Case study: pump company
Correct Medical Diagnosis Keeps Employer from Feeling the Pain of a Mod Increase
An employee herniated a healing surgical incision on his second day back. The question was whether this was really a work injury.
Start a conversationThe Employer Success ProgramThe business
Water and sewer pump company with 27 local employees and additional employees in two other states.
The situation
An employee had gall bladder surgery in late January and was released back to work full duty, without restrictions, three weeks later. On his second day back he was moving cross ties and herniated his healing surgical incision, which needed more medical and surgical treatment.
What we found
We looked into the claim and decided it needed further review. We brought in an independent registered nurse with experience in occupational injuries. After reviewing the circumstances and talking with the employer about the employee's recent abdominal surgery, the nurse concluded the herniation was a complication of the surgery.
What we did
The nurse shared this finding with the carrier, and the claim was denied under workers' comp. The carrier agreed the herniation was a complication of, and directly related to, the recent surgery. The claim went to the employee's health insurance plan instead.
The result
8 points
Mod increase avoided, about $15,000 over three years
The claim was closed in less than three weeks, saving the employer the cost of medical care and potential future wages. Disability guidelines put the average cost of a typical uncomplicated incisional hernia at $21,102 ($10,001 indemnity and $11,101 medical). Had this claim been accepted under workers' compensation, it would have raised the employer's experience mod eight points, or about $15,000 over three years (assuming rates and payroll stayed the same).
Where the Employer Success Program comes in
It starts with a Diagnostic and Plan. We read your loss runs, your mod worksheet and your key contracts, and we talk with the people who run the work. You get the pattern behind your claims and a short list of what's worth fixing first.
From there our claims, HR, safety and fleet people work alongside yours, and you get a Score Card at the start and every year after, measured against your own starting point.
Start with a conversation
Tell me what's going on. I read these myself and reply within two business days. If there's nothing worth fixing, I'll tell you that too.