Who Wins and When?
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Transcript of Who Wins and When?
Who Wins and When?
“Win” does the case end?
• Physician: Case ends when all is done that can be; patient lost to follow-up; patient is on autopilot to a determined outcome
• Worker: When wholeness is achieved both economically and physically.
• Missouri: 2 years after last visit to w/c provider • Employer: When productivity, moral, and workforce is restored• Insurers: Motivated to get off books; limit long term liability; case
closure; do the right thing; “Pay what we owe.”• Attorney: ?• System: W/C Case ends at point after which minimal change over
course of the following year is expected
“Win” does the case end?
• Physician: Case ends when all is done that can be; patient lost to follow-up; patient is on autopilot to a determined outcome
• Worker: When wholeness is achieved both economically and physically.
• Missouri: 2 years after last visit to w/c provider • Employer: When productivity, moral, and workforce is restored• Insurers: Motivated to get off books; limit long term liability; case
closure; do the right thing; “Pay what we owe.”• Attorney: $• System: W/C Case ends at point after which minimal change over
course of the following year is expected
“Win” does the case end?
• Physician: Case ends when all is done that can be; patient lost to follow-up; patient is on autopilot to a determined outcome
• Worker: When wholeness is achieved both economically and physically.
• Missouri: 2 years after last visit to w/c provider • Employer: When productivity, moral, and workforce is restored• Insurers: Motivated to get off books; limit long term liability; case
closure; do the right thing; “Pay what we owe.”• Attorney: ?• System: W/C Case ends at point after which minimal change over
course of the following year is expected
Case closure begins…• Application for employment
• Hire strong young men?
• Hire healthy workers– Smokers– Obesity– Chronic disease
Case closure begins…• Application for employment
• Hire strong young men?
• Hire healthy workers– Smokers– Obesity– Chronic disease
TABLE 3. Injury rate ratios and 95% confidence intervals (Cl) by part of body classification amongSouthern Califomia Edison electric utility workers, adjusted for occupation, age, and Job experience,1980-1992
Injury Ratio of rate ratio Female
Number Of Injuries Number of Days Lost (females/
Lost Days
Part of Body Males Females Males Females males) 95% Cl to MaleAll head and neck 5,604 684 15,607 4,146 1.3 1.16-1.39 2.18Neck 840 186 8,399 2,862 1.8 1.53-2.22 1.54All upper extremities 7,178 1,205 12,943 7,493 1.5 1.38-1.59 3.45Hand/wrist 2,220 448 4,643 5,551 1.7 1.49-1.89 5.92Shoulder 889 133 7,706 1,033 1.2 1.00-1.50 0.90Back 4,665 731 59,705 9,751 1.1 1.01-1.20 1.04All lower extremities 6,342 1,396 34,247 9,669 2.1 1.97-2.25 1.28Hip 304 89 3,348 454 2.6 1.88-3.58 0.46Knee 1,908 382 22,200 5,333 1.7 1.48-1.93 1.20Ankle 1,186 295 5,135 1,198 2.4 2.03-2.73 0.94Body systems 756 175 9,081 2,679 1.3 1.06-1.53 1.27All Injuries 31,892 5724 183,014 50,169 1.7 1.53
Sex Differences in Work-related Injury Rates among Electric Utility WorkersMichael A. Kelsh and Jack D. Sahl
Sex Differences in Work-related Injury Rates among Electric Utility WorkersMichael A. Kelsh and Jack D. Sahl
TABLE 4. Injury rate ratios and 95% confidence Intervals (Cl) by selected type of Injury among
Southern California Edison electric utility workers, adjusted for occupation, age, and Job experience, Ratio of
1980-1992 Female
Number of Injuries Number of Lost Days Injury Lost Days
Type of Injury Males Females Males Females Ratio F/M 96% Cl to Male
Fractures 718 78 13,943 1,638 1.2 0.9-1.5 1.08
Surface wounds 8,586 1,676 12,536 3,127 1.8 1.7-1.9 1.28
Bums 974 92 7,948 560 1.2 0.9-1.5 0.75
Object in orifice 2,483 172 312 30 0.9 0.8-1.1 1.39
Sprains/strains 10,467 1,805 98,928 22,148 1.4 1.3-1.5 1.30
Cumulative trauma 139 96 1,951 4,417 3.6 2.4-5.3 3.28
Mental stress 78 48 2,410 1,971 2.9 2.0-4.3 1.33
Poisoning 251 92 634 56 1.5 1.1-2.0 0.24
Case closure begins…• Application for employment
• Hire strong young men?
• Hire healthy workers– Smokers– Obesity– Chronic disease
Case closure begins…• Pre-placement
– Job matching– Strength testing– Culture of collaboration
• Pre-placement and post accident drug testing• Accepting that complaint is legitimate then
verify!• Transparency in seeking the underlying
problem
Case closure begins…• Pre-placement
– Job matching– Strength testing– Relationship building
• Pre-placement and post accident drug testing• Accepting that complaint is legitimate then
verify!• Transparency in seeking the underlying
problem
Case closure begins…• Pre-placement
– Job matching– Strength testing– Relationship building
• Pre-placement and post accident drug testing• Accepting that complaint is legitimate then
verify!• Transparency in seeking the underlying
problem
Case closure begins…• Pre-placement
– Job matching– Strength testing– Relationship building
• Pre-placement and post accident drug testing• Accepting that complaint is legitimate then
verify!• Transparency in seeking the underlying
problem
Reasons for hiring attorney
• Employee does not know what to expect
• Fearful for themselves and families
• Controversy develops between employee/employer or employee/adjuster
Keys to Closure
• Case management intervention before expectations and patterns have developed
• Early diagnosis/aggressive diagnostics including MRI (careful!)
Keys to Closure
• Maintain communication with employee even if off work
• Identify and alleviate employee’s concerns
• Move quickly towards normalcy by closing case, settling, and moving on.
Avoid These Mistakes!
• Provide immediate care
• Late reporting
• Ignoring the employee
• Under reporting compensation
• Not complying with restrictions
Summary• Hire right demographics
• Hire healthy workers
• Pre placement drug testing
• Pre placement job matching and strength testing
• Post accident drug testing
• Early diagnosis; set expectations
• Early closure and move on!