Photo: “Tulalip Bay” by Diane L. Wilson-Simon

1. Photo: “Tulalip Bay” by Diane L. Wilson-Simon

2. Managing Work Injuries Working toward a common goal…

3. Managing Work Injuries Instructor: Kerrie Murphy Edmonds Community College This course is being supported under grant number SH16637SH7 from the Occupational Safety and Health Administration, U.S. Department of Labor. It does not necessarily reflect the views or policies of the U.S. Department of Labor, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. With Thanks to & Cooperation of the Tulalip Occupational Safety & Health Administration (TOSHA)

4. OSHA There are two main parts to the Occupational Safety and Health Act, General Duty Clause, Section 5. 1. The EMPLOYER Responsibilities 2. The EMPLOYEE Responsibilities Everyone needs to cooperate and play their part in safety awareness, prevention and compliance. The overall goal is to achieve a consistently safe workplace and never experience ANY accidents.

5. Accident / Injury Prevention Avoiding an accident and/or injury is, actually, the first priority in managing your claims. Focusing on prevention can: • Avert an accident or injury from happening in the first place. • Lesson the severity of an incident if it does occur. • Don’t Ignore the “Little Things”! For more detailed training on accident prevention and investigation, come to the next training session. Look for the TOSHA training announcements.

6. Types of Prevention • Focus on Behavior • Training, training, training! • Evaluating policies, procedures & actions • Creating a Safety Culture • Focus on Protection • PPE – Personal Protective Equipment • Safe-Guards on facilities, machines, equipment, etc. These need to work together.

7. EXAMPLE Evaluating a worksite: What types of injuries could happen here?

8. But, Accidents Happen • Immediate Response: • DON’T PANIC • Quickly Assess the situation. • If needed, call 911 BEFORE you start first aid. • Do you know: • Where the first aid kit/equipment is? • Who knows First Aid/CPR? • Where fire extinguishers, spill kits, and other emergency equipment is located? • Where the MSDS is filed? • Who to call internally?

9. But, Accidents Happen Depending on where an accident happens, there will be unique challenges in reacting to it. Examples: 1. Indoors vs. Outdoors A. Environmental Factors B. Access to Phones, Running Water, Etc. 2. Public vs. Private areas A. Securing the Scene B. Getting Assistance

10. But, Accidents Happen 2. The top priority should always be attending to the needs of the injured worker(s). However, simultaneously you need to make sure the area is secure and that no further injuries will occur, also that the area is left untainted for the investigation.

11. But, Accidents Happen Pointers for dealing with the injured person: Communicate, offer Empathy & Keep them Engaged. • Let them know what is happening. • For example, let them know that you have called for help. • If you are administering any first aid, let them know what you are going to do before you do it. • Ask them questions about how they feel. • This will let you know early if they are staying coherent or not. • If you need to ask questions about the accident, avoid assigning guilt. • By preparing in advance, you can reassure them with accurate answers to questions and concerns.

12. Band-Aid Practice As obvious as this may seem, it is not second nature to most of us. It helps to have actually done it. So, pick a partner…

13. But, Accidents Happen 3. The next priority is investigate. • To prevent additional injuries. • To preserve the scene until an investigation can be completed.

14. But, Accidents Happen 4. Have an accident response checklists. • Assign different tasks to different individuals. A. One person should always be assigned to attend to the injured person. B. Another person can be assigned to secure the area. Everyone will want to come see what happened but that can create additional problems. If there is a hazard or danger, you don’t want another accident. Also, the injured person needs privacy. C. Others can be assigned to clean up, repair or to place warnings, whatever is needed to prevent further harm. D. The investigation should begin as soon as possible.

15. But, Accidents Happen 5. Prepare packets in advance: A.Information & Forms for the Accident Investigation & Report B. Information & Forms for Injured Worker C. Information & Forms for Physician The last thing you want to do when someone is injured is to be looking around for forms or information that is needed. Prepare in advance!

