Give employees time back in an always-on working world

With time being the most precious benefit of all, a growing number of employers are offering benefits designed to save employees time. Continue reading to learn more.


When it comes to employee benefits, what do people really want?

As HR and benefits professionals, we shouldn’t make broad assumptions or generalizations about what benefits our employees need or want. Each employee in any given organization is an individual with different circumstances to be met at every stage in their lives — from those entering the workforce to those preparing to retire, and everyone in between. This is why employers must differentiate their benefits packages to meet the needs of a diverse and multigenerational workforce. And as consumers demand more choice in how they spend their benefits dollars, employers are getting more creative and curating a more expansive set of options for everyone.

No matter how efficient an employee is, work inevitably extends beyond the traditional workday from time to time. Similarly, as the lines between home and work blur with flexible work arrangements and email available 24/7 on smartphones, employees still need to take care of personal tasks, like scheduling family dentist appointments, setting up child care, disputing medical bills or calling the veterinarian … all during the workday.

Regardless of generation, industry, position or title, people are yearning to find the right balance between work and life demand. Time is the most precious benefit of them all. As a result, there are a growing number of employers offering benefits designed to save employees time.

Previously offered predominantly by large, tech companies in Silicon Valley, we’re seeing time-saving benefits spread to employers and industries of all kinds and encompass a variety of conveniences, from on-site dry cleaning pickup, to employer-funded shuttles to get employees to and from work, gym memberships, grocery delivery and services like dog walking and personal errands. This benefits category can also include more significant, personalized benefits like concierge health services, assistance in evaluating elderly care options, telehealth for humans and pets, and emergency childcare services.

Once seen as just perks, these services run deeper. Employers care about their people, and these time-saving benefits — anything people leave work early for, or deal with during the work day — has created a new benefits category that increases employees’ productivity and capacity for work by eliminating distractions and freeing up mental space. While these types of benefits may seem like “nice to have” instead of essentials, they can add up and make a substantial difference in employees’ lives.

Life is complicated. Things go wrong that impact productivity, contribute to presenteeism and the well-being of our workforce; these employee benefits offered through employers are returning valuable time back into someone’s day, helping them focus on work and better balance work and life expectations.

Employees need HR’s help. By not offering a wide variety of benefits personalized to the workforce, employers are missing out on an opportunity to provide great value to employees and make a tremendously positive change in their lives. But many HR professionals falsely assume employees will ask for voluntary benefits directly and proactively make suggestions about what would help them. You may say, “My employees aren’t coming to me asking for things like elder care services, so they don’t need them.” My response is, of course, they’re not asking: they may not want you to know about challenges they’re facing in their personal lives.

Employee’s personal situations are just that - deeply personal. They may be suffering in silence. Americans are now facing the highest housing, education and medical costs in our history, meaning nearly everyone is stressed out about family, work and finances; it’s causing problems in the workplace. If their minds are somewhere else and not focused on work, their productivity could be suffering.

Open Enrollment is rapidly approaching. Don’t wait for your employees to ask you for benefits. Take advantage of OE to ask your employees what they’re looking for, as this is the time they’ll already be assessing what types of benefits they need in the coming year anyway. Use this time to survey the workforce to see what people do or don’t like about their benefits. Be sure to specifically ask “What can we offer you?”

It’s a question, and a gesture, that may matter more to employees than you know.

SOURCE: Oldham, J. (14 September 2018) "Give employees time back in an always-on working world" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/give-employees-time-back-in-an-always-on-working-world?feed=00000152-18a4-d58e-ad5a-99fc032b0000


Interact Sensitively with Employees Addicted to Opioids

According to the National Institute of Drug Abuse, 21-29 percent of patients who are prescribed opioids for pain will end up misusing them. Read this blog post to learn more.


Employees who abuse opioids often are given a second chance by their employers. But well-meaning employers could wind up being sued for discriminating against those workers in violation of the Americans with Disabilities Act (ADA) if they don't handle the situation very carefully.

