by Grant Davis | Insurance, Workers Compensation
Medical Considerations For Workers Compensation Claims
Workers compensation insurance is designed to provide treatment to an injured worker to recover from a work related illness or injury. Workers compensation will partially replace wages lost during recovery and help your employee return to work.
These medical consideration tips will help you evaluate the necessity of some treatments and to verify that your employee’s treatment or care is appropriate.
A Broker at GDI Insurance Agency, Inc. can help you with a complete Workers Compensation program. Contact us at 1-888-991-2929.
Medical Considerations
- Make sure that your occupational medical practitioner does a thorough and proper examination when an employee first goes to see them; this way, you will not be surprised when the independent medical examiner (IME) tells you that you have a problem claimant. This includes performing Waddell’s tests when there is a lower back injury involved.
- A diagnosis should be supported by the conditions of the accident. If the two don’t match up, then the diagnosed injury could be a result of something not directly related to work functions. In these situations, be very careful of what you pay for.
- Don’t pay a bill for a surgery or procedure without reading the operative report. Sometimes it can contain things that had nothing to do with the incident that should not be your financial responsibility.
- Don’t let diagnostic tests dictate your case management; tests only proves that there is an injury, not whether it happened at your workplace.
- For a quick and easy way to save money, refer employees to physicians that you trust to provide legitimate findings and diagnoses.
- Before a surgery takes place, establish whether it was caused by a work-related condition. Doctors may suggest surgery a bit more readily when they know it is a workers’ compensation claim.
- Make sure that diagnoses are legitimate and universally accepted before you pay a claim. For instance, don’t list “pain” as your work-related diagnosis. Pain is a subjective finding – you cannot qualify it or quantify it.
- Know the basics about common medical terms that you may encounter. For example, fibromyalgia is not a diagnosis; it is a symptom. The word itself means “pain in the fibrous tissue” (the suffix “algia” always indicates a symptom).
- Be wary of paying for surgeries or operations caused by arthritis. Arthritis is not caused by trauma and thus cannot result from an on-the-job injury; therefore, in most cases, it should not be considered a workers’ compensation claim. The only exception is arthritis caused by repetitive trauma, found in employees who do a lot of squatting, kneeling or repetitive hand and finger movements.
- Be wary of other common claims that may be masked as workers’ compensation injuries. For example, in general, trauma does not affect an existing replaced knee, making it rare for necessary loose knee replacement to be work-related.
Legal Considerations
- Know and understand the interplay between your state workers’ compensation laws, the American with Disabilities Act (ADA), and the Family and Medical Leave Act (FMLA).
- Keep your legal counsel in the loop on workplace injuries right from the beginning. The first 24 hours after an incident are crucial, and your lawyer needs to be informed about conditions, investigations and any updates.
- When hiring, provide detailed job descriptions that include an accurate percentage of the amount of work that is physical. This may prevent later legal disputes.
- Document and file everything throughout the workers’ compensation and return to work process, as it may become relevant information if there is a claim or later dispute.
- After an incident, review the employee’s personnel file. This will help you understand the employee better, and it may offer clues or tendencies for potential fraud or a vendetta against a co-worker or manager.
- After an incident, your legal team or representative should do an on-site inspection where the injury occurred. Be sure that they interview others who do a similar job in addition to any witnesses.
- If there are changes in the diagnosis, the accident needs to be re-evaluated. It may not have happened as reported.
- Keep an organized case chronology, documenting everything from initial claim to the close of a case. This includes previous history of the employee that may be relevant (past disputes with co-workers, claims history, problems at home, etc).
- Make sure to provide the IME with everything you have, including your chronology.
- Before a trial, make sure your witnesses are prepared. Someone from the company should be present at every hearing; it’s important to make sure that everyone is always on the same page.
Learn More About Workers Compensation
Download our “Money Saving Workers Compensation Tips”. This PDF is full of Workers Compensation strategies that will positively effect your bottom line.
California’s Leader in Workers Compensation Insurance and Risk Management
As one of the fastest growing agencies in California, GDI Insurance Agency, Inc is able to provide its clients with the latest and greatest of what the insurance industry has to offer and much, much more. With locations across the heart of California’s Central Valley and beyond to provide a local feel to the solutions and services we provide our clients. We pride ourselves on exceeding our client’s expectations in every interaction to make sure that our client’s know how much we value and appreciate their business.
