ITO Services Improve Workers’ Compensation Support | Article

injured workerImagine a scenario where a “stuffer” at a patio-furniture manufacturing company becomes injured on the job. How can the doctor accurately assess whether and when this employee is again physically capable of doing the job and ready to return to work? What exactly does a stuffer do? Does this person need to bend, lift, reach or crouch; and what are the types of hand movements this job requires? The employer faces significant financial and legal risks if the doctor lacks this information and sends the injured person back to work too soon or if the employee is kept at home too long.

Some insurance carriers or third-party administrators proactively offer recommendations to their policyholders or clients to help them better manage such workers’ compensation exposures.

Take, for instance, Specialty Risk Services (SRS), a wholly owned subsidiary of The Hartford Financial Services Group, one of the largest insurance companies in the United States. SRS is a third-party administrator handling insurance claims (primarily workers’ compensation) for self-insured entities or for other insurance carriers. Most of its clients are Fortune 500 companies with a national presence.

Nancy Brennan, Vice President of Product Development and Marketing at SRS, surveys the landscape. “We have best practices, claims professionals, and medical staff to handle the management of a workers’ comp claim from day one when someone is injured. For the vast majority of claims — 90 percent of what comes in the door — this portfolio of resources gets great results.”

But as in anything else, there is always a small percentage of individual claims that accounts for a huge percentage of expense. Brennan cautions that if the employer does not manage these claims expertly, they could negatively impact an employer’s overall numbers, trends, and insurance rates. She says 10 percent or less of the workers’ compensation claims account for a huge percentage of the dollars that an employer might be exposed to.

Brennan explains, “It is impractical to add resources to address a small number of geographically-dispersed claims, so we look for partners out in the marketplace that bring unique tools to the table that help get at those small percentages.”

The Solution

One of those partners is Return to Work America (RTWA). With its outsourced solution, a doctor can view an online video of an employee’s job so the doctor can easily see the physical strength and body positions required. He or she can then click a link to quickly generate the required report online and transmit the resulting PDF to the employer and insurance adjustor in a matter of seconds.

RTWA, a partnership formed in 2005 and headquartered in Sarasota, Florida, is a subsidiary of WorkersCompensation.com, an Internet portal and the largest publicly accessible data source for the workers’ compensation industry. Its solution takes an injured worker’s workplace to the doctors, insurers, attorneys, and judges providing stakeholders with real understanding of the environment about which they are trying to make decisions. The improved information speeds an employee’s return to work, benefiting both the employee and the employer.

SRS is an RTWA client and secures the solution for its individual subscriber customers. Brennan suggests that employers should focus on solutions, such as the one RTWA provides, in situations where it is really difficult to describe a particular job’s cognitive or functional requirements. “Even if it could be written down, the doctor may not be sure what the description really means,” she states.

According to Brennan, a company closing a plant in a particular location, or a company with a particular front-line position where a lot of people keep getting injured on the job, are examples of situations warranting involvement of the RTWA system. A component of SRS’ services is evaluating the extent of its clients’ workers’ compensation risk exposure. “We then consult with them on proactive and pre-emptive steps to better manage the situation, getting injured individuals back to work while keeping company costs down,” Brennan explains.

She says clients expect RTWA to make safety recommendations or bring in additional resources for better results. “But it’s always our client’s (employer’s) call as to whether a particular resource will work effectively for them,” she explains. As many SRS clients are self-insured, all the dollars spent on a claim ultimately fall back to them.

The Solution’s Benefits

(1)Expertise in Video Job Analysis. According to Robert Wilson, President of RTWA and of WorkersCompensation.com, the company’s licensed vocational experts shoot each video job analysis, which they edit down to two or three minutes.

Wilson explains, “An employer doing its own job analysis videos becomes a credibility issue in court — was it slanted to look one way or the other?” RTWA uses its group of licensed professional vocational experts working in the rehabilitation field to shoot the videos; this removes bias as to whether the video was done in a proper environment and it properly reflects job tasks. “If the case ends up in court, our vocational experts’ testimony about how a video was produced–showing no company-induced bias in its development– holds up in court,” he states. “RTWA is a completely neutral party.” The supplier also stores the original videos in their entirety in case there is ever a question about the editing.

