Claim Management

A Healthy Bottom Line Means Healthy Employees

Allan Posted by Allan Brown

In today's business world we are faced with escalating healthcare costs. Employees are asked to contribute more to the cost of their healthcare policy and employers are providing wellness programs and incentives to change behavior and ultimately improve employee's health and reduce costs. Smart investments can work to bring these costs down, as the old saying goes, an ounce of prevention is worth a pound of cure. This remains true in health and workers' compensation. MEMIC prides itself on partnering with employers to create safe workplaces so injuries don’t happen and helping employees recover from injury as quickly as possible. Changing workplace culture by emphasizing prevention helped bring workers’ comp costs in Maine down by more than 50% and lost-time injuries down by about 40% since MEMIC’s inception in 1993.[i]

Preventing injuries still remains a primary focus but has become more complicated as the percentage of obese and overweight workers has reached epidemic proportions. The adult obesity rate in the United States has more than doubled in 20 years, from less than 12% in 1991 to more than 27% in 2011.[ii] Studies have shown what common sense knows: the range of medical treatment and time to recover are all greater for obese employees, with medical costs being three times higher in the first year and five times higher at 60 months.[iii] This is one reason why MEMIC has begun helping employers meet this challenge and in the past 3 years we have focused on expanding  the traditional emphasis of workplace safety to include ergonomics and wellness.

You don’t have to be a big company to be serious about employee wellness. In many states, like Maine, employers with 20 or fewer employees are allowed an annual tax credit for comprehensive workplace wellness programs.[iv] Putting a focus on employee wellness does not need to be expensive or time consuming. You may have heard people say “Sitting is the new smoking.” Something as simple as doing regular stand and stretch breaks can be a great place to start. See my other post about the little things that can cause back pain:


Here is a list of workplace wellness program resources:

WellSteps has free webinars, presentations and tools as does the National Wellness Institute.

(Note: national groups like National Wellness Institute and WellSteps may have local partners with dual membership like Lifeline Center for Workplace Wellness or Wellness Council of Maine.)

WELCOA (The Wellness Council of America) has free resources like case studies, presentations, surveys and samples.

The American Heart Associations’ Fit-Friendly Worksites Program has a free worksite wellness toolkit and employee resources, such as an online activity tracker, walking and exercise programs, and healthy eating resources.

National Business Group for Health offers resources and represents large employers' perspective on national health policy issues.

Partnership for Workplace Mental Health works with businesses to ensure that employees and their families living with mental illness, including substance use disorders, receive effective care.

National Health Awards offers descriptions of award winning employee health promotion programs.

Scoping paper by the Australian Government: “Overweight and obesity: implications for workplace health and safety and workers’ compensation

CDC (Centers for Disease Control) offers a variety of resources including Healthier Worksite Initiative, National Healthy Worksite Program and Workplace Health Promotion.


It's That Time Again: Post Your OSHA 300 Log Summary

Koch Peter 1 Posted by Peter Koch

OSHA's  29CFR 1904.1  requires all employers with more than 10 employees to keep a record of workplace injuries and illnesses.  All employers are required to complete this recordkeeping unless they have 10 or fewer employees during all of the last calendar year or the business is classified in a specific low-hazard retail, service, finance, insurance, or real estate industry.  Click on the following link to see a list of Partially Exempt Industries.

Because the OSHA Record Keeping Rule has many facets, this blog will only outline what OSHA requires for forms and posting.  More detail regarding definitions, requirements, timelines, and forms can be found at the OSHA Recordkeeping web page.

As we close the book on 2012 it's time to review the workplace injuries that occurred over the past year, enter recordable injuries on the OSHA 300 Log, and post the summary.  In the Recordkeeping Standard, OSHA outlines:

  • What is considered a recordable injury
  • How injuries are categorized
  • Forms, on which, injuries are recorded
  • How long to post the summary, and
  • How long to keep the forms

Following is a general outline of the steps you have to take to complete the required forms:

  1. Review your OSHA 300 log for 2012 (relevant injuries that occurred January 1, 2012 through December 31, 2012) - 29 CFR 1904.29.
  2. Complete the OSHA 300a Summary form by February 1, 2013 - 29 CFR 1904.32.
  3. Post the OSHA 300a Summary form from February 1, 2013 to April 30, 2013 - 29 CFR 1904.3.
  4. Fill out the OSHA 301, or equivalent form (some state workers' compensation first reports may be acceptable), for each OSHA recordable injury on the OSHA 300 log.

Some businesses receive an Annual OSHA Injury and Illness Survey.  This must be completed as directed in the survey and returned to OSHA or the stated designee [1904.41(a)], in addition to the forms/logs described above.

The forms, instructions, and the OSHA standard can also be found through the following links:

The standard is well written and in a question and answer format. 

Does Your Business Have An Effective Injury Management System?

Webb Hartley Posted by Hartley Webb

Operating a business is never easy, but is especially challenging in a difficult economy.  This should lead management to identify cost control methods.  Workplace injuries are extremely expensive when both the direct and indirect costs are considered.  An injury management system can help limit these costs while assisting injured employees return to the workforce.   I’ve worked as a MEMIC safety management consultant since 1993, and I still see businesses that do not have effective injury management systems. 