Opioid addiction has been rampant in the U.S. for some time. More than three out of five drug overdose deaths last year involved an opioid, and overdoses rose 70 percent in the 12 months ending September 2017, according to the Centers for Disease Control and Prevention.

So what can HR professionals do about it? If a worker admits to the problem, the path is fairly clear. But if the employer merely suspects that an employee is addicted to prescription pain relievers but has no real proof, the employee should be treated like any other employee who is having attendance or performance issues, said Kathryn Russo, an attorney with Jackson Lewis in Melville, N.Y.

An employer should never accuse someone of having an addiction, because if the employer is wrong, the accusation could lead to an ADA claim, Russo cautioned. Although current drug use isn't considered an ADA disability, a history of drug addiction is. Moreover, someone using prescription drugs might have an underlying condition covered by the ADA.

Statistics on opioid use

If an employee admits to opioid abuse, or the problem is discovered through drug testing, the employer should discuss it with the employee to determine if he or she needs a reasonable accommodation, such as leave to obtain treatment, Russo said. The illegal use of drugs need not be tolerated at work, she added.

Reasonably accommodate the employee so long as there's no direct threat to the health and safety of himself or herself, or others, recommended Nancy Delogu, an attorney with Littler in Washington, D.C.

Drug Testing

The Equal Employment Opportunity Commission has opined that employers may ask about an employee's use of prescribed medicine or conduct a drug test to determine such use only if the employer has reasonable suspicion that its use will interfere with the employee's ability to perform the job's essential functions or will pose a direct threat.

Many employers are expanding their drug-testing panels to include semisynthetic opioids such as hydrocodone, hydromorphone, oxycodone and oxymorphone, in addition to traditional opioids such as heroin, codeine and morphine, Russo said. This is lawful in most states as long as the employer does not take adverse employment actions when drugs are used legally, she noted, which is why an employer should use a medical review officer in the drug-testing process. If the medical review officer concludes that the positive test result is the result of lawful drug use, the result is reported to the employer as negative.

Sometimes an employer will say it has reasonable suspicion that the employee came to work impaired by drug use and is considering a mandatory drug test. At that point, some employees will say the drug test would be positive and the test consequently is not necessary.

Discussions with Employees

If there are performance problems and the employee has admitted to opioid addiction, some employers tell employees that they can remain employed so long as they go through inpatient treatment. Delogu discourages that approach. Employers aren't workers' doctors, so they shouldn't be deciding whether someone needs a treatment program, she explained.

But if someone voluntarily seeks to enter an addiction-recovery program, that person may have legal protections under state law, said Wendy Lane, an attorney with Greenberg Glusker in Los Angeles. For example, California has a law requiring employers with 25 or more employees to reasonably accommodate alcohol and drug rehabilitation.

Delogu recommended that employers that believe there is a problem with substance abuse ask if the addicted employee needs assistance from the employee assistance program.

An employer can require that an employee who has violated a policy be evaluated by a substance abuse professional and complete treatment prescribed for them, without dictating what that treatment will be, she said. The employer may choose to forgo disciplinary action if an employee agrees to these terms and signs an agreement to this effect. The employer then would not have to be informed about the person's decided course of treatment, whether inpatient, outpatient or no treatment at all, she said. The employee typically will be subjected to follow-up drug testing to make sure he or she hasn't resumed the use of illegal drugs.

Many employers are willing to give employees with performance problems resulting from opioid addiction a second chance, she noted.

SOURCE: Smith, A. (1 November 2018) "Interact Sensitively with Employees Addicted to Opioids" (Web Blog Post). Retrieved from https://www.shrm.org/ResourcesAndTools/legal-and-compliance/employment-law/Pages/employees-addicted-to-opioids.aspx


Predictive Analytics Will Be The Silent Game-Changer In Employee Benefits

Have you heard of predictive analytics? Predictive analytics analyzes current and historical data to make predictions about unknown events. Read on to learn how this technology could be used to help fine-tune employee benefits offerings.


