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#24: Tackling Workers Comp

April 24, 2019 | 1 hour 9 minutes 30 seconds

In this episode, Chief Safety Officer and host of the show, Jill James, talks with Cassandra, a workers compensation claims consultant. Cassandra’s accidental path to the world of occupational safety began in college. Having trouble choosing a course of study and career, Cassandra eventually found herself working as a receptionist with a printer packaging company. That role soon presented an unexpected opportunity—an interview for the risk management position (she got it) that started her career in safety.

Cassandra and Jill discuss workers comp in some detail, including experience modifiers, how to deal with the sometimes dishonest “11%”, and how different state laws affect working in this field.

Transcript

Jill:

This is The Accidental Safety Pro brought to you by Vivid Learning Systems and the Health and Safety Institute. Episode number 24. My name is Jill James Vivid's Chief Safety Officer. And today I'm joined by Cassandra Rudy, a Workers' Compensation Claims Consultant and the Insurance Industry with over 17 years of experience.

Jill:

Now, when we think about Workers' Compensation and the Insurance Industry, we might not make an immediate line to what does this have to do with the safety profession, but I assure you it has a lot to do with the safety profession and we're going to hear all about it from Cassandra today. So thank you so much for joining us.

Cassandra:

Well, thank you for having me, Jill, I'm really excited to be here.

Jill:

Oh, so Cassandra, you're not a safety professional yourself, but you absolutely support the work of safety professionals and sometimes safety professionals end up having to do the work of Workers' Compensation Claims Management, which was exactly my situation about eight years ago. I was already 17 years into my safety career, had never touched anything with worker's compensation. And then all of a sudden it was, "Hey, Jill, you have this new job and guess what, you're also going to manage all of our workers' compensation cases," which at that time was claims that were about averaging $1.4 million a year. And I'm like, "Holy crap, I have no idea what I'm doing," but I had to learn baptism by fire.

Jill:

And it was you, Cassandra who were one of the people who taught me and helped me along the way. We've known each other for about eight years and I said, "I needed a magic wand to learn this," and the first time you and I met you brought an actual magic wand to our first meeting. So thank you for that.

Cassandra:

You're welcome. Workers' compensation is very difficult, it's typically, I would say no one's favorite subject or kind of conversation to have and they are difficult conversations. I'm usually brought in what we talk about the 10 to 11 percenters, those individuals that have employment issues, performance, attendance, that kind of going conjunction with the workers' compensation claim where we're having difficulty getting them return to work. They have body creeping instances with the claim. So, I carry that magic wand, just so you know bibbidi bobbidi boo, let's try and get through this.

Cassandra:

And a lot of times too, I'll come with treats, cookies, candy, whatever it takes because I may just be the messenger, and the worker's compensation system can be pretty difficult.

Jill:

Yeah. So Cassandra, let's talk about how you actually got started in this. And then we'll continue talking about, how do we help the safety profession with what you do? But I'm interested to hear story like we hear for everybody's story that we have on the podcast. How did you get into workers' compensation? What was your career path? What did you think you are going to do and how did you end up doing this?

Cassandra:

I really thought my goal is to be just a princess around the world that didn't work out. And my family members, it was so odd, I was the youngest of four growing up and each one knew exactly who they were and what they wanted to be when they grow up, from a police officer to artist to a mother. I mean they were just bent on that from as when I got to know them and that is what they are today. And I was just floating around in the wind wherever it would take me, not really with any direction.

Cassandra:

I mean, I did go to college for biology and chemistry majors, but at some point I just didn't work out and I went to waitressing for a while. After a couple of years of that I realized, maybe I should get into some sort of degree, I went and interviewed for a receptionist job at a couple of facilities. I got two job offers and one of them was at a major printer packager, decided to take that and as I was doing the receptionist job, just got a little bored and started to take on a lot of different jobs within that industry. So I was doing scheduling, purchasing, some HR.

Cassandra:

And what I think is the most fortunate incident in my life is the risk manager at that location and they saw my drive and willingness and decided to interview me now. Quite a funny story, I think I was very much in my early 20's and never really had a formal interview and also just kind of like I said, going with the wind, didn't really have any plans in life, just whatever happened, happened. So one of his questions I think was, where do you see yourself in five years? Right?

Jill:

Mm-hmm (affirmative).

Cassandra:

Just very typical interview question.

Jill:

And you're like, "Oh my gosh."

Cassandra:

Well I'm also pretty outspoken about really thinking about what I'm going to say because I'm pretty honest, and at that point when you're young and naive you don't think too much about it, but I said, "I don't know, maybe partying less, maybe more settled down," and he still hired me. But he is a great mentor, really gave me the autonomy within the position I was a risk management analyst. And he set these carrots right in front of me in regard to goals, "finish your degree, we will pay for it."

Jill:

Wow.

Cassandra:

"Now you're going to be doing analytics, you're going to be handling all claims for 32 location, 7500 employees." And just gave me the information to run with it. And like I said, the autonomy and the direction but also not micromanaging me so that I was really able to use that platform and develop really strong claim management skills. I worked really closely with the adjusters, we had a quarter of a million dollar deductible. So I really felt that every dollar that was spent was our money. And literally it was but I felt it because then I would have to respond back and do the allocation to the locations in regard to these are the claims that you sustained in this month and this is your allocation.

