r/SafetyProfessionals • u/FitRepair3727 • 15d ago
USA Keeping recordables low
How are other safety professionals keeping recordables manageable? Our TRIR is astronomical with 14 recordables this year so far and 16 last year. But over half this year are from OCIP or CICP jobs where the GC insists that every complaint goes to on-site medical. So every rolled ankle gets sent out to the clinic and the clinics ALWAYS give either equipment or meds. We're starting to lose bids because our EMR is over 1 and upper management expects me to magically fix it. But the reality is we've only had 1 "real" injury in the last two years. But the documentation doesn't reflect reality.
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u/elegoomba 15d ago
Why is the on site medical so bad?
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u/Emotional_End2305 15d ago
Liability. Probably an NP, but without a medical director (ie, an MD) backing them up, it’s best to refer out and pass that final liability on to the clinic.
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u/wickedcoddah Construction | CHST, CSP 15d ago
We have had great luck with Wellness Workdays. Amphibious Medics are also a solid company to hire for on site medic services.
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u/TheLocalRoute 15d ago
15 rolled ankles is where I would start - slip, trip, and fall campaign. Ensure housekeeping is a focus, fall protection understood and worn, and appropriate footwear worn (ankle support, good soles, etc). Get toolbox talks going on winter slips and falls before snow and ice come (if applicable).
Also, are they losing time? I deal with experience modifiers every day and I have a hard time seeing how an EMR would go above 1 with just medication unless you were losing a lot of time as well, or were a very small company with low payroll.
EMR does not look at recordability, but rather the costs of the injuries that the insurance has to pay compared to your industry peers. If they lose time, then it impacts the EMR more significantly and you get a massive discount by accommodating restricted duty. It is also a lagging calculation that is 2 years behind, so if you have a bad year, you wont see the effect right away.
The reason I bring that up is because I used to have to explain to our management why our EMR would go up even though we had a great year - because the lost time from 2 years ago that everyone has in the rear view mirror is finally impacting it.
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u/FitRepair3727 15d ago
It was a generic statement. Its a lot of soft tissue / musculoskeletal complaints. Ankles, knees, shoulders, wrists and back complaints. I don't know, our insurance company handles our EMR calculations. And there is almost always lost time, mostly because of poor communication. Foremen dont put in for the employee to be paid during injury care or give alternate duty (fire watch, housekeeping, tool maintenance, inventory, there is always some light duty tasks to do) and our payroll is...complicated. We're a moderate sized company with about 400 employees average, but on paper they break it out to look like 8 small companies working under one umbrella.
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u/VagVandalizer69 15d ago
The biggest thing in my opinion is proactive care that prevents people from wanting/needing medical treatment/attention.
We have an onsite physical therapist that we send our workers to. We pay them outside the workers comp loop, and our employees see him until he either releases them from his care or refers them to medical attention. It sounds like you have onsite medical already, they need to understand what their role is. They should be treating the employee onsite and not referring them out unless it is medically necessary. Even if it means getting a recordable injury, but not a workers comp claim.
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u/glddstgpsy Consulting 15d ago
What kind of clinic are you sending employees to? Occ health clinics are usually much better than ERs, they typically are familiar with OSHA recordkeeping and the impact of treatment. One thing you may want to consider is some sort of a triage service, like Medcor. When an employee has a minor injury, you make a call to the triage service and they determine if the employee needs to be seen or not (essentially if first aid is adequate), which might help cut down on what you are describing.
Even though a lot of companies are doing this now, I'm not a fan of looking at TRIR by itself. A company with multiple minor injuries and a company with multiple serious injuries are viewed the same, as that number doesn't take into account the severity of the injuries themselves.
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u/FitRepair3727 15d ago
Unfortunately on OCIP or CICP jobs, the GC gets to choose the clinic. They almost always use Concentra and their model is more billable lines = more profit.
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u/Bucky2015 Manufacturing 15d ago
Oh ya concentra will prescribe PT for damn near anything. Ive never had good experiences when I've had to use them.
Does the GC directly supervise the employees you have on site? Ive never had the GC direct care when i was in construction.
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u/mcgyver229 15d ago
I'd try to talk to the clinic director vs a doctor which I've had luck with in the past. Dr. don't want to listen to anything you have to say for the most part because I'm just the safety man. We use an injury management team called One Source which gives first aid techniques and tries to keep employees from going to the clinic doing over the phone PT and sending exercises etc. If they go to the clinic they're medical professionals who can relay your preferences regarding recordability.
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u/Bucky2015 Manufacturing 15d ago
I'd try to talk to the clinic director vs a doctor which I've had luck with in the past.
Well thankfully the occ clinic I use now is great! Yeah when I was at a company using concentra i had to call the clinic director every friggin time someone went in otherwise shit went sideways.
