Category Archives: Workers’ Compensation

Workers’ Compensation and SSDI Dual Eligibility: Costly Changes Coming?

In 2014, workers’ compensation loss costs (indemnity wage replacement plus medical benefits) totalled $62.3 billion, nationally, while Social Security Disability Insurance (SSDI) paid $141.5 billion in wage replacement benefits to disabled persons and their dependents. In the same year, 10.3  1.3* million disabled workers qualified for both workers’ compensation and SSDI wage replacement. They are dually eligible for both programs given their on the job injuries.

If a worker becomes eligible for both SSDI and workers’ compensation cash benefits, one or both programs will reduce benefits to avoid making excessive payments relative to the worker’s past earnings. Social Security amendments passed in 1965 require SSDI benefits to be reduced so the combined total of payments does not exceed 80% of the injured worker’s pre-injury wages.

However, prior to the 1965 amendments, fifteen states, including New Jersey, had passed what are called “reverse offset” laws, which required that it is the workers’ compensation benefits, rather than SSDI’s, which are reduced to stay under the 80% cap. The reverse offset laws were grandfathered into the 1965 amendments. This produces millions of dollars in savings per year for insurers and employers.

A bristly fly has just done a swan dive into the reverse offset ointment. President Trump’s proposed budget calls for eliminating the reverse offset law. If this provision makes it into the final budget proposal, New Jersey employers would face the prospect of not insignificant increases in total loss costs. Thousands of injured workers in the state are dually eligible for workers’ compensation and SSDI benefits. No one knows for sure the exact number, because Social Security doesn’t have a good verification program. The president’s budget estimates eliminating the reverse offset law would save $164 million over ten years, all of which would come from the 15 states that would lose the reverse offset advantage.

If you’d like to know more about the reverse offset inside baseball game, the National Academy of Social Insurance has an excellent description on page 48 of its October, 2016, workers’ compensation annual report.

Thanks to Work Comp Central’s Elaine Goodman for a story on this issue (subscription required).

*Thanks to Mathematica’s Yonatan Ben-Shalom for catching this typographical error.

Modified Duty: An Employer’s Silver Bullet

Time away from work can be frightening and debilitating for injured workers. They often begin to think of themselves as “disabled.” The longer they stay out of work, the harder it becomes to even approach getting back into the work routine. When that happens, depression and other mental health issues rear their heads.

Consequently, it is crucial to speed recovery through the use of modified duty, one of the most important tools an employer has to reduce lost time and costs. This is just as true for injuries compromised by behavioral or mental health issues as it is for the common slip and fall.

Modified duty is a bridge back to full duty, keeping workers active and part of the team. If you’re an employer, you should instruct your medical provider to focus on what the employee cannot do while injured, clearly delineating work restrictions.

To prove the point, for a moment, put yourself in the skin of the injured worker and imagine you are talking with your doctor about your injury. Would you want the doctor to list for you the potentially countless physical tasks you could actually still do while injured? Or, would you want the doctor to tell you the realistically few things you should not do? The latter approach is the one doctors prefer, too.

Once you have the medical restrictions, work with your supervisors to develop progressive, short-term transitional jobs and tasks. Most important, make sure that injured employees and supervisors carefully follow the physician’s restrictions: The goal is to speed recovery, not aggravate the condition and make things worse. As medical treatment continues and your medical provider gradually lifts restrictions, increase job demands to ease the employee back to his or her original job.

Until now, the traditional method for mental health clinicians to counsel injured workers was to approach the thing as if sitting on a two-legged stool. It was the clinician and the worker. Pretty precarious and often ineffective. But the clinicians and therapists at Workers Compensation Psychological Network know they are sitting on a solid, five-legged stool held up by the worker, the clinician, the employer, the claims adjuster and the medical provider. Our clinicians have been trained in the proper use of modified duty. They know that their job also involves helping the worker return to the workplace as soon as possible with appropriate medically supervised work restrictions.

And they will work with you to make that happen.

This is good for the worker and produces large cost savings for the employer.

That is one more way we keep our pledge to you: Recovery: Sooner -Faster – Smarter.


New Jersey Self-Insurers’ Association Spring Conference and Vendor Fair: Key Takeaways

First, congratulations to the Staff and Members of the association for an informative and entertaining conference at Harrah’s Resort and Casino in Atlantic City.

