Responsible businesses guard against injuries through their infrastructure and policies. But even for the most safety-conscious, mistakes and outside influences can lead to accidents. When an employee is injured on the job, taking care of them efficiently and competently is in the company’s best interest. Workers’ compensation and insurance make sure that policies offer appropriate coverage and protection to the company and its staff.
Panelists:
Mark Lynch, director of claims at A.I.M. Mutual Insurance Companies, aimmutual.com
Joseph Sculley, president of NH Motor Transport Association, and secretary of NHMTA Self-Insurance Group Trust, nhmta.org
Mark Lynch, director of Claims at A.I.M. Mutual Insurance Companies
Q. Aren’t all workers’ compensation insurance carriers the same when it comes to claim handling?
Absolutely not. When a company buys workers’ compensation coverage, one of the main things they are purchasing is claim service, and all insurers are not the same. Companies want to see their injured employees treated fairly and with respect. At the same time, not all claims reported are compensable, and companies want their carrier to investigate and effectively deal with those claims, also. A.I.M. Mutual provides workers’ compensation insurance to more than 18,000 businesses in the Granite State and throughout New England. The company holds a financial strength rating of A (Excellent) from AM Best Company, the industry’s leading rating agency. We strive to provide both to help our policyholders control costs.
Q. Where does nurse case management come in?
Nurses often work with adjusters to help injured workers navigate the health care system. Finding qualified providers, getting appointments and putting services in place can be a challenge, especially if you are dealing with an injury and the stress of being out of work. Our nurses have relationships with local medical providers and that can make a real difference in helping employees get the care they need, so they can return to work when it is safe for them to do so.
Q. What should businesses expect in terms of claim services?
It depends on the carrier. We are a regional workers’ compensation insurer, and we make sure employers and their broker representatives can always reach a “real person” if they need to. Injured workers have direct phone access to their adjuster and nurse if one is assigned. Automation has its place, of course, and claim reporting can be done online, but we offer fax or phone reporting as well. Whatever option you choose, response time is a priority. We believe businesses still welcome a personal touch, and we look to bring peace of mind to the workers’ comp process.
Q. Is it worthwhile for businesses to plan for modified or alternate duty positions?
Most definitely. So often we hear from injured workers that they feel forgotten by their employers. Companies who stay in touch while an employee recovers and can offer meaningful work during the recovery find that everyone “wins.” The injured worker feels valued, co-workers see that the company cares, and the impact on productivity is far less. The time to plan for providing modified or alternative duty is before an injury. Our Stay at Work/Return to Work program helps employers achieve more favorable outcomes and manage costs associated with workers’ compensation claims.
Q. What is the Second Injury Fund, and how can it potentially impact workers’ comp costs?
The Second Injury Fund was established by the state of New Hampshire to encourage employers to hire people with previous injuries, illnesses or disabilities by offering the employer a limitation on workers’ compensation liability with respect to these health conditions. This law is good for these employees and for the companies who employ them.
If an employee injured on the job also has a known (to the employer) documented previous impairment, restriction, injury, illness or disability, a carrier may apply to the Second Injury Fund to potentially recoup some of the money paid on the claim. This money is applied to the claim file, reducing the cost and ultimately reducing the impact of that claim on the cost of workers’ compensation insurance.
Joseph Sculley, president of NH Motor Transport Association
Q. What are some challenges that transportation companies face in terms of workers’ compensation, and how are you working to address them?
The trucking industry is a complex, highly regulated industry. The need to have a clear understanding of industry practices, and government regulations comes into play when insurance is involved, particularly workers’ compensation insurance.
So, it can be a challenge for a business operating in the trucking industry to find someone in the insurance industry who has a wealth of knowledge about industry practices and government regulations, but at NHMTA, we have that expertise in-house. We put that knowledge to work in order to help our members comply, operate safely and keep their loss costs down.