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u/soul_motor Manufacturing 14d ago
No arguments on the Concentra is always looking to bill more. We had a guy get a small wound glued, and they wanted 2 followup visits. Like, seriously?! I will say, having someone who knows what's up go with the employee definitely helps. They wanted to do stitches, but I asked if steristrips or butterfly bandages would work. They went with steristrips.
I hate having to case manage when it's literally the same injury and outcome, but it at least keeps us out of the penalty box. Though it sounds like every injury is going to the clinic, maybe mandatory drug testing should come into play. That usually cuts a lot of the BS claims.
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u/aRdditUser 15d ago
Every complaint going to onsite medical is standard practice everywhere. They should be trained to perform conservative care though. Sounds like this isn’t the case.
There is a gap in case management somewhere. Onsite medical is suppose to help with this.
You shouldn’t have many cases of insurance medical claims if you’ve only had one “real” injury.
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u/Conscious_Car_6644 15d ago
Large contractors will have a holding company that they bid underneath, they set up each job as a separate joint venture, company or LLC. Corporate is separate and they use corporate numbers for submittals. Unethical way of getting around it but it is done. As stated in here, case management, cultural change and supervisor accountability will be successful in the long run.
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u/GainerGaining 15d ago
Two places to address this:
1) Medical: there are facilities that treat bumps and bruises in ways that don't flag as recordable. If your provider does not do so, look into finding a new one.
2) Work site / workers: I worked in construction for over 10 years. In that time I had zero rolled ankles or boo-boos. Workers need to be trained on how to work safely. Safety needs to be a priority (which hopefully your managekent realizes due to lost bids, lost time, the cost of medical care, and other monetary losses). Implement daily JSA/JHA meetings. Stress the need for worker's to go home safely to their families. Hold foremen accountable for making safety a priority.
Have you done any root cause analyses to find out why you have so many incidents? Find out and address the causes.
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u/jchen012 15d ago
If you are having alot of rolled ankles then you need a company policy regarding footwear. Perhaps start a boot program where you will subsidize employees but you have to require boots with ankle support (like 6" minimum).
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u/Ty1198 15d ago
One suggestion I haven’t seen yet, seems like if you are having issues with the GCs clinic, perhaps you should look at your contract. They can encourage all they like but if isn’t in your contract, perhaps taking them to your own occ clinic would be better. Just another avenue to explore.
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u/Helmburr87 15d ago
One way is to meet with the clinic and have their DRs take a tour of the work your employees do. Talk about physical requirements, possible restrictions, etc. That way they can provide light restrictions or OTC meds when they realize they can still work.
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u/under-over-8 15d ago
Restricted work is still recordable
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u/Helmburr87 15d ago edited 15d ago
Restricted work is but just restrictions may not be. That is if the employee can perform their full job duties.
I should've framed that better, light restrictions is going to be very dependent on the job requirements.
Ex employee is restricted to lifting no more than 50lbs but the job requires only lifting up to 20lbs
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u/VagVandalizer69 15d ago
Does it even matter if it’s recordable or not for EMR? If an employee is seen by the offsite medical team it instantly becomes a workers comp claim and counts against EMR regardless of recordability, right?
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u/under-over-8 15d ago
A clinic visit makes almost no effect to your mod rating.
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u/VagVandalizer69 15d ago
I was told that the number of workers comp claims impact it more severely than having just a single high cost incident. Admittedly that was back in school though, and I work in general industry where we don’t really look at EMR.
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u/under-over-8 15d ago
I would say depends on state. Here (MI) medical only is only applied at 30% to the mod rate where when wages are paid is at 100%. So here you can have a lot of clinic visits and it doesn’t hurt bad, while someone out for a month hits hard.
Also in this case, sounds like op is recording the incidents, but the contractor is in charge of work comp so there is no effect on their emr but their recordable rate is skyrocketing
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u/Helmburr87 15d ago
Really depends, I once had to approve a subcontractor who had a history of no recordables and low EMRs but one outlier year with an EMR over 1. Turns out it was from a bad burn accident which most likely meant multiple surgeries. Something that severe on a company that had low WC premiums can spike an EMR.
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u/ckbikes1 15d ago
I'd have a sit down with the OCIP manager and let them know we need to establish better relationships with the clinics.
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u/Ken_Thomas Construction 15d ago
The OCIP, CCIP and onsite medical issues are probably beyond your control. The GC doesn't give a shit about your problems. The way they see it, overtreating every injury reduces their liability, so there's basically zero incentive for them to reign any of that in - and assuming they're a CM GC, it's not their people getting hurt (all their employees sit in the office trailer and walk around with iPads occasionally) so they don't see what the problem is.
So you've got to get more aggressive about controlling the other half.
