July 2009 Archives

July 30, 2009

 

Nancy Germond is hosting this week's Cavalcade of Risk at her blog, Insurance Copywriter. She should get hazardous duty pay - she tells us that it is 113 degrees by noon on any given day in Phoenix - yikes. Nancy's post covers topics as diverse as damaged guitars, dog health, and - of course - the health care debate. By the way, you can find more risk-related articles authored by Nancy at AllBusiness.

Other news notes
As we noted previously, Roberto Ceniceros has been attending the Disability Management Employer Coalition annual meeting and has been posting about the meeting on his blog. We found one item that he wrote about in Business Insurance of particular interest: his report that Harley Davidson is using functional assessments to reduce workers comp and disability claims among new hires and in its return-to-work programs. Hanover, Md.-based BTE Technologies Inc. provides the electronic functional assessment testing system and accompanying software and evaluates worksites to perform physical-demand analyses. The "...system evaluates attributes such as range of motion, dexterity, grip strength, lifting ability and tolerance of certain positions. Employees are measured by pushing against a column, lifting weights and other efforts matched to specific job requirements that are recorded electronically." The company estimates savings of nearly $260,000 in workers comp claims costs by preventing new hire injuries alone, which doesn't encompass the other benefits and savings from the disability and RTW components.

In Risk and Insurance, Peter Rousmaniere launches a three-part series on health issues facing veterans as they return to the workplace. His first post tells the story of one Sgt. Stephen Kinney of New Hampshire, ho was the victim of an IED explosion on the outskirts of Camp Anaconda in Iraq. Among injuries, Kinney sustained brain injuries and post-traumatic stress disorder (PTSD) that left him unable to resume his prior job as mail carrier.

NIOSH Science Blog posts about safe and health green jobs and tells us that, with its partners, NIOSH has launched a Going Green: Safe and Healthy Jobs initiative. The note that as America moves towards energy efficiency and more environmentally-friendly practices, it is likely that there will be changes to traditional jobs and the creation of new kinds of occupations. The purpose of the initiative is to eliminate hazards in the green jobs through planning, organization, and engineering - a concept known at NIOSH as Prevention through Design (PtD).

Supporting Safer Healthcare posts that U.S. News & Word report has issued its 2009 list of best hospitals.

The Ohio Department of Insurance has a new web address - update your bookmarks accordingly: www.insurance.ohio.gov/ (Please note - we had previously said that it was the Ohio Bureau of Workers Comp that had a new web address but we were wrong - that stays the same: www.ohiobwc.com - sorry for any confusion!)

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July 29, 2009

 

Back in May, we blogged the appalling story of Albania Deleon, a legal immigrant who founded Environmental Compliance Training (ECT), the largest asbestos removal training school in New England. Despite the fact that the training only requires 32 hours, she frequently sold certificates of completion to "students" who never attended classes. In other words, she sent these marginal workers - many of them undocumented - into asbestos-ridden jobsites with no preparation whatsoever.

Well, Albania, meet Chong-mun Chae, an illegal immigrant who ran a Queens-based asbestos removal company apparently modeled on ECT standards. Chae claimed to have only one employee, a receptionist. In other words, his company removed asbestos from job sites all over New York, but he accomplished this without any workers. By calling his workforce "independent contractors," he avoided workers comp premiums to the tune of $1.6 million. As we read in the New York Times, Chae has been sentenced to 4 years in prison, to be followed by deportation to South Korea.

Chae avoided detection for over a decade by frequently changing the name of the company. He was not without a sense of humor - let's call it diabolical - as one of his company's incarnations was "Charlie Brown Services." His premium avoidance scheme was exposed when an investigator read a report filed by Chae stating that he had no workers. You might think that a connection would easily be made between a company with hundreds of thousands in billings and no payroll, but that was not the case. In our collective haste to get rid of asbestos, we try not to think very much about the people actually performing the work.

Killer Jobs
Chae, like Albania Deleon, is getting off lightly. After all, he has only been convicted of insurance fraud. At some point in the not-too-distant future, when Chae is enjoying his retirement in South Korea, he will be guilty of murder, as his phantom workforce and their families succomb to debilitating lung disease. We don't know who they are or where they live. Collectively, perhaps we don't really care.

Entrepreneurs like Chae and Deleon exploit the margins of the working world, removing a deadly menace in a deadly manner. They offer jobs that pay relatively well, to a workforce that labors in the shadows. Chae and Deleon are nothing less than murderers. It's too bad that our system of justice is incapable of holding them accountable for their deeds.

