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#24: Tackling Workers Comp
83 Plays6 years ago
In this episode, Chief Safety Officer and host of the show, Jill James, talks with Cassandra, a workers compensation claims consultant. Cassandra’s accidental path to the world of occupational safety began in college. Having trouble choosing a course of study and career, Cassandra eventually found herself working as a receptionist with a printer packaging company. That role soon presented an unexpected opportunity—an interview for the risk management position (she got it) that started her career in safety. Cassandra and Jill discuss workers comp in some detail, including experience modifiers, how to deal with the sometimes dishonest “11%”, and how different state laws affect working in this field.
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Transcript
Introduction to Episode
00:00:10
Speaker
This is the Accidental Safety Pro brought to you by Vivid Learning Systems and the Health and Safety Institute. Episode number 24. My name is Jill James, Vivid's Chief Safety Officer, and today I'm joined by Cassandra Rudy, a Workers' Compensation Claims Consultant in the insurance industry with over 17 years of experience.
Connecting Workers' Compensation and Safety
00:00:31
Speaker
Now, when we think about workers' compensation and the insurance industry, we might not make an immediate line to what does this have to do with the safety profession. But I assure you, it has a lot to do with the safety profession, and we're going to hear all about it from Cassandra today. So thank you so much for joining us. Well, thank you for having me, Jill.
Cassandra's Role in Workers' Compensation
00:00:54
Speaker
I'm really excited to be here.
00:00:56
Speaker
Oh, so Cassandra, you're not a safety professional yourself, but you absolutely support the work of safety professionals. And sometimes safety professionals end up having to do the work of workers compensation.
00:01:11
Speaker
i'm claims management which was exactly my situation about eight years ago i was already seventeen years into my into my safety career had never touched anything with workers compensation and then all of a sudden it was hl you have this new job and guess what you're also going to manage all of our workers compensation
00:01:30
Speaker
cases which at that time was claims that were about averaging 1.4 million dollars a year and I'm like holy crap I have no idea what I'm doing but I had to I had to learn baptism by fire and it was you Cassandra who were one of the people who taught me
Managing Workers' Compensation Conversations
00:01:48
Speaker
and help me along the way. We've known each other for about eight years and I said I needed a magic wand to learn this and the first time you and I met you brought an actual magic wand to our first meeting. So thank you for that. Hi, you're welcome. Workers' compensation is very difficult. It's typically I would say no one's favorite subject or kind of conversation to have and they are difficult conversations.
00:02:17
Speaker
I'm usually brought in when we talk about the 10 to 11 percenters, those individuals that have employment issues, performance, attendance, that kind of going in conjunction with the workers' compensation claim where we're having difficulty getting them returned to work. They have body creeping instances with the claim.
00:02:40
Speaker
I carry that magic wand just to you know bibbidi bopbidi boo let's try and get through this and a lot of times to all come with treats cookies candy whatever it takes because I may just be the messenger and
00:02:54
Speaker
the workers' compensation system can be pretty difficult. Yeah.
Cassandra's Career Journey
00:02:59
Speaker
So Cassandra, let's talk about how you actually got started in this. And then, and then we'll continue talking about, you know, how do we help the safety profession with what you do? But I'm interested to hear your story. Like we hear for everybody's story that we have on the podcast, how did you get into workers' compensation? What was your, what was your career path? Where did, what did you think you were going to do? And how did you end up doing this?
00:03:22
Speaker
I really thought my goal was to be just a princess around the world that didn't work out. And, you know, my family members, it was so odd. I was the youngest of four growing up and each one knew exactly who they were and what they wanted to be when they grew up. From a police officer to a artist to a mother. I mean, they were just bent on that from
00:03:49
Speaker
as, you know, when I got to know them, and that is what they are today. And I was just floating around in the wind wherever it would take me, not really with any direction. I mean, I did go to college for biology and chemistry majors. But at some point, you know, I just didn't work out and I went to waitressing for a while. After a couple years of that, I realized, you know, maybe I should
00:04:17
Speaker
get into some sort of degree. I went and interviewed for a receptionist job at a couple of facilities. I got two job offers and one of them was at a major printer-packager, decided to take that. And as I was doing the receptionist job, just got a little bored and started to take on a lot of different jobs within that industry. So I was doing scheduling, purchasing, some HR,
00:04:47
Speaker
And what I think is the most fortunate incident in my life is the risk manager at that location and they saw my drive and willingness and decided to interview me. Now, quite a funny story. I think I was very much in my early twenties and never really had a formal interview and also
00:05:07
Speaker
just kind of like I said, going with the wind didn't really have any plans in life, just whatever happened, happened. So one of his questions, I think, was, where do you seal yourself in five years, right? Just very difficult interview question. And you're like, oh my gosh. Well, I'm also pretty outspoken without really thinking about what I'm going to say, because I'm pretty honest. And I, at that point, when you're young and naive, you don't think too much about it. But I said, I don't know, maybe
00:05:36
Speaker
partying less, maybe more settled down and he still hired me. So, you know, but he, a great mentor really gave me the autonomy within the position. I was a risk management analyst and he set these carrots right in front of me in regard to goals.
00:05:59
Speaker
you know, finish your degree, we will pay for it. Here's, now you're going to be doing analytics. You're going to be handling all claims for 32 locations, 7,500 employees, and just gave me the, the information to run with it. And like I said, the autonomy and the direction, but also not micromanaging me so that I was really able to use that platform and develop really strong claim management skills.
00:06:29
Speaker
I worked really closely with the adjusters. We had a quarter of a million dollar deductible. So I really felt that every dollar that was spent was our money and literally it was, but I felt it because then I would have to respond back and do the allocation to the locations in regard to these are the claims that you sustained in this month and this is your allocation. So he gave me that opportunity to kind of start at point A and see it out to point Z and
00:06:59
Speaker
What I realized as I was in that industry doing the claims management is first and foremost, I was pretty good at it. And that's where I think I developed the passion, which really grew. That company went through a hostile takeover and then a buyout. And that's when I got to the agency side and my passion grew because I was there helping companies through
Navigating State Regulations
00:07:27
Speaker
Something that I had well developed that they just didn't have a Cassandra on their team or a small to middle market agency where I help these companies and you know, there's safety consultants. There's HR people that don't have the work comp background and they're running in so many directions. Work comp can be pretty difficult.
