Photo: “Tulalip Bay” by Diane L. Wilson-Simon

Photo: “Tulalip Bay” by Diane L. Wilson-Simon

Managing Work Injuries

Working toward a common goal…

Managing Work InjuriesInstructor: Kerrie MurphyEdmonds Community College

This course is being supported under grant number SH16637SH7 from the Occupational Safety and Health Administration, U.S. Department of Labor. It does not necessarily reflect the views or policies of the U.S. Department of Labor, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.

With Thanks to & Cooperation of the Tulalip Occupational Safety & Health Administration (TOSHA)

OSHA There are two main parts to the Occupational Safety and Health Act, General Duty Clause, Section 5.1. The EMPLOYER Responsibilities2. The EMPLOYEE Responsibilities

Everyone needs to cooperate and play their part in safety awareness, prevention and compliance.The overall goal is to achieve a consistently safe workplace and never experience ANY accidents.

Accident / Injury PreventionAvoiding an accident and/or injury is, actually, the first priority in managing your claims.Focusing on prevention can: Avert an accident or injury from happening

in the first place. Lesson the severity of an incident if it does occur. Don’t Ignore the “Little Things”!

For more detailed training on accident prevention and investigation, come to the next training session.

Look for the TOSHA training announcements.

Types of Prevention1. Focus on Behavior

Training, training, training! Evaluating policies, procedures & actions Creating a Safety Culture

2. Focus on Protection PPE – Personal Protective Equipment Safe-Guards on facilities, machines, equipment,

etc.

These need to work together.These need to work together.

EXAMPLEEvaluating a worksite:

What types of injuries could happen here?

But, Accidents Happen1. Immediate Response:

A. DON’T PANIC

B. Quickly Assess the situation.

C. If needed, call 911 BEFORE you start first aid.

D. Do you know:• Where the first aid kit/equipment is?

• Who knows First Aid/CPR?

• Where fire extinguishers, spill kits, and other emergency equipment is located?

• Where the MSDS is filed?

• Who to call internally?

But, Accidents HappenDepending on where an accident happens, there will be unique challenges in reacting to it.Examples:1. Indoors vs. OutdoorsA. Environmental FactorsB. Access to Phones, Running Water, Etc.2. Public vs. Private areasA. Securing the SceneB. Getting Assistance

But, Accidents Happen2. The top priority should always be attending to

the needs of the injured worker(s).

However, simultaneously you need to make sure the area is secure and that no further injuries will occur, also that the area is left untainted for the investigation.

But, Accidents HappenPointers for dealing with the injured person:

Communicate, offer Empathy & Keep them Engaged.A. Let them know what is happening.

For example, let them know that you have called for help. If you are administering any first aid, let them know what you

are going to do before you do it.B. Ask them questions about how they feel.

This will let you know early if they arestaying coherent or not.

C. If you need to ask questions aboutthe accident, avoid assigning guilt.

D. By preparing in advance, you canreassure them with accurate answersto questions and concerns.

Band-Aid PracticeAs obvious as this may seem, it is not second nature to most of us. It helps to have actually done it.

So, pick a partner…

But, Accidents Happen3. The next priority is investigate.

A. To prevent additional injuries.B. To preserve the scene until an investigation can

be completed.

But, Accidents Happen4. Have an accident response checklists.

Assign different tasks to different individuals.A. One person should always be assigned to attend to the injured person.B. Another person can be assigned to secure the area.Everyone will want to come see what happened butthat can create additional problems.If there is a hazard or danger, you don’t wantanother accident.Also, the injured person needs privacy.C. Others can be assigned to clean up, repair or to place warnings, whatever is needed to prevent further harm.D. The investigation should begin as soon as possible.

But, Accidents Happen5. Prepare packets in advance:

A. Information & Forms for the Accident Investigation & Report

B. Information & Forms for Injured WorkerC. Information & Forms for Physician

The last thing you want to do when someone is injured is to be looking around for forms or information that is needed. Prepare in advance!