Contact us today 1-209-634-2929 for your California Workers Compensation insurance quote!
by Grant Davis | Construction, GDI Insurance, Insurance, OSHA, Risk Management, Safety Tips
Keep Your Construction Site Safe with Ground Faults Protection
According to the National Institute of Safety and Health, the most frequently cited Occupational Safety and Health Administration (OSHA) electrical violation is improper grounding of equipment or circuits. This is especially troubling for construction managers in light of the fact that construction workers suffer more electrical burns and fatal electrical injuries than workers in all other industries combined. Each incident carries significant costs in terms of lost time and resources and increases the employer’s risk of costly lawsuits. The most unfortunate aspect of this threat is that many of these accidents could have been prevented with the implementation of proper ground fault protection practices.
GDI Insurance Agency, Inc. provides California contractors insurance solutions specifically-tailored for construction businesses.
We include the following for our clients:
OSHA Regulations
OSHA requires employers to provide at least one of the following:
- Ground fault circuit interrupters (GFCIs) on construction sites for receptacle outlets in use and not part of the permanent wiring of the building or structure
- A scheduled and recorded Assured Equipment Grounding Conductor Program (AEGCP), covering all cord sets, receptacles not part of the permanent wiring of the building, and equipment connected by cord and plug
About GFCIs
Grounding a tool or electrical system involves creating a low-resistance electrical path that connects to the earth. A ground-fault occurs in a tool or electrical system when there is a break in this low-resistance grounding path. The electrical current may then take an alternative path to the ground through the user, resulting in serious injuries or death. GFCIs automatically limit or stop the flow of current in the event of a ground fault, overload or short circuit in the wiring system. They operate by monitoring the amount of current going into electric equipment and the amount of current flowing out along the circuit conductors. If the difference exceeds 5 milliamperes, the device automatically shuts off the power to prevent injury.
About AEGCPs
The OSHA-approved alternative to using GFCIs on a construction site is an AEGCP, which is a regimented system for testing electrical tools and extension cords to assure their proper ground fault protection. If an AEGCP is used in place of GFCIs for ground fault protection, the following minimum requirements apply:
- Keep a written description of the program at the jobsite. Outline specific procedures for the required equipment inspections, tests and test schedule, and make them available to OSHA and to affected persons upon demand.
- Designate one or more competent persons to implement the program. OSHA defines a competent person as someone who is qualified to identify hazards and authorized to take prompt corrective measures.
- Visually inspect all cord sets, attachment caps, plugs and receptacles, and any equipment connected by cord and plug, before use each day. If you see any external damage—such as deformed or missing pins, or damaged insulation—or discover internal damage, take the equipment out of use until it is repaired.
- Perform two OSHA-required tests on all electrical equipment, a continuity test, and a terminal connection test. These tests are required under the following circumstances:
- Before first use
- After any repairs, and before placing back in service
- After suspected damage, and before returning to use
- Every 3 months
- Maintain a written record of the required tests, identifying all equipment that passed the test and the last date it was tested (or the testing interval). Like the program description, make it available to OSHA inspectors and affected persons upon demand.
Using GFCIs in Conjunction with AEGCPs
Although OSHA permits the use of an AEGCP in lieu of GFCIs, it would be a mistake to view the choice as strictly an either/or proposition. The best course of action is to use GFCIs in conjunction with an Assured Equipment Grounding Conductor Program. Taking this step will not eliminate the possibility of a costly electrical accident on the worksite, but it will significantly reduce the risk of injury or death due to ground faults.
California’s Leader in Insurance and Risk Management
As one of the fastest growing agencies in California, GDI Insurance Agency, Inc. is able to provide its clients with the latest and greatest of what the insurance industry has to offer and much, much more. With locations across the heart of California’s Central Valley and beyond to provide a local feel to the solutions and services we provide our clients. We pride ourselves on exceeding our client’s expectations in every interaction to make sure that our client’s know how much we value and appreciate their business. Contact us today 1-209-634-2929 for your comprehensive contractors insurance quote!
by Grant Davis | Business Insurance, Cyber Liability, GDI Insurance, Insurance, Risk Management
Ransomware Insurance and Cyber Insurance
With ransomware attacks on the rise, the role of insurance is becoming more robust. And, although ransomware coverage has been traditionally sublimited within cyber policies, stand-alone cyber policies that cover ransomware are becoming more necessary.
In an attempt to find additional coverage for ransomware, many businesses and carriers have been turning to kidnap and ransom (K&R) policies. K&R policies have traditionally been used by organizations to protect their executives, not to protect against ransomware. Because K&R policies were not designed for ransomware, they may only provide a quick fix. K&R policies tend to be less suitable for ransomware than cyber policies and payouts tend to be lower.
