The Next John Geaney Seminar: Not To Be Missed!

Question: On Wednesday, April 5, 2017, where will more than 200 really smart New Jersey workers’ compensation professionals be?

Answer: At the Doubletree Hotel in Mount Laurel, New Jersey, attending John Geaney’s “Complete One-Day New jersey Workers’ Compensation Seminar.”

Well, technically the seminar is put on by Millennium Seminars, LLC, but Geaney, a Shareholder and Executive Committee Member of the prestigious law firm, Capehart Scatchard, is the creator of these seminars for workers’ compensation pros. He’s been organizing and running these things for many years, but the events never seem to get old or stale.

At Work Comp Psych Net, we’re proud, honored even, to be sponsoring the upcoming educational day.

The Spring Seminar’s Agenda is chock full of information geared to helping overworked claims adjusters, nurses, case managers and attorneys do their jobs more efficiently and effectively.

In addition to learning about recent case law, listening to leading physicians discuss up to date medical issues (one session is “Causation and Treatment of Spine Claims”), hearing leading employer workers’ compensation managers offer tips to rein in costs (at this seminar, managers from United Airlines, ABM Industries and Verizon will present) John Geaney always manages to weave in some fun (at his last seminar, he organized a College Bowl style competition).

If you’re a workers’ comp professional, you really ought to register to attend this worthwhile event.  And if you do go, please stop by the Work Comp Psych Net booth to say hello. We’d love to see you.

Psychosocial Issues And How To Deal With Them

Workers’ compensation claims adjusters are busier than the Ed Sullivan Plate Spinner. Running around with one or two hundred lost time claims would make anyone dizzy, but at the recent National Workers’ Compensation & Disability Conference (NWCDC) in New Orleans, presenters tossed the frazzled spinners a few more plates to shoot up on the sticks.

The issue? Psychosocial factors delaying claim resolution.

At one well-attended session, Marco Iglesias, Medical Director for The Hartford, and Robert Hall, Corporate Medical Director for Optum went into great detail about how psychosocial factors rear their heads in the claim process and how they impede recovery.

For example, consider these research statistics based on a study of 75,000 claims:

Time out of work increases 30% for a musculoskeletal claim with one co-morbid complication;

Duration increases 57% if the claim co-morbidity is depression;

According to The Hartford’s Dr. Iglesias, 10% of claims, the ones with all those psychosocial issues, cause 60% of claim costs;

At another presentation, attendees learned that Mental Health, Addiction and Obesity are the three comorbidities causing the greatest cost and time away from work.

Also, according to an AETNA presentation, 97% of depressed patients have a second co-morbid condition.

Research aplenty; solutions, not so many.

The pitch at the conference seemed to be two-phased. First, here are a number of factors, which, if present, can significantly delay recovery (see our Predictive Triggers post for more on this). Second, if you’re an adjuster or nurse case manager and you recognize any of these factors in one of your claims, put on your sensitive side psychology hat and provide gentle guidance and counsel to help the injured worker overcome the problems delaying recovery.

At the breaks after the sessions adjusters were talking in small groups about how this was all well and good, but it required increased time on claim, time they didn’t have. Also, many of them admitted that their claim resolution approach, honed over many years, veered more to the cut and dried than the touchy feely.

So, what should overworked adjusters and nurse case managers do with this  fast-approaching, ever-enlarging, dead-ahead iceberg?

Well, there are three critical things to know when one suspects the presence of psychosocial triggers:

First, are they real?

Second, are they work-related?

Third, are they truly impeding recovery?

The only way to know with credibility the answers to those three questions is to have a qualified clinician conduct a thorough Initial Psychological Evaluation.

So, with all due respect to the excellent doctors who presented at the NWCDC, we suggest logging in to our claimant Intake & Referral Portal and referring these difficult claims with their thorny issues for a highly-reliable, speedy and comprehensive Initial Psychological Evaluation. The cost is only $450, and you’ll be glad you did it.