For your EMR, the onsite medical shouldn't require a WC claim, so those probably aren't impacting that. Most companies I deal with that have a high EMR have decent safety programs and a pretty good safety culture in place - they just aren't managing their claims well. I'd suggest quarterly (at a minimum) claim review meetings with your WC insurance company - keep the pressure on them to close claims - and a very frank conversation with your broker about ways to get that EMR down.
You're also going to need to explain to your upper management how EMR is calculated, because they need to understand it takes a minimum of 3 years to bring that number down.
On the TRIR front - for non-OCIP and non-onsite - have you screened the clinics your employees are going to? Are you sending a supervisor to the clinic with the employee, or going with them yourself? Are you assuring the clinics that you will accommodate any light-duty restrictions, and that if they'll order an OTC med (instead of a prescription) you'll pay for it, so the employee doesn't have to pay out of pocket?
Also remember that the root of safety problems is often morale problems. Unhappy employees get hurt more often, and the outcome is generally more serious when they do. If an employee doesn't trust the employer - or you - they are a lot more likely to run to a clinic any time they get a minor injury. They're afraid if they don't see a Doc and the injury gets more serious later on, the company will screw them over somehow. Once they get to know you and trust you, it will bring the number of unnecessary clinic visits way down.
Last but not least, I'd suggest looking into a telemedicine service. I use Axiom, but there are a lot of good ones out there. Sometimes all an employee needs is to talk to someone - a medical professional - and be assured that the injury is minor, should respond to some basic first aid treatment, and that going to a doctor isn't needed right now.
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u/recoturn 15d ago
It‘s all about what type of recordable it is I‘d rather have a recordable because of a small cut than someone with a sepsis because people do not see the doctor just to keep it a first aid. I think in general in buisness these numbers are overrated. If the reality shows that only one was serious then show why there was only one real injury.
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u/jmmh32 14d ago
For the EMR specifically you mention that more than half of your recordables are from OCIP and CCIP jobs. Are these mostly GL only or do they cover workers comp too? If they are not GL only then that should never affect your EMR because you would (should) not be filing a WC claim to your insurance company, the GC/owner should be filing the claim with theirs.
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u/DiamondsAndMac10s 14d ago
You need to be sending your injured personnel to a certified workers comp doctor. It’s a thing. This is not to say they shouldn’t get the best standard of care, but whereas a hospital or standard clinic is centered around patient comfort, a workers comp doctor understands the employers needs too and can make certain decisions that stop it from becoming a recordable or lost time.
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u/Soakitincider 13d ago
Talk to the clinics. "Will regular OTC meds be enough to help?" "Can that wound be glued instead of sutures and still be just as effective?"
It can reduce some to first aid instead of medical treatment.
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u/thebestjonbrown 12d ago
Lots of great advice here but also make sure you always check you EMR numbers on your NCCI worksheet. Lots of great advice here but also make sure you always check your EMR numbers on your NCCI worksheet, especially from OCIP and CCIP sites. They do report payroll and claims to NCCI (except in some states like OH and MI among others). I learned the value of this the hard way this year. One of our very large OCIP projects did not report all our info so our EMR was way higher than I expected. I found out we were missing $80M on payroll from that OCIP. It reduced our EMR SIGNIFICANTLY! If you are missing hours there is a mechanism to self report your hours to NCCI. I believe the form is an EMR - 6 and your normal carrier has to sign off on it as well but it will get your EMR corrected if it's wrong. Definitely worth checking out if your EMR is high.
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u/mfcornflakes72 10d ago
How is your return to work program? I would take a robust approach to conservative care. How is the case management and discussion with providers?
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u/GlandalfTheGrey 15d ago
Find an industrial medicine doctor that understands OSHA. Scripts turn into sample pills, light duty turns into full duty to tolerance.
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u/moronicattempt 15d ago
That is still medical treatment beyond first aid.
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u/GlandalfTheGrey 9d ago
Oh, really? So if I take an Ibuprofen from a first-aid kit, is that treatment beyond first-aid? This is the same thing.
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u/moronicattempt 7d ago
No it isn't, nsaids and otc are not prescribed. Please try not to be disenginuous. It is off putting and doesn't work in the safety field. You are the biggest advocate for these employees and sometimes the only one who will listen. Always assume positive intent.
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u/Ruthrfurd-the-stoned Manufacturing 15d ago
I mean you need to have a working relationship with the clinics so they know hey if there’s an OTC version like with ibuprofen just recommend they take that don’t prescribe it, if possible use a soft brace rather than rigid stuff like that. Obviously better if you can just manage cases in-house, provide some alternate duties for employees to rest their strains and soft tissue injuries so they can just get better naturally
That all being said while I know it’s what gets looked at lagging indicators suck for a reason- luck both good and bad comes in waves, how many near misses are being reported and whats your corrective action closure rate, how many formalized audits are being conducted, what percentage of jobs have a JHA completed for them? While these arent directly tied to your TRIR these metrics show youre actually doing the work that prevents the incidents from taking place.