Cassandra:

So he gave me that opportunity to kind of start at point A and see it out to point Z. And what I realized as I was in that industry doing the claims management is first and foremost I was pretty good at it. And that's where I think I developed the passion, which really grew, that company went through a hostile takeover and then a buyout. And that's when I got to the agency side and my passion grew because I was there helping companies through, something that I had well developed that they just didn't have a Cassandra on their teamwork. A small to middle market agency where I helped these companies and their safety consultants, there's HR people that don't have the work comp background and they're running in so many directions or comp can be pretty difficult. It's bureaucratic.

Jill:

And every and every state has some different parameters around it and yeah, especially if you work in different states, the person that in the company that's trying to manage it needs some guidelines.

Cassandra:

Absolutely, and those are the what I find the most interesting is, working in the states such as Colorado, which is such a different beast in regard to their rules versus jurisdictions and [inaudible 00:08:07], California typically not going to be my most favorite state, it is the most, in my opinion, difficult state in regard to the medical care and such.

Cassandra:

But my passion just grew in, I think what it is, is people are unpredictable so I could have the same exact injury and a completely different outcome based on psychosomatic issues, attendance issues, performance issues, and just how people are built. I mean younger versus older people.

Jill:

So, Cassandra, it sounds like you had a fabulous mentor and when you, you said you learned A to Z and you've got to be able to go through the entire process. When you first started, did you think, "Oh my gosh, am I really doing this?" Or did you just jump right in and just kept learning?

Cassandra:

I just really jumped right in and I think it goes with my personality of not really having any direction, honestly is I'm going to see this through and I was given that confidence and I think when someone kind of just gives you that autonomy and says, "You can do this." I believed that I could and I was able to do that. I got a lot of support as well in regard to going to sitting with an adjuster for a day, seeing how they manage their desk, going to seminars and just really getting that mentorship on a daily basis. It was just a risk management department of two. So he brought me into a lot of situations that I wouldn't have been privy to, that really helped me along the process.

Jill:

Sure, sure. So workers' compensation, when an employee is injured, there's two sides, right? So there's the side where we had something happen to someone and it's a human being who deserves to be treated with humanity and respect and to be taken care of and made whole again. And you have the other side which is the company and the insurance side where you're talking about costs and expenses and managing the medical cases and working with providers and ensuring that they're providing correct and good treatment to the worker. How early on and what does that feel like for you to kind of be in that, in those two camps?

Jill:

You're advocating for the employer but you're also helping a human being. What does that feel like for you? How do you do that?

Cassandra:

Well, the older I get, I think the more difficult it is for me, especially having children, you become a lot more compassionate because when I first started out in the industry, I just really saw dollars and how it was impacting my company. With that being said, I would still had injured employees coming into my office trying to advocate on their behalf for their medical care, which is very, very difficult, especially as a young 20 something female on having gentleman come in with low back injuries explaining how that was affecting their life, which I had no understanding of at that time.

Cassandra:

But as I do get older, I do see that the impact that will have on individuals and one of the biggest plays that I see with individuals in workers' compensation claims that go on for a lengthy period is the disabled mentality. And that is what I think it impacts me the most and the company. So it goes hand in hand. If you don't have a good return to work program or advocating for that employee in regard to their medical care, it is shown study after study that individuals can easily slip and do the best disabled mentality.

Cassandra:

Because if you think about it, if you're authorized off work, you're not going out, and going out to lunch or hanging out with your friends, everyone else's at work, you're sitting at home, probably not getting up, you're not showering and it's pretty easy to fall into a depression which is very commonly seen. And you'll see it with individuals with a back injury, there'll be taken off work and yet their back continues to worsen. And it has again been shown that some individuals can develop back pain from depression.

Cassandra:

And those are the ones that I get very concerned about because unfortunately the workers' compensation system does not treat the individual as a whole. The individual for the work comp injury and then you may have some psych issues present themselves that are very, very difficult to control.

Jill:

Yeah. I understand that it was, the work that I did in workers' compensation case manager with some of the best work I feel in my entire safety career because it taught me so much about human beings, and about a lot of the things that you're talking about and certainly changed. It wasn't a compassionate person before, but it really gave me a new lens that deepened my drive to do what I wanted to do as a safety professional, to send people home whole as you say and healthy every day.

Jill:

And I also have a family member who had a disabling work injury and had to leave a career. And so I've seen that play out not only with cases that I manage myself, but within my own family and it certainly brings a different perspective to the safety practice. I really wanted to take advantage of you, Cassandra, that might not be a fair thing to say, but you're here and you are someone with 17 years of experience in claims consulting.

Jill:

And some people who are listening to this are maybe like I was, maybe new to their position or maybe 17 years into their position like I was. And then guess what your job also includes workers' compensation claims management or maybe someone who's listening is like, "I've really wanted to know more about it and my safety profession, but I don't know where to start asking questions." So I'm wondering if we can spend our time today doing a little bit of work comp one on one so that we can try to teach some people along the way and provide at least a starting point. Sound good?

Cassandra:

Absolutely, sounds great.

Jill:

So one of the things I was, when it comes to who does the work within a company of managing workers' compensation, what do you generally see in terms of titles, like job titles? What's most common talk about safety professionals when they usually come in? What do you normally see?

Cassandra:

Typically, I'm going to see the HR department running the workers' compensation and there should be some interplay with safety. The CFO typically does get involved because of the cost associated with the workers' compensation program, which is generally our clients number one cost but typically it is going to be those HR professionals.

Jill:

If I were to give you the magic wand for yourself, what would you prefer in terms of what do you, in all the years that you've been doing this, what do you think makes a good team within disciplines, within a company to manage workers' compensation, if you could make up your ideal team?

