A View from Inside Worker's Comp at One Higher Ed Campus

Lynda Manley from the University of Oklahoma, Norman Campus provides this month’s newsletter.  Many of you have known Lynda for many years.  Lynda took over the Workers’ Compensation program at OU about a year ago.  In this issue she offers her personal insights into what she’s learned and how to manage this program.

Lynda’s Tale 

When I volunteered to become the full-time Project Specialist for Workers' Compensation at OU, I had the idea of sharing my introduction to the wonderful world of workers' compensation with the members of the Regents’ Training Center because I had written these newsletters for years.  Reasoning that there are others who will be or who have already experienced the joys and tribulations of becoming a "worker's comp guru," I'm writing this newsletter to those persons from a purely personal point of view after one year on the job.  I'm doing this in the hopes that others will learn from my insights (please notice that I did not say mistakes) or will enjoy hearing that someone else has suffered as they did.

A Little Background

Around 1994-1995, OU became self-insured for workers' compensation and hired an outside administrator to manage our claims with the Court and to provide medical case management of our injuries.  In late 1997, OU also entered into a certified workplace medical plan with an additional outside administrator to provide aggressive medical case management of our injuries, and this contract was canceled in 1999.  An employee of the OU Personnel Services office served as a part-time workers' comp problem solver, but essentially all the work of administering OU's claims was to be done by outside companies who were not even located in the same town as most of our employees.  OU's total numbers of injuries average about 300 a year and our claims experience in 1994-95 was nearing the $2,000,000 mark.  I entered the picture in July of 1998…

How It Was Supposed To Work

The injury reporting process called for the injured employee's supervisor to obtain the Employee's Report, to complete the Supervisor's Report and the Form 2, and then to forward all three forms to the Safety Office by fax—which were then forwarded to our Claims Administrators.  This process worked effectively when the information on the reports was correct.  My first or second day on the job, I discovered that some supervisors and/or employees didn't know what department they work for, what account they are paid from, what their rates of pay are, what their titles are, and other such basic, but pertinent, essentials.

Fortunately, OU's Personnel Services shared access to one screen on the OU on-line payroll system so that I can confirm essentials, such as the employee's legal name, the hiring department, the account under which he/she is paid, the rate of pay, the FTE appointment, etc.  This on-line access has proved invaluable in getting the correct initial information to our Claims Administrator.

Additionally, we worked out a system where I email Payroll when an employee has been injured, when he/she went to the doctor, and when he/she returned to work, or how long he/she is expected to be off.  Payroll then monitors the hours missed from work for Temporary Total Disability status.  In essence, the department reports the number of hours that the employee missed from work as "OJI" hours on our on-line payroll sys-tem.  Payroll then reports those hours to our Claims Administrator and together they decide from what source an employee will be paid—either TTD and/or OU benefits such as paid leave.  This interaction has helped ensure that our injured employees aren't inconvenienced by delayed TTD payments and that they aren't given benefits they shouldn't be getting.  Payroll also uses the email notice of injury as an opportunity to inform the injured employee that any time lost as OJI will reduce the employee's Family Medical Leave Act entitlement.

Paper, Paper Everywhere

The first couple of months, I was awash in paperwork.  I was working with injury reports that had arrived in the months prior to my tackling the job, with year-old injury reports that had been passed along to the Safety Office for hazard resolution.  I had a 5-drawer lateral filing cabinet crammed with older claims that were filed by claim year in the Personnel Services office.  None of this chaos arose from a lackadaisical attitude to retention of records, but rather from the workers' comp program moving from one "keeper" to another over the years within OU.

I soon was called upon to find records that were months and years in age—at times an impossible task when all I had was the name of the employee!  So, I began alphabetizing and entering every injury into a simple database, which I set up in Microsoft Access.  Many months later, I had every injury report and/or claim file in alphabetical order in our paper files, and the database records totaled over 3,000.  Our database can tell me the employee's name, department, title, date of injury, nature of injury, cause of injury, the amount paid to date for the claim, and whether or not the claim is closed.  (Our office layout does not allow for all the paper files to be near my desk, so I have to know whether or not a claim is open or closed and the date of the injury to find the paper file.)

Going one step further, I double-checked the records in the database against the paid claims reports from our Claims Administrator and the State Insurance Fund (our former workers' comp administrator).  This ensured that our database had every claim entered into it, because over the years some of the paper files had vanished.

Our Database Continued

Our database also serves another purpose.  Each of our Claims Administrators issued reports on the claims paid, but these reports are not something that OU chooses to share with managers at the departmental level.  Our simple database uses a "common sense" approach so that I can produce reports for managers which show how many of their employees got hurt, how they got hurt, and how much money has been spent by our self-insurance fund.  These reports have been an eye-opener for many departmental managers and have sometimes resulted in a receptive attitude toward safety.