If hell operated a dating service, surely the decrepid Chae and the fugitive Deleon would be a match: at 71, he is a lot older, where Deleon is a single mother with a now-abandoned 3 year old child. Despite the difference in ages, however, they have a lot in common. They have ruined hundreds of lives, wreaked havoc on thousands of families and reaped the profits of a corrupt business scheme. With values like those, age is surely no barrier.

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July 28, 2009

 

Summer brings extremes in weather that pose dangers to workers and challenges to employers who must plan for worker safety. This week, four construction workers were hit by lightning in Michigan. A quick Google search demonstrates this is not an anomaly - refinery workers, airport workers, firefighters, farmers and other working people all have too-close encounters with lightning, and a surprising number live to tell the tales of their harrowing lightning encounters.

In a recent MSNBC story, survivors share their experiences and stress the importance of safety. The article highlights 9 myths of lightning safety - including the common misconception that it's unsafe to touch a lightning victim, a myth that often delays critical assistance, and the faulty idea that you are safe from lightning if you are indoors. As for your odds:

"Nearly 25 million cloud-to-ground strikes occur in the United States each year, according to the National Lightning Detection Network, with Florida topping the list with more than 1.4 million flashes a year and about 25.3 flashes per square mile. By contrast, Washington state is at the bottom of the list, with less than 20,000 flashes per year and about .3 flashes per square mile."
While experts put your odds of being struck by lightning in any given year at 1 in 700,000, your lifetime odds narrow to 1 in 5,000, and your odds of knowing or being affected by someone who is struck by lightning are 1 in 500. And while it is not totally understood why, some people are struck more than once, such as this unfortunate Oklahoma plant worker who has been hit by lightning 4 times.

The National Weather Service (NWS) keeps track of annual lightning fatalities by state. This year, there have been 25 fatalities, with 4 of those occurring in Florida.

NWS also offers this breakdown of casualties by location or activity:
45% - Open Areas (including sports fields)
23% - Going Under Trees To Keep Dry
14% - Water Related Activities (swimming, boating, and fishing)
6% - Golfing (while in the open)
5% - Farm And Construction Vehicles (with open exposed cockpits)
4% - Corded Telephone (#1 indoor source of lightning casualties)
25 - Golfing (while mistakenly seeking "shelter" under trees)
1% - Using Radios And Radio Equipment

Experts estimate that about a third of all injuries occur during work. Survivors often face daunting medical after effects, which can include personality changes, seizures, memory lapses,fatigue, and depression. Victims are also often are left with permanent scars and markings that are sometimes referred to as lightning flowers or lightning trees, or arborescent erythema.

Resources
For help in learning about or coping with lightning strike after effects, survivors and their families can turn to the non-profit support group Lightning Strike & Electric Shock Survivors International, Inc. (LS&ESSI, Inc.).

The National Lightning Institute issues a fact sheet on Lightning Safety for Outdoor Workers. For more information, see NWS' page of Factsheets, Publications, Statistics, Policy Statements, Lightning Strikes, More Links. Also, see our past posts on the topic: Lightning safety precautions for work and home and Lightning strike prevention and survivor resources

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July 23, 2009

 

Paul Testa of New Health Dialogue Blog takes the notion of a carnival to heart while hosting this week's edition of Health Wonk Review: All's Fair in Love and Health Reform. Join him as he takes us along the Midway that is Pennsylvania Avenue, the big tent of bipartisanship, the funhouse mirrors of the health reform debates, and the roller coaster rides in Congress. Great edition!

And in other news...
Think you can safely text while driving? Studies show that drivers overestimate their ability to multitask behind the wheel. This game from the new York Times measures how your reaction time is affected by external distractions: Texting While Driving Simulator.

West Virginia touts progress one year into privatization. Cited among the successes: 154 insurance companies have active workers compensation policies in the voluntary market, the unfunded liability on "old fund" claims has dropped by more than half to $1,5 billion, and claim protests have fallen 68%.

Attorney Jon Gelman looks at the challenges that declining salaries and unemployment pose to workers' compensation.

Roberto Ceniceros is blogging from the Disability Management Employer Coalition conference. His report yesterday focused on the generational impact on disability, with each generation facing different disability drivers.

James Dao in the New York Times posts about a new study pointing to an increase in mental health diagnoses in vets, usually PTSD or depression: "The study ... was based on the department health records of 289,328 veterans involved in the two wars who used the veterans health system for the first time from April 1, 2002, to April 1, 2008. The researchers found that 37 percent of those people received mental health diagnoses. Of those, the diagnosis for 22 percent was post-traumatic stress disorder, or PTSD, for 17 percent it was depression and for 7 percent it was alcohol abuse."