Cassandra:

Yeah, and I try and build that up within my client based and I really feel it's from the top down or from the bottom up. I want to see supervisors that are managing the injured workers involved in the process because they're going to be the front lines, they're going to know exactly what's going on with that individual, they see that individual on a daily basis. Are they limping? Are they communicating something that they're not communicating up? I mean, let's be honest, if you're in a company of 200 people, you may not have known the HR representative or maybe don't want to speak with them or you've never met the CFO, they may not be there or present. So that person, the supervisor will have a role and their role is really to be paying attention, looking at the restrictions, making sure that employee is working appropriately.

Cassandra:

There are people, who we call the martyr syndrome, they tend to work outside those restrictions, their own detriment. So we talk about claims management and what do you put in place, like a light duty job log to make sure that employee is working in their restrictions, every day you sign off, the supervisor signs off, the employee signs off. So that supervisor is kind of the eyes and ears of what's going on in that floor every day.

Cassandra:

From there, you want to have a partnership with both the safety professional and the HR representative because the safety professional is going to make sure that that injury doesn't occur again. From a near miss to a catastrophic claim, we all learn our mistakes and there's sometimes things you just don't know what employees are doing all around the floor and tell an injury occurs.

Cassandra:

And that is a really great learning tool, so you take the accident description, you take the employee statement, the supervisor statement, you take that in your accident investigation, the safety professional should be doing that, taking the pictures, doing the statements, and then getting a result, write a recommendation on how do we preclude this incident from happening again, and communicating that down to the whole employee base. We've seen this, it's unfortunate, here's how we're going to handle it going forward so that no one else has to suffer the same circumstance.

Jill:

Yeah. So an ideal situation might be having that HR person, perhaps safety person, the supervisor, the CFO because dollars are involved and the employee in working in partnership if you will in their different areas but working together.

Cassandra:

Right, and so then when we have the claim reviews the HR professional is typically going to be looking at FMLA, absence of leave, leaves of absence, excuse me, that will help assist that individual. But when you all come together with the CFO too, and you all come together on the claim review with the adjuster, with the attorney on the file, I think we're all going to have different aspects of the claim that individuals we wouldn't have just because it's not our area of expertise.

Cassandra:

When you have the supervisor, the safety professional, the HR rep and the CFO all on the claim review, we all have different goals, right?

Jill:

Mm-hmm (affirmative).

Cassandra:

Safety is to preclude the incident. HR is to make sure the employees doing well and proceeding through the recovery, CFOs to drive down costs and supervisor needs to know because this is all happening above them. But at the end of the day, the supervisors typically probably applying it and may have not in some knowledge on the employee. So that team I think is the most successful in regard to having a great claims management program.

Jill:

And then not to forget the medical community, and that comes into play as well, and the conversations that occur between the employee and the medical providers, that is also something that... what would you say is that, who's that connection point within a company? What do you normally see with regard to the connection back to the medical community?

Cassandra:

Yeah, and that is such a great question because best practice is we do recommend that once an employee is injured, it's actually the safety professional that takes the employee to their initial medical visit or subsequent medical visits. Therefore, you can rate them in their advocate for the employee, I mean when you're in a work comp injury, it can be scary, I mean you're not, you don't know what to expect. And so it's great to have someone to hold your hand.

Cassandra:

And then also right then and there, the safety professional can communicate the workers' compensation program. Let's be honest, most individuals wouldn't have clue one if an employer has a return to work program or light duty, unless it's been communicated in a lot of times, it's not unless you are injured. So, and that initial physician visit, it's imperative to have that discussion with the physician that says, "Okay, here are the restrictions," and for that safety professional to know that return to work light duty program in and out in order to say, "Yes, we can accommodate and this is what this individual will do."

Cassandra:

And so from there, the safety professionals attending those appointments, if the employee agrees of course, and getting the medical information will go to the adjuster and then from there it's going to be handled by the HR to make sure they're recovering. So again, you have that interplay with all divisions within HR and safety and the employee, the supervisor then getting their restrictions, making sure the employee is being accommodated.

Jill:

Right. Yeah, and when I was doing this work, you're right, I did set up those medical appointments and then also worked really tirelessly with my supervisory staff to make them be my partner. And oftentimes, I had the supervisor for the employee going to initial visits, especially when something had just occurred and was really working closely with the supervisors, like as in weekly meetings, talking about return to work and light duty and restricting those things.

Jill:

And of course also early reporting of injuries, not waiting until something catastrophic happened that's going to turn into something big for an employee and for the employer. But also paying attention supervisors to your staff, paying attention to what they're doing and asking those questions like you said it looks like somebody is like, where'd you get that rush? Or you're seem to be walking funny here, you're favoring the side of you, let's talk about that.

Jill:

And really being in partnership, especially in really large corporations with a lot of employees to have that supervisor and the safety professional kind of working in concert with one another about the care of their employees and saw that work pretty successfully. Cassandra, I wanted to make sure that we kind of set a baseline for some terminology that's used in workers' compensation. So if anyone is not familiar with this practice, maybe we can teach them some terms and I'm wondering if, could you maybe explain the way that workers' compensation is insured?

Jill:

So there's like to start maybe there, because we have things that are self-insured and insured employers, and then a few of these things we call monopolistic states. So can you explain kind of what those differences are?