(2) ADA Compliance. Another benefit of RTWA’s system is protection services for compliance with the Americans with Disabilities Act (ADA). Wilson says RTWA shoots two video versions of a specific job–one prior to modification–and a second with the modified position, demonstrating accommodation. In an audit, the employer can demonstrate what it has done to make “reasonable accommodation” in compliance with ADA.

Kathy Lella, RTWA’s vice president of sales, agrees ADA compliance is “a customer risk.” But there is a more fundamental problem than constructive job changes–not having job descriptions at all. “In an increasingly litigious business environment and society, it pays to be prepared,” she says.

The job-accommodation videos help a doctor properly identify whether an injured worker can perform that modified job without causing re-injury. Without such a video, Wilson says, “There may be a conservative doctor who holds someone out much longer than he or she needs. Or, it may be a doctor who sends the injured worker back to work too soon or into the wrong job and the worker gets hurt again. Now the employer has compounding costs and problems.”

(3) Speed of System-Handled Forms. The RTWA system greatly impacts the speed and convenience of completing medical forms. Despite the fact that workers’ compensation forms and protocols vary from state to state, the RTWA system automatically generates the status reports and forms in the format required by each state.

The doctor just needs to answer the few questions where the information has not already been entered by the RTWA system and click on “submit.” The report and an email notification go to the employer, and that report is automatically stored online in case it is needed later for litigation.

“In some states, such as Florida,” remarks Wilson, “the doctor doesn’t even need to print and sign the form–the electronic signature qualifies. What used to take two to four weeks or more for a doctor’s report to get out takes about 30 seconds from the time it’s generated with RTWA.”

(4) Additional Benefits. Upon request, RTWA can make other services available to prospective customers. For example, RTWA can directly link the client to an appropriate licensed vocational expert who may be able to add value to the relationship. Says Wilson, “These experts can go into a workplace and help improve the ergonomic work environment or address safety issues, for example.”

Lella emphasizes the loss of functionality and versatility of an in-house process versus the completeness of the RTWA solution: “Companies don’t have the online reporting in-house, so there would be the issue of how to get the video to the doctor. Or if the video is available online, there’s the waiting for a doctor to fill out status reports and forms and send them by snail mail.”

She adds that an in-house solution is not economical because it requires having expensive video editing technology and people who can dedicate their time to setting up and editing videos.

Wilson corroborates that opinion. “It’s a pretty expensive system to generate. There was a lot of development time that went into making it possible to create a PDF on the fly in various forms across multiple states.”

(5) Increased Productivity. The main benefit for employers is cost savings garnered through getting employees back to work sooner. Lella explains, “When staffers return to work faster, companies save money because the patient usually ends up having less medical treatments because they heal faster.” Companies also save on replacement employees and reap greater productivity. “Bringing in temporary workers to cover someone’s job for three months requires training them, and often an inexperienced person takes twice as long to get something done,” Lella states.

Workers also derive benefit from such a system. “From the mental standpoint, most employees would rather be functioning and doing something other than sitting at home on the couch,” Wilson states. “Moreover, they receive more money back at work than on workers’ comp. If the company can get them back to work, it’s a win-win situation.”

There are workers’ compensation studies that indicate that, where injured workers remain off work for six months, there is a negligible likelihood they will ever return to the workplace. Studies also reveal that the longer someone is off work, it is more likely that he or she will develop emotional issues such as depression. Companies that choose to take advantage of solutions such as those available through RTWA will no longer be one of these statistics.

Lessons from Outsourcing Journal:

  • Outsourcing brings buyers a supplier’s expertise and investments in technology enablement of a particular process.
  • In-house solutions are usually too expensive to build, especially if a process includes variables for multiple states or regions.
  • Keeping up with technology enablement for changing regulations impacting a business process or industry is simpler and less expensive when the process is outsourced.
  • Outsourcing a video job analysis process for workers’ compensation claims provides authenticity for legal hearings if the issue goes to court.
  • Outsourcing a video job analysis process for workers’ compensation claims helps employers get their employees back to work sooner, which helps them cut the costs of the injury. But it also helps them determine when to send an employee back to work, so they don’t return too early and get re-injured.


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