Category Archives: Company

What is Saliva-Based Drug Testing and Why is It Beneficial for Employers?

A saliva-based drug test is an alternative method to test for the use of illegal and controlled substances in the workplace.  A saliva-based test can be used for all aspects of a company’s drug testing program, including pre-employment, random, for-cause, and post-accident drug testing.  These products have more flexibility: they are less invasive, allow for onsite administration, and can detect up to 12 different substances at a cost that is significantly less ($11) than traditional drug testing performed at a doctor’s office ($60).

In workers’ compensation, saliva-based testing methods are particularly beneficial in post-accident scenarios.  After an injury, employers can quickly obtain the injured worker’s saliva to determine if the presence of illegal or unauthorized controlled substances may have contributed to the accident (which may affect the compensability of the employee’s workers’ compensation claim).

Another key benefit to saliva-based testing kits relates to their detection time.  Drugs can generally be detected in saliva for up to 24 hours.  Thus, they have the ability to demonstrate an employee’s impairment at the time of the accident (i.e. the employee’s drug usage was a proximate cause of the accident/injury).  A traditional urine-based drug screen performed at a doctor’s office can detect drug metabolites for several weeks in some cases; thus, a positive result cannot “prove” that an employee was under the influence at the time of the accident.  This is important in regards to the relevant workers’ compensation statutes regarding positive drug tests and claim compensability.  Additionally, the narrower detection window can assist your organization in complying with the anti-retaliation provision (effective 11/1/16) in OSHA’s Final Rule on Recordkeeping – Improve Tracking of Workplace Injuries and Illnesses.  This provision states that a post-accident drug test must be designed to elicit actual impairment at the time of the employee’s accident, for the same reasons described above.

It is important to note that the laws regulating the use of saliva-based drug testing kits for post-accident purposes may vary by state.  As an example, North Carolina only allows for the collection of an employee’s saliva; the analysis of each saliva sample must be performed by a certified laboratory.  Other states allow the use of a “quick-test” kit, which will detect the presence of drugs immediately upon collection of the saliva sample.

Interested in incorporating saliva-based drug tests in your organization? Contact your Synergy Loss Prevention Consultant or email us at info@synergyinsurance.net for more information.  Be sure to also ask about combining this novel drug testing approach with our Telemedicine option (Phone a Physician) for initial medical treatment.  Combining these two programs can save you over $130 on each injury, without having to leave your facility.  Now that’s Synergy!

Doctor Says Injury may be Work-Related, but Is It Really?

It is sometimes difficult to delineate the real cause of common injuries to the knee, back, or shoulders; it is important that we investigate deeply because they can easily turn into expensive workers’ compensation claims.

Quite often, doctors’ medical reports state that the injury might or could be work related but fail to consider the numerous other factors that contributed or may have been the cause of an injury; additional factors include everyday wear and tear, repetitive motion, and prior injuries. When a doctor so much as mentions the injury may be work-related, it is an uphill battle to argue otherwise.

However, in a recent ruling by the North Carolina Industrial Commission regarding a Synergy Coverage Solutions case, the Deputy Commissioner ruled in favor of the employer and denied the claimant’s request for benefits due to insufficient competent evidence of injury. In this situation, the claimant described a compensable trip and fall accident.  Evidence of the fall was confirmed and treatment to the left knee was provided and completed.  The employee later complained of right knee pain which required surgery; this condition was denied and went to a hearing.  Synergy Coverage Solutions was successful in proving that the claimant had changed her story multiple times regarding the mechanism of the fall and the timeline for the pain following the incident.  Additionally, the employee indicated that she had not treated for her knee previously, and Synergy Coverage Solutions was able to prove that this in fact was not true.  Finally, one of the physicians who initially related the injury to the fall, later testified upon questioning that the condition was ‘most likely a gradual process.’  Based on the inconsistencies in the claimant’s story and the testimony of the physicians, the deputy commissioner opined in Synergy and the employer’s favor.

For the employer, this is a significant ruling, as it shows the NC Industrial Commission taking notice of inconsistencies in the claimant’s account of their health and the incident.  Additionally, the Commission is paying attention to the actual injury and the likelihood of it being a result of a compensable incident.  Synergy knows that paying attention to all of these details can significantly reduce the cost of the claim, especially when the Industrial Commission takes a close look at the details presented.

Large Deductible Case Study

A school system, originally on a Guaranteed Cost policy, moved to a Large Deductible policy to obtain additional premium savings. In the first year of their Large Deductible policy, claim costs decreased by 62% and claim count decreased by 39%. This organization’s success can be attributed to strong management commitment to safety, implementation of crucial safety programs including Post-offer Medical Questionnaires, and a strongly enforced Early Return to Work program.

With a Large Deductible policy, our team at Synergy works in close conjunction with the employer to keep all parties informed and up-to-date on claims. This includes areas such as:

  • Regular claim reviews
  • Consultations on establishing reserves
  • Settlement of claims
  • Assignment of 3rd party vendors

Large deductible


Why choose our Large Deductible program?