That’s all part of our pledge to you: Recovery – Sooner, Faster, Smarter!

 

The Oregon Bellwether Bi-Annual Study’s Conclusion: Workers’ Comp Is REALLY Expensive in New Jersey!

Every two years, Oregon’s Department of Consumer and Business Services publishes its Workers’ Compensation Premium Rate Ranking Summary. Last week, the state issued its 2016 Study Summary. Just before the Study was released, Workers’ Comp Insider published a Primer on how to interpret it. This from that post:

The executive summary of this year’s study is due to be released in the next few days, and the findings are closely watched in quite a few states. Unlike the National Academy of Social Insurance report, issued last week, the Oregon study takes the comparison beyond simple averages. Instead, Oregon derives average rates for what a hypothetical set of comparable employers would pay, thus factoring out much of the difference in states’ risk profiles.

Oregon’s Premium Ranking Study looks at premium rates for a set of the most common job classifications, establishes a single index rate for each state based on the job classification rates and then compares those index rates among all the states.

California, the state which, if it were a country, would have the world’s fifth leading GDP, is always in its own universe in studies like this. However, after discounting California, the state with the highest index ranking in the nation at $2.92 per hundred dollars of payroll is (drum roll): New Jersey. The New Jersey index rate is 158% higher than the median rate for all states.

New York and Connecticut are right behind New Jersey in cost, with index rates of $2.83 and $2.74, respectively.

There is no medical fee schedule in New Jersey, which is one of the reasons for the high costs. Fee schedules do exist in New York and Connecticut, but they’re quite high. On the other hand, Massachusetts also has a fee schedule, one of the lowest in the nation, and it’s index rate reflects that. Massachusetts’s index rate of $1.29, which is 70% of the median, makes it the sixth lowest cost state in the country.

At Work Comp Psych Net we are highly sensitive to the high costs within New Jersey, because head injuries and psychosocial issues impact those costs in a significant manner. According to the New Jersey ‘ Compensation Rating & Inspection Bureau, total incurred costs (paid plus reserved) for all head injuries for the 5-year period from 2009 through 2013 were $1.72 billion. And that’s just for insured companies. It does not include self-insureds, which means that total state costs are more than likely near $3 billion for the period.

Clearly, carriers and third-party administrators representing insured and self-insured employers need all the help they can get. Early evaluation and intervention in claims that may contain mental health components delaying recovery is a proven way to eat into the high costs that so bedevil workers’ compensation professionals in New Jersey. That’s why we’re here with solutions that are: Sooner, Faster, Smarter.

Predictive Psychosocial Triggers For Workers’ Compensation Claims

There are a number of factors, which, if present, provide accurate prediction of who will benefit from early psychological evaluation. Current research is conclusive that the two most predictive psychological factors regarding who will file a non-traumatic occupational injury claim are:

  • Job task dissatisfaction; and,
  • Distress as reported on Scale 3 of the Minnesota Multiphasic Personality Inventory (MMPI). The MMPI Scale 3 was created using patients who exhibited some physical complaint for which no general medical explanation could be established.

However, employers rarely sense job dissatisfaction in one of their workers and claims adjusters don’t administer the MMPI to claimants before or even after they file claims.

So, when we attend claims association meetings in New Jersey, we are often asked what psychosocial factors, if present in a claim, should prompt a speedy referral for an Initial Psychological Evaluation. With that in mind, and drawing on the best evidence-based scientific research available, we’ve put together a list of specific Predictive Triggers for workers’ comp claims, Triggers which, if three or more are present, indicate early referral for an Initial Psychological Evaluation  is important. Keep in mind that our Initial Psychological Evaluation, although not technically an IME, is done at the IME level.