Last year’s World Series between the Houston Astros and the Los Angeles Dodgers came down to a seven-game battle based not only on talent, athleticism and coaching but also on data. Just as Sports Illustrated suggested back in 2014 via predictive data, the Astros were the victors.

The publication of Moneyball: The Art of Winning an Unfair Game spurred not only Major League Baseball teams to deploy predictive analytics, but also businesses to take a harder look at what their data means. It's no longer part of the hype cycle: Statista forecasts (paywall) that the predictive analytics market worldwide will reach $6.2 billion in 2018 and $10.95 billion in 2022.

I believe we are also at a transformational point in improving corporate employee benefits and our employees’ lives by embracing predictive analytics. HR is swimming in rich data. Instead of guesstimating needs across multiple generations of employees, employers can turn to their own data to fine-tune what they are offering as benefits solutions. Companies spend 25-40% of an employee’s salary on benefits. It simply makes strategic and financial sense to get it right.

Bring Employee Benefits Out Of The Dark Ages

Hiring and retaining great talent is at the very soul of almost every company’s strategy. Not surprisingly, more companies have turned to predictive analytics to give them a leg up in recruitment. However, HR benefits have lagged behind. As John Greenwood reported to Corporate Adviser, “More than half of reward and employee benefits professionals see predictive analytics as a game-changer, but 90 percent are still using spreadsheets to manage data, research from the Reward & Employee Benefits Association shows.”

One reason for benefits lagging behind recruitment in adopting predictive analytics is that the way companies choose new benefits varies greatly from business to business. Given that the majority of HR departments keep data in disparate spreadsheets, even if some HR departments conduct employee surveys or historical cost analyses, they often do not integrate the data about their workforce. If a new benefit offering is chosen based on a needs analysis, only some know the “why” behind a request from the workforce. Knowing how many employees are logging into a benefits platform is helpful; market standard benefit utilization reports provide this level of information. Yet they do not give insight into the underlying reason for an employee to utilize a benefit. The user of deeper analytics is required to look deeper into employees' behavior.

We have found firsthand that many HR departments do not have a full understanding of how their employees are utilizing their benefits across the entire offering suite. A one-size-fits-all or a one-off strategy no longer is effective. Companies must understand not only their employees’ needs but also the underlying data related to these needs to provide a valuable benefits offering.

Put Your Existing Data To Use

For the past five years, I have watched our clients glean valuable insights into what the real underlying issues are for their employees and what must be done to address these pressing needs. I also have been watching companies realize that what they thought were the core problems at hand sometimes were not.

For example, one of our national high-tech clients, with over 50,000 benefit-eligible employees, believed that a high number of their employees had children struggling with autism. This belief was initially based on input from some of their employees. After approximately 16 months, the client reviewed the masked utilization data from their benefit platform. The data illustrated that the overwhelming majority of employee families (tenfold) in fact faced challenges associated with youth anxiety, a concern that had never been expressed to HR previously. Once they reviewed what employees were doing within our platform, their results mirrored the National Institute of Mental Health’s report that approximately 31.9% of U.S. children ages 13-18 struggle with anxiety disorders.

Their own data helped them understand much more specifically where their employees’ stress lay, and their HR department was able to focus communications around it.

Getting Started

Mining and viewing use data across all benefits is ideal. This enables an employer to determine if the benefit suite is serving employees effectively. We have found that as quickly as year over year, users' behaviors shift. If a company solely chooses a benefit based on what they saw as most heavily utilized the previous year, they are not being strategic.

For that reason, HR should utilize past and current data to better predict future patterns of need for a truly strategic approach to benefit choice. With this insight, they can make better choices and serve their workforce more effectively.

Given the limitations across many employee benefit vendors today, to start initially:

1. Embrace KPIs. Agree upon them internally, and measure benefit vendors on them.

2. Work with your current vendors to determine what data they provide to support your internal analysis. Ensure you have access to all the data you need, and if not, consider a vendor change.

