Collaboration among states improves program

By Kendra DePaul, BWC Other States Coverage Manager

In late August, underwriting consultant Julie Phillips and I traveled to the User’s Conference for Other States Coverage. The conference was hosted by United States Insurance Services (USIS) who is the vendor we work with, along with Zurich American Insurance to offer workers’ comp coverage outside the state of Ohio.

As I have mentioned in previous blog posts, workers’ compensation can be complicated for employers working in multiple states as each state has different rules and laws that must be followed. The Other States Coverage program allows BWC and several other state’s funds to assist their policyholders with securing proper coverage nationwide.

The purpose of the annual conference is to get together with the other states to discuss program results, best practices and troubleshoot common questions.

There are six other state funds in the program and in 2016 about 3,000 policies were issued collectively. The majority of the policies are small, with 68% being under $5,000 in premium. Although there are some large accounts, the collective group has primarily embraced this program to offer coverage options for smaller employers.

Around the meeting table it was clear that the reason each of the state funds offered this option is because they cared deeply about their policyholders and wanted to assist them with being successful. The issue with coverage and claims in a multitude of different states is not unique to Ohio. Each of these state’s funds have dealt with similar issues of employees hired in one state and injured in another, or with employers being fined for not having coverage in a specific state. It is also clear that some states are harder to work with than others and require multiple forms to be filed when policies are issued there.

A big push at this User’s Conference is for each state to share lessons learned or tools created to make the program more efficient for each user. One example of this has to do with schedule rating forms. Schedule rating is an available premium adjustment on private workers’ comp policies. An insurer can offer debits or credits for unique conditions of an employer.

For every policy we issue we are required to complete a form stating whether a schedule rating was used and the specific reasons why. Most states have a separate form for this purpose and if you issue a policy in multiple states, multiple forms are often required.

In an effort to reduce the time spent completing these forms, Julie Phillips took the initiative to create an Excel tool where policy information only has to be entered once and then is populated to multiple forms and saved as a PDF document. This new format has allowed our underwriters to spend much less time completing individual forms. Julie presented the Excel tool at the User’s Conference so they could begin taking advantage of it as well.

I am thankful for Julie’s hard work in completing this and I am continuously impressed by the collaborative spirit of all the state funds involved in the program. Each of them has offered assistance as we continue to improve our Other States Coverage program in Ohio. We all have the same goal of providing excellent customer service to our policyholders. Working together, I am confident we will do just that.

Total Worker Health – the next step in workplace evolution

By Greg Williams, BWC Occupational Safety and Hygiene Fellow

When I was little I remember hearing stories of the Industrial Revolution in school. I remember accounts of children, my age or younger, having to go to work to support their families, often in abhorrent conditions.

Eastern Illinois University describes it this way: “Young children working endured some of the harshest conditions. Workdays would often be 10 to 14 hours with minimal breaks during the shift. Factories employing children were often very dangerous places leading to injuries and even deaths.  Machinery often ran so quickly that little fingers, arms and legs could easily get caught.”

While working conditions were abhorrent for children, they weren’t any better for their parents. Wages were dismal, hours were long and workplaces put safety on the backburner in favor of production.

One of the worst industrial accidents took place in 1911 in the Triangle Factory in New York City. Cramped conditions, inadequate exits, and an inability of workers to speak out for their safety led to a fire killing scores of workers.

We look back upon these stories and wonder how it could have ever been this way. Who would let a 6-year-old work in a factory? Who would expose workers to such dangerous hazards? Why didn’t someone intervene?

A lot has changed since then. It’s been more than a century, and laws prohibit children from working under a certain age. The Occupational Safety and Health Administration (OSHA) regulates conditions in workplaces around the country. The number of workers losing their lives on the job is lower than it has ever been. Indeed it seems like we have it all figured out, right?

That’s when I think about where we will be a hundred years from now. What conditions do we subject individuals to now that our great-great grandchildren will find appalling? What will they teach in schools in the year 2117 about labor in the year 2017? What are the next steps we should be taking to care for workers in the 21st century?

