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when to report and not report New Jersey

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  • when to report and not report New Jersey

    I need help with an ongoing argument among our management staff.
    My company has exorbitant worker's comp costs when we have very few actual injuries requiring medical treatment or time out of work. The big problem driving our cost up is our number of reports. People might trip over their own feet, bang their elbow, or get a small cut, and they report this to HR, who then has to track it. Very few of these people decide to get medically evaluated, but they report their "injury" to HR because their supervisors are emphasizing that everything HAS TO be reported.

    MY position is: if you think you need medical attention, or if you think your injury was caused by something on the job (a facility problem, a specific job task, etc) then definitely report. But if you are okay, and your fall or injury was not caused by something job-related (meaning you tripped on your own shoes or banged your head on your desk while tying your shoes), then reporting it only serves to drive up our costs.

    The WC carrier assigns "reserve" funds to a lot of our reports, in anticipation of the person possibly needing medical treatment in the future, according to their actuarial tables or something.

    Anyway, other managers disagree with me, saying that ANY injury while on work time is "work-related," or they say something like "the law says we have to report EVERY little fall or injury." I couldn't find this particular statement in "the law."

    Am I right or are they? Does anyone have a link to a good list of examples of what to report and not report, or what would and would not be "work-related."
    BTW, please don't advise me to ask our carrier for advice, because they are clearly invested in our premiums staying high.
    Thanks

  • #2
    If there is no medical treatment or lost time the claim need not be reported to the carrier. It should not be affecting your premiums and I'd be asking questions as to why these claims have reserves assigned to them or count against your experience rating. I do agree that it is best to have the employees report even these minor instances to you. It does help to look at trend data and safety issues. However, I wouldn't be sending every stubbed toe and paper cut to the carrier until it is clear that there is something to pay on the claim such as a doctor bill. Once you become aware of medical treatment being sought or time bein missed, then you can foward it on to your carrier. Otherwise, you are just taking up space in their filing cabinets.

    There are no laws that govern no medical treatment claims and whether these must be sent to the carrier. I handle mine as described above.
    I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

    Comment


    • #3
      Thanks. I think the person in HR taking all the calls was one of the ones insisting that every little thing be reported to her, then she reported them all to the WC carrier.

      I agree that we can collect all the info for internal monitoring, but only things that will cost time or money should be sent to the carrier.

      Her response was that there was a time limit in which she had to report things to the carrier (though I think she was rushing too much), and that she had to report every little bump because it "might" result in the need for medical tx some time in the future, and if it is not reported the employee would not be covered for it.
      I responded that it's not likely a stubbed tow or a bump on the elbow would need future medical tx, and she had all these horror stories about small injuries not seeming bad at the time, then later turning into serious things like RSD, etc. Ugh. She's watching too much Discovery Health channel....
      Or she owns stock in the WC carrier

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      • #4
        Claims must be reported within 3 weeks of learning about them. That is sufficient time to determine whether an injury is going to require medcal care or lost time. Yes, there are going to be rare cases where the employee waits longer than that but if you have no credible reason to believe Susie went to the doctor until 4 weeks after she bumped her elbow, you file it then. I promise you that this is already occurring as undoubtedly there are minor injuries that aren't being reported now. Pulled muscles and the like don't even always become evident until a day or two later and if every minor bump were really being reported, you'd be flooded with paper daily.

        Incidentally employees have 2 years to file their claims before they hit the statute of limitations. Her fear that they will not be covered unless you file the paoerwork with the carrier immediately is just not founded.
        I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

        Comment


        • #5
          Great, thanks for the help. You'd be surprised at how many of these silly little "injuries" we have on our report thanks to her, and the other mgrs who agree with her. Fortunately, the CFO is on my side and thinks it's ridiculous.

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          • #6
            My other suggestion is to shop around. There are a few on this board whose jaws will hit the floor when they see me actually advocating a possible change in carrier, but if your premiums are really out of line, it doesn't hurt to shop around. Even if you ultimately stay with the same carrier, it might entice them to make a better offer if they know you are shopping.
            I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

            Comment


            • #7
              We can't shop around until we get out of the "assigned risk pool." It's a racket.

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              • #8
                You can talk to directly to your carrier too about what you should be reporting to them and they will tell you. I just recently did this and they were a really big help to me.

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                • #9
                  To comment on the statement that its unlikely that a stubbed toe (or something minor) would require treatment later, let me add my experiences. As HR I see this ALL the TIME.

                  Someone has a minor injury, doesnt seek medical treatment then talks to their family and friends about it and find out that "someone's cousins- brother-in law's uncle had the "exact same injury" and now he is sitting home collect WC and has been for years, in fact, he makes more now than he did working" or some such balony.
                  The employee sees dollar signs in his eyes and now that stubbed toe starts to look like a ticket on the gravy train.

                  I agree your HR may have been hasty in reporting it, especially if it isnt treated any more. Our carrier does not count what we call "information only" notifications against our experience so we do report them. If they counted at all, I would be waiting 2 weeks or so to see what happened.