In no particular order, here are the Triggers:

  • History of abuse, sexual and/or physical
  • Excessive alcohol consumption
  • History of narcotics abuse
  • Depression, or a history of it
  • Coping inadequacy
  • Two or more prescriptions for narcotics
  • Perception of poor health in general
  • Passive attitude
  • Widowed or divorced
  • Tendency to catastrophize and make a referral
  • Blue collar, physically demanding job
  • Complaints of headaches, with no head injury
  • PTSD complaint, without traumatic experience
  • Age over 40
  • Low non-work activity levels
  • History of Somatization (Somatization is the conversion of anxiety to physical symptoms)
  • Driving distance from home to work greater than  30 miles
  • History of filing workers’ comp claims, or other legal claims
  • Poor performance in high school

If you’re a claims adjuster, a nurse case manager or an attorney handling workers’ comp claims, you’ve seen many claims where a number of these Predictive Triggers are present. And you’ve probably been frustrated because the claims have not closed when they should have; they drag on; MMI seems elusive. Work Comp Psych Net can help. Give us a chance. Create an account and login at www.workcomppsych.net to Make a ReferralSooner – Faster – Smarter.

A Pleasant Way To Do Real Good

Reprinted from today’s Workers’ Comp Insider

Today we’re participating and helping out at the Central New Jersey Claims Association’s annual golf event. We’re at Mercer Oaks Municipal Golf Course in Windsor Township. There are seventeen foursomes roaming the links trying not to hurt themselves or anyone else.

The proceeds of the event go to Kids’ Chance of New Jersey, a wonderful organization providing scholarships to children of workers who have been “seriously, catastrophically or fatally injured in a work-related injury.” The three New Jersey claims associations, led by the Central (you guessed it – the others are North and South), are deeply serious about helping these children.

The New Jersey chapter of Kids’ Chance was formed in 2012 when the Central Association awarded its first scholarship. This year the number rose to 15 and totaled $125,000.

Right now, one of the early scholarship recipients, Scott Kwiatek, whose Dad was killed in a workplace explosion when Scott was two months old, is running a putting contest a stone’s throw from where I write this. This is what Scott says about his scholarship:

“Before receiving the … Kids’ Chance of New Jersey scholarship, I could only afford to go to a community college. This award has truly changed my life, because now I am able to attend my dream college, the New Jersey Institute of Technology, to pursue a career in Civil Engineering. Words cannot express how grateful I am.”

Claims adjusters sometimes have to deal with awful stuff, workers who are profoundly injured, sometimes killed. Every once in a while they get to see tragedy up close and personal, families devastated by the loss of a parent due to a workplace injury. That sort of thing is difficult to deal with; it can harden a person. It’s gratifying, indeed, to see this group of adjuster professionals giving so much of themselves (and having a good time doing it!) to help children victimized so early in life.

Are Nurses And Health Care Workers Facing More On-The-Job Violence?

If you asked the average person to list professions with the highest rates of violent assault, few would put health care professionals high up on that list. But the reality is that when it comes to workplace violence, nurses, nursing aids, and paramedics have the dubious distinction of being very high up on the list; only police and correctional officers suffer a higher rate of on-the-job assaults. And many nurses say that the violence is only getting worse. In a fact sheet on violence, The International Council of Nurses, a federation of more than 130 national nurses associations representing the millions of nurses worldwide, says that:

  • Health care workers are more likely to be attacked at work than prison guards or police officers.
  • Nurses are the health care workers most at risk, with female nurses considered the most vulnerable.
  • General patient rooms have replaced psychiatric units at the second most frequent area for assaults.
  • Physical assault is almost exclusively perpetrated by patients.
  • 97% of nurse respondents to a UK survey knew a nurse who had been physically assaulted during the past year.
  • 72% of nurses don’t feel safe from assault in their workplace.
  • Up to 95% of nurses reported having been bullied at work.
  • Up to 75% of nurses reported having been subjected to sexual harassment at work.

