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How Would Value-Based Care Change Workers' Compensation?There is an ongoing debate in the workers’ compensation insurance industry about whether more insurers should adopt a value-based care model for paying claims. VBC proponents in the industry cite the potential to provide treatment that is more effective in cost and outcome for the patient. How would a VBC system change workers’ compensation for claimants? It may benefit them in theory, but there are still questions about how the system would actually work.

Value-Based Care vs. Fee for Service

Workers’ compensation insurers use a fee-for-service payment model, in which the insurer pays the healthcare provider for each visit or procedure that it performs. Critics of fee for service say that it puts a greater incentive on the number of visits than the quality of care provided. A VBC payment system compensates healthcare providers based on the nature of the injury and the recovery of the patient. There are several payment models for VBC, including:

  • Pay for performance;
  • Bundled payments; and
  • Outcomes-based payments.

VBC proponents call this a more holistic and patient-centered approach to workers’ compensation. The doctor’s financial incentive is to help a worker reach maximum recovery as soon as possible, which could result in injured employees returning to work more quickly. Of course, insurers could also benefit from more predictable pricing and shorter periods of disability payments.

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Collecting Workers' Compensation After a Parking Lot FallTypically around one-third of Illinois’ workers’ compensation claims during the winter are from injuries caused by slips and falls. Snow and ice present a hazard for any employees who must walk from their vehicles to their place of employment. Normally, a workers’ compensation injury must occur when an employee is on the clock or performing a work-related task. However, Illinois has a parking lot exception that allows employees to receive compensation if injured from a slip or fall in an employer’s parking lot.

Parking Lot Exception

Illinois courts have ruled that an employer must cover worker injuries that occur in a parking lot because it is an extension of the employer’s premises. It does not matter whether the employer owns the parking lot as long as it is the designated area where employees are expected to park. The court will also consider whether the employee is exposed to a risk of injury that is different from what a member of the general public would normally experience. For instance, a court once rejected a woman’s workers’ compensation claim because she parked in a lot that was meant for both employees and customers of a store. However, the court may have accepted her claim if the store had required its employees to park in a designated area.

Safety Measures

Employers are not required to clear their parking lots of snow and ice, but their negligence would increase the risk of employees being injured and filing for workers’ compensation. Attentive employers will have a contract with a professional snow removal company, as well as salt and sand on site to create safer walkways. They will also instruct employees about safe walking practices, such as:

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Separate Injuries Allow Separate Workers' Compensation BenefitsAn Illinois appellate court recently overturned a trial court’s ruling on whether a claimant could receive two forms of workers’ compensation benefits from separate injuries that were consolidated as one claim. There are several types of benefits that the Illinois Workers’ Compensation Commission can award, including:

The benefits that a worker receives depends on the severity of his or her injury and how it affects his or her ability to continue to work or find other employment.

Recent Case

In Pisano v. Illinois Workers’ Compensation Commission, a hoist engineer for the city of Chicago injured his wrist, elbow, and shoulders in three separate incidents from 2005 to 2010. An arbitrator awarded the man Permanent Partial Disability for his elbow and wrist injury in the first incident and wage-differential benefits for his wrist injury in the second incident. The arbitrator determined that the third incident was related to the first two and did not require additional benefits. The arbitrator denied the claimant’s request for Permanent Total Disability because he is physically capable of obtaining other employment if he goes through vocational training. The Illinois Workers’ Compensation Commission approved the ruling, with some changes to the wage-differential rate.

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Dangers of Electrical Work Go Beyond ElectrocutionElectricians are at greater risk of injury than many other professions because of the nature of their work. An accident with live electricity can cause severe injuries or even death. However, an electrical shock is not the most common workplace injury for electricians, and people in other professions can also be at risk of electricity-based injuries. Whether you are an electrician or work in another field, you will likely need workers’ compensation benefits to pay for your recovery after a workplace injury involving electricity.

Risks for Electricians

An electrician’s work is dangerous, and accidents can occur even when professionals are being cautious. Electricians are most likely to suffer an injury from:

  1. Falls: Electricians often work on wiring in high places, requiring them to use ladders or lay on high perches. They may lose their balance and fall while concentrating on precise and dangerous electrical work.
  2. Electric Shock: Coming into contact live electricity can result in an immediate electric shock. A severe shock can cause burns, limb paralysis, or death.
  3. Flash Burns: An electrical explosion creates extreme heat that burns anyone close to it and shoots off small pieces of metal shrapnel that can damage people’s skin and eyes.
  4. Chemical Inhalation: An electrician may be exposed to harmful substances such as asbestos when working in older buildings or construction sites.
  5. Repetitive Stress: The physical requirements of electrical work can gradually wear out someone’s body. Electricians regularly bend themselves in awkward positions and do intensive manual labor, which puts stress on their joints and hands.

Falls are the most common source of work injuries for electricians, and repetitive stress will likely develop into chronic pain for someone who stays with the career. However, electric shocks and explosions have the greatest potential to cause catastrophic or fatal injuries.

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How a Functional Capacity Evaluation Affects Workers' CompensationThere are some workplace injuries from which you may never fully recover. If your injury permanently restricts your ability to perform your job, you may qualify for long-term workers’ compensation benefits, such as Permanent Partial Disability or Permanent Total Disability. You can also receive compensation to pay for vocational training for a new career. Your employer’s insurance company will want proof that you can no longer perform your work duties. Your doctor may recommend a Functional Capacity Evaluation to determine your physical capabilities.

FCE Process

An FCE is a series of tests that attempt to simulate the physical requirements of your job. The exam mainly measures your strength, flexibility, and stamina, though some exams will also test your cognitive abilities. An FCE can take as long as eight hours, depending on the number of tests that must be performed. Common tests include:

  • Pushing and pulling;
  • Lifting;
  • Carrying;
  • Positional tolerance;
  • Range-of-motion testing; and
  • Hand dexterity testing.

The examiner will look at your ability to complete the tests and the amount of pain it causes you. Your doctor will review the FCE results and make a recommendation on whether you are capable of returning to work.

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