00:07:50
Speaker
It's bureaucratic. And every state has some different parameters around it. Especially if you work in different states, the person in the company that's trying to manage it needs some guidelines. Absolutely. And those are what I find the most interesting is working in the states such as Colorado, which
00:08:13
Speaker
is such a different beast in regard to their rules versus jurisdictions and in baseball. California, typically not going to be my most favorite state. It's the most, in my opinion, difficult state in regard to the medical care and such. But my passion just grew. And I think what it is is people are unpredictable. So I could have the same exact injury and a completely different outcome based on psychosomatic issues,
00:08:43
Speaker
Um, you know how, you know, attendance issues, performance issues, uh, and just how people are built. Right. I mean, younger versus older people. Right. Right. So Cassandra, it sounds like you had a fabulous mentor. And when you, you know, you said you learned A to Z and you got to be able to go through the entire process. When you first started, did you think, Oh my gosh, how did, am I really doing this? You know, or did you just jump right in and just kept learning?
00:09:11
Speaker
I just really jumped right in. And I think it goes with my personality. I'm not really having any direction, honestly, is, you know, I'm going to see this through. And I was given that confidence. And I think when someone kind of just gives you that autonomy and says, you can do this, I believed that I could. And I was able to do that. And, you know, I got a lot of support as well in regard to
00:09:37
Speaker
you know, going to sitting with an adjuster for a day, seeing how they manage their desk, going to seminars and just really getting that mentorship on a daily basis. You know, it was just a risk management department of two. So he brought me into a lot of situations that I wouldn't have been privy to
00:09:59
Speaker
that really helped me along the process. Sure, sure.
Balancing Advocacy and Cost Management
00:10:02
Speaker
So workers compensation, you know, when an employee is injured, there's two sides, right? So there's the side of we had something happen to someone and it's a human being who deserves to be treated with humanity and respect.
00:10:18
Speaker
to be taken care of and made whole again and you have the other side which is you know the company and the insurance side where you're where you're talking about costs and expenses and managing the medical cases and working with providers and and ensuring that they're providing correct and good treatment to the to the worker how do you
00:10:44
Speaker
How early on and what does that feel like for you to kind of be in those two camps? You're advocating for the employer, but you're also helping a human being. What does that feel like for you? How do you do that? Well, the older I get, I think the more difficult it is for me, especially having children, you become a lot more compassionate because
00:11:10
Speaker
When I first started out in the industry, I just really saw dollars and how it was impacting my company. With that being said, I would still have injured employees coming into my office, trying to advocate on their behalf for their medical care, which was very, very difficult, especially as a young 20 something female, having gentlemen come in with low back injuries, explaining how that was affecting their life, which I had no understanding of, you know, at that time.
00:11:40
Speaker
But as I do get older, I do see that the impact that it will have on individuals. And one of the biggest plays that I see with individuals and workers' compensation claims that go on for a lengthy period is the disabled mentality. And that is what I think impacts me the most and the company. So it really goes hand in hand. You know, if you don't have a good return to work program or advocating for that employee in regard to their medical care,
00:12:09
Speaker
it is shown study after study that individuals can easily slip into this disabled mentality. Because if you think about it, you know, if you're authorized off work, you're not going out and, you know, going out to lunch or hanging out with your friends, everyone else is at work. You're sitting at home, probably not getting up. You're not showering. And it's pretty easy to fall into a, you know, a depression, which is,
00:12:39
Speaker
very commonly seen and you'll see it with individuals with a back injury, they'll be taken off work and yet their back continues to worsen. And it has again been shown that some individuals can develop back pain from depression. And those are the ones that I get very concerned about because unfortunately the workers' compensation system does not treat the individual as a whole. They treat the individual for the work comp injury
00:13:07
Speaker
And then you may have some psych issues present themselves that are very, very difficult to control. Yeah, yeah.
Building an Ideal Claims Management Team
00:13:18
Speaker
Understand that it was the work that I did in Workers' Compensation Case Management was some of the best work I feel in my entire safety career because it taught me so much about human beings.
00:13:30
Speaker
and about a lot of the things that you're talking about and certainly changed. It wasn't that I wasn't a compassionate person before, but it really gave me a new lens that deepened my drive to do what I wanted to do as a safety professional to send people home whole, as you say.
00:13:48
Speaker
and healthy every day. And I also have a family member who had a disabling work injury and had to leave a career. And so I've seen that play out not only with cases that I manage myself, but within my own family. And it certainly brings a different perspective to the safety practice.
00:14:07
Speaker
So I really wanted to take advantage of you, Cassandra. That might not be a fair thing to say, but you're here and you are someone with 17 years of experience in claims consulting.
00:14:23
Speaker
some people who are listening to this are maybe like I was maybe new to their position or maybe 17 years into their position like I was and then you know guess what your job also includes workers compensation claims management or maybe someone who's listening is like I've really wanted to know more about it in my safety profession but I don't know where to start asking questions so I'm wondering if
00:14:49
Speaker
We can spend our time today doing a little bit of Work Comp 101 so that we can try to teach some people along the way and provide at least a starting point. Sound good?
00:15:03
Speaker
Absolutely. Sounds great. So one of the things I was, um, when it, when it comes to who does the work in it, within a company of managing workers' compensation, what do you generally see in terms of titles like job titles? What's, what's most common talk about safety professionals when they usually come in? What do you normally see? Typically I'm going to see the HR department running the workers' compensation.
00:15:33
Speaker
And there should be some interplay with safety. The CFO typically does get involved because of the cost associated with the workers' compensation program, which is generally our client's number one cost.
00:15:48
Speaker
So, but typically it is going to be those HR professionals. Yeah. And, and if, if I were to give you the magic wand for yourself, what would you, what would you prefer in terms of what do you, in all the years that you've been doing this, what do you think makes a good team, um, within disciplines, within a company to manage workers' compensation, if you could make up your ideal team? Yeah. And, and I,
00:16:15
Speaker
Try and build that up within my client base. And I really feel it's from the top down or from the down, you know, from the bottom up. I want to see supervisors that are managing the injured workers involved in the process because they're going to be the front lines. They're going to know exactly what's going on with that individual. They see that individual on a daily basis. Are they limping? Are they communicating something that they're not communicating up?