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July 21, 2009

 

The following article is a guest post by Joey Lucia, a loss prevention supervisor at Austin-based Texas Mutual Insurance Co., the largest provider of workers' compensation insurance in Texas.

Non-English-speaking Hispanic workers present unique safety challenges.

Picture this: It's your first day on the job with a construction crew. Your boss asks you to help lay a foundation for an office building. High above, another worker is walking along a scaffold. He accidentally kicks a hammer off the scaffold, and you're directly below it.

Fortunately, your company embraces a "total safety" culture. In a "total safety" culture, employees look out for one other. Everyone is accountable for not only their own safety but also their co-workers' safety.

With that in mind, someone yells, "¡Cuidado, el martillo se puede cáer sobre ti!" Your co-worker warned you to get out of the way. If you didn't understand Spanish, you might have been involved in a serious accident.

In 2006, Hispanic workers died at a rate that was 25 percent higher than all other workers in the United States, according to a study published last year in Morbidity & Mortality Weekly Report. As of 2006, nearly 20 million workers in this country were Hispanic, making them one of the fastest-growing segments of the U.S. workforce.

Here are some tips for keeping non-English-speaking Hispanic workers safe. Follow the ones that fit your business, and you can help make your workplace safer and more productive.

Challenge: language
Language can be a barrier to communication, even among people who speak the same language. Imagine how hard it is for Hispanic workers who speak little or no English.

Solutions

  • Use more pictures and fewer words to point out hazards and teach safety procedures.
  • Most communication is nonverbal. Watch workers' eyes, body language and expressions to see whether they understand instructions.
  • Train supervisors in basic, conversational Spanish. Send non-English-speaking Hispanic workers to a conversational English class. Focus on commonly used words in your industry.
  • Hire Spanish-speaking supervisors who have experience in your industry.
  • Ask bilingual employees to translate safety messages.
  • If you have training requirements, the Occupational Safety and Health Administration mandates that you provide them in a language that workers can understand. Hire a translation company to put safety training material into Spanish. Make sure the translator is fluent in the Spanish dialects spoken by your employees.
Challenge: literacy
Many Hispanic workers do not have the luxury of pursuing their education because they have to help support their families. About 40 percent of Hispanics age 25 and up do not have a high school diploma, according to the U.S. Census Bureau. By comparison, about 14 percent of the total U.S. population does not have a high school diploma.

Solutions:

  • Keep training basic.
  • Provide simple, hands-on safety demonstrations.
  • Do not let employees start work until they show that they understand the training.
  • Provide follow-up training, and be sure to address new workplace hazards.
Challenge: fear
Have you ever been afraid of asking a question in front of a large group of people? Imagine asking it in a different language. Non-English-speaking Hispanic workers may put themselves at risk because they're too embarrassed to ask questions about safety procedures. Some may even fear for their jobs if they report unsafe working conditions.

Solutions

  • Encourage every employee to report unsafe conditions.
  • Offer safety training away from the workplace. If the trainer is someone other than a manager, employees may be less intimidated and more likely to ask questions.
  • Make sure non-English-speaking Hispanic workers have peers they feel comfortable talking to.
  • Deliver the safety message to employees in their environment. For example, distribute Spanish-language safety training material at community functions.
  • Reward safe behavior in front of co-workers.
  • Take time to learn about your Hispanic workers and their culture.

Past blog posts that relate to this topic:
Safety for Spanish-speaking workers must address cultural as well as language barriers
Keeping the multicultural workforce safe
Qualified interpreters can save lives
Hispanic Fatalities on the job: the Tip of the Iceberg
When it comes to safety, make sure you speak the same language!
Mandatory English at the workplace?

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July 20, 2009

 

College athletics is big business. While athletes are not paid for their efforts (well, some are), they can reap substantial benefits while pursuing glory on the playing fields of their Alma Maters. But athletes, like workers, are prone to injuries. And once injured, they may find themselves liable for the cost of medical treatment. There is no workers comp for injured athletes, but perhaps there ought to be.

Kristina Peterson writes in the New York Times that athletes are often stuck with the medical bills for sport injuries. Students may have coverage through their parents's insurance policies, but these often exclude varsity sports, limit out-of-state treatment or do not cover much of the bill. Schools may offer supplemental plans, but these vary greatly. Athletes who play for major Division I schools often benefit from robust coverage. Big Ten athletes rarely have to pay for medical treatment. The NCAA offers catastrophic insurance for all athletes, but coverage begins at $90,000. An athlete would run through an awful lot of treatment to reach that level of medical billing.

Even in the Big Ten, where insurance coverage is robust, stuff happens. Jason Whitehead played football at The Ohio State University. He was badly injured during a practice and was airlifted to a hospital.

