In a recent edition of 20/20, ABC News conducted surveillance of suspected offenders of false workers’ comp claims. They caught several people right on camera. You can see the segment in the video clip: Worker’s Compensation Fraudsters Caught Faking Injuries

If you suspect worker fraud, your workers’ compensation insurer can help ferret it out. If you are self-insured, your state insurance authority has anti-fraud resources that can help. Human nature being what it is, there will always be some amount of fraud, but if an organization has too much fraud, it’s often indicative of underutilized employer controls: communicating and establishing expectations with employees, managing injuries immediately, and bringing employees back on Return To Work programs. Your EAP can also help. See our article by Jim Walter:

Turbo-Charging your Workers Comp Program with your EAP

Ask employers to describe an employee assistance program. They’ll usually talk about resources and services to solve employee personal problems. They’ll describe it as an employee benefit. And if they’ve had occasion to use the services of an EAP, they’ll probably tell you that it is a very valuable benefit.
What you won’t hear is any reference to workers’ comp. Few employers talk about how an EAP can be an effective tool to reduce workers’ comp and disability costs or how an EAP can support employees during the recovery process to ensure they get back to their normal life as quickly as possible.
But those of us at ESI Employee Assistance Group believe that we have cracked the code and figured out how to insert the EAP into an organization to help the employee expedite recovery while also helping the organization reduce overall comp costs.

The Workers’ Comp Problem

Let’s start with the fundamental reason why organizations opt to have an employee assistance program. It all revolves around that fact that 1 out of every 5 employees face some sort of significant personal problem in any given year. Those problems impact their lives and their productivity at work. A good EAP can go a long way toward addressing these problems and helping these employees get back to full productivity.

When it comes to workers’ comp, the fundamental problem is two-fold. First, too many people get injured on the job. And when injured, employees are frequently away from work far longer than the injuries require. And that’s where the EAP and workers’ comp connect.

The EAP – Workers’ Comp Connection

Anyone who is familiar with workers’ comp knows that there are three key elements to an effective cost containment program:

  • An aggressive injury prevention effort
  • Immediate medical treatment by quality providers who understand workers’ comp
  • An active return to work and transitional duty program
  • What we’ve learned at ESI, is that it is possible to utilize the EAP to essentially turbo-charge this sort of program.

Start with how injuries occur. While some injuries are the result of work site hazards, many injuries—arguably the lion’s share—are the result of unsafe behavior. Relevant data clearly indicates that personal issues are the single most significant cause of unsafe behavior. The U.S. Department of Labor’s data suggests that upwards of 40 percent of all workplace injuries have alcohol or substance abuse as the key contributing factor. And if you add other personal problems to the mix—depression, stress, medical issues, etc. — it is clear that employee problems are at the root of many workplace injuries. An effective EAP can head off many of these problems before they result in harm to the employee, to coworkers and to your organization.

Examining why why injured workers have extended disability is instructive. Often, unresolved personal problems rather than medical problems sabotage the person’s recovery. Personal issues are frequently barriers keeping people from returning to work and resuming normal life in a timely fashion. Issues such as depression, family problems, debt and, once again, alcohol and substance abuse are the main contributors to extended disability. By helping employees tap into the services of the EAP, these barriers are knocked down and recovery and return to work is expedited

Why don’t more employers use this cost reduction tool?

Properly used, an effective employee assistance program can address both the pre- and post-injury issues. So why aren’t organizations using their EAPs more effectively?

First, responsibility for the workers’ compensation program and the EAP almost always reside in different parts of the organization. The human resource department is responsible for the EAP, while risk management or the CFO is responsible for comp. Rarely is there one person or one department handling both. Add to that the fact that most EAPs are not attuned to the opportunity to impact workers’ comp and disability. And, finally, the EAP is generally viewed as a nice benefit, but not a strategic business partner; and not as a strategy for turbo-charging prevention and return to work programs

To ensure an effective program, a couple of things have to happen. HR and Risk Management must work together to promote the EAP as a benefit for employees and a post-injury management tool. Next, employees must be fully aware of the benefit. Supervisors must be trained to identify problem employees and how to steer employees to the EAP. The organization must select an EAP provider that is up to the task, Choose an EAP fully understands productivity demands, disability prevention and the counseling needs of employees.

Over the years, we have seen many employers integrate the EAP into their risk management efforts with extraordinary results. One large self insurance group has experienced an overall drop of more than 40% in claims. We believe we’ve just begun to scratch the surface of making the EAP an effective cost containment tool. We’re working to make it even more effective.

Clearly, an EAP can be an effective tool in your overall workers’ comp program. You and your EAP just have to know how to do it right.

Want to ensure a winning team in your organization? In addition to help for your employees, ESI EAP offers a full suite of tools for supervisors and managers, including our ESI Management Academy. Trainings cover compliance issues, management skills and more. To learn more about how ESI  provides more employee EAP benefits and more employer services, call us at 800-535-4841.


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