Cassandra:

Yeah, I think I'll start with monopolistic states, North Dakota, Washington, Ohio, to name a few. And those you actually cannot go in the standard market and purchase insurance through a carrier. And the states run those programs and they do, so again, pretty autonomously. You can get updates here and there, if you have certain contacts but typically they're just going to be monitoring that and paying the bills. And there's programs of course within those states to drive down those premiums through the state that are I think are very beneficial if you take advantage of those.

Cassandra:

And typically again, pretty easy to take advantage of those and I encourage employers in states with monopolistic coverage to take advantage of that. So then there's about five of those and the rest of the states are going to be where you'll need to get insurance through the standard market. And there are different programs. I could talk about there's guaranteed cost, deductible retention, there's high and lows and then there's self-insured. So, at the very bottom we talk about guaranteed costs, it basically means that you're going to be paying a certain premium based on what the actuary has determined underwriter, basically looking at your program, looking at your experience mod, that's another terminology.

Jill:

Another term to talk about.

Cassandra:

And so they're looking at your measure of safety and your claims incurred and they're also looking at loss development factors, claims, the longer they stay open, the more costly they become. So they're looking at claims as they develop as the years progressed. So there's factors that they multiply your total claim incurred dollars to get that value and then they'll give you a premium. Now, whatever happens throughout the year, that premium is not affected that is the premium you paid for 2019. But if you have a bad claims exposure 2019, your premium will go up in 2020 right?

Jill:

Mm-hmm (affirmative).

Cassandra:

Because they'll say, "Well, our loss ratio, we paid out 70% of claims, so that means there's 30%, but yet they have to keep their lights on." We always talk about that where a carrier in a guaranteed cost program would prefer to see their employers at 35% to 40% loss ratio or less. Because 60%, number one, they still need to make a profit but they also have to keep the lights on, they have to pay the adjusters and things of that sort. You don't have much control in a guaranteed cost program.

Cassandra:

The carriers are making all the decisions, they're determining settlements. Now, good carrier of course is going to get your buy in but at the end of the day, they make those decisions.

Jill:

Right, yeah. And so would it be fair to, if I'm understanding this correctly from the work that I had done and another way to reframe it, the insured market would be similar to we all have to get car insurance, and our rate is based on maybe our experience, right? What you were just explaining our age and the type of vehicles that we have and some people can relate to adding a teen driver and knowing what happens to your premiums and then we also know that after something happens like a number of speeding tickets or different occurrences or accidents that our premiums can go up.

Jill:

So it's similar, similar in the workers' compensation field just on a much grander scale. Am I getting that? Is that a fair analogy?

Cassandra:

Well, I'm going to add one caveat and that is the experience mod. The experience mod will impact your workers' compensation premium greatly in the standard market, because they're going to be using that as a multiplier. So experience mod of 1.00 is average, basically getting a C on your report card. Now, there's no such thing as a zero because even in the clerical industry you're still going to have a class code with an injury rate associated with it because I could slip and fall in the parking lot. I could develop carpal tunnel, I could fall on the stairs.

Cassandra:

So I'm still going to have a rate associated as a clerical individual, but every year that may change. So it's always valuable for the organization to know what is their lowest achievable mod. Now, that means that they wouldn't have any claims over three years because the experience mod is a measure of your safety performance, your claims performance over three years, not including the year that just resolved because those claims are still developing. So they want to get those a chance to either, resolve, close or if there's going to be a surgical.

Cassandra:

So they want those to develop a little bit before they put that in your experience mod. Now say that you had an experience mod of not just for easy sake, say it was a 2.00 and I think the worst I've seen is a 2.6. So that means basically you are going to be paying twice as much as your competitor down the road for your workers' compensation premium because the auditors, when they calculate your experience mod they're going to use your class codes and they're going to use your payroll.

Cassandra:

So they're looking at like industries, so I have so many clients will ask me, how am I doing in my measure of safety? And I'll say, "Look at your experience mod." And I know that a lot of safety professionals are also looking at their dart rates and they're all show rates, things of that sort. But the experienced mod is another measure to be looking at your level of safety, and then the carriers actually take that experience mod and use it as a multiplier.

Cassandra:

So workers' compensation is different in the sense of like auto insurance that you are typically going to be paying dollar for dollar for the losses you incur, and sometimes four times the dollar amount.

Jill:

Right, depending on their rating.

Cassandra:

Right. Whereas if I were to get in an auto accident, my rates might go up, but I'm probably not going to pay for a total vehicle right over a year. And workers compensation over three years is actually going to come for that money, dollar for dollar and like I said, sometimes four times a dollar amount. So you're going to be paying for one way or another.

Jill:

Right. So safety professionals who are listening to this, if some of this is a bit of foreign language, so one question you may ask and maybe you go to that CFO in your company or to that HR person and say, "Are we insured for workers' compensation?" That would be one question. If they say yes, you could say, "What is our experience modification rate?" And then be able to use that number like Cassandra's explaining, like to find out, "Do we have that C grade at one? Are we higher? Are we lower?"

Jill:

And that helps you, it's an assessment like Cassandra said, "One element of your safety initiatives and success or maybe an area where you need to dig in a little more." And so that would be something that you can ask for if you have not asked for that before, and then there's a lot of other metrics that you can get from there as well. But backing up, so if the employer is self-insured, then would it be safe to summarize it, Cassandra, this way that the company has essentially proven to the state or states where they're working, that they have a certain dollar amount in the bank, so to speak, to cover injuries and then the employer pays the full cost for those as they occur? Would that be one way to say it?

