• Reducing Absenteeism: Knowing the role of your nurse case manager
• I have kept my employee working on modified duty ... but now what?
• Rebuttable Presumption: What you need to know

BWC Plans to Continue and Expand the Safety Council Rebate Incentive Program
The Ohio BWC has announced the continuation and expansion of the Safety Council Rebate Incentive Program, which allows employers to earn rebates on their workers’ compensation premiums for participating in their local safety council and reducing workplace injuries.

A 2% rebate is awarded to employers who attend a number of specific safety council programs, and an additional 2% for demonstrating a reduction in the frequency and/or severity of workplace incidents. As an expansion of the program, the BWC intends to allow group-rated employers to participate in safety councils and earn an additional 2% performance rebate for demonstrating improvements in workplace safety.

To read the full press release, visit the BWC media center.

For more information on the safety councils and rebate program, visit the BWC website, or call your TPA account executive for more information.

A step toward victory in the crackdown on prescription drug abuse and workers’ compensation fraud
On March 16, 2011, Ohio Bureau of Workers’ Compensation Administrator Stephen Buehrer released a statement on Scioto & Huron County fraud investigations relating to legal action taken against Dr. James E. Lundeen Sr., a physician who largely treats injured workers.

Lundeen is at the center of an ongoing investigation of workers’ compensation fraud and possible prescription drug abuse based on reported patterns of over-prescribing narcotics to injured workers. While no charges have been filed to date, Lundeen’s Plymouth and Portsmouth offices have been searched as part of the investigation. Tom Wersell, director of BWC investigations, has reported that Lundeen is responsible for 61 percent of all Scioto County narcotics prescriptions in the BWC system.

As part of his news release statement, Buehrer asserted,

“Ohio BWC spends more than $50 million in prescription narcotics each year. While these prescriptions can be a valid part of treatment, the inappropriate use of pain medicines in treating injured workers hurts the worker and constitutes fraud against the taxpayers and businesses of Ohio. I hope today’s actions put those who would take advantage of Ohio’s injured workers on notice that it is something we absolutely will not tolerate.”

Since the release of this statement, Lundeen has been decertified as a medical provider for the BWC. He can continue to practice medicine, which includes the treatment of injured workers; however, he will no longer be reimbursed for these services by BWC. The resulting cost will fall to the injured worker. As the investigation continues, we will certainly keep you posted on the progress of this case.

Experts in workers’ compensation, workplace absence management, and return-to-work strategies present on industry trends, offer helpful resources, and answer your questions during live, interactive webinars. The comprehensive line-up of topics revolve around medical and administrative cost containment and are intended to help you make well-informed decisions regarding your workers’ compensation and absence management programs.

Safety in the Workplace: Drug-Free Environment
Thursday, April 7, 10:00 – 11:00 a.m.
***Eligible for one hour of safety training for the group-rated employer
Presenter: Joseph Hallal, Code Three Risk Management
$20 for clients; $35 for general public

How to Expedite Medical Care and Cut Costs/ Building Relationships with Your Medical Provider
Wednesday, April 27, 10:00 – 11:00 a.m.
Presenter: Dr. Harvey Popovich, MD, Family & Occupational Medicine; Medical Director, AdvoCare, Inc.
$20 for clients; $35 for general public

Safety in the Workplace: 10-Step Safety Program
Thursday, May 5, 10:00 - 11:00 a.m.
***Eligible for one hour of safety training for the group-rated employer
Presenter: Joseph Hallal, Code Three Risk Management
Fee: $20 for clients; $35 for general public

State-Funded Employer: Proactive Strategies to Dealing with the Most Challenging Cases
Thursday, May 12, 10:00 - 11:00 a.m.
Presenters: Joseph Cannelongo, LPC, CRC, Rehabilitation Counselor, Vocational Expert, CEO, AdvoCare Group and Kathy Urry, Rehabilitation Manager, VoCare Services, Inc.
Fee: $20 for clients; $35 for the public

Whether you manage group health, wellness programs, general employee absenteeism, and/or workers’ compensation for your company, you should always be aware of your best ally in protecting your business and your employees: the nurse case manager. This person is at the center of the communication that takes place between your employee, the provider, you (the employer), and any other outside vendors. The nurse case manager is your direct link to and advocate for medical cost containment and controlling absenteeism, as well as lasting wellness for your employees. In an effort to increase your understanding of the process, we felt it would be beneficial to offer you a look at the nurse case manager’s primary objectives and how you, as an employer, can jump-start an effective return-to-work strategy.

The nurse case manager will manage the following tasks when facilitating a case from beginning to close:

• CONTACT ALL PARTIES and review related medical information and history to develop a care plan specific to an employee’s unique condition and treatment
• FACILITATE EARLY REFERRALS to appropriate specialists to ensure expedient diagnosis and quality treatment
• REVIEW TREATMENTS REQUESTS FOR A MEDICAL NECESSITY, and in the case of the BWC, relatedness to the injury
• ASSIST EMPLOYEES IN FINDING RESOURCES specific to their cases; this includes guidance on appropriate and reputable medical providers, social agencies, employee assistance programs, pharmacy assistance programs, etc.
• DETERMINE THE TYPICAL DISABILITY PERIOD for individual conditions based on national guidelines to assist the employer in plans for staffing, etc.
• COLLABORATE WITH YOU (THE EMPLOYER), THE EMPLOYEE, THE PHYSICIAN, AND THE TPA to ensure all parties have access to pertinent information and that all are working toward the same successful outcome
• ASSIST THE EMPLOYER IN FINDING WORK WITHIN THE COMPANY/ORGANIZATION that would allow a recovering employee to work in a modified capacity or find other temporary employment or volunteer opportunities if modified duties are not available

Ultimately, the goal of the case manager is to guide the employee toward independence in his/her care, thereby motivating a healthful, confident, and timely return to work.

