10/13/2016 MARY WELLS BRIAN PLAUTZ

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1 MARY WELLS Director of Risk Management 25+ Years Experience ID, Prevent, Mitigate Risk Claims Management Litigation Management Cost Containment BRIAN PLAUTZ Loss Control and Fraud Prevention Director 20+ Years Experience Fraud Investigation Accident Investigation Loss Control and Prevention 1

2 MINNESOTA COMP ADVISOR Certified Work Comp, HR, Safety, Risk Experience Mod, Audit, Payroll Claims Management HR Support Loss Control and Prevention Risk Management MINNESOTA WORK COMP STATS 2014 Minnesota Work Comp Costs $1.66 billion From 1997 to 2013 Medical benefits rose 104% & Indemnity 52% Indemnity claims make up 23% of Claims Average Indemnity Claim is $42,100 Medical Onlys make up 77% of claims Average Medical Only Claim is $1,190 Top nature of injury is Sprains/Strains (53%) Top event of exposure is Slip and Falls (29%) B E R R Y, D A V I D A N D B R I A N Z A I D M A N. " M I N N E S O T A W O R K E R S C O M P E N S A T I O N S Y S T E M R E P O R T, M I N N E S O T A D E P A R T M E N T O F L A B O R A N D I N D U S T R Y, J U N E

3 COMPENSABILITY If an employee sustains an injury at work, workers compensation will pay, right? Not necessarily today we will discuss some recent Slip and Fall cases that challenges this. THE PRECEDENT: DYKHOFF The employee was walking, fell and sustained an injury to her knee Flat, dry, non-slippery floor The accident investigation could not determine reason for fall THE PRECEDENT: DYKHOFF Claim denied by claims professional WC Judge agreed with denial WC Court of appeals reversed denial MN Supreme Court reversed the appeals court ruling, upheld denial 3

4 THE PRECEDENT: DYKHOFF Minnesota Supreme Court Determined: Injury not compensable solely because it occurs on employer premises Must be causal connection between injury and employment Injury from neutral condition compensable if increased risk of injury caused by peculiarities or characteristics beyond what the employee would face outside of work These claims seemed minor, but a good investigation can make a major difference in prevention and also to let adjuster have adequate details Have someone investigate every loss Take good detailed notes of what happened Interview the injured employee Interview any witnesses Take photos Measurements, diagrams, and surveillance video 5 Photos: Panoramic of the entire area Close up from side 1 Close up from side 2 Tight shot of specific item or area Reference photo 4

5 Fact Finding: Note environmental conditions, air quality Note housekeeping and general working environment Note floor or working surface condition Take many pictures Draw the scene Fact Finding: Address time-sensitive physical evidence first Ask for assistance with numerous time-sensitive items Some scenes return to normal very quickly Are you prepared to recreate the scene from your documentation? SINCE DYKHOFF KAINZ Employee fractured her ankle while descending a flight of stairs. She was not carrying anything at the time and there were no defects on the stairway. Investigation showed the stairway had handrails the entire stairway. 5

6 Kainz Fractured ankle Descending stairs Handrails present No defects Not carrying anything Kainz Claim denied by claims professional WC judge claim compensable finding no handrails WC court of appeals compensable stairway was a special risk and/or presented an increased risk of injury Appealed to Mn Supreme Court found finding was contrary to the evidence as the photographs showed handrails and employee s testimony that the stairway was kind of steep also conflicted with photographs Case was remanded back to Compensation Judge who found that since employee was rushing at the time of her injury, this created an increased risk and is therefore compensable Kainz We learned that in order for an injury to be compensable, the Compensation Judge must have a specific finding that the employees injury arose from either a special hazard or from a condition that caused an increased risk of injury. Rushing is the Increased Risk 6

7 Kainz Photograph and measure the stairwell Figure out the angle of the stairs Interview witnesses Saw the fall or; Has seen the injured employee going up and down this stairwell in the past Time considerations-going to and where from Having Increased Risk and Special Hazard as a point of details going into report. Hohlt Slip and fall while walking from building she worked in to her car Fractured hip Icy, snow-covered ADA crosswalk ramp On employer premises as employer maintained the sidewalk Hohlt Claim Denied (no special risk) WC Judge upheld denial Sidewalk presented no special risk or hazard Dykhoff doctrine applies WC appeals court reversed ruling; Special risk or hazard does not apply to employer premises, but Ice and snow on employer s premises presented an increased risk of injury The employer has appealed to the Supreme Court 7

8 Hohlt Take date-stamped photos shortly after the incident at location with surroundings. Review surveillance video from the area if possible. Look at other factors Shoe type, salt/sand logs, etc Witnesses Look for details to the fall Items in hands can be contributing factors: shoes, smartphone, glasses, etc Interview the injured employee Gather as many facts as possible Don t look to blame; detail what happened to prevent future incidents Kubis Nurse returning from responding to Code Ascending stairs with no defects Injured Shoulder End of shift; employee testified she was tired, rushing to avoid overtime Needed to finish briefing nurse coming on duty Kubis: Claim Denied WC Judge upheld denial Fatigue did not present an increased risk of injury WC court of appeals reversed lower court ruling Rushing presented an increased risk of injury Employer appealed to MN Supreme Court; awaiting ruling 8

9 Kubis Interview the injured employee Gather details: At minimum, what was going on in the 24 hours before the incident 3-4 days prior to the incident may be needed Interview the supervisor Was there a rush or time-sensitive situation? Is this a regular occurrence? Take photos of the stairwell Review surveillance video prior to the incident date Does the employee rush all the time or drag their feet? Look at other factors: shoes, etc Make a point to find out if employee was doing a normal job duties with normal parameters around those duties when injured. Was there rush to get job done quickly Late in the shift Added duty not normally done during average day of work Witnesses and injured employee interview are important to flush out the abnormalities of why this injury may have been caused by increased risk, due to rushing. Williams Janitor setting up bleachers Descending from one step to another Felt pop in her foot and sustained a fracture Gymnasium bleachers No defects Employee testified she felt rushed 9

10 Williams Claim denied WC Judge Upheld denial No increased risk WC Court of appeals reversed lower court ruling Agreed nature of task may have presented an increased risk Ultimately decided work-related rushing presented an increased risk as stairs were different than normal flight of stairs Did not appeal to Supreme Court INVESTIGATION Photographs of the bleachers would be important. Measurements of stairs are also always a need. Log of how often this employee would be asked to move these bleachers. Shift hours and when this task was done in relation to them. Witness information on how often and difficulties of this task. Additional investigation on slip and falls may be a factor in the adjuster making a decision. But your details can also help to prevent costly denials that wont hold up. REPORT FINDINGS Answer the following in the report: When and where did the accident happen? What was the sequence of events? Who was involved? What injuries occurred or what equipment was damaged? How was the employee injured? Add documentation for specifics Add photos with measurements or arrows to highlight a specific point or fact in the report 10

11 WORK COMP SURVIVAL GUIDE The Minnesota School System Workers Compensation SURVIVAL GUIDE minnesotacompadvisor.com/ survivalguide 11