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When addressing questions related to employer/employee relationships, the first aspect to note is whether the employee in question is a "covered employee" or not. Workers compensation benefits naturally apply to those employees who have established this specific relationship and who fall ill, sick or injured secondary to a workplace hazard or occupational incident. But what about those employers that are not covered by workers compensation? Many states, including Texas, do not require employers to carry workers compensation insurance for their employees. But “going bare” is always at the risk of the employer and leaves them open to litigation and issues of liability. The various protections established in civil court that workers compensation insurance offers do not extend to non-subscriber employers. Therefore, it is the sole responsibility of this uninsured employer to create a work environment that is safe and secure for employees and to establish clear and set expectations with their team. The first step in establishing a positive employer/employee relationship is reassuring employees that the leadership of their company always has their best interests in mind and they will do everything in their power to protect their team from any unforeseen issues. By guarding the interests of [...]

Although each industry comes with its own set of workplace hazards, every employer should put a special emphasis on workplace safety. Though most industries are not necessarily at risk for workplace deaths, a reported total of 5,333 workers died in the US secondary to work related injuries in 2020 – a 2% increase from the previous year. With workplace deaths steadily rising, it’s essential that every employer maintain up-to-date safety protocols and practice diligence in all areas. According to a recent study, the three leading causes of death in the workplace are: Falls from a height Being struck by a moving vehicle Being struck by a falling object While these incidents are not common in most workplaces, there are a few physically demanding industries where adequate safety is crucial to protect a workplace and its employees. Not only can a safer workplace help protect its employees from injuries or illnesses, it can also assist employers to: Reduce costs associated with workers compensation insurance Reduce injury/illness costs Reduce absenteeism and employee turnover These reductions lead to increased productivity, improved product quality and even higher employee morale. And increased morale has a direct effect on the productivity and efficacy [...]

From regular checkups and maintenance to accidents and emergencies, one thing is certain: healthcare is expensive.  And when it comes to workers compensation, the questions of compensability and extent of injury can be much more difficult to answer, leaving adjusters to determine what to do when there is a compensable injury and the injured individual feels that every piece of pathology identified is a function of that injury. In short, how can adjusters identify and treat the components of a workplace injury without inheriting or assuming responsibility for a patient’s pre-existing pathologies? In medicine there is a saying that “Common things happen commonly and rare things happen rarely.” Given the countless factors and variables involved in workplace injuries including treatment costs, potential fraud and legal precedence, there are several important questions that must be answered before an adjuster can determine compensability. Among these crucial questions are: Was this an acute injury? Is the injury the sole cause for the pathology? Is the noted pathology a function of the work injury or a natural progression of the pre-existing ordinary disease of life? Is this current pathology an aggravation or exacerbation of a pre-existing clinical situation? Keeping these factors in mind, [...]

Although 2020 has been a challenging year for the workers compensation and insurance industries, it has offered valuable insights into the keys to a successful workplace safety program. Looking ahead to 2021, employers and employees should focus on reviewing, updating and optimizing their safety protocols. In a recent article by the National Safety Council, Richard Fairfax remarks on the genesis and procedures of OSHA (Occupational Safety and Health Administration), a very potent agency that has been setting safety precedents for over 50 years. The safety requirements and issues outlined by OSHA are at the core of the workers compensation industry and directly affect employers and employees in the workplace. We all know that these ground rules can be onerous at times, but OSHA compliance officers are diligent and place emphasis on industries deemed to be especially hazardous, with construction and manufacturing leading the way. The ten most cited hazards in these industries include: Fall protection (training requirements) Hazard communication Scaffolding Control of hazardous energy Respiratory protection Ladder Powered trucks Machinery Eye/Face protection All these hazards and citations enumerated by OSHA highlight one simple fact: when it comes to workers compensation, safety is paramount. To enable a safe and successful [...]

(n) The capacity to recover quickly from difficulties; toughness Those in the construction industry would consider resilience to be the ability of a substance or an object to spring back into shape or elasticity. By any measure, 2020 presented everyone (and I certainly do mean everyone) with challenges and opportunities to bounce back and become more resilient. 2020 has undoubtedly been a difficult year for many, but those in the workers compensation industry know that this year has been particularly challenging for adjusters, employers and insurers all around the country. From the COVID-19 quarantine and its endless implications to ever-changing presumption laws and state regulations, 2020 has tested our resolve as an industry and highlighted the importance of a solid business plan and dedicated workforce. When it comes to maintaining and supporting a business, this pandemic has raised an important question: what exactly goes into an organization that makes them resilient? In the case of Clinical Compensation Consultants (C³), our resilience was established at the start of our organization 9 years ago, when we first outlined our business model, our business plan and how we were going to execute both. In taking advantage of all the robust technologies [...]