00:16:43
Speaker
I mean, let's be honest, if you're in a company of 200 people, you may not have known the HR representative or maybe don't want to speak with them or you've never met the CFO, you know, they may not be there or present. So that person, the supervisor, um, will have a role and their role is really to be paying attention, looking at the restrictions, making sure that employee is working appropriately.
00:17:12
Speaker
Um, you know, there are people what we call the martyr syndrome. They tend to work outside those restrictions, you know, their own detriment. So we talk about claims management and what do you put in place? You know, a light duty job log to make sure that employee is working in the restrictions. Every day you sign off, the supervisor signs off, the employee signs off. So that supervisor is kind of the eyes and ears of what's going on in that floor every day from there.
00:17:40
Speaker
you want to have a partnership with both the safety professional and the HR representative because they, the safety professional is going to make sure that that injury doesn't occur again. From a near miss to a catastrophic claim, right? We all learn from our mistakes and there's sometimes things you just don't know what employees are doing out on the floor until an injury occurs.
00:18:05
Speaker
And that is a really great learning tool. So you take the accident description, you take the employee statement, the supervisor statement, you take that in your accident investigation. The safety professional should be doing that, taking the pictures, doing the statements, and then getting a result, right? A recommendation on how do we preclude this incident from happening again and communicating that down to the whole employee base.
00:18:35
Speaker
We've seen this. It's unfortunate. Here's how we're going to handle it going forward so that no one else has to suffer the same circumstance. Yeah. So an ideal situation might be having that HR person, perhaps the safety person, the supervisor, you know, the CFO because dollars are involved and the employee in working in partnership, if you will, in their different areas, but working together.
00:19:04
Speaker
Right. Right. And so then when we have the claim reviews, the HR professionals typically going to be looking at, you know, FMLA absence of leave, leaves of absence, excuse me, that will help, you know, assist that individual. But when you all come together with the CFO too, and you all come together on the claim review with the adjuster, with the attorney on the file, I think we're all going to have different
00:19:35
Speaker
aspects of the claim that individuals we wouldn't have just because it's not our area of expertise. But when you have the supervisor, the safety professional, the HR rep, and the CFO all on the claim review, we all have different goals, right? Safety is to preclude the incident, HR is to make sure the employee is doing well and proceeding through recovery, CFOs to drive down costs, and the supervisor needs to know because
00:20:01
Speaker
this is all happening above them, but at the end of the day, the supervisor's typically probably applying it and may have some knowledge on that employee. So that team, I think is the most successful in regard to having a great claims management program.
00:20:17
Speaker
Right. Right. And then, you know, not to forget the medical community. And that comes into play as well. Right. And do you and the and the conversations that occur between the employee and the medical providers. That is also something that what would you what would you say is that who's that connection point within a company? What do you normally see with regard to the connection back to the medical community?
Importance of Injury Reporting and Advocacy
00:20:44
Speaker
Yeah, and that is such a great question because best practice is we do recommend that once an employee is injured, it's actually the safety professional that takes the employee to their initial medical visit or subsequent medical visits. Therefore, you can right then and there advocate for the employee. I mean, when you're in a work comp injury, it can be scary, right? I mean, you're not
00:21:11
Speaker
you don't know what to expect. And so it's great to have someone to hold your hand. And then also right then and there, the safety professional can communicate the workers' compensation program. Let's be honest, most individuals wouldn't have, you know, clue one if an employer has a return to work program or light duty, unless it's been communicated. And a lot of times it's not unless you are injured. So in that initial physician visit, it's,
00:21:39
Speaker
imperative to have that discussion with the physician that says, you know, okay, here are the restrictions and for that safety professional to know that return to work light duty program in and out in order to say, yes, we can accommodate and this is what this individual will do. Right. And so from there, you know, the safety professional is attending those appointments. Uh, if the employee agrees, of course,
00:22:06
Speaker
And getting the medical information will go to the adjuster. And then from there, it's going to be handled by the HR to make sure they're recovering. So again, you have that interplay with all divisions within, you know, HR and safety and the employee, the supervisor, then getting their restrictions, making sure the employee is being accommodated.
00:22:29
Speaker
Right, right. Yeah, and when I was doing this work, you're right, I did set up those medical appointments and then also worked really tirelessly with my supervisory staff to make them be my partner.
00:22:44
Speaker
And oftentimes i had the supervisor for the employee going to initial visits you know especially when something had just occurred and was really working closely with the supervisors like as in weekly meetings talking about return to work and light duty and restricting those things and of course also.
00:23:05
Speaker
early reporting of injuries, not waiting until something catastrophic happened that's going to turn into something big for an employee and for the employer, but also paying attention, supervisors to your staff, paying attention to what they're doing and asking those questions. Like you said, it looks like somebody's like, where'd you get that rash? Or you seem to be walking funny here. You're favoring the side of your, let's talk about that.
00:23:30
Speaker
And really being in partnership, especially in really large corporations, with a lot of employees to have that supervisor and the safety professional kind of working in concert with one another about the care of their employees. And I saw that
00:23:47
Speaker
saw that work pretty successfully.
Understanding Different Insurance Models
00:23:50
Speaker
Cassandra, I wanted to make sure that we kind of set a baseline for some terminology that's used in workers' compensation. So if anyone is not familiar with this practice, maybe we can teach them some terms. And I'm wondering, could you maybe explain the way that workers' compensation is insured?
