Q. WHAT IS TRANSITIONAL WORK, AND WHY IS IT IMPORTANT FOR EMPLOYERS?

A: Transitional work is an approach that focuses on an employees ability to return to work by providing specific job tasks consistent with the physical capacity of the employee as determined by the treating physician, for a pre-determined period of time. This approach produces a positive return on human resources in addition to lowering your workers' compensation costs.

 

Q. HOW HAVE MANAGED CARE ORGANIZATIONS PROVIDED MORE SERVICES TO OHIO EMPLOYERS AND INJURED WORKERS?

A: Specifically, Managed Care Organizations (MCOs) provide more return to work options for injured workers, and they monitor the type of care being provided by the physician by staying close to the treatment progress of the injured worker. MCOs act quickly if treatment is not progressing. MCOs have helped achieve more than a 20 percent reduction in lost-time claims since their existence. This resulted in millions of dollars in cost savings for Ohio employers.

 

Q. I WAS TOLD THAT IT'S ADVANTAGEOUS TO SELECT THE MCO AFFILIATED WITH MY CURRENT TPA. WHAT IS THE ADVANTAGE?

A: There is no advantage. Your MCO selection does not have to be connected to your selection of a Third-Party Administrator (TPA). The state of Ohio has strict guidelines explaining what services and functions a MCO or TPA may provide. The 2006 MCO-BWC contract states: "The MCO and any affiliated TPA, if applicable, shall have complete separation of functions, offices, systems, and staff. Complete separation of staff shall include but not be limited to case management and marketing staff. The MCO and any subcontractors must be separate legal entities and may not have the same Bureau provider number or tax identification number. The MCO shall not be a Bureau certified health care provider." The selection of any managed care organization in Ohio is solely the choice of the employer.

 

Q. WHAT TOOLS ARE AVAILABLE FOR EMPLOYERS LOOKING TO REDUCE LOST TIME CLAIMS AND CONTROL THEIR WORKERS' COMPENSATION PREMIUMS?

A: "Transitional work gives employers the opportunity to gradually reintroduce injured employees back to work quicker through alternative work duties, helping eliminate lost time claims, prevent reserve charges and control future premiums," says Scott F. Vaka, vice president of sales and customer relations, CareWorks. "With BWC's Transitional WorkGRANT$ funding covering most of a program's development costs, there may never be a better time to implement transitional work and capitalize on the significant financial impact of early return to work."

 

Q. WHAT QUESTION SHOULD BE ASKED WHEN SELECTING A MANAGED CARE ORGQANIZATION (MCO)?

A: "A pertinent question to ask is, 'Does the MCO have a proven track record of helping employers decrease costs and improve productivity?'" says Pam Rodriques RN, ONC, CCM, director for Premier Comp of HomeTown Health Network. "Your MCO should offer quality case management that assures prompt medical care and a safe and timely return to work.  An experienced, certified case management staff should customize services to your company's individual needs."

 

Q. SINCE THE RECENT COURT RULING , TPA'S SEEM TO HAVE CHANGED SOME BUSINESS PRACTICES.  CAN A TPA STILL REPRESENT AN EMPLOYER, OR SHOULD I HIRE AN ATTORNEY?

A: Yes, the TPA (third-party administrator) can still represent the employer. The Ohio Supreme Court recognized a longstanding tradition of non-lawyer representatives in workers' compensation hearings. Recent changes resulted in new guidelines on how the employer's position is stated at hearings. The TPA can still be an effective tool in defending the employer's position. Presentations at hearings can be done by an attorney representing the employer, or an employee of the TPA.