Policy Definitions, Terms and Conditions
Since cyber insurance isn’t standardized, organizations should review all policy language with a broker before choosing a plan that effectively covers ransomware. Policies can vary significantly in their language and coverage options, so insurance experts recommend policies that—at the very least—provide coverage for extortion demands and payments as well as lost income resulting from an attack.
Organizations should also take a close look at the following definitions, terms and conditions when choosing a policy:
- Sublimits and deductibles—Most policies set a sublimit for covering ransomware. It is important to review this limit carefully, considering that demands may start on the low side, but can increase quickly. Also, since making a ransom payment may make organizations a target for subsequent ransom demands within the policy year, the deductible amount should reflect that risk.
- Payment terms—Most policies require prior written consent before the insured can pay any ransom. This can result in payment delays and increased demands by the hackers. If an organization pays a ransom in order to resume business, without prior written consent by the insurer, there’s a chance that it may not be reimbursed. Therefore, organizations need to be comfortable with a policy’s terms in order to avoid compromising coverage.
- Definition of extortion—It is important for organizations to fully understand and agree with their insurance company’s definition of extortion, since the definition dictates the trigger for coverage. For example, although hackers may intend to sell or misuse information, the ransom demand may only involve a countdown timer and demand for money. While the combination of the two may seem like an obvious threat to the insured, a carrier could possibly deny coverage on the basis that there was no explicit threat to sell or misuse information—all because of its unique definition of extortion.
What to Look for in a Ransomware Insurance Policy
Companies should look for ransomware coverage that uses broad terminology and protects against a wide range of threats, including threats to do the following:
- Access, sell, disclose or misuse data stored on your network, including digital assets.
- Alter, damage, or destroy software or programs.
- Introduce malicious software, including viruses and self-propagating code.
- Impair or restrict access. Look for policies with broad terms like, “threats to disrupt business operations.”
- Impersonate the insured in order to gather protected information from its clients, also known as pharming or phishing.
- Use your network to transmit malware.
- Deface or interfere with your company’s website.
The Importance of Risk Management
Ransomware insurance is most effective when coupled with an effective risk management program, as there are many components in the fight against cyber crime. Risk managers should work with an insurance broker to review all applicable options before choosing cyber coverage.
California’s Leader in Insurance and Risk Management
As one of the fastest growing agencies in California, GDI Insurance Agency, Inc. is able to provide its clients with the latest and greatest of what the insurance industry has to offer and much, much more. With locations across the heart of California’s Central Valley and beyond to provide a local feel to the solutions and services we provide our clients. We pride ourselves on exceeding our client’s expectations in every interaction to make sure that our client’s know how much we value and appreciate their business. Contact us today 1-209-634-2929 for your comprehensive business insurance quote!
Contact GDI Insurance Agency, Inc. today 888-991-2929 to learn more about available cyber policies and effective risk management techniques to protect your organization from ransomware attacks.
by Grant Davis | Business Insurance, GDI Insurance, Insurance, Risk Management
Planning for the Worse – Business Interruption or Loss of Income
The reality is 80% of business’s that sustain a major loss at their primary location and are rebuilt and restored by insurance are out of business within 5 years of less! GDI Insurance Agency, Inc. wants to make sure your business is protected with Business Interruption Insurance or Loss of Income insurance.
Statistics show that approximately 25 percent of businesses affected by disasters never reopen their doors. Small business owners and individuals who are self-employed are especially vulnerable to the loss of income that business interruptions can cause. To protect yourself from losses in the event of a forced shutdown, you must purchase adequate business interruption insurance and create a thorough business continuity plan.
Implementation of your business continuity plan means more than simply exercising the plan during an emergency. It means integrating the plan into your company operations, training employees and evaluating the plan.
Amazing?
Not really. In all my years (nearly 38 now) as an insurance broker I have yet to find a company with a real disaster recovery plan that included proper limits for loss of income and extra expense which is business interruption insurance.
Think about your customers. If you can’t fulfill their orders they still need your product or service so they must buy from your competitor. The longer they buy from your competitor the harder it becomes to regain the client. A very vicious circle!
Why Do You Need Business Interruption Insurance
Originally established for the manufacturing industry, Business Interruption Insurance has evolved into an essential risk transfer tool for all industries. Coverage provides resources that aid in recovery and can help get a company back on its feet quickly.
Business Interruption Insurance doesn’t just assist small businesses in meeting payroll and bills during a crisis; according to data from the Institute for Business Home and Safety, 25 percent of businesses never reopen following a disaster or interruption.