I cannot say enough good things about the ease of using our Access database.  Rather than flipping through stacks of paper files, I can (at the touch of one button) tell you how many times one particular employee has been hurt and what body part was hurt each time.  I share this information with our current Claims Administrator when a new injury is reported so that, if the employee has a history of low back strains over the years, our Claims Administrator can consider whether or not to get that employee to a specialist immediately.

You Have To Talk Them Into It?

I have to admit to total surprise at finding myself spending a lot of my time trying to convince employees to report an on-the-job injury or encouraging supervisors to fill out the required reports in a timely manner.  Because the claims process and the OU employees who managed it had changed several times over the last five years, there was confusion.  Another problem was that there had been no recent systematic training of OU employees about the claims process and what the employees' and supervisors' responsibilities were.  In addition, the reporting forms themselves had changed several times over the last five years.  Now you may begin to understand how much time I devoted in the beginning to introducing myself to the campus as their work comp guru.  Of course, I also had to admit that I didn't know much about what I was doing, but that I was willing to help solve any problems!

I immediately targeted the supervisors of the largest departments with the largest numbers of injuries to receive workers' compensation training.  Also, for every call that I received asking about the work comp process, I told the caller that training was available and offered to do it for an audience of one to infinity.  I also began writing two brochures entitled, "What Every OU Employee Should Know About Workers' Comp" and "Supervisor Responsibilities for Workers' Comp at OU."  The first brochure is currently at OU Legal Counsel, awaiting final approval.  The second brochure is still in draft form, awaiting comments and suggestions.  Our intent is to make these brochures available so that every OU employee will know what to do and what to expect from the workers' compensation process if they are injured on-the-job.

Scared to File

As a caring employer, OU must sometimes convince employees to file workers' compensation.  I quickly discovered that there is a genuine fear of reprisal, and I sometimes walk a fine line between convincing an employee to file without forcing them to do so.  The choice is always left up to the employee, but it is a shame that at some worksites in Oklahoma the filing of a claim is an automatic termination from employment (or the reason for not hiring a job applicant).  I try to convince our employees that such a thing will not happen at OU, while at the same time pointing out that employees will be positively disciplined if they were injured because they worked unsafely.

Talk, Talk, Talk!

Given the size of our institution and the number of employees, the workers' compensation process at OU would be dead in the water without extensive communication.  Some days I'm on the phone for hours on end, asking questions, getting answers, sharing the answers with another party, asking more questions and getting more answers, calling the original party back and asking more questions and getting more answers, etc. I sometimes feel as if I was the tennis ball at a Wimbledon match.  However, the great thing about all this communication is that the process runs smoother, and we protect OU while giving the employee the rights allowed them by law.

While some of my work is done by phone, I rely heavily on our fax machine.  As mentioned before, we send the injury reports by fax to our Claims Administrator.  I also forward any medical treatment reports and work status updates to them, which have been forwarded by fax to me by supervisors.  As mentioned previously, I'm also keeping OU Payroll Services informed of the expected length of absences so that they can coordinate the employee's income benefits.

I also may be called upon to work with departmental administrators in the event of severe injury, to help them understand that the injured employee may not be coming back to work for weeks or months and what the impact will be at their worksite.  If the department is interested in hiring temporary replacements or in the termination of an injured employee, I alert OU Employment Services to ensure that all labor and employment laws are observed.  Lastly, but perhaps most importantly, I alert our Safety Personnel when a serious injury or potential hazard should be investigated.

In the midst of all this communication, you may notice that I have not mentioned a lot of interaction between the injured employee and myself.  While I would dearly love to contact each injured employee and explain the workers' compensation process to him/her, my time does not allow for this.  I normally only talk to an employee when there is a problem or he/she has a question.  In the future, though, I hope the routine will be so automatic and flow so smoothly that I will have time to be more proactive with the employees themselves.

Speaking of Questions

Soon after I started this job, I received a call from an injured employee about the status of her claim and return to work.  Fortunately, I had the presence of mind to find the file before beginning our conversation and noticed that the employee had obtained the services of an attorney.  I, therefore, directed the employee to her counsel for answers and was told that her counsel "didn't return her phone calls."

Calls of a similar nature in the last year have prompted me to automatically share the telephone number of the Oklahoma Workers' Compensation Court Counselor Program with everyone who has any question about how workers' compensation is supposed to work.   That initial call also prompted me to notify supervisors at the employees' departments when counsel is obtained, because everyone at the department level should know that a claim is litigated and "our attorney talks to his/her attorney" about any claim and return to work.

It was only by sheer chance that I learned about the Counselor Program, and I strongly believe that each employee should not accept my word or the word of our Claims Administrator as gospel.  Instead, employees should call the Court Counselors and ask how the system is supposed to work.  They then will know whether or not they have been told the truth by their employer and hopefully will be less inclined to seek counsel.  I myself have used the services of the Counselor Program to clarify certain aspects of the law that I did not understand.