Q. What kinds of businesses are ideal candidates for the NHMTA Self-Insured Group (SIG) Trust for workers’ compensation?
To be eligible for the NHMTA SIG, the candidate must be a New Hampshire-based business with employees who work in New Hampshire. (If a NHbased employee has to travel out-of-state in order to carry out part of their job duty, that is covered under our policy.) They must also be classified as a business engaging in transportation, distribution or warehousing. Even within these classifications, there is a wide range of businesses that get their workers’ compensation coverage through the NHMTA SIG.
There are current NHMTA SIG member businesses that do the following things: ambulance services, moving and storage, home heating fuel delivery, limousine services, landscaping, waste and recycling, and beverage distribution. There are more operations covered by the NHTMA SIG, but the point is that a wide array of businesses is covered under the umbrella of transportation, distribution and warehousing.
Q. What is a common misconception people have about workers’ comp, and what is the reality?
Some people view the process of being involved in a workers’ compensation claim as an adversarial process, when generally speaking that is not the case.
At NHMTA, we administer our workers’ compensation SIG in-house. We have claims adjusters, and a nurse case manager, who all report to our director of workers’ compensation and managed care. All of those people work to ensure that both the employee and the employer get everything they need.
Communication is very important to successful resolution of a workers’ compensation claim. The NHMTA team provides constant communication with the employer, employee and medical professionals when necessary.
We want to get them the care they need and get them back to work as soon as they are able. With good communication, proper care and a good return-to-duty plan, all will be well. There will be no need for any aspect of it to be adversarial.
Q. What steps should businesses be taking to ensure they are in compliance with workers’ comp regulations?
Businesses need to ensure that they update their insurance carrier in a timely manner when they have changes that will affect their policy. For example, did your business add an additional location or change locations? Did you create an entirely new entity that needs to obtain coverage and can do so through your existing policy? When you notify your carrier, such as the NHMTA SIG, in a timely manner, we can ensure you get proper coverage and satisfy state requirements. If proper notification is not provided in a timely manner, problems could arise. The state government might need to launch investigations if they have reason to believe employees were not being covered by workers’ compensation insurance. Don’t let it get to that point — update your insurance carrier regarding any changes immediately.
Q. What are some examples of transporters being proactive on workplace safety to reduce the frequency and severity of workers’ comp claims?
One is through attending safety and loss control meetings. All members of NHMTA’s Self-Insured Group (SIG) are required to attend quarterly safety and loss control meetings. These meetings are run by NHMTA’s director of safety and loss control, Mary Grace Johansen. In addition to Mary Grace providing educational content, she brings in a variety of outside speakers to educate attendees.
These can include government officials, such as leaders from the Federal Motor Carrier Safety Administration (FMCSA) and Occupational Safety and Health Administration (OSHA), both of which have jurisdiction over members in the NHMTA SIG. New Hampshire Department of Safety (DOS) officials are regular presenters. Individuals from the private sector with insight on how to improve safety or efficiency may speak at these meetings. NHMTA is always identifying new speakers who can provide knowledge that will help our members improve the safety of their operations.
Q. Are there any provisions in state law that might encourage an employer who wants to hire an individual who was previously injured on the job while working for a prior employer?
Yes, New Hampshire has what is called a Second Injury Fund (SIF), which aims to limit the employer’s financial exposure to increased workers’ compensation costs if a previously injured individual sustains further injury while on the job. An employer might be reluctant to hire an individual who has a preexisting injury, out of fear that they would be prone to get hurt again, and thus raising workers’ compensation costs. The SIF protects against that by reimbursing covered costs if there is proof that the previous injury was reaggravated, or if the previous injury was a factor in incurring the subsequent injury.
NHMTA SIG members have said that they hired individuals with an injury history because of the fact that the SIF exists. If not for the SIF, it would have been too much of a risk for the employer to give the individual a chance.
NHMTA has a talented team of claims adjusters who know how to work with the officials at the NH Department of Labor who administer the SIF. They work hard to recover reimbursements from the SIF in order to keep member costs down.