3. Hold possible new vendors to similar data standards, and create a transparent relationship from the start.

4. Collect current and historical data. Existing vendors can provide this history, so make sure to collect at least 2-3 years of information.

These analytics need to go deeper than basic demographics to show patterns of activity. In order to understand the benefit needs of your workforce, you'll want to analyze trends across multiple data sets: medical, pharmacy, worker's compensation, biometric screenings, utilization patterns, FMLA requests and demographic trends. From there, you can start to pinpoint what your employees need -- and the “whys” behind the needs -- in order to make a measurable impact.

While predictive analytics is still in the nascent phase in the benefits and vendor worlds, the easiest and most proactive thing any employer can do is to focus on other insights vendors can provide related to the workforce and benefit use beyond simple utilization. In doing so, you will be able to support your employees both in their work lives and their personal lives by providing them with the benefits they need to be at their best.

SOURCE: Goldberg, A. (2 October 2018) "Predictive Analytics Will Be The Silent Game-Changer In Employee Benefits" (Web Blog Post). Retrieved from: https://www.forbes.com/sites/forbestechcouncil/2018/10/02/predictive-analytics-will-be-the-silent-game-changer-in-employee-benefits/#26648166e182


How to create a strong communication plan for open enrollment

Do you have a communication plan for open enrollment? Once businesses have their plan changes locked in, it’s time to focus on communicating those changes to their employees. Continue reading to learn how to create a strong communication plan for open enrollment.


Ready or not… the Benefits Super Bowl is here! Whether you are a broker, benefits manager or anywhere in between, you have been knee-deep on plan updates, rate reviews and benefit changes for months. Now that the plan changes are locked, it’s go-time! The focus is now on communicating and educating employees about their benefit options.

It takes an enormous amount of planning and execution to provide a productive open enrollment experience for employees. But, it is well worth it as this is often the only time during the year that employees stop to consider their benefit options.

Learn from past wins and misses

Consider previous years’ open enrollment communications and ask yourself the following:

  • What is the feedback you received from employees (the good, the bad and the ugly)?
  • What were the most common questions?
  • Were there key pieces of information employees had difficulty finding?

Learn from the answers to these questions and then craft your content in a clear and concise manner that is easier for employees to digest.

The communication medium is key to your success

Now that you’ve developed the content to communicate, the next equally important step is determining how, when and where you deliver this information. Is there a centralized location where employees can find information for both core and voluntary benefits? Is the information in a format that the employee can easily share with his or her significant other?

It is critical to have multi-channel communications to reach your audience. Some employees may naturally gravitate to a company-wide email and the company intranet, while others lean on more interactive mediums like E-books, text messages, webinars or lunch and learns. Providing a variety of communication avenues ensures you are reaching employees where they want to receive information.

Make sure your communications campaign provides educational materials at each of the key milestones during the open enrollment journey–such as prior to enrollment, midway through enrollment, and right before enrollment closes. Wherever possible, always support employees through the process and give them options to reach out for help.

How to communicate the same benefits to a diverse workforce

You are likely communicating to a group of employees with diverse needs and wants. What may be appealing to an entry-level recent grad may not resonate with a senior-level employee nearing retirement. For example, employees with young children may be especially interested in accident insurance or pet owners might look to pet insurance to help offset the costs of well-visits and routine care. If possible, tailor your communications to different segments of the employee population.

Communicating voluntary health-related benefits

Core medical benefits are what employees gravitate to during the enrollment period. Are you offering voluntary benefits to employees? The most successful voluntary benefit programs are positioned next to core medical plans on the enrollment platform. This shows employees how those voluntary benefits (critical illness, accident insurance and hospital indemnity) complement the core offerings with extended protection.

When voluntary benefit programs are positioned as an integral part of the employee benefits experience, employees are more likely to understand the value and appreciate the support provided by their employer. For example, a critical illness program can help to bridge the gap of a high-deductible health plan in the case of a covered critical condition. Communicate that voluntary benefits can be an integral part of a “Total Rewards Package” and can contribute to overall financial wellness.