The issue of safety for nurses and allied health professionals was brought to the forefront after the deaths of two California healthcare workers in separate incidents in a single week. Psychiatric technician Donna Gross was strangled to death and robbed at Napa State Hospital. Days later, nurse Cynthia Barraca Palomata died after being assaulted by an inmate at Contra Costa County’s correctional facility in Martinez. The deaths have sparked a new push for better security and stronger worker safeguards, particularly in settings treating prisoners and psychiatric patients.

While the occupational danger in environments like prisons and psychiatric hospitals is recognized and real, these are hardly the only high-hazard settings in which nurses work. Hospital emergency rooms are widely recognized as a hazardous environment, but violence occurs in other wards, too. The Well, a NY Times healthcare blog, featured an article by RN Theresa Brown entitled Violence on the Oncology Ward. And the CDC spotlighted research focusing on an increase in assaults on nursing assistants in nursing homes. In that study, 35% of nursing assistants reported physical injuries resulting from aggression by residents, and 12% reported experiencing a human bite during the year before the interview. There are no healthcare settings that are immune. Assaults routinely occur in general hospitals, in health clinics, and in patients’ homes.

And the Bureau of Labor Statistics reports:

Over the past ten years, healthcare workers have accounted for over half of the nonfatal workplace violence injuries involving days away from work across all industries.

The perpetrators of violence are varied: While many assaults are by patients, friend and family members of patients also can commit the assaults. There are also rapists or muggers who are targeting healthcare settings or solitary workers; drug addicts and robbers, who are looking for medications; and domestic violence also visits the workplace.

It’s unclear why violence is on the rise. Many point to staff shortages. Others see the preponderance of alcohol, drugs, and ready access to weapons as contributing factors; others think that hospital administrators do too little in the area of prevention.

One organization trying to help is the Emergency Nurses Association, which has issued a Workplace Violence Toolkit, targeted specifically at emergency department managers or designated team leaders.

Others are seeking legislative relief that would require hospitals and healthcare facilities to have safety and security plans and training in place.

As far back as 2008, the New Jersey legislature passed and enacted the Violence Prevention in Health Care Facilities Act, which states in part:

Within 6 months of the effective date of this act, a covered health care facility shall establish a violence prevention program for the purpose of protecting health care workers.

Although, writing in 2015, Ann Twomey, president of Health Professionals and Allied Employees (HPAE), New Jersey’s largest union of nurses and health care workers, opined:

Shockingly, the NJ Department of Health has failed to conduct any outreach to either employers or employees to inform them of their rights and responsibilities under the law. No surprise then that an informal survey of hospital staff HPAE conducted in 2013 found fewer than 50% of the respondents reporting their hospital was in full compliance with the law.

A bit biased? Perhaps, but the issue of workplace violence in New Jersey’s health care settings continues to be real and palpable. At Work Comp Psych Net we have been privileged to assist a number of health care professionals  as they cope with PTSD and strive to return to work after suffering the trauma of a violent attack.

Sadly, we do not expect to see a rapid decline in that variety of patient.

 

 

Psychosocial Barriers in Returning to Work Following an Injury

If you want to know whether your employees expect to return to work following an injury, try asking them! In a recent study, 530 injured employees rated their outlook in terms of anticipated recovery and ability to return to work. Of the 162 respondents who predicted that their injury would prevent them from returning to work, 96% never went back to the workplace. Their negative expectations became reality!

Because expectations and beliefs greatly affect an injured employee’s motivation to return to work, even the best return-to-work program can’t guarantee that injured employees will return to the workplace. Some of the factors that may negatively influence an employee’s outlook include inadequate understanding of the medical condition, unrealistic expectations about recovery, and fear that returning to work may create further injury.

There are also various psychological and social factors that can affect how an injured employee feels about returning to work, including:

  • Level of overall job satisfaction
  • Support at home and/or at work
  • Relationships with supervisor and colleagues
  • Beliefs about the cause of injury or pain

How can employers proactively tackle these concerns before an injury occurs?

