Nurse hotlines help reduce costs, litigation

Thousands of companies throughout the country are using a 24-hour nurse on duty. In addition to reduced direct costs, the system results in a more congenial feeling for the injured employee, thus reducing litigation.

If your 2-year-old develops a high fever in the middle of the night, you might call the 24-hour nurse on duty through your group health plan. Based on the child's symptoms, the nurse might be able to tell you exactly what to do and avoid the unnecessary costs and time of going to the emergency room.

That is the idea behind the nurse triage plan being used by thousands of companies throughout the country. In addition to reduced direct costs, the system results in a more congenial feeling for the injured employee, thus reducing litigation.

"Our goal is to create a warm, empathetic hug over the phone," said Paul Binsfeld, president of Company Nurse. "We can try to ease the anxiety and help them with their injury."

Binsfeld founded the Arizona-based company after a midnight call to a 24-hour nurse when his daughter was running a fever. "That's when the light bulb went off," he said. "I said, 'Why can't we do this in the workers' comp business and help employees and their supervisors do the right thing at the time of injury?'"

That was about 13 years ago. Since developing the company, he says employers have seen remarkable savings of 15 to 20 percent and up to 40 percent. The City of Little Rock, Ark., saw a 39 percent decrease in workers' comp claims costs. And a hospice company with a mobile, in-the-field workforce and a decentralized injury reporting process reduced its lag time from an average of 17 days to two days, and litigation drop by nearly 40 percent. Most other organizations, he said, achieve virtually 100 percent same-day reporting.

In addition to Binsfeld's company, he said a California organization started using the nurse triage system for school systems and has seen similar results.

How it works. Whether companies set up the program themselves or outsource the service, the process aims for three key benefits:

Right time, so the injury is reported immediately.Right care, so the injured employee goes to the right health care providers in the right facilities.Right results. "Not only do we help to save money, but we're also able to really improve the experience that an injured employee has when they get injured," Binsfeld said.

In the case of Company Nurse, a participating employer provides all relevant information, such as all its locations, preferences for medical clinics and ERs, the people who should receive the reports of injury, and any special programs, such as return-to-work or a drug-free workplace program that requires drug testing after an injury.

"We set up a database with all that information. When injured employees call in, we're able to reinforce the employer's message and most importantly take care of that employee at the time of injury," he said.

Injured workers that have a positive experience are less likely to seek out an attorney.

"It's a simple process of getting information into the hands of the stakeholders and helping employees have a better experience when they do get injured," Binsfeld said.

Read more at the WorkersComp Forum homepage.

View the original article here

Conflicting medical testimony doesn't block temporary benefits for nurse

In Kentucky when there is conflicting medical evidence, an administrative law judge's decision will not be reversed if there is substantial evidence supporting his decision.
Case name: Bluegrass Regional Mental Health v. Bellamy, No. 2010-CA-000522-WC (Ky. Ct. App. 03/11/11, unpublished).
Ruling: In an unpublished decision, the Kentucky Court of Appeals held that a nurse was entitled to temporary total disability benefits and future medical and income benefits.
What it means: When there is conflicting medical evidence, an administrative law judge's decision will not be reversed if there is substantial evidence supporting his decision.
Summary: A nurse slipped and fell on ice in the parking lot of her employer, injuring her low back and left leg. The parties agreed that she suffered a work-related injury. The nurse had a history of low back problems. She said that her pain increased after the work-related slip and fall from radiating halfway down her left leg to radiating across both legs with numbness in both her legs and arms. The nurse sought benefits. The Kentucky Court of Appeals held that she was entitled to temporary total disability benefits and future medical and income benefits.
The employer argued that the nurse did not suffer a compensable injury. The court disagreed. One doctor testified that the work-related slip and fall produced permanent impairment while two other doctors said the injuries were temporary. Although there was conflicting medical testimony, the court said substantial evidence supported a conclusion of compensability.
The court also found that the doctor's opinion was objective medical evidence. He physically examined her and considered her history of complaints, treatment, and various injuries dating back 10 years. He also conducted motion studies, pinprick studies, strength measurements, and motor, reflex, and pulse testing. Further, he reviewed her medical records.
The court found that an award of TTD benefits was proper because the nurse was unable to return to the type of work she was customarily performing at the time of her injury. The nurse was placed on work restrictions, and the employer would not allow her to return to work with any restrictions.
Read more at the WorkersComp Forum homepage.
View the original article here