By Donna Motley, Vice President of Claims

HOW TO FILE A CLAIM – Sounds simple, right? There is more involved than one might anticipate.

Claims can be filed with our department via facsimile, e-mail or MTMIC’s Portal. (No one uses U.S. mail anymore – if for no other reason, it takes too long!) Early reporting is best. The longer the delay between the date of injury and the date received in our office results in additional investigation of the circumstances surrounding the incident. Causal relationship has to be identified. When claims are reported within one or two days of occurrence, most, if not all, details are still fresh in everyone’s mind. Similar to the childhood game of “re-telling” a story, the more time that passes, the more likely the story (or in this case, facts) can change. Studies have been done where five people witness the same motor vehicle accident, and there are five different versions as to “how” the accident occurred. Wait an additional five days and details tend to blur, change or be forgotten.

By Donna Motley, Vice President of Claims

Statistics indicate 70% to 80% of individuals experience low back pain in their lifetime. I think most likely, everyone has had a sore back at some point in time.Think back to the last time you were working in your yard or garden, washing your car, cleaning your house, playing with your children/grandchildren. Or maybe your sore back is simply the result of an old bed mattress, saggy couch, sitting in one position for too long or driving a long distance. Could be anything.

A sore back can be the result of lifting, pushing, pulling, holding, carrying, throwing, slip/trip with a fall or without a fall, extended leaning, falling from ground level, falling from a height, climbing, bending, crawling, reaching, twisting, stepping, motor vehicle accident and repetitive motions.

By Donna Motley, Vice President of Claims

Pre-existing conditions, physical or mental, have a great impact on work related injury claims. The State of Michigan Workers’ Disability Compensation Act was predicated on the basis that “you take employees as you get them”. Everyone has their own set of baggage. Family health history pre-disposes some people to certain conditions as does our own personal history. Personal hobbies or activities outside of work, housework, yardwork, raking leaves, trimming bushes, shoveling snow can initiate physical conditions or ailments that are amplified or exacerbated when a person performs work functions.

By Donna Motley, Vice President of Claims

Do you believe in angels, ghosts or aliens from outer space? If not, is it because you have never seen one? Well, the average person cannot see the little bug causing havoc with the “world”, but we have “proof” it was here, is here and continues to be here! Something we cannot see is changing the way we live and go about our daily activities. Fall weather has arrived and we are fast approaching winter. And we are still under the watchful eye of COVID-19. Some restrictions have been partially lifted but we are a long way from “life as we knew it” prior to March 2020.

The Workers’ Compensation arena has been affected as well. As you may recall, doctor’s offices were closed for a short period, then only saw patients via telemedicine. While telemedicine was instrumental in a patient being able to be evaluated, the visits technically do not qualify as a form of treatment. Without an actual physical examination, doctors appeared to be somewhat reluctant to do more than prescribe the injured worker to “stay the course”. Of all the cases we handled during that time, not one patient was discharged from care via telemedicine. Typically, a medical professional would want a physical exam of the patient before declaring a full recovery and recommending a return to all normal activities. This results in continued lost wages if the injured worker had previously been diagnosed as disabled from working, and the added fee for a return visit.

By Donna Motley, Vice President of Claims

As we slowly attempt to return to our former lives (I’m not going to say “return to normal” because, let’s face it, I doubt things will ever be what we considered “normal” in the past), there will certainly be challenges that need to be met. MTMIC was fully functional during the “stay safe” order. Challenges were met in making sure injured workers received appropriate care and treatment. Telemedicine and Teletherapy were utilized. Nurse Case Managers were not allowed to attend appointments of those physicians that were continuing to see patients in person, so they would have a follow-up conference with the injured worker and the physician’s office and obtain the required paperwork for our department. However, for the most part, physicians were reluctant to do more than keep the injured worker “status quo” while utilizing Telemedicine. Teletherapy was a little more effective, as the therapist could actually watch and respond to the injured worker while maneuvers were performed. A few injured workers did advise they “preferred” in person therapy and returned (under CDC guidelines) as soon as they were allowed.

By Chris Boggs, CPCU, ARM, ALCM, LPCS, AAI, APA, CWCA, CRIS, AINS

Published with the author’s permission.

A pandemic is defined as, an outbreak of a disease that occurs over a wide geographic area and affects an exceptionally high proportion of the population.” Although the media lives by the motto, If it bleeds, it leads,” declaring a pandemic anytime more than a few people contract a virus, this time even the World Health Organization (WHO) is warning of possible Coronavirus (COVID-19) pandemic. Coronavirus expert, Professor Gabriel Leung, Chair of Public Health at Hong Kong University, says that unchecked, the virus could infect 60 percent of the global population meeting the definition of a pandemic.