An effective Injury Management System consists of the following:

  1. Knowledge of loss experience (injury cause, injury type, body part).
  2. Identify and meet with a local preferred medical provider who can treat occupational injuries and illnesses; establish a working relationship with a shared return-to-work philosophy.
  3. Detailed job descriptions (that include physical tasks required) that can be used to communicate job requirements to the medical provider.
  4. A written plan that identifies the employer and employee responsibilities regarding injury reporting, claim filing, preferred medical provider use, return-to-work guidelines, and communication with injured employees during treatment and restricted duty. 
  5. Identify alternate duty job activities available in the event an injury occurs.
  6. Documented injury management system training to include specific employee responsibilities.

OSHA has developed a “$afety Pays Program” that includes an injury cost estimator.  This tool can provide convincing evidence of the importance of an effective Injury Management System. 

Injury Management 201

I want to take a look at the documentation and training needs that come with having a successful injury management program. I'm sure you're aware of the inevitable paperwork that comes with seeing a doctor – from diagnosis, to follow-up treatment, to providing the healthcare provider accurate documentation. All are part of the claim management.

The first thing the healthcare provider will need to know is what type of work the injured worker does. The job description you provide will enable the treating physician to determine if the employee can go back to the job. Additionally, it is the key to keeping the employee in the workplace even if they have physical restrictions. It's important to remember that the doctor will try to keep an employee on the job if at all possible, as it is a proven way to accelerate the healing process. The days of "stay at home for a couple of weeks" are long gone. Keeping active, staying with the work routine and being engaged with your livelihood is now a major part of the cure.

If the worker is unable to do their usual job they may be able to come back on light-duty or restricted duty.  This is part of your company's Return to Work Program. The documentation associated with this process is of great importance – in essence it is the roadmap to recovery. Remember, that if you vary from the Return to Work Program, what initially was a simple treatment plan can quickly become a legal field day. The bottom line is, if all three parties (employee, employer and healthcare provider) communicate accurately and with great frequency, staying on the road to recovery should be easy.

A quick plug for training – train your employees on properly reporting an injury. The employees must know that the company has a detailed injury management program in order to participate accordingly, should a claim arise. Their immediate report of an injury and adherence to any restricted work program and treatment plan are essential parts of a successful injury management program.

Claims Management 101 – Using a Preferred Medical Provider

The vast majority of employers I have worked with over the years have written an employee health and safety program that is generally specific to their operations.  Unfortunately, there are many times that an important piece is missing. That piece involves managing an injury, or as some call it “claims management,” and without this their employee health and safety program is incomplete. Accordingly, I thought it prudent to begin an overview of why claims management is important and how to go about it.

To say that both the employer and employee will typically do whatever it takes to avoid an injury is an understatement. Unfortunately, in this not so perfect world – sprains, strains, lacerations, etc. – do occur in the workplace.  The two main reasons to develop a formal claims management process are moral and financial in nature:

  1. Seeking treatment and getting the injured person back to full health is the morally correct course of action.  
  2. In regards to the financial impact of a workplace injury, medical treatment can save – or cost – an organization a huge amount of money. The outcome usually depends on whether the worker quickly returns for transitional or “light” duty or if they are out of work for an extended period of time. The latter scenario usually happens because the treating physician knows little to nothing about the employer. 

One thing is for sure, once an accident happens, dollars, time spent and other resources are inevitably going to add up. Having a contingency plan that involves a “company doctor” or preferred medical provider (often referred to as a PMP) is a proven way to get the employee back to work while minimizing the financial costs that go along with a long-term, lost-time injury.

When employers are first introduced to the concept of having a company doctor, many initially view it as a time and resource burden they can not afford. The truth is it's actually quite the opposite. Finding a preferred medical provider requires only a phone book or an Internet search. MEMIC provides a web-based search for medical providers under the “Find a Medical Provider” link on

Establishing a relationship with a preferred medical provider can be done easily over the phone. Typically connected to an occupational health clinic, these providers specialize in working with employers and injured workers for the benefit of both. The bottom line is that a little time spent upfront can have a big impact on how the claim plays out. And with a professional in your corner, the odds of minimizing costs – while getting a worker back to full health – is increased many times over.

Substance Abuse Testing After an Accident

I got an e-mail from my boss recently sharing a Maine client’s request for information regarding drug testing. Specifically, about drug and alcohol testing as part of their accident investigation process:

“Do you know, or can you point me in the right direction, regarding drug testing policies? Is it permissible to establish a blanket policy to require employees to be drug/alcohol tested as part of an accident/incident investigation?”

The Maine Substance Abuse Testing Law makes the establishment of a "blanket policy" somewhat complex—even following a suspected incident of abuse. Under this law, testing can be conducted either prior to hire or after, but if after hire there must be probable cause or testing must be conducted randomly. Furthermore, unless substance abuse testing is required by federal or commercial driver’s license regulations, a Maine employer is required to

  • submit a substance abuse testing policy to the Bureau of Labor Standards for approval before conducting testing,
  • use a testing laboratory that is licensed by the Department of Health and Human Services, and
  • for probable cause and random testing, employers with 20 or more employees, must have an Employee Assistance Program that is approved by the Department of Health and Human Services, Office of Substance Abuse.

The Maine Department of Labor has created model substance abuse testing policies to help employers and to ease their review of the policies. Your preferred medical provider is another key player in this process and can help you in implementing a post-accident substance abuse testing policy.

More information can be found in Substance Abuse Testing Report 2007, which is prepared by the Maine Bureau of Labor Standards.

Although this information references laws pertaining to the state of Maine, all states have similar agencies for guidance. If you are a MEMIC customer, and are unsure about the regulations and your responsibilities, contact your MEMIC safety consultant or an attorney.