Cassandra:

Yeah, that is a good way to say it, ultimately it is having that cash and assets on hand that you can sustain those losses. So it's going to be the bigger organizations, there's also captive programs at work a little bit like that. And in those programs, you have a lot of control, you can choose your vendors, your litigation partners, your surveillance. I mean, depending on your jurisdiction, of course you can choose your physicians as preferred partners, but that will be, you'll just have more control over that and you'll have more control on settlements, you have more control on how the adjusters are determining compensability and having a say in that. But with that control, as you know, comes a lot more responsibility.

Jill:

Right, exactly. Yeah, and so if you're self-insured, you would never ask what your experience modification rate is because you essentially don't have one. And then, what you were saying about the monopolistic states, that's really where the employer ends up being pretty hands off with the management of those injuries because they get turned over essentially to the state. You can call and ask questions, but you don't necessarily have any influence over how that claim is managed. When I was doing this work and met you, I had all three in the states where we had employees working, so we had a little bit of self-insured, a little bit of insured, and then one state that happened to be in the monopolistic arena.

Jill:

And so it was a little bit tricky, so when I was trying to prove up our safety efforts as a safety professional, I couldn't just look at that experience modification rate because that only applied to a couple of the states where we had employees. So I had to dig a little bit deeper with metrics and I'm wondering if maybe you can talk about what some of those metrics are that safety professionals could be asking for within their workers' compensation systems, regardless of which of the three buckets they happen to be utilizing in their company.

Cassandra:

I think you'd really want to start with getting a loss run from the carrier.

Jill:

Well, that's another term. Good. Yeah, please.

Cassandra:

So a loss run is going to be all of your claims data, it's going to be the individual injured, the date of injury, the date of report, the jurisdiction. And then it, every carrier is going to differ, but typically it's going to be the total incurred reserves versus paid. It could have date of hire, date of birth, I mean there are some carriers where you can get an Excel download and just sort for days. We're very lucky to have a trendy analysis on our team that really makes this information meaningful to our clients.

Cassandra:

So from there, you'd really want to pull a loss from each state or each carrier depending on your insurance program, so you'd want to get all your data. The best of course is to get it in Excel so that you can play around with it. And from there, you can determine sort it by location. But I think what is so important and often gets overlooked just because we get so ingrained in the data is that we forget to put it into context.

Cassandra:

I had a client where we went out and we were talking about their metrics for the year and it was 26 pages of metrics in the first page I was, "Wait a minute, we have to stop." These all show that we're decreasing in claims but there's no context on any of this data that we've closed a third of the stores.

Cassandra:

So all of this data needs to be put in regard to payroll exposure, right?

Jill:

Mm-hmm (affirmative).

Cassandra:

And so I think when you look at that and say, "Well, oh my gosh, 60% of our claims are coming from the Indiana location," whoa, that's 60% of our workforce. So putting in data and really putting into context of payroll exposure helps bring it down to something that we can maneuver and put safety policies in place.

Cassandra:

So when we look at a lot of times demographics, well we're seeing 50% in the 20% to 30% or 20 to 30 years of age. And to me that's the highly unusual, especially because most of our employers are working with an aging workforce. And so I said, "Oh, this is a concern." And they said, "It actually isn't, when you look at our demographics, all of our aging workforce retired last year and so we're all hiring." And I was like, "Well there we go." So putting it into context like that, so getting the loss run and then drilling down on body part, on cause of injury.

Cassandra:

Looking for key words because one of the things we do as consultants as partner very, very closely together, whether that be with HR or with our safety professionals, just like our employers, because I don't want our safety consultants kind of just running around without goals and they don't. But when I say, "Oh my gosh, this is the third knee injury this month due to this cause of injury." Or I saw one where it was the second rotator cuff tear in one week in the same exact location.

Cassandra:

So there's where we want to then concentrate efforts. I think too, is when you look at that, one of the most successful strategies we have partnering with safety professionals is they'll come to me and they'll say, "Can you take a look and review our losses because I want to automate this job?" And the equipment cost this much. CFO has told me no, because of the cost. So what we do then is pull out the data of that department, that job title, that action, that movement and we run the losses.

Cassandra:

And I would say nine times out of 10 you're paying for that equipment through the cost of losses over here. So we're able to quantify that and give it to the CFO to push forward that initiative that, that safety professional. And that to me is, that makes me feel so good, that's a huge win where... because I think it's difficult for safety professionals, they know they need it but for us to be able to quantify it and for them also to take this loss run data and pull it apart.

Jill:

You had to make a twist.

Cassandra:

Yes, exactly. I think that's a huge win for them by using that data.

Jill:

Yeah. You said, you can do these loss runs and ask for the loss run and then look at the data eight ways from Tuesday, right? And so as a safety professional, I would say, if you've never done this before, A) partner with whoever your insurance carrier is and who's helping you and ask for a loss run and maybe have an idea in your mind initially like, "What do I want to look at?" And so that you can ask, instead of getting that big spreadsheet and going, "Oh man, I could get lost in this for days," maybe really ask specifically for what you want to see and start there.

Jill:

And so maybe it's show me the average age of the majority of our injuries, so what time of day do the majority of them occur? What location has the greatest rate? And then tell me what are the top five injury getter? What are the top five injury getter types, is it eye injuries is a back injuries and what are the cause associated with them? Because we want to also tease out severity versus frequency. Is it something that happens often, but is it a lower cost or is it something that happens often with a really high cost? And maybe can you talk Cassandra about the difference between severity and frequency and how you view it and help people can ask for that data as well?