My intent is not to accuse the media of sensationalism, nor to intimate that WHO is overreacting (I don’t think they are); my purpose is to answer the question, what makes an illness an occupational illness” and thus compensable under workers’ compensation? More specifically, how does or might workers’ compensation respond to the Coronavirus?

By Donna Motley, Vice President of Claims

An Occupational Clinic plays a very important role in the world of Workers’ Compensation insurance. An Occupational Clinic differs from an Urgent Care Clinic. The treating personnel at Occupational Clinics, primarily, if not exclusively, treat work related injuries.

Work injuries greatly differ from an injury that may occur at home or result from a motor vehicle accident. Think about machine shops, foundries, stamping plants, etc. and all the equipment utilized to manufacture product within those facilities. Even a restaurant kitchen exposes an employee to more hazards than would be encountered at home. Work injuries can affect virtually every part of the human body (and we have seen it all!).

Occupational Clinic personnel “specialize” in work injuries. We encourage you to develop a close working relationship with your chosen Occupational Clinic. Invite a physician or therapist from your Occupational Clinic to tour your facility so they can see the type of work being performed; so they are familiar with the type of injuries that may occur; and thereby also aid them in determining whether or not the injured worker can return to work with restrictions. Most Occupational Clinics are very familiar with the rules governing Workers’ Compensation and attempt to treat accordingly. The personnel know a disability slip is required for an employee to provide to his employer. Occupational Clinics generally know authorization for testing is required prior to scheduling.

By Donna Motley, Vice President of Claims 

The path an injured worker’s claim can take, can go in many directions.

The perfect claim would be: an employee sustains an injury in the course of employment; it is reported immediately to the employer (supervisor or Human Resources) per company protocol; the injured worker is immediately sent to the Occupational Clinic for an evaluation, diagnosis and treatment plan; the claim is filed with the MTMIC Claims Department within 24 hours of the injury; the injured worker may be off the “rest of shift” and return to work the next day, with or without restrictions; the injured worker returns to the clinic, the injury has resolved, a full release and discharge from care has been given; medical bills are forwarded to MTMIC for payment; and the claim closes in 90 days or shortly thereafter!

It may sound somewhat “drawn out” but, basically, this is an example of a “simple” claim.

By Donna Motley, Vice President of Claims

I received notice of litigation the other day regarding an injury that allegedly occurred many years ago. The injury did not occur while MTMIC was the Workers’ Compensation carrier, but we currently insure the employer where the employee works. The original injury occurred in 2002. That’s correct – the employee sustained an injury to his foot when he jumped off a truck 17 years ago, and he is now alleging “total disability”. The employee has been working these past 17 years, not necessarily without incident or treatment, but certainly there have been other circumstances in his life that may have had an impact on his feet!

By Donna Motley, Vice President of Claims

A while ago I wrote about the medical profession’s new diagnosis of “Text Neck” – concerns about physical conditions being created by a person’s head being constantly bent forward while using a cell phone. Reading material I have received recently from a physical therapy facility now lists additional “new” diagnoses: Texting Thumb, Selfie Elbow, Text Neck and Tablet Tingling. These are new titles for “overuse conditions” officially titled Trigger Thumb, DeQuervains Tenosynovitis, Epicondylitis and Carpal Tunnel Syndrome. All of these conditions relate to straining and overuse of said body part resulting in inflammation.

By Donna Motley, Vice President of Claims

Truly, it wasn’t that long ago everyone was complaining about snow, ice, cold and asking the question “Where is Spring?” As most assumed, we really didn’t have a “Spring”, instead, we went right into summer. That “sudden change” is a stressor to our bodies. Being immediately thrust into heat and humidity can take a toll on anyone. Typically, Spring gives us time to gradually acclimate to warmer weather conditions. Now that the heat has arrived we have to learn to deal with it!

We are excited to announce that we have enhanced our customer portal so that you will now have the ability to upload medical documents as a means to get them to the claims adjuster that is handling your claim. This can be done by following these simple steps:

By Donna Motley, Vice President of Claims

One of the important reasons we stress an injured worker should seek medical treatment soon after an injury is to obtain an accurate diagnosis. what may appear to be a “simple cut or laceration” may actually be diagnosed as a “nicked” or lacerated tendon. An MRI may be required for an accurate diagnosis. 

Tendons attach or connect muscle to bone, which in turn allows for movement at the joint. Tendons control your hand and fingers, wrist, elbows, feet and toes, ankles and shoulders. Tendon laceration will result in trouble in bending or straightening the (attached) body part. These injuries typically require surgery. Hands and fingers should be repaired within 48 hours to prevent scarring. Tendon adhesions can become stuck to nearby tissue, usually requiring a surgical release. Delayed treatment will result in scar tissue and the tendon retracting. Depending on the mechanism of injury, there could also be damage to the bone, nerve and/or ligament.