  1. Build and maintain positive relationships with employees.  Open communication fosters positive relationships and leads to higher levels of workplace satisfaction. Encourage your employees to share their ideas and concerns with you to demonstrate that you are interested in their well-being and value their contributions.
  2. Flexibility can help motivate employees. Understand what motivates your employees and be prepared to create new options. Some employees seek new challenges while others may want more flexibility in terms of work hours or job tasks. In general, employee motivation may be greatly influenced by your willingness to share planning decisions and adjust work environments or job tasks. Employees who enjoy their jobs are typically loyal to their employers and more eager to return to their workplace after an injury. These principles also apply when establishing a transitional work assignment for an injured employee.
  3. Explain your company’s return-to-work policy. Make sure that all employees understand your company’s motivation and commitment to helping injured employees return to work safely after an injury. You will boost company morale by actively engaging your employees to assist and encourage their recovering co-workers.

Although severe injuries can prevent an employee from ever returning to work, the good news is that an employer can directly and positively impact an injured worker’s recovery outlook and outcomes.

Although the path back to work can sometimes seem like a minefield for both employers and injured workers, the highly trained clinicians and therapists at Work Comp Psych Net are here to assist claims adjusters, employers and injured workers every step of the way.

Recovery: Sooner, Faster, Smarter 

When Should Adjusters Refer Claims For Mental Health Evaluations?

As we roll out Work Comp Psych Net to New Jersey’s insurers, third party administrators, self-insured employers and defense attorneys, we are often asked how to tell if a claim needs referring, as well as how to how to decide where to send the referral.

Well, in order to provide the best possible service, we believe whoever you send claimants to for psych evaluations and/or treatment should understand a few things. Here’s what we understand:

  • We understand MMI, and we know you want your claimants to reach it as soon as possible. We do, too. In a limited number of sessions we can achieve MMI sooner, faster, and smarter.
  • We understand Permanency Benefits, credits and the importance of a deeply detailed patient history. In our first session we will dig down to discover in as much detail as possible the background of the person we are seeing. This information is vital to bringing the claim to a fair and reasonable outcome for you and the claimant.
  • We understand that there is an epidemic of head injuries in New Jersey today and that most head injuries can reach MMI satisfactorily and quickly given the right treatment.
  • We understand that you need information in real time, which is why we’ve built New Jersey’s first online Claimant Referral and Electronic Health Record system for mental health issues.
  • We understand that most claimants who need mental health treatment can return to work in some modified duty capacity as they recover. That’s why our clinicians have been trained in how to work with you, the claimant and the claimant’s employer to find the right modified duty, thus lowering the cost of indemnity payments immediately.
  • Finally, we understand that, although claimants may benefit from mental health treatment, in many cases the cause of their distress is not work-related. In our Initial Psychological Evaluation we are expert in determining if a mental health issue “arose in the course of employment.”

When should you make a referral to us? The answer is when you notice in the claim any of the following:

  • Complex head injury
  • Concussion diagnosis
  • Chronic and/or continuing acute pain
  • Severe depression
  • High anxiety
  • Fear of returning to work
  • PTSD diagnosis

We understand that therapy has to fit the person. We are expert in:

  • Cognitive Rehabilitation
  • Biofeedback
  • Psychotherapy
  • Neuropsychology

We would welcome the opportunity to explore all of the ways Work Comp Psych Net can work for you. Your time is precious. We won’t waste it.

This is our pledge to you ­– Recovery: Sooner, Faster, Smarter.

Modified Duty: An Employer’s Silver Bullet

Time away from work can be frightening and debilitating for injured workers. They often begin to think of themselves as “disabled.” The longer they stay out of work, the harder it becomes to even approach getting back into the work routine. When that happens, depression and other mental health issues rear their heads.

Consequently, it is crucial to speed recovery through the use of modified duty, one of the most important tools an employer has to reduce lost time and costs. This is just as true for injuries compromised by behavioral or mental health issues as it is for the common slip and fall.