16. BREAK The next TOSHA Training Sessions will be announced in the next week. OSHA-10 OSHA 40-Hr Haz-Woper

17. Why All The Paper Work? To kill trees? The answers are: To keep us busy? To punish us? 1. MONEY – healthcare of any kind costs a lot. 2. THE LAW – documentation is vital to responding to inquiries. (fines also cost money!)

18. Documentation Anecdotal or Subjective Evidence Versus Facts and Verifiable Evidence

19. Who is the “Law”? • In the United States, it is FEDERAL law that employers provide a safe and healthy work place. • Each STATE has additional laws that can be even more stringent but can not be less than the federal laws. • In the state of Washington, most work related injuries are administered by the WA State Department of Labor & Industry (L&I). The exceptions are Federal employees and employees of Tribally owned and operated business.

20. Who is the “Law”? • Tribes are considered a “federal” entity, so the Occupational Safety and Health Administration (OSHA) is the regulating body for tribal businesses. • However, tribes are sovereign nations, so they really need a structure of their own, such as: TOSHA. Discussion: What are the Pros and Cons?

21. Why Money? It might seem insensitive at first to think about money when someone has been injured. The fact is, the whole reason we created worker’s compensation was so that everyone could be insured that the costs of a work related injury will be as minimal as possible. Trust me, even the injured person will start worrying about the immediate and long term costs very quickly.

22. Whose Money? • The Injured Person • The Business &/or Tribe • The Physician • The Insurance Carrier / TPA It helps to step back and look at all the different players/stake holders; how they are connected in this process and what each has to gain or loose.

23. History of Worker’s Compensation Prior to the industrial revolution, most people lived in SUBSISTENCE economies. • People farmed or gathered food, fished, hunted and supported themselves and their communities. As populations grew, land ownership changed, farming & fishing became about large quantity trade rather than about subsistence. Economies became more and more about MONEY. There was a pretty quick transition from making your own “stuff” to buying everything at a store.

24. History of Worker’s Compensation The industrial revolution had an additional affect – MACHINES. Not only cars, trucks and airplanes, but new technologies and equipment to mine, manufacture, mass produce, and distribute. There were very little laws of commerce to protect workers at that time. As the industrial revolution exploded in the early 1900s, several movements began, including labor organizing, to address the lack of rights of workers.

25. Worker’s Rights Dept. of Labor 1913 New Deal 1933 Social Security 1935 Equal Pay & Civil Rights 1963 OSHA 1971 Migrant Worker Act 1981 Am. w/ Disabilities Act 1990 Family Medical Leave Act 1993 http://www.dol.gov/oasam/programs/history/dpt.htm

26. Back to the Money & Today • Besides the obvious reason that it is just good ethics to provide a safe and healthy work place, OSHA laws protect the employee (and their families) from the expense that is associated with a serious injury, illness, disability or death that is work related. • It also provides the guidelines and instructions to employers so that they can better prevent accidents and injuries.

27. Costs for the Injured Worker • Medical Costs • Loss of Pay for Missing Work • Loss of the Ability to Work • Cost of Retraining for a Different Job • Disability • Change in the Ability to Earn the Same $ • Extended Medical Care Costs (Beyond the Immediate) • Pain & Suffering – the Mental Cost • People’s identity is often linked to their job…

28. Costs for the Employer • Loss of the Productivity of that Worker • Pay the worker who is out with an injury their salary plus the cost of a temporary person. • Or, the rest of the team has to take on more work. • Cost of Replacing that Worker • Cost of Damage to Equipment, Structures, etc. • Cost of a Litigation • Cost of OSHA Citation(s) • Loss of Reputation

29. Costs for the Physician • It costs the physician to provide care to the injured person. • Without worker’s compensation, the injured worker may not be able to afford the cost of the health care. Broken Bone: (Estimate) Office Visit $100-300 X-Ray $75-500 Setting $200 TOTAL: $375-1000

30. Other Costs? • Family • Friends • Community

31. How Do We Deal With These Costs? INSURANCE! It’s called Transferring the Risk. In many ways it is similar to car insurance. • You purchase it with the hope you never have to use it. • If you have to use it, you are “penalized”. • Your rates go up. • You have to pay a deductable. Etc.

