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Photo: “Tulalip Bay” by Diane L. Wilson-Simon. Managing Work Injuries. Working toward a common goal…. Managing Work Injuries . Instructor: Kerrie Murphy Edmonds Community College

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Managing work injuries
Managing Work Injuries

Working toward a common goal…

Managing work injuries1
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)

Photo tulalip bay by diane l wilson simon

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.

Accident injury prevention
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.

Types of prevention
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.


Evaluating a worksite:

What types of injuries could happen here?

But accidents happen
But, Accidents Happen

  • Immediate Response:


  • 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?

But accidents happen1
But, Accidents Happen

Depending on where an accident happens, there will be unique challenges in reacting to it.


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

But accidents happen2
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.

But accidents happen3
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.

Band aid practice
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…

But accidents happen4
But, Accidents Happen

3. The next priority is investigate.

  • To prevent additional injuries.

  • To preserve the scene until an investigation can be completed.

But accidents happen5
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.

But accidents happen6
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!


The next TOSHA Training Sessions will be announced in the next week.


OSHA 40-Hr Haz-Woper

Why all the paper work
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!)


Anecdotal or Subjective Evidence


Facts and Verifiable Evidence

Who is the law
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.

Who is the law1
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?

Why money
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.

Whose money
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.

History of worker s compensation
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.

History of worker s compensation1
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.

Worker s rights
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

Back to the money today
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.

Costs for the injured worker
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…

Costs for the employer
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

Costs for the physician
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

Other costs
Other Costs?

  • Family

  • Friends

  • Community

How do we deal with these costs
How Do We Deal With These Costs?


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.



The next TOSHA Training Sessions will be announced in the next week.


OSHA 40-Hr Haz-Woper

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.

The third party
The THIRD Party


  • 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.

Third party objectivity
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?

Working toward a common goal
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.

How do we limit the costs
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!

How do we make the process go smoothly
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.

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?

Section two

Employee Section:

  • Employee Name

  • Social Security Number (Why might this be important?)

Section two1

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 #?)

Section two2

Employee Section:

  • Sex

  • Occupation

  • (Why do they want to know this?)

Section two3

Employee Section:

11. Occupation (Job Title)

12 & 12A. Usual Work Times & Employment Status

(Why is this important?)

Section two4

Employee Section:

  • Gross Wages

  • 13.A Other Payments Not Reported as Wages

  • 14. Have you previously injured the “body part in question”?

Section two5

Employee Section:

  • Do you have more than one paying job?

  • 15A. Married?

  • 15B. Dependents?

Section two6

Employee Section:

Release Authorization

Section three

Incident Section:


The next TOSHA Training Sessions will be:

MAY 13thAccident Prevention

MAY 20thBasic Ergonomics

Making treatment go smoothly
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.

Making treatment go smoothly1
Making Treatment Go Smoothly

  • The Physician’s Perspective:


    • 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.

Making treatment go smoothly2
Making Treatment Go Smoothly

  • The Physician’s Perspective:


    • In order to determine potential causes of an injury but also for determining the modified duty status, the doctor needs a detailed description of the injured worker’s job. Including;

    • A. Different tasks from start to finish

    • B. Approximated time the employee does any of the following; STANDING, SITTING, LIFTING, BENDING, KNEELING, TYPING, ETC.

    • C. And any medical surveillance that has been done.

Making treatment go smoothly3
Making Treatment Go Smoothly

  • The Physician’s Perspective:


    • The doctor will want information on what measures are/were taken to protect the employee. Did they perform to their expectation? What will be available for the employee when they return to work? The doctor may suggest additional safeguards for the employee when they return.

Making treatment go smoothly4
Making Treatment Go Smoothly

  • The Physician’s Perspective:


    • It is important to know/remember that licensed medical practitioners are required to report certain things to the county health authority who then reports to state authorities who reports to federal authorities. There is no way to avoid it.

However, it is not a physician’s role to enforce the law and most are usually very clear that the needs and decisions of the patient are their first concern.

Physician s initial report
Physician’s Initial Report

  • Section One is usually Objective Findings

    A. Height, Weight, Temperature, etc.

    B. Description of injury such as:

    (Lac) Laceration on Right Index Finger, 1 cm length, 1 mm depth, etc.

  • Section Two is Subjective Findings

    A. How did the injury “appear” to the doctor.

    The difference is that the objective should be measurable while the subjective is based on the physician’s opinion.

Physician s report
Physician’s Report

  • The physician will determine, based on the examination and sometimes by running some tests on the patient, if, when and how the injured worker can return to work.

    This is supposed to be based on OBJECTIVE findings!

    So what does that mean?

Physician s report1
Physician’s Report

  • Back to Work with NO RESTRICTIONS.

  • Back to Work with RESTRICTIONS or in other words, MODIFIED DUTY.


    • Plan of Treatment.

    • Disability…

      So, Does that mean you are

      on VACATION?!

Modified duty
Modified Duty

  • Sitting

  • Standing

  • Bending

  • Lifting


    In a typical WORK day, how often and how much can you withstand without aggravating the injury?

Why is return to work important
Why is Return to Work Important?

  • Back to the Cost.

  • There is a psychological concern with any injury or illness.

    • The longer someone delays getting back to work the harder it is.

    • Sometimes we can actually make an injury worse by “babying” it too much.

    • Pain and Discomfort are actually part of the healing process.

Being aware
Being Aware

  • Anticipate that there will be a transition period.

  • The employee may experience post traumatic stress, depending on the situation.

    It is important for coworkers, supervisors, family, the physician and the injured employee not to underestimate the mental impact of a work related injury!


Part of any smooth process is making sure all parties communicate.

1. The employer should check in with the injured employee, especially if they are off work.

2. The employee needs to let both the doctor and the employer what is going on, if they are having trouble with treatment or adjusting to a return to work plan.


  • The doctor needs to make sure that the insurance carrier, the patient and the employer all know what is going on with test results, treatment options and any changes to the return to work plan.

  • IMPORTANT! Once a doctor has signed the initial paperwork, they are considered the treating physician. Any treatment or care that does not have the approval of the treating physician will not be covered!


NOTE: There is the option to request a second

opinion and/or to switch doctors.

Again, make sure that you communicate

to your employer, the insurance provider

and your previous doctor to make sure

that the process goes smoothly.

It is best to communicate with everyone

BEFORE you actually proceed with any

changes or your treatment may not be

approved and you will be responsible for

the cost.

Fall out

Be creative and willing to make changes.

NOTE: If we follow basic incident investigation procedures, BLAME is not the focus.

How, Why, What etc. can be achieved without focusing on the blame.

Try to turn the negative into positive.

You can’t change that the accident

happened but you can control the

result(s) of the situation.

Fall out1

It is not uncommon that there may be adjustments that occur following an incident, both for the individual who was injured but also for the work itself.


Use the situation as an

opportunity to make the

work safer for everyone.


The next TOSHA Training Sessions will be:

MAY 13thAccident Prevention

MAY 20thBasic Ergonomics

Photo tulalip bay by diane l wilson simon

The next TOSHA Training Sessions will be:

MAY 13thAccident Prevention

MAY 20thBasic Ergonomics