R&R Insurance Blog

Over the years, R&R Insurance has designed a proven 7-step method to successfully manage workers compensation programs. Our Professional Services have become experts in analyzing medical reserve dollars and can clearly articulate how insurance companies determine the numbers. By knowing market trends, carrier calculations, and your own unique situation, there are dollars to gain.

Wisconsin is one of the top 2 states in the country with the highest medical costs. Nearly 25 years ago, medical costs were 40% of work comp claims. Today, medical claims average 75% of total work comp claims. To put things into perspective, below are average rates based on five insurance carriers:

• Meniscus tear: $30,000 - $40,000
• Knee replacement: $60,000 - $100,000
• ACL repair: $45,000 - $55,000

This shift in costs can be directly correlated to several things:

• Healthcare uncertainty in last 10 years
• Affordable Care Act
• Shifting costs in workers compensation
• Lack of fee schedule in Wisconsin
• Diagnostics
• Actuarial pressures

So what can companies do to start minimizing medical only work comp claims? One of the more effective solutions is the integration of safety and wellness (or what R&R calls WellCompForLife). By cohesively utilizing these committees, companies are able to collectively share resources and ultimately reduce the total insurance spend.  By creating a behavioral change, employees will remain healthy and money will be added back to the bottom line.

To learn more about R&R's proven model, contact a member of our Professional Services.

It's a topic no one wants to talk about.  And everyone hopes will never happen to them.  But the reality is that sometimes the unfortunate happens.  Do you know what to do when an accident occurs that results in a death?

Reporting a Fatality

• OSHA - within 8 hours of finding out
  
  • Call local OSHA office
  • Call 24-hour OSHA hotline
  • Report online www.osha.gov
• Department Workforce Development (DWD) - within 24-hours of death
• Insurance carrier - within 24-hours of death

Reporting Considerations

• Contact R&R Insurance
  • We can help facilitate contacting the carrier and DWD
• Who / how will the family be contacted?
• What is the criteria for the carrier?

Investigation

Law enforcement will be involved! The area will be considered a crime scene, and should be treated as such, until they are done with their investigation. Be sure to preserve all areas and equipment as part of the accident.

• Take photos
• Identify witnesses
• Obtain maintenance records for involved machinery / automobiles
• Document contributing factors: weather, road conditions, construction zone, etc.

Other Consderations

• Crisis management
• Death / marriage certificates
• Media involvement
• Other potential claims: psych treatment for those affected
• Jurisdiction (were employees travelling?)

Looking for crisis management assistence? Contact your Knowledge Broker or safety@rrins.com to get the conversation started.

Do you have employees who travel during their workday? Do you fully understand their exposures? Is it clear when they are driving within the course and scope of employment?

Many of you have heard of the Ninedorf vs. Joyal case, which took place in Wisconsin in 2014. To summarize the case: Mr. Ninedorf and Mr. Joyal worked for a beverage distributor. One Friday afternoon, a customer requested an order from Mr. Joyal and the two men left to deliver the beer together. After the delivery was complete, they stayed at the location for multiple drinks and proceeded to visit several other bars in a nearby town. While Mr. Joyal was driving the two men home, they were involved in an accident which left Mr. Ninedorf paralyzed.

The Circuit Court granted summary judgment to Mr. Joyal’s personal automobile insurer on the basis that the exclusive remedy rule applied - because Mr. Ninedorf was within the course of employment at the time of the injury. Multiple maps confirmed the city where the men were last drinking was a rational place to travel between the delivery and returning home. They continued their trip home along a reasonable route and were deemed to be back in the course of employment.

While there are various opinions regarding the outcome of this case, the court ruled the men had returned to the course of employment due to the route they were traveling and therefore, despite intoxication, workers’ compensation benefit are the exclusive remedy.

This case is just one example of the exposures of traveling employees. For questions regarding potential risks of your employees, contact a knowledge broker at R&R Insurance.

Under the Wisconsin Workers' Compensation Act, there are nine criteria that must be met for a subcontractor to truly be considered an independent contractor for the purpose of workers’ compensation.

Contrary to popular belief, it can be difficult for a subcontractor to meet all nine of these criteria. Unless your subcontractor has their own workers’ compensation policy; you may have an exposure you did not foresee. Potentially, you may have a work comp claim for someone who you do not consider to be your employee.

The criteria are as follows:

1) Does the subcontractor maintain a separate business?

2) Do they have a separate FEIN from the IRS? Or have they filed business or self-employed income tax returns with the IRS for work or services in the previous year?

3) Do they operate under specific contracts? Meaning do they have a contract for services stating what service is to be performed, and for what amount of money?

4) Are they responsible for operating expenses under the contract?

5) Are they responsible for satisfactory completion of the work under the contract?

6) Are they paid per contract, per job, or by commission or competitive bid?

7) Are they subject to profit and loss under the contract?

8) Do they have recurring business liabilities and obligations?

9) Are they in a position to succeed or fail if business expense exceeds income?

As you can see, all of these can be broadly interpreted. There are published court cases that go both ways on whether a business meets the criteria for independent contractor status. These often hinge on one or two small facts about the relationship between the employer and subcontractor.

Keep in my mind that the subcontractor must meet ALL nine of these criteria to be considered an independent contractor for work comp purposes. If they do not meet all of them, courts will generally look somewhere else for coverage for this person. If as a business owner you are directing the work, you may be found to be acting as the employer, and thus be on the hook for a worker’s compensation claim.