00:24:12
Speaker
So there's like to start maybe there because we have things that are self-insured and insured employers and then a few of these things we call monopolistic states. So can you explain kind of what those differences are? Yeah, I think I'll start with monopolistic states, North Dakota, Washington, Ohio, to name a few. And those you actually cannot go in the standard market and purchase insurance
00:24:42
Speaker
through a carrier and the states run those programs and they do so again pretty autonomously. You can get updates here and there if you have certain contacts but typically they're just going to be monitoring that and paying the bills and
00:25:01
Speaker
There's programs of course within those states to drive down those premiums through the state that I think are very beneficial if you take advantage of those and typically again pretty easy to take advantage of those and I encourage employers in states with monopolistic coverage to take advantage of that. But the rest, so then there's about five of those and the rest of the states are going to be
00:25:32
Speaker
where you'll need to get insurance through the standard market. And there are different programs. You know, I could talk about there's guaranteed cost, deductible, retention, you know, there's high and lows, and then they're self-insured. So, you know, at the very bottom, we talk about guaranteed cost. It basically means that you're going to be paying a certain premium based on what the, um,
00:26:00
Speaker
Actuary has determined underwriter, basically looking at your program, looking at your experience mod. That's another terminology. Another term to talk about. Right. And so they're looking at your measure of safety and your claims incurred. And, you know, they're also looking at loss development factors. Claims, the longer they stay open, the more costly they become. So they're looking at claims as they develop.
00:26:31
Speaker
as the years progress. So there's factors that they multiply your total claim incurred dollars to get that value. And then they'll give you a premium. Now, whatever happens throughout the year, that premium is not affected. That is the premium you paid for 2019. But if you have a bad claims exposure 2019 year,
00:26:56
Speaker
premium will go up in 2020, right? Because they'll say, well, our loss ratio, we paid out 70% of claims, but we only, you know, so that means there's 30%, but yet they have to keep their lights on, right? We always talk about that where a carrier in a guaranteed cost program would prefer to see their employers at a 35 to 40% loss ratio or less because 60%
00:27:26
Speaker
Number one, they still need to make a profit, but they also have to keep the lights on, right? They have to pay the adjusters and things of that sort. You don't have much control in a guaranteed cost program. The carriers are making all the decisions. They're determining settlements. Now, a good carry, of course, is going to get your buy-in, but at the end of the day, they make those decisions.
00:27:48
Speaker
Right, right. Yeah, and so would it be fair to, if I'm understanding this correctly from the work that I had done and another way to reframe it, the insured market would be similar to we all have to get car insurance.
00:28:04
Speaker
And our rate is based on maybe our experience, right? What you were just explaining, our age and the type of vehicles that we have and some people can relate to adding a teen driver and knowing what happens to your premiums. And then, you know, we also know that after something happens, like a number of speeding tickets or different occurrences or accidents that our premiums can go up. So it's similar in the workers' compensation field, just on a much grander scale.
00:28:34
Speaker
Am I getting that? Is that a fair analogy?
Evaluating Safety Performance Metrics
00:28:38
Speaker
Well, I'm going to add one caveat and that is the experience mod. The experience mod will impact your workers' compensation premium greatly in the standard market because they're going to be using that as a multiplier.
00:28:55
Speaker
So a experience amount of 1.00 is average, basically getting a C on your report card. Now there's no such thing as a zero because even in the clerical industry, you're still going to have a class code with an injury rate associated with it because I could slip and fall in the parking lot, I could develop carpal tunnel, things, you know, I could fall on the stairs. So I'm still going to have a rate associated as a clerical individual.
00:29:25
Speaker
So, but every year that may change. So it's always valuable for the organization to know what is their lowest achievable mod. Now that means that they wouldn't have any claims over three years because the experience mod is a measure of your safety performance, your claims performance over three years, not including the year that just resolved because those claims are still developing. So they want to get those a chance to either resolve, close,
00:29:54
Speaker
or if there's going to be a surgical, so they want those to develop a little bit before they put that in your experience mod. Now say that you had an experience mod of, let's just for easy sake, say it was a 2.00 and I think the worst I've seen is a 2.6. So that means basically you are going to be paying twice as much as your competitor down the road for your workers compensation premium.
00:30:24
Speaker
because the auditors, when they calculate your experience mod, they're going to use your class codes and they're going to use your payroll. So they're looking at like industries. So I have so many clients will ask me, how am I doing in my measure of safety? And I'll say, look at your experience mod. And I know that a lot of safety professionals are also looking at their dart rates and their OSHA rates, things of that sort. But experience mod is another
00:30:49
Speaker
measure to be looking at your level of safety and then the carriers actually take that experience mod and use it as a multiplier. So workers compensation is different in the sense of like auto insurance that you are typically going to be paying dollar for dollar for the losses you incur and sometimes four times the dollar. Right depending on that rating.
00:31:14
Speaker
Right. Whereas if I were to get in an auto accident, my rates might go up, but I don't, I'm probably not going to pay for a total vehicle right over a year. And workers compensation over three years is actually going to come for that money dollar for dollar. And like I said, sometimes four times a dollar amount. So
00:31:30
Speaker
You're going to be paying for it one way or another. Yeah. Right. So safety professionals who are listening to this, if some of this is a bit of foreign language, so one question you may ask and maybe you go to that CFO in your company or to that HR person and say, are we insured for workers' compensation? That would be one question if they say yes.
00:31:51
Speaker
And you could say, what is our experience modification rate? And then be able to use that number, like Cassandra's explaining, to find out, do we have that C grade at one? Are we higher? Are we lower? And that helps you. It's an assessment, like Cassandra said, one element of your safety initiatives and success, or maybe an area where you need to dig in a little more. And so that would be something that you can ask
00:32:21
Speaker
if you have not asked for that before. And then there's a lot of other metrics that you can get from there as well. But backing up, so if the employer is self-insured, then would it be safe to summarize it, Cassandra, this way that the company has essentially proven to the state or states where they're working that they have a certain dollar amount
00:32:46
Speaker
in the bank, so to speak, to cover injuries, and then the employer pays the full cost for those as they occur. Would that be one way to say it? Yeah, that is a good way to say it. Ultimately, it is having that cash and assets on hand that you can sustain those losses. So it's going to be the bigger organizations. There's also captive programs that
00:33:14
Speaker
a little bit like that. And in those programs, you have a lot of control. You can choose your vendors, your litigation partners, your surveillance, your, you know, I mean, and depending on your jurisdiction, of course, you can choose your physicians as preferred partners. But that will be you'll just have more control over that. And you'll have more control on settlements, you have more control on how the adjusters are
00:33:44
Speaker
determining compensability and having a say in that. But with that control, as you know, comes a lot more responsibility. Right, right, exactly. Yeah, and so if you're self-insured, you would never ask what your experience modification rate is because you essentially don't have one. And then what you were saying about the monopolistic states, that's really where the employer ends up being pretty hands-off with the management of those injuries because they get turned over essentially to the state. You can call and ask questions,
00:34:14
Speaker
but you don't necessarily have any influence over how that claim is managed. When I was doing this work and met you, I had all three in the states where we had employees working. So we had a little bit of self-insured, a little bit of insured, and then one state that happened to be in the monopolistic arena.