A couple of shout-outs are in order: Donna Wrobel, the Association’s President and Assistant Director for the Archdiocese of Newark, and Regina Lamptey, ABM’s Regional Risk Manager and the Conference Program Chairperson, did an outstanding job organizing the event and making sure it ran with professional efficiency. Kudos to both ladies.

The presenters were interesting and, in many cases, thought provoking. A special mention of Dr. Tom Dwyer, who, as he did at the recent Millennial Seminar organized by Capehart & Scatchard Attorney John Geaney, delivered an exceptional presentation focusing on the intersection between workers’ compensation and orthopedic medicine.

There was an interesting panel on Utilizing Social Media to Schedule Strategic Surveillance. Another panel that caught everyone’s attention, moderated by Ann DeBellis, Esq., of New Jersey Manufacturers Insurance Company, discussed Pain Management, Medical Marijuana and Interventional Spine Techniques. No free Cannabis samples, though.

It was also a big couple of days for us at Workers Compensation Psychological Network. In addition learning a lot, making many new friends and even managing to leave Harrah’s without contributing much to the casino’s profits, we had a highly successful launch of our venture.

While we were happy to meet so many of New Jersey’s key workers’ compensation players, we were even more gratified for their deep interest in how we might help them deal with the many thorny mental health issues that crop up from time to time.

One of the things that seemed to impress the conference attendees was the breadth of our geographic coverage. We built a county coverage map to illustrate it.


Another thing that seemed to hit home was the responsiveness of the system. Workers Compensation Psychological Network’s online referral portal allows instantaneous referral, saving adjusters and attorneys considerable time and effort. The last thing these extremely busy professionals want is to have to spend hours, days or even weeks tracking down the help they need. Our first-in-the-nation online referral system eliminates that.

One final congratulation is in order: As the conference was scheduled for the first day of the NFL draft, the organizers chose the theme, “Drafting The Right Workers’ Compensation Team.” All vendors competed for the prize for the best display illustrating that theme. So, we salute Team Kirshner, of the Kirshner Spine Institute, for its historic win (although, with our superb Pittsburgh Steeler Display, we have to say, “We wuz robbed!”).


Tomorrow Is Official Launch Day!

Well, here it is. After more than a year of building, Workers Compensation Psychological Network Launches tomorrow.

In what seems to come right out of Star Wars’s opening line – Long ago in a galaxy far away – Richard Filippone and Mary Ann Kezmarsky had a vision, a dream of doing something never before done anywhere in America. They realized that the workers’ compensation system in New Jersey for dealing with mental and behavioral health issues was an afterthought, at best, resulting in high costs for employers, frustration for insurers and angst for injured workers. Claims adjusters did not want to “buy a psych claim,” because of the fear that doing so sent the claim into a psychological black hole and created a lifetime annuity for some PhD.

Richard and Mary Ann, PhDs of the first order, themselves, knew there had to be a better way.

And thus was born a dream that becomes reality tomorrow.

At Workers Compensation Psychological Network you’ll find a network of Psychologists and Neuropsychologists, as well as Cognitive Behavioral Health and Biofeedback experts. The network covers all of New Jersey’s 21 counties, from Sussex in the north to Cape May in the south. All members of the network have been highly trained in New Jersey’s workers’ compensation system. They have learned what employers go through every time a worker is injured and misses time away from work. They’ve learned about experience modification and modified duty and how premiums are built. They know how important is the concept of MMI, Maximum Medical Improvement. And they’ve learned all this without checking their expertise and compassion at the door.

But that’s not all. In addition to building this unique network, Richard and Mary Ann have built the nation’s first totally electronic claimant referral portal and electronic health record system. Richard had another vision – no paper. This means that a referral can happen in a matter of minutes, saving claims adjusters hours, even days of time in finding the proper person to see a claimant.

So, tomorrow, at the New Jersey Self-Insurers Association annual conference, we launch. We couldn’t be happier


Upcoming Events

Workers Compensation Psychological Network is making steady progress toward our official launch when we throw open the doors for business. We’re just finishing Beta testing, and if you’ve ever launched a new enterprise, then you know what that’s like. We expect to launch just in time for the New Jersey Self Insurers’ Association’s Annual Conference at Harrah’s Resort and Casino in Atlantic City on April 28 and 29. If you’re there, please stop by and say hello. You’ll find us at Table 42. We look forward to chatting.

The theme for this year’s Conference is “Drafting the Right Workers’ Compensation Team.” We’re hoping you’ll give us a chance to add a lot of value to your team!

