

PPE “is equipment worn to minimize exposure to a variety of hazards,” according to the Occupational Safety and Health Administration’s (OSHA) booklet on the subject. Examples of PPE include gloves, foot and eye protection, earplugs, hard hats, respirators and full body suites.

Implementing a PPE program can greatly reduce the chances of workplace injuries and increase a business’s productivity.

A PPE Program consists of three main components:

1. An assessment of the workplace hazards and procedures, and determining what PPE will be used to protect employees.
2. Employee training.
3. Documentation of hazard assessment and employee training.

Conducting a Hazard Assessment

The OSHA Personal Protective Equipment Standard (29 CFR 1910.132-138) requires that employers ensure appropriate PPE is “provided, used, and maintained in a sanitary and reliable condition whenever it is necessary” to protect workers from hazards. Employers are required to assess the workplace to determine if hazards that require the use of personal protective equipment are present or are likely to be present. The following information will aid in the hazard assessment process:

1. Develop a Hazard Assessment Checklist (a sample is available in the Risk Management Center) to identify exposures in the workplace that could injure a specific body part such as eyes, face, hand, arms, feet, legs, body, head, or hearing.  Once you have identified the potential exposures, include the required PPE to minimize or eliminate the exposure.
2. Conduct a walk-through survey of the workplace and complete the information on the Hazard Assessment Checklist. The purpose of the survey is to identify sources of hazards to workers such as chemical exposures, harmful dust, sharp objects, electrical hazards, etc.  
3. Select suitable PPE.  Should an employer determine that PPE is necessary, they are then required to ensure that it is available and used. It is not enough to select PPE and witness its use, however.  Employers must also make sure that the PPE is suitable for protection from the identified hazards, is properly fitted, and is not defective or damaged in any way.

Employee Training

Before doing work which requires PPE, employees must be trained to know the following:

1. When PPE is necessary.
2. The type of PPE that is necessary.
3. How the PPE is properly worn.
4. PPE's limitations.
5. How to properly care, maintain, and disposal of the PPE.

Written Verification of Hazard Assessments and Employee Training

Employers are responsible for ensuring that employees are trained in the use of PPE and must provide written certification to that effect. Employers must also certify in writing that the employees understand the training.  Also, in general, employers must provide required PPE at no cost to employees. 

A large majority of workplace injuries are preventable through the implementation of a PPE Program.  It is the employer’s responsibility to keep their employees adequately protected at all times. After all, it is certainly difficult to imagine a firefighter performing his or her duties without a helmet, boots, gloves and other necessary protective equipment.

Rancho Mesa Insurance Services has expertise in risk management for the construction industry.  We can provide you with assistance in developing a PPE Program, as well as other risk management and insurance needs. Please contact me with any questions at (619) 937-0174 or jhoolihan@ranchomesa.com.
 

5 Steps to Avoiding Workers’ Compensation Claim Litigation

Author, Jeremy Hoolihan, CRIS, Janitorial Group Leader, Rancho Mesa Insurance Services, Inc.

Workers’ Compensation claims can cost a company time, money, employee productivity, and morale. Litigation is one of the most costly results of a workers’ compensation claim. Once an employee hires an attorney, the time and money it takes for the claim to close drastically increases.

There are several reasons why an employee will find the need to hire an attorney. Practicing a sound Risk Management Program can dramatically reduce the likelihood of litigation. Here are some ways you can prevent most workers’ compensation claims from ever reaching that point:

1. Acknowledge why employees hire attorneys. The employee/employer relationship is a critical factor in determining if a workers’ compensation claim results in litigation. Employees who feel threatened in some way are more likely to hire an attorney. A few key reasons are:
      a. The employee is concerned they will be fired because of the injury and/or ownership or management doesn’t truly feel the injury was work related.
      b. The employee feels they will face retaliation for reporting the claim.
      c. There is a lack of understanding of the workers’ compensation claim process. For those employees that are faced with a workers’ compensation injury, it can be a very stressful time.
      d. There is a fear the claim will be denied or they will be treated unfairly. Attorneys can prey on vulnerable injured employees. Radio and television ads imply injured employees need their assistance in order to get proper treatment and/or a huge settlement they deserve.
    