Review and refine

Finally, don’t miss your opportunity at the end of enrollment to review how your communication campaign performed. Pull stats and analyze your communication campaign for next year’s open enrollment… it is never too early to start! HR managers can glean valuable information and metrics from the employee experience.

SOURCE: Marcia, P. (1 November 2018) "How to create a strong communication plan for open enrollment" (Web Blog Post). Retrieved from https://www.benefitspro.com/2018/11/01/how-to-create-a-strong-communication-plan-for-open/


Creating Better Employee Benefits With Advanced Analytics

Are your employees happy at work? It is important to provide a workplace, employee benefits and payment system that keep your employees happy. Read on to learn more.


Job satisfaction is the most important part of maintaining a happy workforce. If you have a workforce that feels like they could get a better deal elsewhere then they are likely to leave.

It is therefore important to provide a working environment, benefits and payment system, that keeps your employees happy without breaking the bank.

Analytics are being used to make sure that this is being done effectively, seeing where discontent is occurring and helping to suggest how this can be solved.

For instance, there are research companies that can use text analysis tools to analyze hundreds, if not thousands of survey entries that can give a holistic view of employee benefits. Often when survey results are being analyzed by an individual, it is difficult to gauge the overall feeling and there can be bias put on the results.

It also allows for HR to note the frequency of meetings with individuals as well as the frequency and size of any pay rises. If it is flagged that somebody hasn’t had a meeting with HR where they can directly communicate any concerns for a considerable amount of time, then tho scan be rectified.

Analytics can also be used to investigate which teams are happiest, have the highest retention rates or are the most profitable. This then allows companies to investigate in detail what is making these teams happiest or most productive, then create benefit packages to create similar results for other teams in the company.

Analytics and data have allowed companies to collect data to make their workforces happier and more content. This, in turn, creates situations where employees are eager to work and appreciative of the benefits they receive, improving ROI and increasing productivity.

SOURCE: Pannaman, E. (12 October 2018) "Creating Better Employee Benefits With Advanced Analytics" (Web Blog Post). Retrieved from https://channels.theinnovationenterprise.com/articles/202-creating-better-employee-benefits-with-advanced-analytics


When Companies Should Invest in Training Their Employees — and When They Shouldn’t

A recent industry report revealed that U.S. companies spent over $90 billion on employee training and development activities in 2017. Read this blog post to learn more.


According to one industry report, U.S. companies spent over $90 billion dollars on training and development activities in 2017, a year-over-year increase of 32.5 %. While many experts emphasize the importance and benefits of employee development — a more competitive workforce, increased employee retention, and higher employee engagement — critics point to a painful lack of results from these investments. Ultimately, there is truth in both perspectives. Training is useful at times but often fails, especially when it is used to address problems that it can’t actually solve.

Many well-intended leaders view training as a panacea to obvious learning opportunities or behavioral problems. For example, several months ago, a global financial services company asked me to design a workshop to help their employees be less bureaucratic and more entrepreneurial. Their goal was to train people to stop waiting around for their bosses’ approval, and instead, feel empowered to make decisions on their own. They hoped, as an outcome, decisions would be made faster. Though the company seemed eager to invest, a training program was not the right way to introduce the new behavior they wanted their employees to learn.

Training can be a powerful medium when there is proof that the root cause of the learning need is an undeveloped skill or a knowledge deficit. For those situations, a well-designed program with customized content, relevant case material, skill-building practice, and a final measurement of skill acquisition works great. But, in the case of this organization, a lack of skills had very little to do with their problem. After asking leaders in the organization why they felt the need for training, we discovered the root causes of their problem had more to do with:

  • Ineffective decision-making processes that failed to clarify which leaders and groups owned which decisions
  • Narrowly distributed authority, concentrated at the top of the organization
  • No measurable expectations that employees make decisions
  • No technologies to quickly move information to those who needed it to make decisions

Given these systemic issues, it’s unlikely a training program would have had a productive, or sustainable outcome. Worse, it could have backfired, making management look out of touch.