"The next day, when I woke up, the doctor came in and informed me that surgery went well, but this was a career-ending injury...It took a while to sink in."

Whitehead lost his scholorship one year after the injury. He also ended up with $1,800 in medical bills not covered by his father's insurance or by the school's. The school valued Jason as an athlete; as an ordinary student, well, he ended up pretty much on his own.

Rowing to Oblivion
As in workers comp, medical coverage for student athletes is complicated by factors that may or may not be directly related to the injury. Erin Knauer went out for the crew team as a freshman walk-on at Colgate University. She had a cold when she took a five kilometer workout test on rowing machines. On pace for the fastest time, she suddenly felt a shooting pain beginning in her back and reaching her toes.

She eventually was diagnosed with postviral myositis, a muscular inflammation that causes weakness and pain. Colgate officials determined that this was an illness, not an injury, so financial responsibility fell to Knauer. She tapped out her student health policy at $25,000, leaving her $55,000 in debt. She is currently working two jobs and paying down the bills at the rate of $250 a month.

There is little doubt that Knauer's illness was exacerbated, if not caused, by the strenuous workout. If this had been a work-related situation, comp would likely have picked up the entire tab (plus indemnity). But as a student athlete, Knauer has no guarantee of coverage. She wanted to row for the glory of Colgate. She ended up in serious pain and serious debt. Glorious it was not.

College athletics often involve a fundamental trade off: in return for playing sports, athletes benefit from a low-cost or virtually free education. That might be a pretty good deal, except when the sport results in a life-changing injury. As David Dranove, a professor at Northwestern's Kellogg School of Management, puts it: "It makes no more sense to tell the athletes, "You go buy your own health insurance," than it does to say, "You go buy your own plane tickets and uniform.'"

The rationale for mandatory insurance for athletes is similar to the rationale for workers comp. The schools benefit from the labors of their athletes. The least they can do is pay for any and all medical treatment required to make these athletes whole.

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July 16, 2009

 

Roberto Ceniceros blogs about the New York appeals court ruling in Frank P. Torre v. Logic Technology, which awarded workers comp benefits to an employee for an injury sustained in the gym. Usually, injuries sustained in extracurricular activities aren't covered by workers comp, but there are exceptions, such as when injuries occur during "mandatory attendance" events or while an employee is on business travel (see our past posts: Mandatory fun: when recreational activities are compensable and When play becomes work, or the case of the traveling employee).

On first glance, a case like this might seem open and shut. The employee was on his own time at the gym - the injury did not appear to arise out of and in the course of employment. But on closer examination, the court apparently determined that gym participation was furthering the employer's interest for the networking potential. (Is gym the new golf?) When it is determined that an employer has derived significant business benefit from an activity - such as interacting with clients and prospects - then an activity may be compensable.

The courts also noted that the employer encouraged and sponsored this activity. In this case, the sponsorship entailed reimbursement for membership fees. One has to wonder what kind of chilling effect a ruling like this could have on wellness programs. Employers frequently incent employees by paying for or supplementing gym membership, exercise programs, and weight loss or smoking cessation programs. Some companies offer financial incentives for participating in wellness programs or disincentives such as increased cost for insurance for not participating.

This type of endorsement and sponsorship can be tricky when it comes to workers comp. In days gone by, sponsorship generally referred to softball or bowling teams and employers could take some steps top mitigate risks. But as employers become more aggressive about wellness programs in an effort to control health care costs and these wellness programs become more ingrained in the corporate culture, does the compensability exposure increase? Some of the variables that have come into play in determining compensability are the location and time of the activity - is the gym on the employer's premises? Does the activity take place during work hours? Another factor is how strongly the company encourages participation and whether participation is purely voluntary. If a corporate culture is such that it so strongly endorses an activity, the issue of whether participation is truly voluntary could be up for debate.

Comorbidities like obesity and diabetes have been shown to have an impact on claim frequency and severity so it would appear that wellness programs would have a positive net effect on workers comp costs. But good intentions can often have bad outcomes. Take the concept of programs that heighten worker awareness about safety and incent workers for best practices - that may sound great on the surface, but The New York Times recently reported on safety incentive programs that ran headlong into the law of unintended consequences.

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July 15, 2009

 

Our friends Jay and Louise Norris have posted The 82nd Cavalcade of Risk at Colorado Health Insurance Insider. Louise opens with our recent post on Atul Gawande's health care article and she notes that if her own observations are to be believed, she's seen signs of over-utilization in workers comp medical care, too. As might be expected with health care reform being such a hot button issue, much of this Cavalcade is given to the topic, but there are also several good items on the broader topic of risk - we particularly liked Nancy Germond's article on enterprise risk management. Check it out - get your weekly fill of risk-related reading all in one place.