2. Keep lines of communication open with your employee. Reassure the employee that he or she will have a job when they are able to return to work. In addition, show some compassion and stay in regular contact with the individual. An employee is far more likely to hire an attorney if they are concerned about losing their job or no longer of value to the company.
    
3. Consider the ramifications before firing an injured employee. Termination of an employee after they have been injured on the job can put the company at risk of a lawsuit (Section 132 claim). In addition, terminating an injured worker could cost the company more in wage loss benefits; an injured employee will continue to draw from the workers’ compensation policy if they are unable to return to work, regardless if the company continues to employ them or not. Often, employees are released to modified duty (Return To Work Program). If an employer can accommodate the work restrictions, the employee’s temporary benefits are reduced or eliminated. This can significantly reduce the total cost of the claim.
    
4. Act before a problem employee becomes injured.  Once an injury has been reported, it becomes extremely risky to discipline or terminate a problem employee.  Address and deal with the employee immediately and be consistent with your documentation.
    
5. Train your supervisors!!!! It is vital that supervisors are trained in reporting and handling claims. They are your first line of defense in preventing claim litigation. Businesses should have a formalized Accident Investigation Program in place. Rancho Mesa provides a Supervisor’s Report of Accident or Near Miss form and a Witness’ Accident Statement form to assist in the investigation process.  In addition to all the formal documentation, there are other key strategies a supervisor can use: 
      a. Do not accuse the injured employee of fraud, even if you know fraud is involved. Supervisors should simply document the facts.  If there is suspicion of fraud, make sure you document any supporting evidence in the report and inform the adjuster.  
      b. Do not negotiate the injured worker’s treatment or return to work schedule.  Leave that determination to the claims adjuster.
      c. Keep in touch.  Instruct the supervisor to check on the injured worker from time to time.  Show some compassion and build trust. Assure the employee that their job is secure.

While there is no surefire way to eliminate litigated claims, by following these five steps you should see results.  With the average litigated claim costing 30% more than a non-litigated claim, the savings over time could be significant.  To discuss implementing this strategy within your company’s Risk Management Program, please contact Rancho Mesa Insurance Services, Inc. at (619) 937-0164.

Should Union Janitorial Employers have a lower Workers’ Compensation rate than Non-Union Employers?

Author Jeremy Hoolihan, CRIS, Janitorial Group Leader Rancho Mesa Insurance Services, Inc.

A recent study by the Commission on Health, Safety and Workers’ Compensation made an argument that the janitorial industry should be split into two workers’ compensation class codes.  This change would be similar to how many construction operations field class codes are separated between an over and under dollar amount per hourly wage.   As an example, an electrical contractor’s field wages are split at over and under $30/hour.  Why does this matter? It matters, because the workers’ compensation marketplace perceives the higher-wage-earner to be a safer risk (the thinking being - a higher-wage-earner is more experienced and less likely to sustain injury), thus, the workers' compensation premium rates are less for those in the “above” threshold category.  However, the BIG difference between this rationale and the study is that rather than basing the split rates on pay scale, the study proposes the split be between Union and Non-Union companies.

The study’s line of reasoning is that Union firms have fewer injuries and as a whole have a much lower loss ratio than Non-Union firms.  However, many industry experts disagree and believe that the figures are skewed and not representative of the true industry experience.  Clearly with the varying opinions and so much at stake, much more research and discussion needs to take place before anything is implemented.  

With that said, in order to remain relevant and competitive, all janitorial companies need to stay well informed and be prepared for any changes should they occur.  Rancho Mesa’s janitorial department will keep a close eye on any new developments and continue to help improve your company's risk profile, so you will be well informed and prepared for any changes.  If you have any questions please feel free to contact us