From frantic holiday shopping to freezing cold weather, the winter season is rife with safety hazards for employees of all types. Warehouse workers and drivers are rushing to fulfill orders while retail and hospitality workers contend with the throngs of holiday shoppers and diners. That's why it's important to have an effective safety training program and holiday plan in place that's winter-ready in order to minimize workplace safety concerns and maximize workplace efficiency during one of the most chaotic times of the year. Here are a few helpful workplace safety tips to keep in mind during the most chaotic time of the year. Avoid Slips and Falls With slips, trips and falls accounting for more than 800 workplace injuries a year, it's crucial to keep an eye out for potential hurdles or hazards in the workplace. This includes preventing ice build-up around walkways and in parking lots as well as diligent snow removal around the exterior of the workplace. Make sure that all walkways are clear of debris, water or other hazards and ensure that all employees are wearing the proper no-slip footwear. Also be sure to minimize the amount of weight being lifted or carried by each [...]

Low-cost, Expedient, Essential Since presumption laws related to COVID-19 vary by state, it's important for workers comp adjusters to know how to approach the clinical records and files to ensure accuracy in their claims. With legislation related to the virus and workers compensation changing every day, it can be difficult to appropriately determine compensability in workers comp claims with all the variables at play. This is why it's crucial that workers comp adjusters utilize a comprehensive Early Compensability Assessment (ECA) within the first 60 days of evaluating a workers comp claim to establish what the injury is and - more importantly - what it is not. ECA's can help adjusters determine early on in a claim what components of the reported injury are compensable and which items should be contested, saving time and money on treatments, surgical interventions and ongoing therapy. During an ECA, C³'s team of expert physicians - who specialize in various clinical fields - apply the standards of evidence-based medicine to determine what issues are a function of the event and those findings that have not been aggravated, exacerbated or otherwise compromised by the compensable event. C³'s early compensability assessments are proven to [...]

Your Content Goes Here C³'s physician pre-authorization services rely on the expertise of medical specialists to answer specific questions related to utilization of care and claimant treatment plans in workers compensation claims. During the pre-authorization process, C³'s board-certified physician reviewers - who are specialized in various fields - provide medical, evidence-based determinations on clinical necessity and assess the appropriateness of the: Proposed treatment Level of care Length of stay Treatment setting C³ can complete preauthorization requests quickly and efficiently, giving adjusters the results they need in less time. With accurate, thorough reports and a fast turnaround, our low-cost pre-authorization services ensure that adjusters receive - in a timely manner - all the pertinent clinical information necessary to successfully adjudicate their workers comp claims. Watch below as C³ Director of Pre-Authorization Chelsie Merchen discusses the benefits and importance of utilizing this low-cost clinical service. Call us today to learn more about how C³'s physician pre-authorization services can save time and money on your next workers comp claim!

When determining contribution for an injured worker, adjusters are faced with a slew of different questions and issues. What does the statute say? What does the appeals panel dictate? Seeking contribution can be a complex and often tedious undertaking, with countless requirements and hurdles that may complicate the adjudication process. In order to shed more light on this challenging concept, C³ CEO/Founder Donald A. Abrams, P.A. discusses the many facets of seeking contribution and how workers compensation adjusters can successfully navigate even their most difficult claims. Below is a C³ webinar recording on Seeking Contribution, hosted by Donald A. Abrams, P.A., which covers what the appeals panel says, what you need to do, what your doctor needs to do and, most importantly, what needs to be presented when determining contribution for an injured worker. ***For more information on C³'s continuing education program, or to schedule a complimentary CE course - which are available throughout the year for course credit - contact lderouen@comp-consultants.com.*** As a professional workers compensation cost containment and consulting firm with decades of combined experience in the work comp realm, C³ can offer insight and peace of mind on the topics that matter most [...]

To help keep adjusters and TPA's educated and up-to-date on the workers compensation issues at hand, C³ founder and CEO Donald Abrams, P.A. hosts complimentary continuing education courses that cover a variety of workers compensation topics.  In light of the extended quarantine and unusual workplace circumstances, C³ now offers these CE courses online as live webinars. From ethics and file review to impairment ratings and seeking contribution, adjusters can earn course credits in multiple topics from an experienced workers compensation expert, all without ever leaving their desk! Here's a list of the current complimentary online CE course offerings from Clinical Compensation Consultants: For more information on C³'s complimentary CE courses, or to schedule an online course for you or your team, email lderouen@comp-consultants.com. Learn More