  1. Cost Savings. Workers compensation premium is significantly discounted and employees remain fully insured.
  2. Flexible Products. Choose the premium and deductible level that best fits your organization. Deductibles range from $10K to $1M, with A rated carrier options available
  3. Quality Service. Aggressive claims management, combined with constant collaboration and communication with the employer, ensures satisfaction among all parties involved.

What is the Cost of a Bad Hiring Decision?

The cost of a workers’ compensation claim goes beyond medical and claim costs.  If a workplace injury occurs, your organization’s Experience Modification Rate (EMR) is negatively impacted, affecting your workers’ compensation premium for the next three years.

Cost of a claim graph

One way to control workers’ compensation costs is to hire appropriate candidates with the use of Post-offer Medical Questionnaires.

Learn more about Post-offer Medical Questionnaires in our webinar here.

Who Has Your Back?

When claims are effectively managed by the insurance company, employers can experience significant savings through a reduction of their Experience Modification Rate.  Below is an example of a case managed by Synergy Coverage Solutions which resulted in an estimated $100,000 savings in additional workers’ compensation costs.  How did just one claim make such an impact on the employer’s bottom line?

An employee had injured her back at work and filed a claim, which was deemed compensable.  It was initially determined, by the claimant’s general physician, that surgery would be required; the claimant received a 2nd opinion also recommending back surgery.  However, Synergy’s Claims Adjuster received two additional opinions, both stating surgery was not required.  The claimant later decided to undergo back surgery.  The claimant requested compensation for lost wages, medical treatment, and surgery costs with estimated total costs of over $200,000.  Who was responsible for coverage?

In this situation, Synergy denied coverage because surgery was not authorized.  The North Carolina Industrial Commission ruled in favor of the employer and Synergy.  The conclusions of law set forth by the North Carolina Deputy Commissioners were as follows:

  • Synergy Coverage Solutions and the Employer have the right to direct medical care
  • Synergy Coverage Solutions and the Employer are not responsible for unauthorized medical treatment.  The surgery was not authorized because it occurred one year later and two medical providers had advised against surgery.

Aggressive claims management and focus on cost containment improved the employer’s Experience Modification Rate.  The decrease of loss reserve directly reduced their Experience Modification to such an extent that the employer will experience a workers’ compensation premium calculation reduction of at least $100,000 over the next three years.  Synergy Coverage Solutions is focused on providing strong claims management as it allows our employers to experience significant workers’ compensation savings over the long term.

Posting Vacation Photos Online Can Make or Break a Case

Synergy Coverage Solutions’ recent settlement of a claim involving a back injury was reduced by $70,000 due to information gained during our aggressive claims investigation.  Upon injuring her lower back while picking up a patient, the claimant underwent back surgery and was determined to have permanent work restrictions.  Her employer was able to accommodate her work restrictions; however she chose to resign from her position due to unrelated medical complications.

Initially, her attorney demanded a settlement of $90,000, taking the stance that the claimant was permanently and totally disabled.  However, upon deeper investigation of the claim, our Adjuster discovered the claimant had just returned from a trip involving high physical activity, rendering the permanent and total disability claim false.  Synergy was able to provide evidence that the claimant was not actually disabled, which lead to a $70,000 reduction in settlement.

Synergy Coverage Solutions prides itself on diligent and aggressive claims investigation.  Our Claims Adjusters take control of the situation, researching and obtaining details through a variety of resources; in this situation, finding evidence that the claimant was able to participate in high levels of physical activity while on vacation helped us construct a strong legal argument in the case.

A Synergy Moment: How Much Is a Glove Really Worth?

Synergy Coverage Solutions has been in the workers’ compensation industry for nearly 10 years.  In a special series called “Synergy Moments,” we would like to share the situations that capture the true collaborative nature of our business.

In our most recent Synergy Moment, one of our Claims Adjusters noticed a reoccurring injury claim.  Our Adjuster had received several claims from the employer in which employees cut their hands on glass or blades while handling trash.  As our Adjuster was able to note and recall the frequency of these particular injuries from this employer, he notified our Loss Prevention team and brainstormed ways in which this frequent injury could be avoided.  By utilizing special gloves while handling trash, cuts and scrapes would be prevented.  Isn’t the cost of protective gloves worth the spend to reduce employee injuries, as well as claims costs, in the long run?

A Claimant Files a Back Injury Claim – Is It Compensable?

In a recent Claims Success Story, Synergy used medical canvassing to uncover a claimant’s past medical history and ultimately settle the case in our favor.  An employee filed a workers’ compensation claim, alleging he injured his back when lifting an apparatus at work the previous week.  While investigating the claim, our Adjuster used medical canvassing to retrieve prior medical records showing the claimant was receiving medical treatment for his back weeks before the alleged work incident.  Additionally, a written witness statement revealed the claimant complained about back pain when he was new on the job, stating the pain was not work-related, but stemmed from a car accident a few years ago in which back surgery was required.  The medical canvas, combined with the witness statement, helped Synergy prove that the compensability of the claim was questionable.