32. BREAK The next TOSHA Training Sessions will be announced in the next week. OSHA-10 OSHA 40-Hr Haz-Woper

33. TRIBAL FIRST INSURANCE • Claims Administrators are referred to as Third Party Administrators (TPAs) • Tribal First is also an insurance provider but not all TPAs take on this role. • Even though the employer is technically the person insured, having a different party administer claims provides for someone to attempt to balance the needs of the employee and the employer.

34. The THIRD Party • EXERCISE: • 1. Gather in groups of 3 or 4. • You have 30 minutes to discuss the following questions. (Handout) • One person from each group will report back to the large group. • We will discuss everyone’s opinions as a group.

35. Third Party Objectivity • What are the challenges to the employer be objective or not? • What are the challenges to the third party administrator being objective or not? • Where does the regulating body, such as OSHA come into all this and do you think they are objective? • Do you feel the laws are objective? • 5. What challenges are unique to • tribal business? • 6. Should Objectivity be a goal?

36. Working Toward A Common Goal • Everyone wants to limit their individual cost and/or loss. • By acknowledging the other parties similar position, we can try to work together for a common goal.

37. How Do We Limit the Costs? • Make the process go as smooth as possible. • Limit any unnecessary costs. • The longer someone stays off work, the more cost is associated with each claim. • Return to Work Policy • Modified Duty Process We have to be able to TRUST each other!

38. How Do We Make The Process Go Smoothly? • It ALL Comes Back to the FORMS! • The number one reason that a claim is delayed and/or denied: • Missing or Incorrect • Information on the • Initial Report.

39. SECTION ONE Employer Section: • “Firm” Name • 1A. Policy Number • Mailing Address • 2A. Phone Number • Location Address (Why might this be important) • 3A. Location Code • 4. Nature of Business Should the injured employee be expected to fill this section out?

40. SECTION TWO Employee Section: • Employee Name • Social Security Number (Why might this be important?)

41. SECTION TWO Employee Section: • 7. Date of Birth • & 8A. Home Address & Phone • (What happens if you move, give the wrong address and/or don’t provide a phone #?)

42. SECTION TWO Employee Section: • Sex • Occupation • (Why do they want to know this?)

43. SECTION TWO Employee Section: 11. Occupation (Job Title) 12 & 12A. Usual Work Times & Employment Status (Why is this important?)

44. SECTION TWO Employee Section: • Gross Wages • 13.A Other Payments Not Reported as Wages • 14. Have you previously injured the “body part in question”?

45. SECTION TWO Employee Section: • Do you have more than one paying job? • 15A. Married? • 15B. Dependents?

46. SECTION TWO Employee Section: Release Authorization

47. SECTION THREE Incident Section:

48. BREAK The next TOSHA Training Sessions will be: MAY 13thAccident Prevention MAY 20thBasic Ergonomics

49. Making Treatment Go Smoothly • The Physician’s Perspective: • TIME • Can determine if a cut can be stitched or a finger reattached, etc. • May be critical to treatment of exposure or poisoning. • Will help in determining the relationship of the injury with the actual job duties.

50. Making Treatment Go Smoothly • The Physician’s Perspective: • EXPOSURE • MSDS – Material Safety Data Sheets • If there has been any type of exposure to a chemical, the proper procedure is to send a copy of the MSDS for each chemical with the patient. • Medical Surveillance • For many jobs, a basic physical including testing of baseline, periodic and termination levels of a variety of compounds is required and is helpful for the physician, if other than the one who completed the physical.