Meanwhile, we’ll be exhibiting at Millenium Seminars’ One Day New Jersey Workers’ Compensation Seminar on April 14 at Doubletree Suites by Hilton in Mount Laurel, New Jersey. Please say “Hello” if you’re there. And it’s not too late to register for this highly worthwhile conference organized by our good friend John Geaney of the excellent Capehart Scatchard law firm.

We’d love to speak with you at either of these great events. Workers Compensation Psychological Network is the only state-wide network of clinicians who are highly trained and certified in dealing with those hard to handle workers’ compensation claims fraught with biopsychosocial issues. We aim for Recovery: Sooner, Faster, Smarter.

Workers’ Comp State Laws Can Lead To Depression For Injured Workers

According to the Bureau of Labor Statistics’ (BLS) Consumer Price Index calculator, what you bought for $100 in 1973 would today cost $533.82. Despite this, during that same period wage growth for the median hourly worker grew by less that 4%. 

That’s how yesterday’s Workers’ Comp Insider’s blog post begins. Fifty States, Fifty Different Laws underscores the sobering reality that many hourly workers in America live perilously close the edge of the financial cliff, one crisis away from homelessness.

The Insider’s post analyzes “The Uncompensated Worker,” a Special Report from WorkCompCentral’s Peter Rousmaniere. The highly readable, but detailed, report illustrates how workers in every state take a pay cut when injured and out of work. Because all state laws are different, the pay cut can be minimal in a few states and catastrophic in many others.

At Workers Compensation Psychological Network, we see workers who, in addition to struggling to recover from a work injury, are also walking on the edge of an economic razor blade. These workers are deeply fearful that their injuries might lead to their families being forced to bunk under a bridge. Mr. Rousmaniere’s report shows that even short-term injuries can lead to deprivation. For instance, a 50-state chart at the end of the report shows that if an injured worker incurs only a brief disability – say, three, six or ten days – some of the provisions of New Jersey’s workers’ comp law (the calendar days waiting period before indemnity can begin, for example), will force a pay cut of 28% for that period.

As psychologists and neuropsychologists, we are mindful that helping these vulnerable people return to work as quickly as medically possible could spell the difference between financial stability and financial disaster. The mental health benefits of such an outcome are, quite frankly, immeasurable.

That’s why our overarching goal is now and always will be Recovery: Sooner, Faster, Smarter. 

There Is A Need For Better Psychosocial Intervention In Workers’ Compensation

This morning, Workers Comp Insider, the Grand Daddy of workers’ compensation blogs, published an illuminating post focusing on why workers’ comp claims professionals wait far too long to engage qualified psychologists.  This, from the opening of Are We Only Paying Lip Service To Psychosocial Issues In Workers’ Compensation?:

It is a cliché in the workers’ comp industry that claims adjusters never want “to buy a psych claim.” Perhaps that’s why they rarely resort to psychologists until the horse is out of the barn and grazing four pastures over. By then it’s a last resort kind of thing.

The Insider goes on to say that claims payers and psychologists just don’t understand each other. It chides those claims adjusters who settle for asking only the basic questions suggesting that “digging deep” and

peeling the injured person’s personality onion to discover what really matters will allow for early detection of those relatively rare cases where speedy referral to a qualified psychologist might make all the difference.

We couldn’t agree more, yet lest we with the PH. D.s after our names begin to feel too comfortable, we come in for some sharp criticism, too. Most of us “know not even the first thing about workers’ compensation and give every indication of being proud of it.” Ouch.

The blog post suggests that we and the payers need to come together to build a system that works for everyone and that if claims adjusters are attuned to the subtle nuance inherent in a good conversation with an injured person, then perhaps certain signs will become apparent that indicate early psychological intervention is warranted.

Part of that coming together requires trust on both sides. The Insider suggests that a sign of trust on the side of the payers would be to adopt a  policy that “entrance into a payer network should not be determined solely by a license to practice and the forced acceptance of a ridiculously low fee. Quality and results matter.”

Finally, the post tells payers that they have a whole lot of educating to do, education that should start today. Why?

Because identifying early and resolving quickly the factors that have the potential to turn physical injuries into mental health problems will save employers, the folks who pay the bills, a significant amount of money and adjusters, whose goal it is to put the toothpaste back in the tube, considerable otherwise wasted time.

That, in a nutshell, is why we created Workers Compensation Psychological Network. To partner with payers for the betterment of injured workers to build a better system – Sooner, Faster, Smarter.