The answer to this question is simple. Instead of sending workers home the same way we found them, we need to send them home better than we found them. This is the idea behind Total Worker Health, a program put in place by the National Institute for Occupational Safety and Health (NIOSH). This program takes a comprehensive look at worker well-being. Not only does it promote following OSHA standards, but it also advocates proper benefits and policies for employees, commitment to wellness from employers, comprehensive wellness programs for workers, and so much more.

The idea driving this TWH approach is that the workplace is a perfect environment to implement health and safety interventions. It makes sense. The most recent employment statistics from the U.S. Department of Labor show that around 140 million people are currently working in the U.S. American businesses lose trillions of dollars each year in productivity, absenteeism and medical costs. Where better to try and intervene in the health, safety and wellness of individuals than the place they spend half their day?

This mindset led BWC to partner with NIOSH on research and initiatives to better the lives of workers both on and off the clock.

We’re also honored to be part of the NIOSH TWH Affiliate Program and its focus on an integrated approach to protecting and promoting worker well-being.

This article is not about giving a template on how to build a great worksite wellness and safety program. It’s not about telling you everything you need to be doing to promote a healthy workforce. Instead, it’s about the why behind taking the next steps to improve worker health. Indeed when our descendants look back on our generation, we want them to see all the efforts we made to protect and promote the health and well-being of our workers.

Make your business a falls-free zone!

September is Falls Prevention Awareness Month

Submitted by STEADY U Ohio, an initiative of the Ohio Department of Aging

Older adults probably play an important role in the success of your business, both as consumers and employees. That is, until they fall down.

One in three older adults will fall this year. Every five minutes, an older Ohioan is injured in a fall. When staff or customers fall in your business, it doesn’t just hurt them; it also hurts your reputation and your bottom line. A single fall can affect an older adult’s ability to remain independent and contribute to your continuing success.

Most falls in businesses can be prevented, and prevention can be achieved largely through staff and customer education and motivation. The STEADY U Ohio initiative is ready to help businesses create a safer environment for older adults and Ohioans of all ages who do business with them. Here are a few steps every business should take to prevent falls:

  • Create a falls prevention policy for your business and make sure your employees know and understand it.
  • Routinely identify issues with flooring, stairs, lighting and housekeeping that could cause accidents.
  • Post signs at your entrance and around the business advising customers to notify staff of slipping or tripping hazards.
  • Ensure that walkways are clean and clear of cords and obstructions. If you must use rugs or mats, ensure that they remain flat and that they do not move under foot.
  • Ensure that people can move freely around displays in the aisles without adjusting their gait. Avoid displays at the end of aisles that obscure a customer’s view of other customers and obstacles.
  • Have staff regularly monitor aisles for items that have fallen off shelves and are blocking.
  • Quickly clean up all spills (dry and wet). Provide supplies (i.e., towels, “wet floor” signs, trash cans) in convenient locations around your business.
  • Provide seating around your business, particularly in areas where customers may have to wait during busy times (e.g., near checkout lines, the service desk, the pharmacy, restrooms and exits).
  • When it’s snowy or icy, extend sales or offer shopping options for older customers (e.g., delivery or rain checks by phone) so they don’t have to risk falling to get a good deal.
  • Educate staff on proper lifting and carrying techniques and equipment, and instruct them to help customers carry large or bulky objects and bags.
  • If someone falls, document the incident and examine the cause so that you can prevent future accidents. Use our incident report template to get started.
  • Empower staff to offer assistance to customers who appear to be having trouble getting around.

Find tools to help your business prevent falls at our website, www.steadyu.ohio.gov. Resources include a sample falls prevention policy, a hazard checklist, an incident report template, tip sheets and a falls risk self-assessment. Educate yourself, your staff and your consumers, and make your business a falls-free zone!