BREAK

The next TOSHA Training Sessions will be announced in the next week.

OSHA-10

OSHA 40-Hr Haz-Woper

Why All The Paper Work?

The answers are:

To kill trees?

To keep us busy?

To punish us?

1. MONEY – healthcare of any kind costs a lot.2. THE LAW – documentation is vital to responding to inquiries. (fines also cost money!)

DocumentationAnecdotal or Subjective Evidence

VersusFacts and Verifiable Evidence

Who is the “Law”? In the United States, it is FEDERAL law that

employers provide a safe and healthy work place.

Each STATE has additional laws that can be even more stringent but can not be less than the federal laws.

In the state of Washington, most work related injuries are administered by the WA State Department of Labor & Industry (L&I). The exceptions are Federal Federal employeesemployees and employees of Tribally owned and Tribally owned and operated businessoperated business.

Who is the “Law”? Tribes are considered a “federal” entity, so the

Occupational Safety and Health Administration (OSHA) is the regulating body for tribal businesses.

However, tribes are sovereign nations, so they really need a structure of their own, such as: TOSHATOSHA.

Discussion: What are the Pros and Cons?

Why Money?It might seem insensitive at first to think about money when someone has been injured.The fact is, the whole reason we created worker’s compensation was so that everyone could be insured that the costs of a work related injury will be as minimal as possible. Trust me, even the injured person will start worrying about the immediate and long term costs very quickly.

Whose Money?1. The Injured Person2. The Business &/or Tribe3. The Physician4. The Insurance Carrier / TPA

It helps to step back and look at all the different players/stake holders; how they are connected in this process and what each has to gain or loose.

History of Worker’s Compensation

Prior to the industrial revolution, most people lived in SUBSISTENCE economies.

People farmed or gathered food, fished, hunted and supported themselves and their communities.

As populations grew, land ownership changed, farming & fishing became about large quantity trade rather than about subsistence.

Economies became more and more about MONEYMONEY.

There was a pretty quick transition from making your own “stuff” to buying everything at a store.

History of Worker’s CompensationThe industrial revolution had an

additional affect – MACHINESMACHINES.Not only cars, trucks and airplanes, but new technologies and equipment to mine, manufacture, mass produce,and distribute.There were very little laws of commerce to protect workers at that time. As the industrial revolution exploded in the early 1900s, several movements began, including labor organizing, to address the lack of rights of workers.

Worker’s RightsDept. of Labor 1913New Deal 1933Social Security 1935Equal Pay & Civil Rights 1963OSHA 1971Migrant Worker Act 1981Am. w/ Disabilities Act 1990Family Medical Leave Act 1993http://www.dol.gov/oasam/programs/history/dpt.htm

http://www.dol.gov/oasam/programs/history/dpt.htm

http://www.dol.gov/oasam/programs/history/dpt.htm

Back to the Money & Today Besides the obvious reason that it is just good

ethics to provide a safe and healthy work place, OSHA laws protect the employee (and their families) from the expenseexpense that is associated with a serious injury, illness, disability or death that is work related.

It also provides the guidelines and instructions to employers so that they can better prevent accidents and injuries.

Costs for the Injured Worker Medical Costs Loss of Pay for Missing Work Loss of the Ability to Work

Cost of Retraining for a Different Job Disability

Change in the Ability to Earn the Same $ Extended Medical Care Costs

(Beyond the Immediate) Pain & Suffering – the Mental Cost

People’s identity is often linked to their job…

Costs for the Employer Loss of the Productivity of that Worker

Pay the worker who is out with an injury their salary plus the cost of a temporary person.

Or, the rest of the team has to take on more work. Cost of Replacing that Worker Cost of Damage to

Equipment, Structures, etc. Cost of a Litigation Cost of OSHA Citation(s) Loss of Reputation

Costs for the Physician It costs the physician to provide care to the

injured person. Without worker’s compensation, the injured

worker may not be able to afford the cost of the health care.