Cassandra:

And so the experience mod is going to give you that severity versus frequency, and actually there is a program that we run for our employers but many companies, money agencies, insurance carriers have this program as well, it's called mod master. And we're able to run, I think it's a nine or 10 page report that breaks down that mod and tells you exactly what that calculation and that number means to you. And one of the first pages that I really like because I'm typically working with CFOs and their want to have a measure.

Cassandra:

And so the first page I'll say, if you get a 5% reduction, here's your new premium, here's your new mod, because we'll always talk about, it's so hard to quantify workers' compensation claims management. If we institute a return to work program or volunteer return to work or light duty, anything of that sort, it's hard to quantify that and push it through.

Cassandra:

But if we're able to say, "Listen, studies have shown that institute in this program can have a 30% improvement on our overall costs." Well we can just take that document from the mod master and say 30%. Okay, that's what it means in regard to our company, our premium and our experience mod. And again, that's a way to really push through programs, then it will show you what is driving your experience mod. Is it frequency or is it severity?

Cassandra:

And I surprisingly are confronted with employers who have no idea. They'll say, "We never have any losses, it's just been those two fraudulent losses." Other than that, we're a great company and so without looking at the data, I never judge because I know I'm not in that company. We run the data and we find many times that just isn't true. The data will tell us that frequency is typically going to be the driver of your workers' compensation experience mod in costs, and why that is, is again, the calculation has ratios, weight ratios, they're waiting certain criteria more than others.

Cassandra:

One of those being frequency because for every 10 lacerations you're going to have tendon involvement, that's what studies have shown. What they're going to do is say, "We're waiting the primary dollars for us, and we're probably getting a little too much in regard to semantics here." And that number has been driven up because of medical inflation. When I first started in the industry, it was $5,000 as the primary and that was weighted more heavily than anything over.

Cassandra:

But in the last couple years, medical inflation has gone through the roof. So now the first 16,250 is weighted more significantly. So we've seen employers, same losses, same payroll, and their premiums have gone up 10%. Just because of the calculation change. Now, severity, I mean, the first 16,250 is going to be weighted more. And so if you have a claim for 150,000 well the first 16,000 is only waited.

Cassandra:

But if you think about it, if you have 10 claims at 16,250, that's 160,280 that's going in at that amount. And I might have to pull up my calculator.

Jill:

It sounds like you've done this a few times.

Cassandra:

Right, so I'll just do this real quick. Yes, 162,800 is going in at the full weight, but then if you think if you have one claim of 162,800, only 16,280 is weighted. So those catastrophic claims don't impact to you as much in regard to your experience mod in your premium. Because every carrier ultimately expects that every employer is probably going to have a cat loss every five years.

Jill:

So Cassandra, for our audience who's listening, particularly if they're listening and thinking as a safety professional, well I don't have a seat at this table right now, I don't have a seat at the work comp table in my company. How do I get one? What kind of ask do I make? Because it's sounding like this information is really powerful and absolutely help safety professionals determine, "Where should my focus be?" And kind of help triage, if you will, where a safety professional would want to be making a difference to ensure their employees are going home whole and healthy.

Jill:

And I know that you like to talk about communication and the importance of communication within an organization, but also with carriers as well. Can you maybe talk about how safety professional can use communication and what you would recommend they do to get themselves a seat at this table?

Cassandra:

Absolutely, so I'll start with getting a seat at the table and I think really it looks like getting a coach and determining who is currently handling that process. And that might be a little bit difficult to hash out, because there may be a lot of different players, sometimes the roles and responsibilities aren't very clarified within an organization.

Cassandra:

But I think, to go to the leadership and say, "I think that's really impacts my department and how can I better learn about this so that I can assist and make sure again that my employees are going home safe and I can learn from the injuries that are occurring."

Cassandra:

And from there, there's so many coaches out there and people involved in workers' compensation that are passionate just like myself, love to share the information, there's seminars. I mean, just like you guys have organizations for safety professionals, we have nerd organizations for work comp professionals as well. I mean, I call myself the work comp nerd and I just, I get super passionate about it and I was like, "That's interesting. We're going to start doing surveillance with the drones? I'm in it."

Cassandra:

So those are the things that I get stoked about and were willing to share, and there's so many articles, things of that sort to get involved in. But really to just say, just as you prefaced it, I mean it does impact the safety professional. So put it in that sense that this impacts me and impacts the employees that I'm caring for and looking after every day. And so how do I get invited into these claim reviews that we're having? And you just stick your toe in and you'll start learning all about the terminology as time goes on.

Cassandra:

I mean, it takes some time to learn all what we're saying because sometimes we're talking a foreign language when we start to get into our language, and then from there, the communication is very key. It's one of the top things I stress when I do work comp 101 is to communicate. A lot of times and not so much anymore, thank goodness. But a couple years back, one of the propensity is when an employee was injured was to not talk to that individual.

Cassandra:

And I think it's because of fear, I don't want to say the wrong thing. But when you are managing from a place of fear, people can feel that and all of a sudden what they feel is your fear and they may feel that fear of, "Wait a minute, I'm going to get fired. I may have broken that safety policy that led to my work injury. I'm going to get fired."

Cassandra:

So I think it's really communicating with the individual even before an injury every occurs. I am a big proponent of doing a 10, 15, 20 minutes spiel every day or not every day, every year when you guys, a lot of my companies have an annual safety day. Throwing 20 minutes of, "Here's our work comp procedure, here's our light duty program, here's our preferred clinics. If you have any questions, here's your claims coordinator, so on so we'll be taking you to the clinic. Please let us know ASAP, we expect injuries through be reported within 24 hours. Because claim streets brands that are reported after that tend to increase in claim cost, but not only that but claim exposure in regard to that individual's injury actually worsening."

