Sprains and Strains in Workers Comp: What Adjusters Should Know

Statistically the most commonly filed workers comp claim, strains and sprains account for nearly half of all reported workplace incidents (according to the BLS). Although these two injuries vary significantly, oftentimes workers are clinically diagnosed with a combination strain/sprain injury, which can cause confusion when it comes to determining appropriate treatment and compensation. To clarify, a sprain is an injury to a specific ligament while a strain is an injury to a muscle. Ligament injuries such as sprains involve a stretching or tearing of the tissue, whereas strains occur in a muscle or tendon and can range from a simple overstretch to a partial or complete muscle/tendon tear. Both sprains and strains are most likely to occur in the manufacturing, moving, transportation, and warehouse industries, however they can happen in virtually any job or industry. Since the treatments, interventions and length of injury for a sprain and strain vary widely, it is imperative that the distinction be made between these two pathologies when accepting a compensable diagnosis for a workers comp claim. Statistically one of the most commonly reported workplace incidents, strains and sprains account for over 30% of all workers comp claims (according to the BLS). Since [...]

Sprains and Strains in Workers Comp: What Adjusters Should Know2021-06-24T22:16:58+00:00

Topics for the Workers Comp Adjuster: Back Injuries

Back Injuries What Adjusters Should Know Statistically one of the most common compensable injuries in the workplace, back pain accounts for over 20% of workers compensation claims in the U.S. With half a million employees making back injury claims a year, the cost to employers is continuing to increase significantly. Recent data shows that the cost for an employee back injury can be anywhere from $40,000-$80,000, but the average payout from employers is $24,000. While many of these workplace injuries occur in more physically demanding industries such as construction, there are also a surprising number of back pain claims made by employees that spend the majority of their work day sitting at a desk. This is why it is important for adjusters to understand the various elements of back injuries and how they are treated and compensated in workers compensation claims. Cost containment tools such as Early Compensability Assessments and Diagnostic Re-reads can also offer much-needed clinical insight into these complex claims and help identify key components of a workplace injury to determine what the exact compensable injury is and how it should be treated. Because back injuries can occur in virtually any workplace situation - and [...]

Topics for the Workers Comp Adjuster: Back Injuries2021-04-22T21:11:20+00:00

Understanding Pre-Authorization in Workers Compensation

Physician Pre-Authorization One of C³'s most crucial containment tools, our 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 comp claims. During the pre-authorization process, C³'s board-certified physician reviewers provide medical, evidence-based determinations on medical necessity and assess the appropriateness of the: Proposed treatment Level of care Length of stay Treatment setting C³'s pre-authorization services are quick and efficient, giving adjusters the results they need in less time. And our expert panel of board-certified physicians can provide accurate, thorough reports on a wide array of claims to help adjusters successfully contain costs. The above video features one of C³'s physician panelists Dr. Steven Thornton as he discusses the importance and benefits of utilizing expert pre-authorization services. Call us today at (512) 519-9069 to learn more about C3's superior cost containment services. Learn More

Understanding Pre-Authorization in Workers Compensation2021-03-27T18:53:08+00:00

Liberal Construction in Workers Compensation Law

Previously established statutes, rules and provisions regarding workers comp can easily become compromised or manipulated by the nuances of language, making it difficult to reach an objective and accurate resolution. To help clear up some of the problems with interpretation of surrounding workers compensation rules and statutes, a legal concept known as “liberal construction”, coined in 1928, is applied. This concept allows many state statutes, including workers compensation laws, to be construed in a fashion that favors the injured employee. The effect is to give injured employees the benefit of the doubt when dealing with gray areas within state law. The purpose of Worker’s Compensation statutes is to protect and serve injured employees. That said, participating in the workers compensation system requires the injured employee to forgo certain protections.  Judicious use of this concept can compensate for this loss- protecting the worker’s interests when adjudicating their claims. A loose (or expansive) interpretation of the statutes is meant to assist the injured worker in any way reasonably possible. In some instances, there may be facts presented as part of the case that the judge can disregard as being tangential or inconsequential. Occasionally this can result in all the facts [...]

Liberal Construction in Workers Compensation Law2021-03-05T18:55:42+00:00

Employer and Employee Relationships in the Workers Compensation Environment

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 [...]

Employer and Employee Relationships in the Workers Compensation Environment2021-02-08T23:02:57+00:00

Safety Strategies for the Workplace

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 [...]

Safety Strategies for the Workplace2021-01-28T21:27:28+00:00

Cost Containment Strategies for the Workers Comp Adjuster

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, [...]

Cost Containment Strategies for the Workers Comp Adjuster2021-01-23T01:22:30+00:00

OSHA Workplace Safety Resources You Should Know About

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 [...]

OSHA Workplace Safety Resources You Should Know About2021-01-06T22:53:35+00:00

Our 2020 Resilience Story

(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 [...]

Our 2020 Resilience Story2020-12-31T21:57:00+00:00

2020 Holiday Workplace Safety Tips

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 [...]

2020 Holiday Workplace Safety Tips2020-12-02T21:02:55+00:00
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