Protecting Ohioans in agriculture

By Erik Harden, BWC Public Information Officer

Agriculture has always been a critical component of Ohio’s economy and one of the state’s major industries for employment.

According to the National Safety Council, agriculture is also the most hazardous industry in the country. Each day, almost 100 agriculture workers in the U.S. suffer a lost-time work injury, with 60 percent related to overexertion or slips, trips and falls.

With all of this in mind, BWC’s Division of Safety & Hygiene (DSH) decided once again to promote its products and services at the Farm Science Review – one of the premier agricultural trade and education shows in the nation. Hosted by The Ohio State University, this year’s event runs Sept. 19-21 at the Molly Caren Agricultural Center in London, Ohio.

For the second straight year, representatives from DSH will staff a booth to engage visitors about the free programs and services we offer to assist employers and workers in Ohio’s agribusiness.

For example, our industrial hygienists can help farms guard against environmental hazards, including chemicals, pesticides, fertilizers, dust, mold, extreme noise and temperature extremes.

Our ergonomists can illustrate ways to cut down on hazards resulting from:

  • Manual materials handling;
  • Repetitive, hand-intensive work;
  • Poor workstation design;
  • Sedentary work.

The average cost of a lost-time claim for Ohio agriculture companies* is a little more than $52,000. Our safety consultants can help prevent common but costly injuries to protect the bottom line of Ohio’s agriculture businesses and their workers.

If you’re going to Farm Science Review this week, stop by and see us! We’re booth No. 32 in Building 513.     

Related links
Grain Storage and Handling Operations – The Deadliest Hazards
Safe at Work, Safe at Home  

*With 10 to 49 employees

Opioid infographic illustrates BWC’s success, pharmacy leadership

Document’s release coincides with director’s retirement

By Nick Trego, Clinical Operations Manager, Pharmacy Department

Click on infographic  for larger image.

BWC’s communications department recently completed an infographic summarizing our work over the last six years to rein in excessive opioid prescriptions and the dangers they pose to injured workers, namely abuse, addiction and death.

Using a mix of colors, illustrations and statistics, the infographic is a roadmap of the steps we’ve taken to reduce the number of injured workers dependent on opioids from 8,029 in 2011 to 4,101 in 2016, a near 50 percent drop.

It’s called “Saving Lives — BWC battles the opioid crisis.” A better title might be, “Saving Lives — a tribute to John Hanna.”

Hanna, our pharmacy director, retires Sept. 29 after eight years in the job. More than anyone, it is John who is responsible for the achievements highlighted in the infographic, as well as for other pharmacy program reforms we’ve implemented to protect injured workers.  Along the way, with the backing of BWC leadership, he also built a pharmacy department that is a model in the work comp industry today.

When John arrived at BWC in 2009, we had no real pharmacy department to speak of. It was essentially a mix of disparate services shared by various personnel in service offices throughout the state. We had no formulary, no clinical review committees. Controls and best practices were low. Costs and drug utilization were high. For a system that experienced more than 100,000 new injured workers a year, we had to do better.

What followed over the next several years were a series of improvements to reduce inappropriate prescribing of opioids and other dangerous drugs. We created a Pharmacy & Therapeutics Committee of six physicians and six pharmacists to provide recommendations on all medication-related policy. We created the first work-comp-specific closed formulary in the nation. We stopped coverage of any new opioid formulation until it was reviewed by our P&T Committee. And in 2016, we implemented a rule that requires providers to use a set of best practice guidelines when prescribing opioids. If they don’t follow those guidelines, they risk losing their BWC certification.

To further demonstrate our commitment, we offer injured workers who meet specific criteria up to 18 months of paid recovery services if the treatment for their workplace injury leads to an opioid addiction.