Cassandra:

I mean, I'll take a carpal tunnel, you catch it early, you get a brace, you do some exercises, you're good to go. You let it kind of build-up, you're sitting there at surgery, and that's just very common. So I think also to put it into context for those individuals that at the end of the day we want you to leave whole just as you can. So that you're able to have that weekend with the family and sit in the car and drive to the park and things of that sort without having back pain.

Jill:

I think that's a great tip Casandra to talk with, for safety professionals when they're doing annual training, quarterly training at higher training, not necessarily to put it all in HR's hands, but here from the safety professional partner with them to develop some message, some training for your employees around. If something happens at work, if you have an injury, if you develop an illness, we have a path for that. This is the path, this is who you talk to, this is what we want to hear about it.

Jill:

Don't wait until like, it's so terrible that you're like, "Oh my gosh, this is bad. Like talk about it early and often." And like you said, don't shy away from having those conversations, it's not a healthy place to be, I think that's a great tip to add that into training.

Cassandra:

And then I would just expound on that, that the communication then from internal really needs to go external. Again, I come from a place of dealing with the most difficult work comp claims, and where I find those start occurring is as soon as the claim is reported unfortunately it's those employees that have personal issues or performance issues that end up being our biggest claims.

Cassandra:

Individuals known to have substance abuse, individuals going through a personal life events such as divorce, death, having a child. Things like that tend to compound on top all the workers' compensation claim and develop more difficult exposure that we have to navigate through. So if you have, a lot of times clients will say, "Well that doesn't impact their injury," and I would argue and say, "It absolutely does." And so we need to know that information, isn't employee Ben, were they just about to be terminated, where they demoted? Did they not get a raise?

Cassandra:

Those things greatly impact a claims outcome, and so would you may not think, "Oh, you know, they just are doesn't need to know this. This is personal." It comes to play in the work comp claims sooner rather than later, and the adjuster does need to know that information as soon as possible. I can't tell you how many times we've been on settlement doors and the employer will say, "Well, wait a minute, what about when they were doing their roof last time when we got the report of injury?" And I'm like, "Whew, we're about to settle, we'd have to get witness statements." So those are things where if, you know, of an individual or even just small things like, we an individual that was had a severe back injury and yet they caught him running through the warehouse and dancing.

Cassandra:

And a supervisor who was like, "Well, I didn't know if it really mattered." I mean, it warns us looking into, do we assign surveillance? And I think those are all in very imperative information that we need to manage that claim.

Jill:

Right, and you had pointed out before that you usually get involved when a claim is something that's catastrophic. I like and what you do to what I did as an OSHA investigator, we're looking at some of the most extreme cases when we're doing inspections with OSHA and we happen to see some not necessarily great work practices. And you're talking about some of that with employees as well. And I don't want anyone to get the idea that an injured worker is A) trying to get injured, B) trying to game a system to their own advantage because I think you'll be able to tell me Cassandra that is not the case with most injured employees.

Jill:

It just happens to be that you do see those that do occur because that is part of what you do, but it's not the line share of people who are injured. Correct?

Cassandra:

No, we talk about 88%, 89% of individuals get through the work comp system, easy breezy. It's the 11 percenters that I deal with, but they take up. If you're a professional listening to this podcast and you'll know exactly what I mean, they take up that 11 percent will take up 80% of your work day. So you know how it is, it's negative comment can ruin our whole day. And the positive ones, will just throw all those aside.

Cassandra:

And so that's where it seems like it's such a big deal but 88% of individuals, high moral character, want to get through the work comp process, recover, get back to their families, forget about the injury, get on their way. So that is the typical process of work comp is the 88%.

Jill:

Very good, very good. With regard to the safety profession and another place for them to insert themselves in workers' compensation could be with return to work programming as well. Can you talk about what that is and what that looks like? And so safety professionals who might not be familiar with that know what they could be advocating or asking for, for another place at that table.

Cassandra:

Yeah, I think that return to work programs have really come a long way, but first and foremost we want to make sure that it's in writing. So a lot of my clients do have it in their safety handbook. They have the return to work light duty program as a policy in that safety handbook. I think that it's really important to go over that in the orientation and ultimately we would like it pretty general, because you don't want to get boxed in, we will do this, we will do that. You're just creating an issue in regard to employment practices if you do that.

Cassandra:

But you do want to make sure that everyone knows that you will devote yourself to ever return to work program if that employee gets injured. And I'm just going to draw it back to the experience mod real quick. If you are in that type of program, an employee that is brought back to work within a waiting period and that's going to vary between states, it's usually between three to seven days.

Cassandra:

The bureau on the experience mod will give you a 70% reduction on that total incurred cost. That's huge. So it is so imperative to have return to work program and then communicate it. That light duty, what it looks like is I think first and foremost you want to have a job bank. The most difficult jobs to accommodate are going to be one handed and sedentary. So determine what could an employee do?

Cassandra:

And what I always talk about is we now have interns, thank goodness because I have a bin of work, I will never get to. It just sits there for years and it's things that I need to like it's carrier information, it's old claim reviews I need to load in, things of that sort of that are just sitting there but I just don't have time. So there's that clerical work, but there's many individuals or say, "Well, this is a construction field. We don't have, we got off trailer, what are we going to have and do for clerical? Could they sit there and do a safety audit? Could they do their OSHA 30? Could they do their OSHA 10?" Get real creative.