Modified duty is a bridge back to full duty, keeping workers active and part of the team. If you’re an employer, you should instruct your medical provider to focus on what the employee cannot do while injured, clearly delineating work restrictions.

To prove the point, for a moment, put yourself in the skin of the injured worker and imagine you are talking with your doctor about your injury. Would you want the doctor to list for you the potentially countless physical tasks you could actually still do while injured? Or, would you want the doctor to tell you the realistically few things you should not do? The latter approach is the one doctors prefer, too.

Once you have the medical restrictions, work with your supervisors to develop progressive, short-term transitional jobs and tasks. Most important, make sure that injured employees and supervisors carefully follow the physician’s restrictions: The goal is to speed recovery, not aggravate the condition and make things worse. As medical treatment continues and your medical provider gradually lifts restrictions, increase job demands to ease the employee back to his or her original job.

Until now, the traditional method for mental health clinicians to counsel injured workers was to approach the thing as if sitting on a two-legged stool. It was the clinician and the worker. Pretty precarious and often ineffective. But the clinicians and therapists at Work Comp Psych Net know they are sitting on a solid, five-legged stool held up by the worker, the clinician, the employer, the claims adjuster and the medical provider. Our clinicians have been trained in the proper use of modified duty. They know that their job also involves helping the worker return to the workplace as soon as possible with appropriate medically supervised work restrictions.

And they will work with you to make that happen.

This is good for the worker and produces large cost savings for the employer.

That is one more way we keep our pledge to you: Recovery: Sooner -Faster – Smarter.

 

New Jersey Self-Insurers’ Association Spring Conference and Vendor Fair: Key Takeaways

First, congratulations to the Staff and Members of the association for an informative and entertaining conference at Harrah’s Resort and Casino in Atlantic City.

A couple of shout-outs are in order: Donna Wrobel, the Association’s President and Assistant Director for the Archdiocese of Newark, and Regina Lamptey, ABM’s Regional Risk Manager and the Conference Program Chairperson, did an outstanding job organizing the event and making sure it ran with professional efficiency. Kudos to both ladies.

The presenters were interesting and, in many cases, thought provoking. A special mention of Dr. Tom Dwyer, who, as he did at the recent Millennial Seminar organized by Capehart & Scatchard Attorney John Geaney, delivered an exceptional presentation focusing on the intersection between workers’ compensation and orthopedic medicine.

There was an interesting panel on Utilizing Social Media to Schedule Strategic Surveillance. Another panel that caught everyone’s attention, moderated by Ann DeBellis, Esq., of New Jersey Manufacturers Insurance Company, discussed Pain Management, Medical Marijuana and Interventional Spine Techniques. No free Cannabis samples, though.

It was also a big couple of days for us at Work Comp Psych Net. In addition learning a lot, making many new friends and even managing to leave Harrah’s without contributing much to the casino’s profits, we had a highly successful launch of our venture.

While we were happy to meet so many of New Jersey’s key workers’ compensation players, we were even more gratified for their deep interest in how we might help them deal with the many thorny mental health issues that crop up from time to time.

One of the things that seemed to impress the conference attendees was the breadth of our geographic coverage. We built a county coverage map to illustrate it.

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Another thing that seemed to hit home was the responsiveness of the system. Work Comp Psych Net’s online referral portal allows instantaneous referral, saving adjusters and attorneys considerable time and effort. The last thing these extremely busy professionals want is to have to spend hours, days or even weeks tracking down the help they need. Our first-in-the-nation online referral system eliminates that.

One final congratulation is in order: As the conference was scheduled for the first day of the NFL draft, the organizers chose the theme, “Drafting The Right Workers’ Compensation Team.” All vendors competed for the prize for the best display illustrating that theme. So, we salute Team Kirshner, of the Kirshner Spine Institute, for its historic win (although, with our superb Pittsburgh Steeler Display, we have to say, “We wuz robbed!”).

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