How you can work with your nurse case manager to reduce absenteeism:

• CALL YOUR MCO
  Find out who your nurse case manager is and consult with him/her on any cases.
• EARLY CONTACT IS KEY
  If you know or have a feeling that an injury or illness will result in lost time or extended absence, call your nurse case manager upon first notice from your employee. This can sometimes prevent absence in the first place. Research has shown that early referral to case management services results in decreased disability periods.
• HAVE YOUR EMPLOYEE RESOURCES READY
  Provide the nurse case manager with any company resources available to your employee, such as an employee assistance program (EAP) or other wellness programs. This gives your nurse case manager tools to improve outcomes for you and your employee.
• COMMUNICATE WITH YOUR EMPLOYEE
  Don’t be afraid to ask how he/she is doing. Your employee most likely wants to know you care. Plus, this call is an opportunity for you to direct your employee to utilize the nurse case manager.
• PROVIDE A JOB DESCRIPTION A job description can be a road map for the nurse case manager to prioritize treatment that focuses on body functions most necessary to the employee’s return to full duty. The job description provides all parties with an awareness of what the employee must be capable of accomplishing in order to return to full duty. It can also be a tool to assist in the development of strategies for implementing modified work duty, which enables an employee to continue recovery in the workplace as he/she works toward full duty. Restrictions can then be determined based on the job duties and goals set to assist the employee in gradually retuning back to full capacity.

—Cheri Pira, RN, BSN, CCM, Nurse Case Manager, AdvoCare, Inc.

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Many medical only claims are for minor injuries that resolve quickly with minimal disruption to the workplace. But there are those few cases where employees return to work after an injury only to remain on ‘restricted duty’ for an extended period of time. Remain at Work Services (RAW) may be helpful in resolving these more complex medical only claims, so, we have provided some insights on what RAW services aim to accomplish below.

The case manager implementing RAW services can offer the medical provider valuable insights about the nature of the job to facilitate recommendations for achieving the goal of full duty.

RAW provides rehabilitation services to employees who are able to remain at work after an injury. This assistance can shorten the duration of restrictions and promote a speedy recovery, allowing for a quicker reinstatement of normal job duties. Upon referral for services, a field case manager meets with the injured worker and you, as the employer, to gather information such as a job description, prescribed treatment, the worker’s current limitations and challenges, and the nature of the workplace. The case manager will then meet with the treating provider and the injured worker to develop a plan for supporting the worker’s return to full duty. The case manager can offer the provider valuable insights about the nature of the job to facilitate recommendations for achieving the goal of full duty. Common services implemented through the RAW program include functional capacity evaluations, work conditioning programs, and on-site therapy services.

RAW programs are sometimes easier to provide in an established Transitional Work Program, but a formal program does not have to be in place to offer RAW services. Transitional work focuses on using real job duties as part of the therapeutic process to progress the worker to his/her original job functions. Bringing a therapist to the work site may allow for less disruption to the work day and eliminates travel and wait time for the worker and employer. The injured worker is monitored and the physician is kept up-to-date on the employee’s progress in accordance with the return-to-full-duty plan, allowing for the restrictions to be gradually lifted.

Employers may be reluctant to utilize RAW services because they are risk expenditures. Realistically, the only truly additional expense the claim incurs is for the hours billed for case management because the injured worker would have been eligible for the restorative services as part of the medical management process. However, through the RAW program, the field case manager has the ability and tools to properly inform and engage the medical provider as he/she makes specific recommendations for modified and/or full duty assessments. Ultimately, the field case manager can proactively deter potential lost time and even re-injury, both being so much more costly overall. A few hours of field case management may be a good investment!

While these types of claims are routinely reviewed for referral to RAW services, you, as employer, can be proactive by notifying AdvoCare of your interest in learning more should you identify a case that may not be progressing as quickly as anticipated.

—Denise Nutter, Account Executive, AdvoCare, Inc.

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Ohio Revised Code 4123.54 (eff. 10/14/2004) aims to curb substance abuse in the workplace. Under the law, an employer may seek the disallowance of a workers’ compensation claim filed by an injured worker if the employee tests positive for alcohol or specified controlled substances/drugs. Keep in mind that rebuttable presumption does not apply to injuries that would have occurred regardless of the injured worker’s physical state.

In theory, under rebuttable presumption, if an employee tests positive or refuses to be tested, the burden of proof shifts to the employee to prove that the presence of alcohol or drugs was not the proximate cause of the work-related injury.

As part of the legislation, the Ohio Bureau of Workers’ Compensation provides all employers with a written notice along with their certificate of coverage; both must be posted on-site conspicuously so that employees can view them.

Failure to do so may result in the company forfeiting its rights to protection under the regulation. Employers must post this notice to alert employees they may not be eligible for workers’ compensation benefits if they’re injured while intoxicated or under the influence. This applies to claims with dates of injury after October 13, 2004 or whenever written notice is posted, whichever is later. It may appear to employers that a positive drug test should result in a claim being denied, but the Bureau is very specific on what has to occur for that to happen. The following are some items the Bureau looks for in an employer’s documentation to make their decision:

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