In other enhancements, we developed an automated program that flags claimants with high-risk medication regimens. We implemented “electronic edits” that require all drugs in medical-only claims to have a prior authorization to continue to be covered past 60 days. The same goes for workers who’ve had no claim activity for 270 days. We became the first state agency to cover naloxone products, as well as the first state agency to add Abuse Deterrent Formulations of opioids as a choice for prescribers. And earlier this year, our board of directors approved a rule restricting first prescriptions for opioids to seven days or 30 doses.

Our work has garnered local and national media attention, and work comp programs across the country are calling us, wanting to mirror our success. Topping it off, we wound up saving our agency money. That’s right, I said “saving.” For every dollar we spent on reforms, 50 came back to us in savings. All told, our department spends nearly $49.6 million less on medications today than we did in 2011.

Not that any of this was cost-driven. John always told us, “If we implement best clinical practices, the savings will follow.”

Earlier this year, Gov. Kasich recognized John for his efforts, awarding him the Governor’s Award for Employee Excellence. The industry has recognized his efforts, too. Just last month, the International Association of Industrial Accident Boards and Commissions named John and our team winners of its 2017 Innovation Award.

None of this was easy, but John kept us focused on one guiding principal: “Do what’s best for the injured worker. That’s why we’re here.”

Thanks, John.

Click here for more on BWC’s efforts on the opioid front.

 

BWC fraud investigators secure 8 convictions in August

Business owners, claimants and a healthcare provider who attempted to cheat the Ohio Bureau of Workers’ Compensation (BWC) are among eight convictions secured by the agency in August.

The cases bring the year’s total convictions for BWC’s special investigations department (SID) to 100.

“Employer premiums are set aside to care for Ohio’s injured workers,” said SID Director Jim Wernecke. “We’re holding employers, medical providers and injured workers who cheat the system accountable to protect those dollars for Ohioans who need assistance until they can return to work.”

Among those convicted last month:

Richard Rocco, Rocco Prosthetics and Orthotics, of Cincinnati, Ohio
Rocco pleaded guilty Aug. 31 in the Franklin County Municipal Court to one count of falsification, a first-degree misdemeanor.  Rocco, operator of Rocco Prosthetic and Orthotics, submitted multiple C-9 forms (Physician’s Request for Medical Service) without the knowledge or authority of the physicians whose names appeared on the forms. Investigators seized from his clinic a master template and copies of blank forms with names and signatures of physicians. Rocco was sentenced to pay investigative cost restitution to BWC in the amount of $16,762.

Natoya Finley, dba Close to Home Child Development Center, of Cleveland, Ohio
Finley and Rebecca Barbee-Whitt, co-owner of the child care center, were operating the center without workers ‘compensation coverage. The pair ignored requests from BWC investigators to reinstate the policy. Finley entered into a payment plan July 24 after she was charged with four counts of failure to comply, all second-degree misdemeanors, in the Cleveland Municipal Court. She then withdrew her not guilty pleas and agreed to the Selective Intervention Program. She is required to report monthly compliance with the established payment plan. Barbee-Whitt has a warrant for her arrest for failure to appear on the charges.

Thomas N. Jung, dba Tom’s Industrial Truck Service, of Lima, Ohio
Jung pleaded guilty Aug. 4 in Lima Municipal Court to three counts of failure to comply, all second-degree misdemeanors. BWC’s Employer Fraud Team found Jung was operating his business, Tom’s Industrial Truck Service, with lapsed workers’ compensation coverage. Jung was previously investigated in 2012 for lapsed coverage and before bringing his policy into compliance. Jung’s sentencing is scheduled for Oct. 2. He will not receive jail time if he brings his policy into good standing prior to sentencing.

Mark J. Cothern of Danville, Ohio
Cothern pleaded guilty Aug. 11 in the Knox County Court of Common Pleas to a fifth-degree felony count of attempted workers’ compensation fraud.  BWC’s investigation, which involved surveillance and multiple undercover operations, found that Cothern had worked at the Scoreboard Drive-in performing various duties while receiving temporary total benefits. Cothern was sentenced to 180 days in jail, which was suspended for three years of community control, obtain and maintain full-time employment and repay restitution in the amount of $9,406.46.

