The key for businesses and insurers seeking to clamp down onworkers' compensation expense is an intensive, comprehensive lookat cost drivers from the moment an injury occurs to the day theemployee goes back on the job.

This involves studying a wide variety of points, including anevaluation of personnel, procedures, data and files, as well asfield visits to see what your company or client does.

What it comes down to is this: If you don't understand what isdriving the costs, you won't be able to design an effective programto reduce those costs.

Most companies should shoot for a workers' comp injury cost thatis 50 percent lower than the national average cost per full-timeequivalent employee, better known as FTE.

The “2004 RIMS Benchmarking Survey” indicates the average costper FTE for all industries is $885. Measure the number of lostworkdays in the prior three years, and then establish a goal of 15percent reduction of the number of lost workdays over each of thenext three years.

Trimming costs also involves seeing whether post-injuryprocedures during the 24 hours immediately following an injury areairtight.

When an employee is injured, check whether they return to workas soon as medically able. Supervisors must know exactly what to dowhen an injury occurs. The employer must be in control.

When injured employees go for medical treatment, make sure theybring a Work Ability Form with them, where the medical provider canenter an assessment of what work they are able to perform.

When an employer does not have a complete system in place, theclaim can escalate quickly, with the employee staying out of worklonger than necessary.

Businesses should ensure that injury documentation andprocedures are both thorough and easy to read and use.

Conveying your company's concerns about injuries throughbrochures, wallet cards and thoughtful gestures ensures employeesget your program–that they are wanted back at work–rather than atelevised message from an attorney suggesting they engage inlitigation.

Communications with senior management, general managers,supervisors and employees should be based on the intended use andthe reading level of users.

Generally, documents should be at the sixth-grade reading levelso they can be read by all. Some companies may need to usepictograms to supplement text.

Once an employee is injured, returning them to work as soon asmedically possible should become a primary focus.

Make sure all injured employees are given the option ofreturning in a temporary transitional-duty position, perhaps lessstrenuous than the original job, while they recuperate.

Figure out how many employees are out of work right now and seeif the local general manager knows how many employees are out ofwork and on transitional duty.

The employer must have a transitional-duty policy, and allemployees must sign a written acknowledgement they understand thepolicy.

A company unit handling injuries should have a disabilityduration guide to quickly determine the average length of time aninjury should take to heal.

Ascertain whether job offers are made to every employee who canwork in some capacity. Studies have shown that employees healfaster when they return to work soon after their injury.

Management support is imperative. Find out how your companybuilds support to bring managers on board. Is there adollar-for-dollar monthly chargeback system in place, or is it avague system that fails to motivate supervisors and managers?

Make sure safety performance and improvement is seen as a keyperformance indicator for all levels of management.

Pinpoint what organizational resources are available. Knowwhether the company manages and monitors claims internally. Askwhat role each department plays in the post-injury andreturn-to-work process.

Determine if the people responsible for claims management areknowledgeable about innovative risk management and workers' compcost-containment techniques.

Look to see that procedural goals are set so that the insurancecompany's or third-party administrator's claim office handles yourclaims effectively and meets your return-to-work targets.

Find out what process is in place to hold medical, investigativeand legal vendors accountable to your overall cost-reductiongoals.

Make sure the goal of returning all injured employees to work assoon as they are medically able is spelled out in account-handlinginstructions.

See whether your TPA is held accountable to get workrestrictions in writing immediately after each medical visit.

Many companies misidentify the problem as being caused by theinsurance company or claims administrator. Hold a vendor day tofind out in detail what your claims administrator provides.

Ask for sample investigation reports and sample nursecase-management reports. Set an agenda and invite everyone who isinvolved in the workers' comp process.

Medical care must be coordinated so injured employees receiveprompt, quality care by a physician or clinic that supports yourcompany's goal of rapid healing and return to productivity.

There should be a medical advisor on your team to review medicalcare and effectiveness of medical vendors proactively within thefirst few weeks of disability–not after the claim has reached a$25,000 threshold.

Often, adjusters are unaware of their medical knowledge gaps, sothey occasionally accept claims that are related to a chroniccondition instead of a work incident.

Your company should strive for overall cost reduction, whichsometimes means paying more for a doctor who will spend more timewith your injured employees.

Find out if your company's workers' comp team knows the redflags of fraud. Do they report their suspicions to the adjusterimmediately? Does the workers' comp manager review surveillancereports, videotapes and photographs? There should be an antifraudprogram that includes a toll-free tip line.

Make sure there is check endorsement language on the back of allindemnity checks.

A consultant can evaluate your program by asking questions onthe phone or during on-site visits. A consultant should also reviewdocumentation and data to determine what procedures are in placeand how closely the procedures are followed.

For maximum effectiveness, physicians familiar with the workers'comp system should review a cross-section of files to determine howwell the medical aspects have been handled.