In this situation, Fitness for Duty assessments would have been extremely beneficial for both the employer and the employee.  These assessments are used to determine an employee’s risk of injury while carrying out typical job duties.  Had these fit-for-duty assessments been completed, the results may have revealed that this individual would have an increased risk of injury due to his previous back surgery, and would not be a safe candidate for hiring in this particular position.

Synergy Coverage Solutions is dedicated to helping employers control workers’ compensation costs and investigating every claim thoroughly for compensability.  To learn more about hiring practices and Fitness for Duty testing, click here or contact us by email here.

Synergy…Working Together to Prevent Injuries

Synergy often utilizes communication between our Claims and Loss Prevention departments to enhance our customer service and experience.  Recently, a Claims Adjuster recognized a dangerous machine guarding situation while reviewing a minor claim generated by a near-miss (stemming from improper machine guarding).  Immediately, the Claims Adjuster communicated the cause to one of our Loss Prevention Consultants.  With this information, Loss Prevention was able to schedule a safety meeting with the organization and assist with corrective action to prevent future, perhaps more serious, injuries.

While this may sound like a simple occurrence, this is just one example of how Synergy goes above and beyond to protect our policyholders.  Because we are big believers in effective communication and collaboration, the way we do business only offers an even more enhanced effect for our customers.

To learn more about our Loss Prevention services, please visit www.synergyinsurance.net or contact us at info@synergyinsurance.net.

Accident Investigation and Aggressive Claims Management Leads to Positive Outcome from the NC Industrial Commission

Synergy Coverage Solutions is committed to providing extensive loss prevention services and aggressive claims management.  The workers’ compensation industry is surrounded by exaggerated and fraudulent claims; therefore it is of utmost importance for an employer to have an accident investigation program in place and conduct an accident investigation immediately following any alleged injury (accident investigations also offers insight so a similar or more disastrous accident may be prevented).  In the same way the employer conducts the accident investigation, the workers’ compensation service provider must begin a thorough claims investigation to research and piece together all details of the claim.

A recent claim handled by Synergy Coverage Solutions demonstrates the importance of timely accident investigation and aggressive claims management, resulting in a positive ruling for Synergy Coverage Solutions and the employer by the North Carolina Industrial Commission.  In summary, the claimant was working when she was unable to exit a room due to a door jam.  She was eventually instructed by the custodian to exit via the first floor room window, 40 inches from the ground, and use a ladder on the outside of the building to reach the ground.  The claimant contends she suffered neck and low back pain from climbing out of the window and lowering herself onto the ladder on the outside of the building.

Typically, the NC Industrial Commission is favorable towards neck and back claims.  However, in this case, Synergy’s aggressive and diligent claims investigation lead us to the decision to challenge the way the commission typically rules, based on the detailed facts gathered in the investigation.  After reviewing medical records from the claimant’s doctor (who had performed surgery from a prior incident involving a neck injury), and reviewing the employer’s accident investigation information, the Claims Adjuster denied the claim based on the conclusion that the pain and treatment received was not a direct or natural result of, or causally related to the incident.  The North Carolina Industrial Commission concurred with Synergy’s decision and upheld the denial.  The Commissioner’s opinion indicated that to be compensable, an injury “must result from an accident, which is considered as a separate event preceding and causing the injury; the mere fact of injury does not of itself establish the fact of accident.” 

Working with the employer, Synergy took a decisive, yet fair, stance after gathering all the details regarding the incident.  The employer’s ability to complete a thorough and timely accident investigation helped build a strong representation of the incident.  The employer was able to identify and gather detailed statements from witnesses in a timely manner, so the details from the incident were not lost, but easily recalled.  A tool that our competitors don’t typically use is obtaining information on past medical treatment.  Synergy Claims Adjusters are trained to think creatively, and out-of-the-box, to gather details that paint a clearer picture of the alleged injury.  Our Adjusters obtain information through a variety of resources; in this situation, prior medical records proved to be a critical reason for the success of this case.  After quickly obtaining past and current medical information and reviewing the accident investigation, Synergy was then able to construct a strong legal argument supported by the facts.

The fact of the matter is the workers’ compensation industry continues to change throughout the years.  Previously, standard accidents could be resolved by adhering to proper medical restrictions with a Return to Work program.  Today, it’s not that simple.  With an aging workforce, unhealthy habits, and healthcare conditions such as obesity and diabetes, claim costs continue to increase and the link between the workplace and an injury becomes unclear.  Increasing numbers of workers’ compensation claims are financially motivated and perhaps even tied to the weak job market, stagnant low wages, access to prescription drugs, and an expanding Social Security Disability program.

Synergy Coverage Solutions is dedicated to providing superior workers’ compensation services and adjusting to today’s reality.  We work hard to stay ahead of the curve and identify programs, such as Fitness for Duty, to ensure employers are finding the right candidates to perform their job duties in a safe and effective manner.  Our dedicated Claims Adjusters aggressively research claims to determine compensability, and are committed to taking a strong stance for the facts a workplace incident may reveal.  In the workers’ compensation industry, Synergy Coverage Solutions stands ready to change with the times to consistently offer superior workers’ compensation services.