By Donna Motley, Vice President of Claims

At this time of year, particularly this year, we seem to talk and complain about the weather. The winter season 2018 – 2019 has been confusing, if nothing else. We’ve had snow, ice, sleet/freezing rain, temperatures that range from sub-zero to almost spring. As a result of our yo-yo weather, a lot of people have gotten sick and a lot of people have sustained an injury. Our department is receiving a lot of claims for “slip and fall on ice and snow” resulting in broken bones, sore muscles and head injuries that are being defined as a “concussion”. A concussion is considered to be a “traumatic brain injury” – a mild traumatic brain injury – the least serious type of brain injury. A concussion is defined as a short loss of normal brain function.

We are excited to announce that we have enhanced our customer portal so that you will now have the ability to upload medical documents as a means to get them to the claims adjuster that is handling your claim. This can be done by following these simple steps:

• Log into the portal
• Go to the claims tab
• Click on the open claims tab
• Look up the name of your injured employee
• Click the Upload Documents button and attach the documents in either a .pdf or .jpg format

As soon as the documents are uploaded, the claims adjuster assigned to the claim will receive an alert that there is medical documentation waiting for them. You will be able to view the documentation after it is uploaded. Please contact Patty at (248) 715-0013 or patricia.allen@mtmic.com/blog with questions.

We are excited to announce that we have enhanced our customer portal so that you will now have the ability to upload medical documents as a means to get them to the claims adjuster that is handling your claim. This can be done by following these simple steps:

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By Donna Motley, Vice President of Claims

Employees are often eligible for multiple benefits with their employer. Workers’ Compensation coverage is mandatory in the State of Michigan. Optional benefits may be Short Term Disability (STD), Long Term Disability (LTD), Sick Time, Personal Time Off (PTO), Family Medical Leave (FMLA).

Of these programs, FMLA is “unpaid” with time limited to 12 weeks away from work, but the employee’s job is “protected” – meaning a position is to be available to the employee at the end of 12 weeks at the same rate of pay and same benefits.

STD and LTD generally pay a percentage of the employee’s wages. Of the STD cases I have seen (and handled), the employee has been paid approximately 65% of their wages. STD is generally limited to a set number of weeks, and LTD may or may not have a time limit (but again, recipients are paid at a lesser rate of pay).

Sick Time and PTO may or may not pay for days missed and generally have a time limit of eligible days that can be taken.

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By Donna Motley, Vice President of Claims

The Michigan Workers’ Compensation Act & Administrative Rules originated in 1912. The Act was revised with Amendments in 1969. Then in 2011, at 100 years old, the Act was updated with Statute changes to accommodate the past amendments and hopefully, better address, with clarity, issues facing our ever changing world. One of the updated issues was to define “disability”. No longer is the injured worker considered disabled because they cannot return to the job that caused their injury. Disability as defined by the Workers’ Compensation Act is: “A limitation of an employee’s wage earning capacity in work suitable to his or her qualifications and training. . . . . . The establishment of disability does not create a presumption of wage loss.”

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By Cindy Boyce, Senior Claims Adjuster

I have worked for MTMIC for 26 years in growing capacities, and currently am the Senior Claims Adjuster. In this role I handle the majority of the litigation in the office, especially the complex ligation issues. I have had the pleasure of working with a great deal of you throughout the years, however since we have seen growth in the number of our insured’s some of you may not know me. If you don’t know me, that’s a good thing as most likely your company has not involved in a complex claim or related issue. I am licensed in the State of Michigan as an Insurance Claims Adjuster and have a degree in business and as a medical assistant, along with extensive training and experience in all aspects of workers’ compensation claims including, causal relationships of injuries, medical issues, medical treatments, and remedies related to typical and complex cases. In addition to being knowledgeable, you will also find me easy to work with and comfortable that you will always be in good hands!

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By Donna Motley, Vice President of Claims

As I was reading the newspaper recently and a heading caught my eye – “OFFICE FASHION – TATTOOS ARE IN – TIES ARE OUT”! WHAT? I was shocked. I know I’m going to “date” myself (first of all, I was “reading” an actual newspaper), but when I first started in the world of Claims for a large self-insured company, the claims were handled within the Law Department. As is somewhat customary, there was a senior attorney and a junior attorney. I worked for the junior attorney – and he had a “moustache”. You would have thought he committed a crime – attorneys at that time were frowned upon if they had any facial hair! (Again, I know I am dating myself.) Now, when at the Workers’ Compensation Agency, in addition to facial hair, I’ve even seen a pony tail or two!

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