00:34:40
Speaker
And so it was a little bit tricky. So when I was trying to prove up our safety efforts as a safety professional, I couldn't just look at that experience modification rate because that only applied to a couple of states where we had employees. So I had to dig a little bit deeper with metrics.
00:34:57
Speaker
And I'm wondering if maybe you can talk about what some of those metrics are that safety professionals could be asking for within their workers' compensation systems, regardless of which of the three buckets they happen to be utilizing in their company. I think you'd really want to start with getting a loss run from the carrier. So that's another term. Good. Yeah, please. So a loss run is going to be all of
00:35:25
Speaker
your claims data, it's going to be the individual injured, the date of injury, the date of report, the jurisdiction, and then every carrier is going to differ, but typically it's going to be the total incurred, reserves versus paid. It could have date of hire, date of birth. I mean, there are some carriers where you can get an Excel download.
00:35:50
Speaker
and just sort for days, right? We're very lucky to have a trending analysis on our team that really makes this information meaningful to our clients. So from there, you'd really wanna pull a loss from each state or each carrier, depending on your insurance program. So you'd wanna get all your data. The best of course is to get it in Excel so that you can play around with it. And from there, you can determine
00:36:20
Speaker
you know, sort it by location. But I think what is so important and often gets overlooked just because we get so ingrained in the data is that we forget to put it into context. Yeah. I had a client where we went out and we were talking about their metrics for the year and they, you know, it was 26 pages of metrics in the first page. I was, wait a minute, we have to stop.
00:36:47
Speaker
These all show that we're decreasing in claims, but there's no context on any of this data that we've closed a third of the stores. So all of this data needs to be put in regard to payroll exposure, right? And so I think when you look at that and say, well, oh my gosh, 60% of our claims are coming from the Indiana location. Whoa.
00:37:12
Speaker
that's 60% of our workforce. So, you know, putting it in data and really putting it into context of payroll exposure helps bring it down, right? To something that we can maneuver and put safety policies in place. So when we look at a lot of times demographics, while we're seeing 50% in the 20 to 30% or 20 to 30 years of age,
00:37:40
Speaker
And to me, that's highly unusual, especially because most of our employers are working with an aging workforce. And so I said, oh, this is a concern. And they said it actually isn't. When you look at our demographics, all of our aging workforce retired last year. And so we're all hiring. And I was like, well, there we go. So putting it into context like that. So getting the loss run and then drilling down on body part, on cause of injury.
00:38:06
Speaker
looking for keywords because one of the things we do as consultants is partner very, very closely together, whether that be with HR or with our safety professionals, just like your employers, because I don't want our safety consultants kind of just running around without goals and they don't. But when I say, oh my gosh, this is the third knee injury this month due to this cause of injury,
00:38:33
Speaker
or I saw one where it was the second rotator cuff tear in one week in the same exact location. So there's where we want to then concentrate efforts. I think too is when you look at that, one of the most successful strategies we have partnering with safety professionals is they'll come to me and they'll say, can you take a look and review our losses because I want to automate this job.
00:39:02
Speaker
And the equipment costs this much. The CFO has told me, no, because of the cost. So what we do then is pull out the data of that department, that job title, that action, that movement, and we run the losses. And I would say nine times out of 10,
00:39:23
Speaker
you're paying for that equipment through the cost of losses over here. So we're able to quantify that and give it to the CFO to push forward that initiative that that safety professional and that to me is, that makes me feel so good. That's a huge win where, cause I think it's difficult for safety professionals. They know they need it.
00:39:46
Speaker
but for us to be able to quantify it and for them also to take this loss run data and pull it apart. You had to make a case. Yes, exactly. I think that's a huge win for them by using that data. Yeah, you said you can do these loss runs and ask for the loss run and then look at the data eight ways from Tuesday, right? And so as a safety professional, I would say if you've never done this before, A, partner with whoever your insurance carrier is,
00:40:16
Speaker
who's helping you and ask for a loss run and maybe have an idea in your mind initially like what do I want to look at and so that you can ask you know instead of getting that big spreadsheet and going oh man I could get lost in this for days maybe really ask specifically for what you want to see and start there and so maybe it's you know show me the average age of the majority of our injuries what time of day
00:40:42
Speaker
do the majority of them occur what location has the greatest rate and then you know tell me what are the top five injury getter what are the top five injury getter types is it injuries is a back injuries and what are the costs associated with them because we wanna we wanna also tease out severity versus frequency is it something that happens often but is it a lower cost
00:41:09
Speaker
or is it something that happens often with a really high cost? And maybe can you talk Cassandra about the difference between severity and frequency and how you view it and how people can ask for that data as well?
Impact of Claims Frequency and Communication
00:41:21
Speaker
And so the experience mod is going to give you that security, uh, severity versus frequency. And actually there is a program that we run for our employers, but many companies, money agencies, insurance carriers have this program as well.
00:41:36
Speaker
It's called mod master and we're able to run, I think it's a nine or 10 page report that breaks down that mod and tells you exactly what that calculation and that number means to you. And one of the first pages that I really like because I'm typically working with CFOs and they want to have a measure. And so the first page will say, if you get a 5% reduction, here's your new premium, here's your new mod, because we'll always talk about
00:42:07
Speaker
It's so hard to quantify workers compensation claims management, right? If we institute a return to work program or volunteer return to work or light duty, anything of that sort, it's hard to quantify that and push it through. But if we're able to say, listen, studies have shown that instituting this program can have a 30% improvement on our overall cost.