Learning is a consequence of thinking, not teaching. It happens when people reflect on and choose a new behavior. But if the work environment doesn’t support that behavior, a well-trained employee won’t make a difference. Here are three conditions needed to ensure a training solution sticks.

1. Internal systems support the newly desired behavior. Spotting unwanted behavior is certainly a clue that something needs to change. But the origins of that unwanted behavior may not be a lack of skill. Individual behaviors in an organization are influenced by many factors, like: how clearly managers establish, communicate, and stick to priorities, what the culture values and reinforces, how performance is measured and rewarded, or how many levels of hierarchy there are. These all play a role in shaping employee behaviors. In the case above, people weren’t behaving in a disempowered way because they didn’t know better. The company’s decision-making processes forbid them from behaving any other way. Multiple levels of approval were required for even tactical decisions. Access to basic information was limited to high-ranking managers. The culture reinforced asking permission for everything. Unless those issues were addressed, a workshop would prove useless.

2. There is commitment to change. Any thorough organizational assessment will not only define the skills employees need to develop, it will also reveal the conditions required to reinforce and sustain those skills once a training solution is implemented. Just because an organization recognizes the factors driving unwanted behavior, doesn’t mean they’re open to changing them. When I raised the obvious concerns with the organization above, I got the classic response, “Yes, yes, of course we know those issues aren’t helping, but we think if we can get the workshop going, we’ll build momentum and then get to those later.” This is usually code for, “It’s never going to happen.” If an organization isn’t willing to address the causes of a problem, a training will not yield its intended benefit.

3. The training solution directly serves strategic priorities. When an organization deploys a new strategy — like launching a new market or product — training can play a critical role in equipping people with the skills and knowledge they need to help that strategy succeed. But when a training initiative has no discernible purpose or end goal, the risk of failure is raised. For example, one of my clients rolled out a company-wide mindfulness workshop. When I asked a few employees what they thought, they said, “It was interesting. At least it got me two hours away from my cubicle.” When I asked the sponsoring executive to explain her thought process behind the training, she said, “Our employee engagement data indicated our people are feeling stressed and overworked, so I thought it would be a nice perk to help them focus and reduce tension.” But when I asked her what was causing the stress, her answer was less definitive: “I don’t really know, but most of the negative data came from Millennials and they complain about being overworked. Plus, they like this kind of stuff.” She believed her training solution had strategic relevance because it linked to a vital employee metric. But evaluations indicated that, though employees found the training “interesting,” it didn’t actually reduce their stress. There are a myriad of reasons why the workload could have been causing employees stress. Therefore, this manager’s energy would have been better directed at trying to determine those reasons in her specific department and addressing them accordingly — despite her good intentions.

If you are going to invest millions of dollars into company training, be confident it is addressing a strategic learning need. Further, be sure your organization can and will sustain new skills and knowledge by addressing the broader factors that may threaten their success. If you aren’t confident in these conditions, don’t spend the money.

SOURCE: Carucci, R. (29 October 2018). "When Companies Should Invest in Training Their Employees – and When They Shouldn’t" (Web Blog Post). Retrieved from https://hbr.org/2018/10/when-companies-should-invest-in-training-their-employees-and-when-they-shouldnt


8 scary benefits behaviors employees should avoid

Are your employees mishandling their employee benefits? When employees fail to review open enrollment materials, they could be making decisions based on little to no knowledge. Read this blog post to for eight of the scariest benefit mistakes.


Halloween is already frightening enough, but what really scares benefits professionals are the ways employees can mishandle their benefits. Here are eight of the biggest mistakes, with tips on correcting them.

Participants don’t review any annual enrollment materials

Why it’s scary: Employees are making or not making decisions based on little or no knowledge.

Potential actions: Employers can implement a strategic communications campaign to educate and engage employees in the media and format appropriate for that employee class, or consider engaging an enrollment counselor to work with participants in a more personalized manner.