Broken Bone: (Estimate)

Office Visit $100-300

X-Ray $75-500

Setting $200

TOTAL: $375-1000

Other Costs? Family Friends Community

How Do We Deal With These Costs?

INSURANCE!It’s called Transferring the Risk.In many ways it is similar to car insurance.1. You purchase it with the hope you never

have to use it.2. If you have to use it, you are “penalized”.

1. Your rates go up.2. You have to pay a deductable.Etc.

BREAK

The next TOSHA Training Sessions will be announced in the next week.

OSHA-10

OSHA 40-Hr Haz-Woper

TRIBAL FIRST INSURANCE

Claims Administrators are referred to as Third Party Administrators (TPAs)

Tribal First is also an insurance provider but not all TPAs take on this role.

Even though the employer is technically the person insured, having a different party administer claims provides for someone to attempt to balance the needs of the employee and the employer.

The THIRD PartyEXERCISE:

1. Gather in groups of 3 or 4.

2. You have 30 minutes to discuss the following questions. (Handout)

3. One person from each group will report back to the large group.

4. We will discuss everyone’s opinions as a group.

Third Party Objectivity1. What are the challenges to the employer be objective

or not?

2. What are the challenges to the third party administrator being objective or not?

3. Where does the regulating body, such as OSHA come into all this and do you think they are objective?

4. Do you feel the laws are objective?

5. What challenges are unique to tribal business?

6. Should Objectivity be a goal?

Working Toward A Common Goal1. Everyone wants to limit their individual cost

and/or loss.

2. By acknowledging the other parties similar position, we can try to work together for a common goal.

How Do We Limit the Costs?1. Make the process go as smooth as possible.

2. Limit any unnecessary costs. The longer someone stays off work, the more

cost is associated with each claim.

Return to Work Policy

Modified Duty Process

We have to be able to TRUST each other!

How Do We Make The Process Go Smoothly?

1. It ALL Comes Back to the FORMS!

A. The number one reason that a claim is delayed and/or denied:

Missing or IncorrectMissing or Incorrect

Information on theInformation on the

Initial Report.Initial Report.

SECTION ONEEmployer Section:

1. “Firm” Name

1A. Policy Number

2. Mailing Address

2A. Phone Number

3. Location Address (Why might this be important)

3A. Location Code

4. Nature of Business

Should the injured employee be expected to fill this section out?

SECTION TWOEmployee Section:

5. Employee Name

6. Social Security Number (Why might this be important?)


7. Date of Birth

8. & 8A. Home Address & Phone

(What happens if you move, give the wrong address and/or don’t provide a phone #?)


9. Sex

10. Occupation

(Why do they want to know this?)


11. Occupation (Job Title)

12 & 12A. Usual Work Times & Employment Status

(Why is this important?)


13. Gross Wages

13.A Other Payments Not Reported as Wages

14. Have you previously injured the “body part in question”?


15. Do you have more than one paying job?

15A. Married?

15B. Dependents?


Release Authorization

SECTION THREEIncident Section:

BREAK

The next TOSHA Training Sessions will be:

MAY 13th Accident Prevention

MAY 20th Basic Ergonomics

Making Treatment Go Smoothly

The Physician’s Perspective:

TIMETIME1. Can determine if a cut can be stitched or a finger reattached,

etc.

2. May be critical to treatment of exposure or poisoning.

3. Will help in determining the relationship of the injury with the actual job duties.



EXPOSUREEXPOSURE1. MSDS – Material Safety Data Sheets

If there has been any type of exposure to a chemical, the proper procedure is to send a copy of the MSDS for each chemical with the patient.

2. Medical Surveillance

For many jobs, a basic physical including testing of baseline, periodic and termination levels of a variety of compounds is required and is helpful for the physician, if other than the one who completed the physical.