I Thought I Knew

Before venturing into Workers' Compensation, I was the Risk Management Specialist at OU for nearly ten years.  I knew that risk management principles apply to workers' compensation, but I was somewhat clueless about the day-to-day applications of workers' comp.  I thought surely there would be some "classes" available to me so that I could become an expert.  So, I began attending some of the one-day seminars that are held each year.   Then, I was lucky to hear about the 1998 Workers' Comp Court Conference in Stillwater and was able to register at the last moment.

After attending these seminars and the Court Conference, I now know a little bit about case law and learned about some effective proactive programs at Oklahoma employers.  I did not, however, learn how to fill out a Form 2 or other extremely basic techniques.  I did obtain a copy of the Workers' Compensation Court Handbook, which has proven handy when called upon to quote to disgruntled employees the section of the law about starting TTD.

It seems that each and every day I learn one new thing—one more link in the chain that is the workers' compensation sys-tem.  I also manage to learn new things about how the OU process interacts with workers' compensation law.  You may wonder why I want to know so much when we have a Claims Administrator to manage our claims.  The reason is that OU is a caring employer, who spends millions each year hiring and placing employees in jobs all over our campus.  The services of any claims administrator does not relieve our institution of ensuring that its employees are treated fairly and that every-thing is done to get them well and back to optimum performance as quickly as possible.  By knowing the process thoroughly, I can anticipate problems and help facilitate solutions with all the parties involved.

A Collection Letter By Any Other Name

I now make contact with each medical provider to ensure that they know the name and address of our workers' comp administrator.  When employees first began forwarding collect-ion letters from hospitals and doctor's offices on workers' compensation injuries, I quickly found out that correcting the information in these computer systems was as easy as engraving a diamond with a feather!  Slowly, over the last year, our local doctors and hospitals are getting the correct information on where to send medical bills so that OU employees don't receive any of those nasty collection notices (which they insist were not collection letters).

Listening to Gripes and Peeves

While the current push in government is for additional workers' compensation reform, it is true that the system is not necessarily fair when an employee has been injured through no fault of his/her own.  Consider student employees, counted in the thousands in Oklahoma higher education.  Today a student employee can be killed on-the-job in an institutional vehicle and his/her spouse will receive $20,000 lump sum in death benefits and possible additional monthly benefits based upon a percent-age of the deceased's annual salary. Think about the fact that most student employees are not provided life insurance by their employers, that the future earning potential of graduate and doctoral students is in no way reflected in their higher education salary, and that most graduate and doctoral students are married persons with children.  Consider the employee who is injured and treated in today's "managed care" arena.  One loyal, hard-working employee can lose hundreds of hours from work and never receive TTD benefits because "managed care" and "light duty" means that the employee never missed three consecutive days away from work.

 I will be honest and admit that I no longer have the patience to listen to complaints about the unfairness of workers' compensation law.  While I sympathize, I simply refer the complainer to his/her local legislator.  My reason for this is that legislators who write the laws should be provided with real examples of these laws at work from the persons who have been affected.

How Do You Fight Abuse?

Having touched literally every workers compensation claim file in the last 8 years, I'm aware that abuse of the workers' compensation system is found at OU too.  While I sympathize about the "unfairness" of the laws for some injured employees, I also bemoan how easily it appears that some employees can abuse the system for all it's worth.

Unfortunately, there is nothing that I can do about suspected abuse, other than to point out to all OU employees that they should report abuse of the system in a confidential manner.  (Our Claims Administrator does thoroughly investigate claims that are doubtful or that have been reported as fraudulent.)  I let all OU employees know that the monies that are received fraudulently are not coming from an anonymous insurance company, but instead come from a self-insurance pool which is funded in a large part from State of Oklahoma taxpayer dollars.

What's the Cost?

Because I am continually asked by OU administrators for the numbers of dollars spent for workers' compensation, I also developed a simple database of claims paid and funds expended by our self-insurance fund.  Because we had first purchased insurance and then became self-insured, and were first administered by the SIF and then by an outside company, there were so many sources from which I had to tally dollars that I felt a database was my most simple solution to scrambling for dollars.  When I discovered that the SIF Claims Analysis Reports did not update each month as reinsurance claims were paid, this database really became a lifesaver.  I update the dollars paid each month and the computer spits out new totals at the touch of a button.

Any Others Out There?

Within Oklahoma higher education, each institution may handle the administration of its workers' compensation claims in different ways than we do at OU, but I believe that there is at least one person at each institution who is my counterpart.  To those work comp gurus, I extend the hand of friendship and the hope that we can learn from each other.  If you are interested in starting an informal network among the higher education institutions, then please contact me, Lynda Manley, by phone (405/325-0866), fax (405/325-7238), or email (lmanley@ou.edu).  This last year in workers' compensation has enriched me and befuddled me.  I know that I don't know nearly as much as I need to know, but I've learned a little and I'm willing to share.