For larger businesses, Business Interruption Insurance can provide employees and shareholders peace of mind. Shareholders especially like to know a business’ profits are protected in case of fire, tornado, hurricane or other disaster.
Don’t wait until your business experiences a significant loss to consider this vital business insurance protection. Contact GDI Insurance Agency, Inc. at 209-634-2929 to review how this type of coverage can fit into your overall business insurance portfolio.
Take a look at the video on this page, then:
Drop me an email or call my office 888-991-2929 for a copy of these two reports:
1. The white paper I am showing you “The Benefits Of Business Interruption Insurance”
2. A copy of the “Disaster Recovery Planning Guide” in word so you can make it yours!
All free with no obligation or anyone bugging you.
GDI Insurance Agency, Inc. is the right insurance broker for your company if your are serious about insurance cost reduction and staying in business no matter what!
Take a look here to see some of what we offer. It is just the best and right way to protect your company.
We offer this level of protection to all our clients that simple ask us for it!
We have free programs for everything you need for your business to assure you stay in business. We are happy to give it all to you for free. We only ask that you consider us for your insurance needs. Seems like a good deal considering what it would cost to buy all this material. Of course for our clients you also get our help with all this too.
The key to insurance cost reduction is to reduce the risk of having a loss, as well as reducing the size of losses when they happen. This is a key step to assuring your company survives a large loss.
California’s Leader in Insurance and Risk Management
As one of the fastest growing agencies in California, GDI Insurance Agency, Inc. is able to provide its clients with the latest and greatest of what the insurance industry has to offer and much, much more. With locations across the heart of California’s Central Valley and beyond to provide a local feel to the solutions and services we provide our clients. We pride ourselves on exceeding our client’s expectations in every interaction to make sure that our client’s know how much we value and appreciate their business. Contact us today 1-209-634-2929 for your comprehensive business insurance quote!
by Grant Davis | Business Insurance, Insurance, Workers Compensation
How Does Your Business Handle Claims Management for Workers Compensation Claims?
Having a workers compensation claims management process or “best practices” saves you time, energy, money and stress. Having a plan in place can positively influence on your bottom line.
A Broker at GDI Insurance Agency, Inc. can help you with a Workers Compensation Program. Contact us at 1-888-991-2929.
Workers Compensation Claims Management
- Contact your injured workers early and often. This will let them know that you care about them, which can help keep morale up and encourage their return to full, regular duty.
- Consider unconventional or outside-the-box treatment if it will help an employee recover and return faster.
- If your state allows you to direct or encourage employees to use certain doctors, use doctors who understand your business whenever possible. This will help ensure the best treatment for your employees and hopefully aid in return to work scenarios, keeping claims costs down.
- Integrate strategic wellness programs into your company to help reduce injuries. Understand how chronic conditions, like obesity and diabetes, can affect or cause other injuries. Managing such diseases properly can reduce workers’ compensation claims costs.
- Explain workers’ compensation benefits, programs and expectations during new employee orientation to keep future claims costs down. Make sure employees understand that they will not be punished in any way for making a claim or reporting an injury, and explain the importance of promptly reporting any injury or incident.
- Make return to work a priority across your entire organization – every job should have a return to work provision, and every employee should know about it. Return to work program awareness should not just be the job of human resources or your claims adjuster.
- Keep up to date on laws that impact your workers’ compensation claims. Be sure to know your requirements and responsibilities as an employer and how to address any possible or suspected fraud.
- Keep tabs on what your claims administrator is doing; you should always know what is happening with a claim.
Claims Investigation
- Exercise due diligence when investigating a claim. Beyond speaking to the direct supervisor and the injured employee, interview other witnesses or co-workers that could shed light on the situation.
- After an incident or claim, be sure to investigate early and keep all the information organized. Make sure you gather all appropriate evidence and information so it can be verified later.
- Determine whether the employee was actually working on the date that they claim to have been injured. Discrepancies or falsities happen often, particularly with late claims.
California’s Leader in Workers Compensation Insurance and Risk Management
As one of the fastest growing agencies in California, GDI Insurance Agency, Inc is able to provide its clients with the latest and greatest of what the insurance industry has to offer and much, much more. With locations across the heart of California’s Central Valley and beyond to provide a local feel to the solutions and services we provide our clients. We pride ourselves on exceeding our client’s expectations in every interaction to make sure that our client’s know how much we value and appreciate their business.
Contact us today 1-209-634-2929 for your California Workers Compensation insurance quote!