Alfred Bowlson of Toledo, Ohio
Bowlson pleaded guilty Aug. 29 in the Franklin County Common Pleas Court to a fifth-degree felony count of workers’ compensation fraud. Bowlson reported wages for employment to the State of Ohio for his work as a maintenance person in various apartment complexes in the Toledo area while receiving BWC disability. He was also receiving vocational rehabilitation and indicated he was discouraged at being unemployed and unable to provide for his family. Bowlson was sentenced to non-reporting community control for five years and ordered to pay restitution of $18,501.46 to the BWC. He will serve 11 months in prison if he violates these terms.

Elton Rista, dba ED & R Dining Services, of Avon Lake, Ohio
Rista, owner and operator of Ed & R Dining Services, pleaded guilty to a second-degree misdemeanor count of failure to comply Aug. 18. BWC investigators found Rista was operating his business without workers’ compensation coverage between June 2011 and August 2015. A Lorain County Court of Common Pleas judge sentenced Rista to 90 days in jail (suspended) and two years of non-reporting community control. He must also pay restitution of $9,478, return to compliance with workers’ compensation laws, and pay court costs.

Shardette Nyarko of Columbus, Ohio
Nyarko pleaded guilty Aug. 1 in the Franklin County Court of Common Pleas to one count of workers’ compensation fraud, a first-degree misdemeanor. BWC received an allegation that Nyarko may have filed false BWC claims. The investigation found Nyarko filed three false claims in order to receive BWC benefits. Nyarko filed the claims stating she was injured at work, when in fact, she was not employed at the time of the alleged injuries. A judge fined her $100, then suspended the fine.

To report suspected workers’ compensation fraud, call 1-800-644-6292 or visit bwc.ohio.gov.

Motivation equals success

By Jim Landon, RN, and Mukesh Kumar Singh, CFE, LLM, MBA, BWC Compliance & Performance Management

In any workers’ compensation claim, motivation is always a key factor in not only the rehabilitation of the injured worker but for a successful return to work.

While this holds true in any industrial injury claim, it’s particularly true for catastrophic injuries that result in an amputation. When an injured worker suffers an amputation injury, not only are they faced with physical hurdles to overcome but also the challenge of regaining their self-esteem.

Obtainable goals, collaboration
Injured workers who suffer an amputation must learn to adapt both physically and mentally to return to a state of normalcy post-injury. Without motivation and obtainable goals, the injured worker will quite often ultimately fail. However, for an injured worker to be motivated it is crucial they have a strong support system. This system should consist of a positive collaboration between family members, the employer, providers, as well as BWC and the managed care organization (MCO) for ultimate success.

A key to this success is fitting the injured worker with the correct prosthesis as soon as he or she is medically stable to do so. The philosophy of this is well proven. There is only a limited window of opportunity in sustaining the motivation factor for the injured worker before frustration and poor self-esteem set in. If this does not occur, a successful return-to-work and the return to a normal life are unlikely.

The process of fitting the injured worker with the correct prosthesis follows a very simple logic. In choosing the proper device it need not be high tech or low tech, but the right tech.  The choice should be fitting a device that provides optimal function and gives the injured worker the best chance of not only returning to gainful employment but to a pre-injury quality of life.

Support + motivation = success
We must remember that behind every claim number is a person that is more than likely going through the worst period of their life, and they need collaborative support. Support provides motivation.  Motivation equals success.

We saw this recently when we participated with Ryan Nagy, an injured Middleburg Heights police officer, in the Wounded Heroes’ Trek of Hope. Together, we trekked the Annapurna circuit in Nepal.

Ryan’s successful return to work and a normal life following his above-the-knee amputation is a testament to teamwork along with BWC and finding ability in disability with a courageous attitude. His motivation, goal setting, collaboration and a strong support system at home and at work made the difference. Learn more about Ryan’s story by viewing this video.