Employees don’t enroll in the 401(k) or don’t know what investment options to choose

Why it’s scary: U.S. employees are responsible for much of their own retirement planning and often leave money on the table if there is an employer match.

Potential actions: Employers can offer auto-enrollment up to the matching amount/percent; consider partnering with a financial wellness partner, and provide regular and ongoing communications of the 401(k)’s benefits to all employees.

Employees don’t engage in the wellness program

Why it’s scary: The employee is potentially missing out on the financial and personal benefits of participating in a well-being program.

Potential actions: Employers need to continuously communicate the wellness program throughout the year through various media, including home media. Employers also should ensure the program is meeting the needs of the employees and their families.

Employees don’t update ineligible dependents on the plan

Why it’s scary: Due to ambiguity where the liability would reside, either the employee or the plan could have unexpected liability.

Potential action: Employers can require ongoing documentation of dependents and periodically conduct a dependent audit.

Employees don’t review their beneficiary information regularly

Why it’s scary: Life insurance policy proceeds may not be awarded according to the employee’s wishes.

Potential action: Employers can require beneficiary confirmation or updates during open enrollment.

Employees do not evaluate the options for disability — whether to elect a higher benefit or have the benefit paid post-tax

Why it’s scary: Disability, especially a short-term episode, is very common during one’s working life; maximizing the benefit costs very little in terms of pay deductions, but can reap significant value when someone is unable to work.

Potential action: Employers can provide webinars/educational sessions on non-medical benefits to address those needs.

Employees do not take the opportunity to contribute to the health savings account

Why it’s scary: The HSA offers triple tax benefits for long-term financial security, while providing a safety net for near-term medical expenses.

Potential actions: Employers can select the most administratively simple process to enroll participants in the HSA and allow for longer enrollment periods for this coverage.

Employees do not use all of their vacation time

Why it’s scary: Vacation allows an employee an opportunity to recharge for the job.

Potential actions: Employers can encourage employees to use their vacation and suggest when the workload might be more accommodating to time off for those employees who worry about workloads.

SOURCE: Gill, S. & Manning-Hughes, R. (31 October 2018) "8 Scary Benefits Behaviors Employees Should Avoid" (Web Blog Post). Retrieved from https://www.benefitnews.com/slideshow/8-scary-benefits-behaviors-employees-have?brief=00000152-14a5-d1cc-a5fa-7cff48fe0001


When is a Workers’ Compensation Claim Compensable?

Carefully evaluating workers’ compensation claims is crucial in helping your company save money and prevent fraud. Workers’ compensation is simply a form of insurance that offers employees medical coverage in the event they are injured during a work-related function. Depending on the state of residence, it may also give compensation for disabilities sustained or cover rehabilitation costs so the employee can return to the workplace quickly and smoothly.

Compensable workers’ compensation claims have specific characteristics that will help you determine if and when an injury is covered.

Workers’ compensation is crucial to protecting employees, but it is often a source of contention among employers because it comes with considerable gray areas. When is a claim compensable? How do we identify a fraudulent claim? How do we report a claim, and should we report all workplace injuries no matter how serious? This piece is designed to help you determine when—and if—an injury is covered by workers’ compensation.

Requirements

The claim must meet all five of these requirements in order to be compensable:

Happened to One of Your Employees

The first requirement is in place to ensure it is your employee filing the claim, not an independent contractor or vendor who works for themselves or a third party. Even if the incident occurs on your property, unless it is someone who works directly for you, the claim is not compensable.

Resulted in an Injury or Illness

Injury is not the only thing that can potentially be covered by workers’ compensation. Illnesses could also qualify as a compensable claim, but only if they are related directly to the job. The illness also must be caused directly by the working conditions to be covered in a workers’ compensation policy. For example, a miner’s contraction of black lung would be compensable in all states. However, an employee in an office with a co-worker who smokes would not be eligible for workers’ compensation for treatment of illness due to secondhand smoke.