                  However, your HR person has probably seen the small item turn into a big mess and is trying to be proactive.
                  I find that the harder I work, the more luck I seem to have.
                  Thomas Jefferson

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                  • #10
                    Joe, our industry is residential human services (with people with mental illness and developmental disabilities).
                    We average about 3 employees per quarter who get hit or kicked by clients/consumers/residents. We usually have about 3 lifting injuries per quarter (employees are told not to lift furniture or clients, but still try to), a whole bunch of pulled and strained muscles, especially from unhealthy or obese workers (a whole other story!), and a bunch of trips & falls.
                    The people who get hit by clients are rarely ever seriously injured, but the carrier puts thousands of dollars in "reserve" because they say statistically, people who get attacked by clients on the job later go for psych treatment for post-trauma symtoms,a nd that costs a lot. So far we had one employee in a year who actually went for post-trauma therapy after such an incident.
                    We seem to get one or two very costly injuries per year from semmingly "freak accidents".
                    Our very high premium and risk pool status are due to:
                    1. our very few high cost injuries in the past 3 years (about 5)
                    2. the assigning of "reserve" costs to certain WC reports based on the carrier's statistical analysis
                    3. our large number of injury reports (most of which have no need for time off or medical tx, but simply having the report on record affects us)
                    4. (unofficially) our carrier doesn't really understand our industry. We are not a hospital or nursing home

                    I don't know about other states, but in NJ if you are in the assigned risk pool, certain insurance companies participating in the risk pool have to take you, and you have no choice but to go with them. You are stuck until you get out of risk pool status.

                    (PS, I was a therapist for years, then got into quality & compliance, and NEVER thought I'd have to deal with this stuff!)

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                    • #11
                      Morgana, yes I agree with the dollar signs & gravy train thing! Here it seems to be "how can I get a paid summer vacation based on stubbing my toe?

                      Comment


                      • #12
                        Originally posted by TSCompliance View Post
                        The WC carrier assigns "reserve" funds to a lot of our reports, in anticipation of the person possibly needing medical treatment in the future, according to their actuarial tables or something.
                        Reporting injuries that eventually involve no medical or indemnity costs you nothing.

                        The problem is that if the reserves are still there when the carrier sends the loss data to NCCI, you get clobbered for no reason.

                        Someone in the company needs to work very closely with the claims department at the carrier. At least once a quarter, get the carrier or broker in and scrub every open claim, looking to either close it or to reduce the reserves to a reasonable level.

                        You have about six months from the end of the policy year to when the data is sent to NCCI. That is plenty of time to get your "losses" down as low as possible.

                        You should also take a close look at lost time claims. One lost time claim will cost you roughly three times more in additional premiums than a medical only claim of the exact same dollars in losses.

                        It is imperative that you avoid lost time claims by having an effective return to work (light duty) policy. This will mean having an effective claims management system. I am a cynic and do not believe that carriers represent their clients well, especially those, like you, that are virtual hostages. Whatever they pay out, they will get back from you in the next three years in increased premiums. So they are not really aggressive in trying to avoid lost time.

                        Okay, okay, I am off my soap box now.
                        Senior Professional in Human Resources and Certified Staffing Professional with over 30 years experience. Any advice provided is based upon experience and education, but does not constitute legal advice.

                        Comment


                        • #13
                          I don't know if this will help any, but I was recently in a situation where, in a white collar industry that was exempt from completing the OSHA 300 form (yes, I had it direct from OSHA's own lips) and which shouldn't have been having more than 2 claims a year, I was having 3 a month, ALL from one location.

                          OSHA, when I called them for advice, referred me to a form that could be completed by the offending location which should identify the problems. The problem is that I can't remember what the form was called and a review of OSHA publications does not jog my memory.

                          Does someone better knowledgeable about OSHA know what form I'm trying to refer to?
                          The above answer, whatever it is, assumes that no legally binding and enforceable contract or CBA says otherwise. If it does, then the terms of the contract or CBA apply.

                          Comment


                          • #14
                            Originally posted by joec
                            The highest paid W.C premiums in the state,are paid by employers in the logging Industry. To the tune of $10. an hour per employee.
                            Logging is expensive, but despite the fact that we have a lot of loggers in this state, roofing is the most expensive job, like 33% of gross wages.

                            The reason for that is when someone falls, they will be hurt badly. They fall because idiots (companies and/or employees) ignore fall protection standards.

                            Logging is not as bad thanks to the state requirement for certification as Certified Loggers (not all regulation is bad).
                            Senior Professional in Human Resources and Certified Staffing Professional with over 30 years experience. Any advice provided is based upon experience and education, but does not constitute legal advice.

                            Comment


                            • #15
                              If my field were logging or roofing, I might understand the high cost and number of reports. But our people teach people with diabilities how to cook & clean, help them shop and budget their money, and take them to doctor's appointments. Their work setting is sometimes an office, sometimes in a regular house or apartment. Our settings all get monthly or weekly safety inspections, and they are actually safer than the average home.
                              Our injuries are very rarely due to a facility problem. If they trip & fall, it's not due to flooring, but to the employee wearing the wrong shoes or not paying attention to where they walk. If the injury is due to lifting, it's either lifting a grocery bag when helping a resident shop, or lifting something they've been told not to lift.

                              Comment

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