JOB DESCRIPTIONJOB DESCRIPTION1. In order to determine potential causes of an injury but also

for determining the modified duty status, the doctor needs a detailed description of the injured worker’s job. Including;

A. Different tasks from start to finish

B. Approximated time the employee does any of the following; STANDING, SITTING, LIFTING, BENDING, KNEELING, TYPING, ETC.

C. And any medical surveillance that has been done.



PROTECTIONPROTECTION1. The doctor will want information on what measures

are/were taken to protect the employee. Did they perform to their expectation? What will be available for the employee when they return to work? The doctor may suggest additional safeguards for the employee when they return.



REPORTINGREPORTINGIt is important to know/remember that licensed medical practitioners are required to report certain things to the county health authority who then reports to state authorities who reports to federal authorities. There is no way to avoid it.

However, it is not a physician’s role to enforce the law and most are usually very clear that the needs and decisions of the patient are their first concern.

Physician’s Initial Report1. Section One is usually ObjectiveObjective Findings

A. Height, Weight, Temperature, etc.B. Description of injury such as:

(Lac) Laceration on Right Index Finger, 1 cm length, 1 mm depth, etc.

2. Section Two is SubjectiveSubjective FindingsA. How did the injury “appear” to the doctor.

The difference is that the objective should be measurable while the subjective is based on the physician’s opinion.

Physician’s Report3. The physician will determine, based on the

examination and sometimes by running some tests on the patient, if, when and how the injured worker can return to work.This is supposed to be based on OBJECTIVE findings!

So what does that mean?

Physician’s Report1. Back to Work with NO RESTRICTIONS.2. Back to Work with RESTRICTIONS or in

other words, MODIFIED DUTY.3. OFF WORK

A. Plan of Treatment.B. Disability…

So, Does that mean you areon VACATION?!

Modified Duty1. Sitting2. Standing3. Bending4. Lifting

Etc.

In a typical WORK day, how often and how much can you withstand without aggravating the injury?

Why is Return to Work Important?

1. Back to the Cost.2. There is a psychological concern

with any injury or illness.A. The longer someone delays getting

back to work the harder it is.B. Sometimes we can actually make

an injury worse by “babying” it too much.

C. Pain and Discomfort are actually part of the healing process.

Being Aware1. Anticipate that there will be a transition

period.2. The employee may experience post traumatic

stress, depending on the situation.

It is important for coworkers, supervisors, family, the physician and the injured employee not to underestimate the mental impact of a work related injury!

COMMUNICATION!Part of any smooth process is making sure all parties communicate.

1. The employer should check in with the injured employee, especially if they are off work.

2. The employee needs to let both the doctor and the employer what is going on, if they are having trouble with treatment or adjusting to a return to work plan.

COMMUNICATION!3. The doctor needs to make sure that the

insurance carrier, the patient and the employer all know what is going on with test results, treatment options and any changes to the return to work plan.

4. IMPORTANT! Once a doctor has signed the initial paperwork, they are considered the treating physician. Any treatment or care that does not have the approval of the treating physician will not be covered!

COMMUNICATION!NOTE: There is the option to request a second

opinion and/or to switch doctors.

Again, make sure that you communicate to your employer, the insurance provider and your previous doctor to make sure that the process goes smoothly.

It is best to communicate with everyone BEFORE you actually proceed with any changes or your treatment may not be approved and you will be responsible for the cost.

Getting Back on the Horse!

FALL OUTBe creative and willing to make changes.

NOTE: If we follow basic incident investigation procedures, BLAME is not the focus.How, Why, What etc. can be achieved without focusing on the blame.Try to turn the negative into positive.

You can’t change that the accidenthappened but you can control theresult(s) of the situation.

FALL OUTIt is not uncommon that there may be adjustments that occur following an incident, both for the individual who was injured but also for the work itself.

THAT’S A GOOD THING!!

Use the situation as anopportunity to make thework safer for everyone.

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Photo: “Tulalip Bay” by Diane L. Wilson-Simon