Workers' Compensation & Utilization Management
November 18, 2016
Adults spend a significant amount of their lives at work. Some individuals have 9-to-5 desk jobs while others hold more physically demanding positions in agriculture, manufacturing and construction. Whatever the work environment, employees expect to be safe from unreasonable dangers and to be able to get up and go to work again the next day. However, when employers fail to uphold the law or are not proactive about worker safety and health, individuals suffer the consequences. Unhealthy and dangerous work environments lead to thousands of work-related injuries, disabilities and fatalities every year. The good news is that employers can shift their focus to workplace injury prevention and improve the overall conditions in their work environments, and when accidents do occur, proper utilization review can ensure patients have access to the most effective treatment available.
While not considered a common worker’s injury, many individuals experience mild to profound hearing loss due to loud noises at their jobs. According to the U.S. Department of Labor (DOL), 22 million workers are subjected to potentially dangerous noise every year. Many people file workers’ compensation claims each year because of a disability related to work-related hearing loss. Ultimately, employers spend an estimated $242 million every year on these claims.
Many employers recognize that hearing loss is preventable, and the funds spent on diagnosing and treating this condition could be saved. To support these prevention efforts, The Occupational Safety and Health Administration (OSHA) requires all employers adhere to noise exposure regulations. Not only should employers keep noise below certain levels for specific amounts of time, but also they must provide workers with hearing protection equipment.
Transportation accidents with both business and pedestrian vehicles notably contribute to worker injuries and deaths every year. In 2014, there were 1,891 fatal transportation incidents, according to the DOL and Bureau of Labor Statistics (BLS). These accounted for 40 percent of all fatal work injuries that year.
The causes of these accidents vary, but distracted driving by workers is a serious issue. Workers are as susceptible to distractions from electronics, reading, eating or drinking and talking to passengers as any other driver. However, when a worker is distracted behind the wheel of a commercial truck or heavy piece of equipment, the potential risk for injuries and death is significant. OSHA, the DOL and other agencies are pushing for U.S. businesses to focus on educating workers about the risks of distracted driving, to establish procedures for what is and is not appropriate behind the wheel, and to create consequences for workers found texting, talking on the phone or participating in other distracting activities while driving on the job.
The number of fatal falls, slips and trips suffered by workers in 2014 was 10 percent higher than in 2013, the DOL and BLS reported. Falls to a lower level of a building or construction site rose 9 percent and falls on the same level of the work environment increased 17 percent between 2013 and 2014. As with transportation incidents, falling, slipping and tripping at work are major issues. Employees need to be able to move around in safe environments, free of the fear that they may not be protected from a harmful fall.
To prevent falls, employers and workers can:
Not all workers are exposed to dangers in highly physical workplaces like the construction or oil and gas industries; many work at desks and counters. While these jobs may be relatively safe, employees are not immune to work-related injuries. Sitting, standing and lifting objects for 8 hours at a time can lead to musculoskeletal disorders like carpal tunnel syndrome, tendonitis, muscle strain, and spinal injury. This is why ergonomics (the science of minimizing injury risks through designing and arranging better equipment, tools, workstations and procedures) is crucial for workers in all industries. By providing ergonomically-designed chairs, desks and other equipment, employers can reduce discomfort and reduce the risk of injuries.
Improving ergonomics starts with a review of the employee’s environment. It’s important to note where workers spend most of their time, the processes for workers to complete their duties and where workers have historically incurred the most injuries. Once a worker’s risks have been assessed, their work environment can be improved through better equipment, procedures, and protocols.
Creating healthful and safe work environments is more than a single-day process, and making safety part of the office culture is only part of the solution. Businesses need a reliable way to facilitate treatment of work-related injuries in the most effective and time-efficient ways possible.
Utilization Review (UR) is a critical tool for businesses on the occasion that injuries occur. By reviewing medical records and utilizing clinical guidelines, UR aims to determine the best possible treatment for an occupational injury. This way, not only do employees receive appropriate and effective care, but businesses limit any negative impacts on time and productivity.
At Advanced Medical Reviews (AMR), a URAC-accredited Independent Review Organization, medical records in UR cases are reviewed by physicians whose specialties bring a necessary expertise to the review process. AMR understands that workers’ compensation injuries are specific to an employee’s duties and his or her work environment. By matching UR Physician Reviewers by specialty and region, AMR ensures that treatment options for a compensable injury are reviewed accurately and efficiently.
Neither workers nor employers want workplace injuries, so prevention and education are key to keeping workers safe and productive. Luckily, when prevention efforts fail, a network of medical care is in place to ensure that workers receive the right treatment at the right time.
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