00:42:30
Speaker
Well, we can just take that document from the Modmaster and say 30%. Okay. That's what it means in regard to our company, our premium and our experience mod. And again, that's a way to really push through programs. Then they will show you what is driving your experience mod. Is it frequency or is it severity? And I surprisingly are confronted with employers who have no idea. They'll say,
00:42:56
Speaker
We never have any losses. It's just been those two fraudulent losses. Other than that, we're a great company. And so I, without looking at the data, I never judge, right? Cause I know I'm not in that company. We run the data and we find many times that just isn't true. The data will tell us that frequency is typically going to be the driver of your worker's compensation experience, modern costs.
00:43:24
Speaker
And why that is, is again, the calculation has ratios, weight ratios. They're weighting certain criteria more than others. One of those being frequency. Because for every 10 lacerations, you're going to have tendon involvement, right? That's what studies have shown. What they're going to do is say, we're waiting.
00:43:48
Speaker
the primary dollars first. And we're probably getting a little too much in regard to semantics here. And that number has been driven up because of medical inflation. When I first started in the industry, it was $5,000 as the primary and that was weighted more heavily than anything over. But in the last couple of years, medical inflation has gone through the roof. So now the first $16,250 is weighted more significantly. So we've seen employers
00:44:17
Speaker
same losses, same payroll and their premiums have gone up 10% just because of the calculation change. Now severity, I mean, right? The first 16,250 is going to be weighted more. And so if you have a claim for 150,000, well, the first 16,000 is only weighted. But if you think about it, if you have 10 claims at, you know, 16,250,
00:44:48
Speaker
That's 160,280 that's going in at that mount. And I might have to pull up my calculator. So... Sounds like you've done this a few times. Right, right. So I'll just do this real quick. Yes, 162,800 is going in at the full weight. But then if you think, if you have one claim of 162,800,
00:45:14
Speaker
800, only 16,280 is weighted. So those catastrophic claims don't impact you as much in regard to your experience model and your premium, because every carrier ultimately expects that every employer is probably going to have a cat loss every five years.
00:45:36
Speaker
So Cassandra, for our audience who's listening, particularly if they're listening and thinking as a safety professional, whoa, I don't have a seat at this table right now. I don't have a seat at the work table in my company. How do I get one? What kind of ask do I make? Because it's sounding like this information is really powerful and can absolutely help safety professionals.
00:46:06
Speaker
determine, you know, where should my focus be and kind of help triage, if you will, where a safety professional would want to be making a difference to ensure their employees are going home whole and healthy. And I know that you like to talk about communication and the importance of communication within an organization, but also with carriers as well. Can you maybe talk about how
00:46:32
Speaker
a safety professional can use communication and what you would recommend they do to get themselves a seat at this table. Absolutely, so I'll start with getting a seat at the table and I think really it looks like getting a coach and determining who is currently handling that process and that might be a little bit difficult to hash out
00:46:57
Speaker
Um, because there may be a lot of different players, um, sometimes the roles and responsibilities aren't very clear, um, clarified within an organization. But I think, you know, to go to the leadership and say, I think this really impacts my department and how can I better learn about this so that I can assist and make sure again, that my employees are going home safe and I can learn from the injuries that are occurring. Um, and.
00:47:27
Speaker
from there there's so many coaches out there and people involved in workers compensation that are passionate just like myself that love to share the information there's seminars i mean just like you guys have organizations for safety professionals we have nerd organizations for work comp professionals as well i mean that's i call myself a work comp nerd and i just i get
00:47:52
Speaker
Super passionate about it. And I was like, that's interesting. We're going to start doing surveillance with drones. I'm in it. So those are the things that I get stoked about and we're willing to share. And there's so many articles, things of that sort to get involved in. But really to just say, just as you prefaced it, I mean, it does impact the safety professional. So put it in that sense that this impacts me and impacts the employees that I'm caring for and looking after every day.
00:48:22
Speaker
And so how do I get invited into these claim reviews that we're having? And you just stick your toe in and you'll start learning all about the terminology as time goes on. I mean, it takes some time, right? To learn all of what we're saying because sometimes we're talking a foreign language when we start to get into our language. And then from there, the communication is very key.
00:48:49
Speaker
It's one of the top things I stress when I do Work Comp 101 is to communicate. A lot of times, and not so much anymore, thank goodness, but a couple years back, one of the propensities when an employee was injured was to not talk to that individual. And I think it's because of fear. I don't want to say the wrong thing. But when you are managing from a place of fear, people can feel that.
00:49:18
Speaker
And all of a sudden what they feel is your fear and they may feel that fear, wait a minute, I'm going to get fired. I may have broken that safety policy that led to my work injury. I'm going to get, you know, I'm going to get fired. So I think it's really communicating with the individual even before an injury ever occurs. I am a big proponent of doing a, you know, 10, 15, 20 minute spiel every day when, or not every day, every year when you guys,
00:49:48
Speaker
A lot of my companies have an annual safety day. Throw in 20 minutes of, here's our work comp procedure. Here's our light duty program. Here's our preferred clinics. If you have any questions, here's your claims coordinator. So-and-so will be taking you to the clinic. Please let us know ASAP. We expect injuries to be reported within 24 hours because claims strains that are reported
00:50:18
Speaker
after that tend to increase in claim cost, but not only that, but claim exposure in regard to that individual's injury actually worsening. I mean, I'll take a carpal tunnel. You catch it early, you get a brace, you do some exercises, you're good to go. You let it kind of build up, you're sitting there at surgery. And that's just very common. So I think also to put it into context for those individuals that
00:50:43
Speaker
At the end of the day, we want you to leave whole just as you came so that you're able to have the weekend with the family and sit in the car and drive to the park and things of that sort without having back pain.