Arose Out of Employment

This requirement means there must be a direct connection between the injury and the desire or attempt to further the employer’s business. If the employer benefits in some way, whether monetarily or otherwise, from the employee’s activity, then the claim meets this qualification.

Occurred in the Course and Scope of Employment

The employee must be at work when the injury occurs. This includes any place or location mandated or expected by the employer. So when an injury occurs at the employee’s physical everyday work site, that employee must prove he or she was injured while actively engaging in the furtherance of the employer’s business. There is a special provision called the “coming and going rule,” which maintains that benefits are denied for injuries received when traveling to or from work. Additionally, injuries arising out of transit from one work site to another, for instance when traveling to visit clients, are compensable. This provision also requires that the actions leading to the injury of the employee in question be prompted by the aspiration to further the employer’s business interests.

Resulted in Impairment and/or Lost Wages

The injury or illness in question must cause the employee to be impaired in some way and lose wages from not being able to complete his or her tasks completely. It is also a compensable incident if the injury or illness results in impairment but without lost wages, or vice versa.

Identifying a Fraudulent Claim

Studies commonly show that roughly 90 percent of all workers’ compensation claims filed are legitimate. However, it is still important as an employer to watch for these red flags that may indicate a fraudulent claim:

  • Filing multiple claims
  • Longer absences than anticipated by the employee, combined with an unwillingness to return to work
  • Unwillingness to be assigned to other, lighter jobs within the company or to complete partial duties
  • Constantly missing medical appointments
  • Employee will not provide date, time or location of the incident that caused injury
  • Employee has no recollection of services provided for related medical bills
  • Lack of witnesses to an accident or incident
  • Employee cannot produce specific information about the nature of the injury
  • Employee has a history of short-term employment

If any of these red flags occur, it by no means makes the claim automatically fraudulent. These are simply guidelines to keep employers proactively evaluating the legitimacy of a workers’ compensation claim.

Newsletter Provided by: Hierl's Property & Casualty Experts

Download the Newsletter


Tri-Agency Proposed Rule on Health Reimbursement Arrangements

The DOL, Department of Treasury and Department of Health and Human Services recently proposed a rule with the intention of expanding the flexibility and use of HRAs. Continue reading to learn more.


The Department of the Treasury (Treasury), Department of Labor (DOL), and Department of Health and Human Services (HHS) (collectively, the Departments) released their proposed rule regarding health reimbursement arrangements (HRAs) and other account-based group health plans. The DOL also issued a news release and fact sheet on the proposed rule.

The proposed rule’s goal is to expand the flexibility and use of HRAs to provide individuals with additional options to obtain quality, affordable healthcare. According to the Departments, these changes will facilitate a more efficient healthcare system by increasing employees’ consumer choice and promoting healthcare market competition by adding employer options.

To do so, the proposed rules would expand the use of HRAs by:

  • Removing the current prohibition against integrating an HRA with individual health insurance coverage (individual coverage)
  • Expanding the definition of limited excepted benefits to recognize certain HRAs as limited excepted benefits if certain conditions are met (excepted benefit HRA)
  • Providing premium tax credit (PTC) eligibility rules for people who are offered an HRA integrated with individual coverage
  • Assuring HRA and Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) plan sponsors that reimbursement of individual coverage by the HRA or QSEHRA does not become part of an ERISA plan when certain conditions are met
  • Changing individual market special enrollment periods for individuals who gain access to HRAs integrated with individual coverage or who are provided QSEHRAs

Public comments are due by December 28, 2018. If the proposed rule is finalized, it will be effective for plan years beginning on or after January 1, 2020.

For more information on ways this proposed rule will affect HRAs, request the full Compliance Advisor from your local UBA Partner Firm.

SOURCE: Hsu, K. (1 November 2018) "Tri-Agency Proposed Rule on Health Reimbursement Arrangements" (Web Blog Post). Retrieved from https://blog.ubabenefits.com/tri-agency-proposed-rule-on-health-reimbursement-arrangements