Cassandra:

And again something I'm super passionate about because a longer employee stays out of work, the longer they'll stay out of work. I mean it's just perpetuates itself. And there's a study that shows that if they've been out of work for six months or more, your chances of getting them back to work with you is 50% less. That's huge. And then there is some creative solutions too that I get really excited about is, it's been in the industry for a decade or so, but it's called volunteer return to work.

Cassandra:

So you, if you're a small shop, a small company and you just don't have light duty and we get that, we have retail stores that unless you can lift 20 pounds, you just can't come and work light duty here. There's a volunteer return to work program, many vendors, many carriers have an in house as well.

Cassandra:

And what you do is you send your employee to a non-profit organization, you pay them out of your payroll because you're getting the hours work but they're still getting that, they're still going to work. And I think it's great because first and foremost are contributing to your community, and a lot of my companies, I already have these partnerships with the non-profit. And then they can send their individuals who are injured to work there, and I think it just really opens our eyes to that, "We may be injured, but when we're working in these nonprofits at the shelters or the food shelves or the Red Cross' of the world, it's harder to fall into that disabled mentality of why did this happen to me." You're still contributing and in a way that is more altruistic than just yourself at the employer when you are here.

Jill:

Right. What a fabulous idea I had never thought of that before, but it makes complete sense, a volunteer return to work program that's fabulous. As you were describing light duty jobs and having a job bank, I was thinking, like let's back that up even further to the importance of having job descriptions for all of the jobs, including what the physical demands of the job are. That seems to be the most important place to start when you have an injured employee that, that medical professional has that job description with those physical demands, so they know what it would mean to release someone to full capacity.

Jill:

And then of course being able to follow up with, we do have a light duty program and we don't expect that you have to take people off of work. So can you talk about maybe the importance of those job descriptions and that's another place where safety professionals can advocate to ensure their employers have those.

Cassandra:

Yeah, that's such great insight, Jill. I absolutely agree that those job descriptions should be updated with the weight and the frequency of doing those manual whatever movements that you may have. And a lot of it you can even take from the official disability guidelines, sedentary light, medium, heavy, very heavy is what we're looking for. What criteria fit in there and what that employee is doing, so that, that doctor can specifically take a look and say, "No, they're not able to do that," because sometimes if we don't give the direction we may not get the direction we need. Their restrictions may come back as lift as tolerated.

Cassandra:

Well, that doesn't really mean much to anyone. So I don't know. My joke always is, sometimes I can't tolerate work at all. What does that mean? We want to give the physician the information so that we're putting ourselves in a position of success. If we're able to give them that specific criteria, they're able then to determine and give us specific data so we can return that employee back to work.

Cassandra:

And I think it goes even further than that in regards to job descriptions is placing an individual to work, and making sure they're working safely. If an employee comes to you and says, "I have permanent restrictions from our prior employment of no lifting greater than 30 pounds, and you're not quite sure if your job descriptions haven't been outlined by weight and frequency, are you sure that they're working safely?"

Cassandra:

And then also a step further is if you do preemployment physicals, any ISO kinetic or cost reduction technology testing, those are basically mandatory to make sure that the employee is put in a safe position.

Jill:

To start in a place of success?

Cassandra:

Mm-hmm (affirmative).

Jill:

Yeah, right, Cassandra, you have been so gracious with your time today. And when you and I were first talking about doing this, you said, "We could talk about this for hours, Jill because we're both nerds in that regard," but you on the comp side and, and me on the safety side and I really do feel like we could be talking for hours about it. And so I want to be respectful of your time and thank you for sharing what you have today.

Jill:

I wanted to, I've been taking some notes while you've been talking and about, I guess where I would start a fight as a safety professional who didn't have a seat at the work comp table yet. And what might be some things I'd be asking and I kind of want to run through a couple of those and tell me what you think you might add. So one of the things I've written down is first finding out how you're insured, so you know which questions to ask by way of what kind of metrics can I ask for, like how are we insured?

Jill:

And then second, if you want to learn more about workers' compensation or if you have the whole job suddenly dumped in your lap, to remember that the insurance carriers and insurance brokers do offer seminars to train people like safety professionals. I know I did that with some of the carriers that I worked with where I specifically went to seminars to learn about it because it is complex. And then I love the piece that you said about adding injury and illness management and what you do in your company to your training platforms that people are using already.

Jill:

And then the power of those loss runs and the data that can come out of it and to be asking for that data specifically. And then the last thing that I've written down is with regard to return to work and light duty, having that job bank, those ideas in place, including volunteering in your community, and I just love that. Do you have things like you'd add for safety professionals?

Cassandra:

I think it's really just sitting down with your internal team and saying if, how can I help? Where do you see my role here? And as safety professionals, where do you see your role as you develop in regard to learning about workers' compensation? I think it's very like I said, the partnership is imperative of having that successful program. And just sitting down with the CFO or the HR rep and what are you doing on a basis? Is there anything... I'm sure safety professionals wear a ton of hats too, but I think that there can, if they can avoid injuries by knowing what injuries are occurring because sometimes we have that mindset. Well it's all this, this is where all our injuries are coming from.

Cassandra:

And again, I'll just draw it back to, we get that communication from employer and we'll pull the data and we'll actually just have to say that's actually not true based on the data. So I think too, you actuall