00:50:59
Speaker
I think that's a great tip, Cassandra, to talk with for safety professionals when they're doing annual training, quarterly training, at-hire training, not necessarily to put it all in HR's hands, but hear from the safety professional, partner with them to develop some
00:51:21
Speaker
some message some training for your employees around you know if something happens at work if you have an injury if you develop an illness we have a path for that this is the path this is who you talk to this is what we want to hear about it don't wait until like it's so terrible that you're like oh my gosh this is
00:51:41
Speaker
this is this is bad you know like talk about it early and often and like you said don't shy away from having those conversations it's um you know it's not a healthy place to be i think that's a great tip to add that into training and then i would just expound on that that the communication then from internal really needs to go external and again i come from a place of dealing with the most difficult work comp claims and where i find
Handling Challenging Claims
00:52:09
Speaker
those start occurring is
00:52:10
Speaker
as soon as the claim is reported. Unfortunately, it's those employees that have personal issues or performance issues that end up being our biggest claims. Individuals known to have substance abuse, individuals going through a personal life event such as divorce, death, having a child, things like that tend to compound on top of the workers compensation claim.
00:52:37
Speaker
and develop more difficult exposure that we have to navigate through. So if you have, a lot of times clients will say, well, that doesn't impact their injury. And I would argue and say it absolutely does. And so we need to know that information. Is the employee been, you know, were they just about to be terminated? Were they demoted? Did they not get a raise? Those things greatly impact a claims outcome. And so,
00:53:07
Speaker
You may not think, oh, this will, the adjuster doesn't need to know this, this is personal. It comes to play in the work comp claims sooner rather than later, and the adjuster does need to know that information as soon as possible. I can't tell you how many times we've been on settlement doors and the employer will say, well, wait a minute, what about when they were doing their roof last time when
00:53:36
Speaker
we got the report of injury and I'm like, we're about to settle. We'd have to get witness statements. So those are things where if you know of an individual or even just small things, like an individual that had a severe back injury and yet they caught him running through the warehouse and dancing. And the supervisor was like, well, I didn't know if it really mattered.
00:54:05
Speaker
I mean, it warns us looking into, right? Do we assign surveillance?
00:54:11
Speaker
I think those are all very imperative information that we need to manage that claim. Right. You had pointed out before that you usually get involved when a claim is something that's catastrophic. I liken what you do to what I did as an OSHA investigator. We're looking at some of the most extreme cases when we're doing inspections with OSHA and we happen to
00:54:40
Speaker
See some you know some not necessarily great work practices and you're talking about some of that with them with employees as well and I don't want anyone to get the idea that an injured worker is a trying to get injured be trying to game a system.
00:54:59
Speaker
to their own advantage because I think you'll be able to tell me, Cassandra, that is not the case with most injured employees. It just happens to be that you do see those that do occur because that is part of what you do, but it's not the lion's share of people who are injured, correct? No, we talk about 88%, 89% of individuals get through the work comp system, easy breezy.
00:55:28
Speaker
It's the 11 percenters that I deal with that, but they take up. If you, if you're a professional listening to this podcast and you'll know exactly what I mean, they take up, you know, that 11 percent will take up 80 percent of your workday. Right. So it's, you know, you know how it is. It's one negative comment can ruin our whole day. Yeah. And the positive ones will just, you know, throw those aside.
00:55:57
Speaker
And so that's where it seems like it's such a big deal, but 88% of individuals, high moral character, want to get through the work comp process, recover, get back to their families, forget about the injury, get on their way. So that is the
00:56:14
Speaker
the typical process of work comp is 88%. Very good, very good. With regard to the safety profession and another place for them to insert themselves in workers compensation could be with return to work programming as well. Can you talk about what that is and what that looks like and so safety professionals who might not be familiar with that know what they could be advocating or asking for another place at that table?
00:56:44
Speaker
Mm hmm. Yeah, I think that return to work programs have really come a long way. But first and foremost, we want to make sure that it's in writing. So a lot of my clients do have it in their safety handbook. They have the return to work light duty program as a policy in that safety handbook. I think that it's really important to go over that in the orientation and
00:57:12
Speaker
you know, ultimately we would like it pretty general, right? Because you don't want to get boxed in in regard to, we will do this, we will do this, right? You're just creating an issue in regard to employment practices if you do that. But you do want to make sure that everyone knows that you will devote yourself to a return to work program if that employee gets injured. And I'm just going to draw it back to the experience mod real quick. If you are in that type of program,
00:57:41
Speaker
an employee that is brought back to work within a waiting period and that's going to vary between states. It's usually between three to seven days. The Bureau on the experience model give you a 70% reduction on that total incurred cost. That's huge. So it is so imperative to have return to work program and then communicate it. You know, that light duty, what it looks like is I think first and foremost, you want to have a job bank.
00:58:10
Speaker
the most difficult jobs to accommodate are going to be one-handed and sedentary. So determine what could an employee do? And what I always talk about is we now have interns, thank goodness, because I have a bin of work I will never get to. It just sits there for years. And it's things that I need to, like, it's carrier information. It's old claim reviews I need to load in.
00:58:39
Speaker
Things of that sort that are just sitting there, but I just don't have time So there's that clerical work, but there's many individuals or say well, you know, this is a construction field I we don't have you know, we got a trailer. What are we gonna have them do for critical? Could they sit there and do a safety audit? Could they do their OSHA 30? Could they do their OSHA Ted get real creative? It's in the again something I'm super passionate about because You know a longer employee
00:59:07
Speaker
stays out of work, the longer they'll stay out of work. I mean, it's just perpetuates itself. And there's a study that shows that if they've been out of work for six months or more, your chances of getting them back to work with you is 50% less. That's huge. And then there is some creative solutions too that I get really excited about. It's been in the industry for a decade or so, but it's called volunteer return to work.
00:59:37
Speaker
so you if you don't if you're a small shop a small company and you just don't have light duty and we get that we have retail stores that unless you can lift 20 pounds you just can't come and work light duty here there's a volunteer return to work program many vendors many carriers have it in house as well and what you do is you
00:59:56
Speaker
send your employee to a nonprofit organization. You pay them out of your payroll because you're getting the hours worked, but they're still getting up. They're still going to work. And I think it's great because first and foremost, they're contributing to your community. And a lot of my companies, I already have these partnerships with the nonprofit. And then they can send their individuals who are injured to work there. And I think it just really opens our eyes to that
01:00:24
Speaker
You know, we may be injured, but when we're working in these nonprofits or the shelters or the food shelves or, you know, the red crosses of the world, it's harder to fall into that disabled mentality of why did this happen to me when you're still contributing in a way that is more altruistic.