The Department of Workforce Development has stated that a person is NOT an independent contractor for workers’ compensation purposes just because they say so, or because the contractor over them says so, or even if other government regulators say so. The Department looks at whether all nine of the criteria mentioned above are met.

The best course of action is to insist that all subcontractors maintain their own workers compensation insurance policy, and ask for proof of that via a certificate of insurance. Contact your knowledge broker for additional information.

As a general rule, if an employee is terminated for cause, the obligation to pay workers compensation benefits continues. Similar to a layoff or the employer's inability to provide light duty work, a termination is viewed in much the same way. The injured worker is still considered to be restricted in the general labor market due to injury, until he or she reaches maximum medical improvement, or is released to return to work without restrictions.

See Brakebush Brothers Inc and Employers Insurance of Wausau vs LIRC 1997

However, in recent years, the Wisconsin Department of Workforce Development has expanded their scope of potential situations where benefits may be suspended as the result of termination.

Here are a few exceptions:

1. The employee's employment with the employer has been suspended or terminated due to the employee's violation of the employer's policy concerning employee drug use during the period when the employee could return to a restricted type of work during the healing period. Compensation for temporary disability may be denied only if prior to the date of injury the employer's policy concerning employee drug use established in writing and regularly enforced by the employer.
2. The employee's employment with the employer has been suspended or terminated due to the employee's alleged commission of a crime, the circumstances of which are substantially related to that employment, and the employee has been charged with the commission of that crime. If the employee is not found guilty of the crime, compensation for temporary disability shall be payable in full.
3. The employee has been convicted of a crime, is incarcerated, and is not available to return to a restricted type of work during the healing period.

The exceptions listed above all make good sense as it relates to benefit cessation. Without those exceptions, the employer's insurance carrier is obligated to continue benefits. This certainly makes good sense as you could create a moral hazard whereby an employer terminates a work simply to circumvent the payment of benefits.

Summer is upon us, and with that will come the opportunities for part time summer jobs. Seasonal businesses expand, and potential employees return home from college for the summer - these are great opportunities for all parties involved.

Wisconsin employers of part time summer help should be aware that there are some potential pitfalls that come with workers compensation claims as they relate to part time summer employees.

In Wisconsin, part time employees, in most cases, are not going to be paid part time wages if they are injured on the job. If your summer help is injured on the job, it is extremely likely that he or she will qualify to be paid full time wages during the period of disability.  Generally, part time wages would be expanded to forty hours, unless the injured worker is part of a regularly scheduled class of part time workers, or restricts his or her availability in the labor market to part time, and is not employed full time somewhere else. As a general rule, these are not conditions that would apply to your summer help.

A second challenge with summer help is that if you have an employee who is working on restrictions, and there is not work available within those restrictions, that person is entitled to an ongoing weekly benefit. The only thing the employer can do to stop that benefit is an offer of work, or a full release from the treating doctor.

The final consideration is what happens when the worker must return to school? If the employer has work available within the restrictions, but the worker is not available because he or she has returned to school, no benefits are owed. If the student is completely off, he or she would be eligible to receive workers compensation benefits until released to light duty. If the worker is attending school far away from where they spend their summers, it can be an even bigger challenge for the workers compensation insurance carrier to get the doctor to provide an updated examination or release to work.

Seasonal work can again be a benefit to all parties involved, employers should; however, be aware of their obligations should a workers become injured on the job. The best solution would be to make sure that you have a light duty return to work program to accommodate any injured worker released to restricted work.

For questions regarding workers compensation insurance in Wisconsin, contact knowledgebroker Mike Geldreich.

There are several advantages to having a structured return to work program, all of which can shorten the length of the lost time claim, thus reducing the overall cost of the work comp claim and your workers compensation program.

1. Reduction of lost time reduces overall cost of the workers compensation claim
2. Gain control over the work comp claim process
3. Employees are more motivated to return to work, the shorter the time frame is from date of injury
4. Enables you the employer to manage the claim at a viewable distance
5. Displays interest in employee's health and empathy toward their situation

To learn more about the advantages of a structured return to work program, watch this quick video...

Time can work for you or against you in the workers compensation system. There are three critical timing aspects in regards to workers compensation claims:

1. Timely investigation (see 3 common mistakes of accident investigation)
2. Timely medical treatment
3. Addressing return-to-work intentions

To learn more about these three critical areas, watch this quick video...

It's important to understand how having a relationship with an occupational medical facility, and physicians can play in your favor when it comes to reducing workers compensation claims.

Showing sincere interest in getting the injured worker back to work, having the physician understand your work environment and a willingness to work together can all help to shorten the lost time claims portion of your workers compensation program. Learn more about developing a relationship with your occ-med provider in this quick video...

We often see claims not handled appropriately, or circumstances where important details were overlooked.

It can never hurt to have another set of eyes reviewing the information on your behalf.  R&R's Resource Center has dedicated claims management specialists who make sure that every detail is reviewed.

Another area where it's truly beneficial to have a resource double checking the work is in the reserve and litigation expenses. These are very large dollar items and can have a huge impact on overall cost of the claim. Again, it never hurts to double check to work of the insurance adjuster.

Learn more about R&R's Claims Management process in these quick videos...