01:00:44
Speaker
than just yourself at the employer. Right. What a fabulous idea. I had never thought of that before, but it makes complete sense. A volunteer return to work program, that's fabulous. As you were describing light duty jobs and having a job bank,
01:01:02
Speaker
I was thinking, let's back that up even further to the importance of having job descriptions for all of the jobs, including what the physical demands of the job are. That seems to be the most important place to start when you have an injured employee that that medical professional has that job description with those physical demands so they know
01:01:28
Speaker
what it would mean to release someone to full capacity. And then, of course, being able to follow up with, we do have a light duty program and we don't expect that you have to take people off of work. So can you talk about maybe the importance of those job descriptions? And that's another place where safety professionals can advocate to ensure their employers have those. Yeah, that's such great insight, Jill. I absolutely agree that those job descriptions
01:01:57
Speaker
um, should be updated with, you know, the weight and the frequency of doing those, uh, you know, manual, whatever movements that you may have. And a lot of it you can even take from the official disability guidelines, you know, sedentary light, medium, heavy, very heavy. Um,
01:02:20
Speaker
is what we're looking for, what criteria
Safe Return to Work Strategies
01:02:23
Speaker
fit in there and what that employee is doing so that that doctor can specifically take a look and say, no, they're not able to do that. Because sometimes if we don't give the direction, we may not get the direction we need. Their restrictions may come back as, you know, lift us tolerated. Well, that doesn't really mean much to anyone.
01:02:48
Speaker
Right. You know, so I don't, I don't know. You know, my joke always is sometimes I can't tolerate work at all. What does that mean? We want to give the physician the information so that we're putting ourselves in a position of success. If we're able to give them that specific criteria, they're able then to determine and give us specific data so we can return that employee back to work. And I think it goes
01:03:18
Speaker
Even further than that in regard to job descriptions is placing an individual to work and making sure they're working safely. If an employee comes to you and says, you know, I have permanent restrictions from a prior employment of no lifting greater than 30 pounds, and you're not quite sure if your job descriptions haven't been outlined by weight and frequency, are you sure that they're working safely? And then also a step further,
01:03:46
Speaker
is if you do pre-employment physicals, any isokinetic or cost reduction technology testing, those are basically mandatory to make sure that the employee is put in a safe position.
01:03:58
Speaker
to start in a place of success. Yeah, right, right. Cassandra, you have been so gracious with your time today. And, you know, when you and I were first talking about doing this, you said, you know, we could talk about this for hours, Jill, because we're both nerds in that regard. But you on the COP side and me on the safety side, and I really do feel like we could be talking for hours about it.
01:04:25
Speaker
And so I want to be respectful of your time and thank you for sharing what you have today. And I wanted to, I've been taking some notes while you've been talking and about, you know, I guess, you know, where I would start if I was a safety professional who didn't have a seat at the work comp table yet and what might be some things I'd be asking. And I kind of want to run through a couple of those and tell me what you think you might add.
01:04:52
Speaker
So, you know, one of the things I've written down is first finding out how you're insured, so you know which questions to ask by way of what kind of metrics can I ask for, you know, like how are we insured. And then second,
01:05:10
Speaker
if you want to learn more about workers' compensation or if you have the whole job suddenly dumped in your lap, to remember that the insurance carriers and insurance brokers do offer seminars to train people like safety professionals. I know I did that with some of the carriers that I worked with where I specifically went to seminars to learn about it because it is complex. And then I love the piece that you said about
01:05:39
Speaker
Adding injury and illness management and what you do in your company to your training platforms that people are using already. And then the power of those loss runs and the data that can come out of it and to be asking for that data specifically. And then the last thing that I've written down is with regard to return to work and light duty,
01:06:04
Speaker
having that job bank, those ideas in place, including volunteering in your community. And I just love that. Do you have things that you'd add for safety professionals? And I think it's really just sitting down with your internal team and saying, how can I help? Where do you see my role here?
01:06:29
Speaker
As safety professionals, where do you see your role as you develop in regard to learning about workers' compensation? I think it's very, you know, like I said, the partnership is imperative of having that successful program and, you know, just sitting down with the CFO or the HR rep and, you know, what are you doing on a basis? Is there anything, you know, I'm, I'm sure safety professionals wear a ton of hats too, but I think that there can
01:07:00
Speaker
you know, if they can avoid injuries by knowing what injuries are occurring because sometimes we have that mindset, right? Well, it's all this. This is where all our injuries are coming from. And again, I'll just draw it back to we get that communication from a employer and we'll pull the data and we'll actually just have to say that's actually not true based on the data.
01:07:29
Speaker
I think to you actually, hopefully as time goes on,
01:07:35
Speaker
able to manage that by looking at the data, drive it down and be involved in the process. Wonderful, wonderful. Cassandra, thank you for sharing what you have today. And thank you for the fantastic supporting role that you play to safety professionals and your industry and other claims consultants out there. It's really critical to a healthy workforce. So thank you for that and thank you for what you do.
01:08:06
Speaker
No, thank you for having me. I was really glad to be here. Yeah. And you know, if anyone who's listening is thinking, gosh, I'd like to hear more about this, let us know. I'd be happy to have more conversations about this. Or if you're listening to something, you're thinking, gosh, I wish that maybe we could do a podcast specifically on this area.
01:08:25
Speaker
maybe we find someone like Cassandra or Cassandra again to be a guest to explain a particular piece of safety regarding workers compensation management that would be I'd be I'd be absolutely open to doing that so give us a give us a note let us know what you're thinking and thank you all so much for joining in today and listening and thank you for the work you all do to make sure your workers including your temporary workers make it home safe every day
01:08:55
Speaker
and special thanks to Will Moss, our podcast producer. You can listen to all the episodes at vividlearningsystems.com or subscribe in the podcast player of your choosing. You can also find us on YouTube and again at our website at vividlearningsystems.com. If you have a suggestion for a guest, including if it's yourself, go ahead and reach out to us at social at vividlearningsystems.com. Until next time, thanks for listening.