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July 14, 2009

 

Earlier this year, legendary baseball great Mark Fidrych died while working on his farm in Northboro, Massachusetts. He was working underneath his truck when his clothing became entangled in a power takeoff (PTO) shaft. PTOs are used to transfer power from tractors or trucks to other machinery. They spin at an incredible rate of speed. A single thread or a wisp of hair can lead to a fatal encounter. Few who are entangled in a PTO live to tell the tale. According to a PTO fact sheet put out by the North Dakota State University's Agricultrual Department, they could "...Wrap your arm or leg around the PTO shaft nine times in one second at 540 PTO rpm, or nearly 16 times in one second at 1000 PTO rpm."

Farm injury survivor Kristi Ruth learned the reality of that statistic the hard way. She was working on her family farm with her Dad and her brother in 2007 when her arm became entangled in a posthole digger's PTO.

"But as Kristi began to remove her hold on the three-point support bar by the auger head, the back of the glove on her cupped left hand caught on a shear bolt that was a quarter inch too long. Although the PTO had already begun to wind down, it was too late.

In a frantic instant, Kristi's left arm wrapped around the machinery up to her shoulder, breaking her bones with every rapid turn. She was trapped, and what started as a beautiful winter day suddenly became a horrific moment frozen by the piercing screams of her father and brothers and sounds of snapping bones and ripping flesh, like fabric being torn into rags. A race to free Kristi from the implement began. Her life hung by the threads of her torn coat.

With the PTO stopped, Joe frantically jumped from the tractor and fished for his cell phone, handing it to Jake, who quickly dialed 9-1-1. With her good hand, Kristi reached for her own cell phone and gave it to Josh so he could also call for help while her father and Jake worked feverishly to untangle her.

They unhooked the digger from the hitch point, and Jake dug in his pocket for his pocketknife. In what seemed like hours, Jake used his dull knife to painstakingly saw away at the shreds of Kristi's coat, being careful not to cut her. They hurriedly unwrapped her from the auger -- her arm spun around the cold metal like a wet rag -- and as she stood, her limp arm drooped to her knees."

Kristi broke her arm in six places and severed a major artery. The level-headed response of her family and an incredible medical effort managed to save her life and her arm, although she has severely diminished functionality in that arm. But after several years of recovery and surgeries, Kristi is on the lecture circuit bringing the farm safety message to other kids. She's also tells her story in My Name is Kristi, a safety DVD available from Iowa State University Extension Service.

Even before her injury, Kristi was all too familiar with agricultural dangers - her uncle was killed in a tractor rollover in 2005. Farming is a dangerous business and encounters with PTOs continue to be an all-too-common common source of farming fatalities. PTOs must be shielded and guarded at all times.

Helpful resources
National Children's Center for Rural and Agricultural Health and Safety

Childhood Agricultural Injuries (PDF)

Farm Safety 4 Just Kids

Straight Facts About PTO Shafts and Sheilds

A PTO safety sheet along with a grim tutorial on freeing a PTO accident victim from the National Ag Safety Database

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July 9, 2009

 

If you find the task of following breaking news developments on the health care reform front a trifle daunting, we have a solution: let the health policy blogosphere's best braniacs dish up and dissect the news for you in bite size portions in the bi-weekly compendium of the best of heath care policy posts. Check out the fresh edition of Health Wonk Review: Crunch Time For Health Reform hosted by Ken Terry at BNET Healthcare Blog.

And in other news:
MHSA - The Pump Handle tells us that Joe Main has been nominated for Assistant Secretary of Labor for Mine Safety and Health and posts some info on his background.

Taking the industry economic pulse - With another quarter in the year under our belt, several industry watchers have taken the pulse of the industry's health. In Business Insurance, Roberto Ceniceros reports that a tough climate is shaping up for workers comp. Among the many problems he notes, he reports that sources have told him that "...rising bankruptcies have insurers concerned that defunct businesses may not pay all their premiums and leave their insurer stuck with claims that should have been paid by the company." Risk and Insurance features an article on a report from Fitch Ratings which discusses the challenges that the workers compensation market is facing in 2009. According to the report, underwriting performance is expected to worsen in 2009 as rate reductions persist. And we've recently noted grim news in the industry at large: first quarter of 2009 was the worst on record for property casualty insurers since quarterly results were first compiled in 1986.

Training - Eric at The Safety Blog reports that OSHA is targeting fraudulent trainers in construction and general industries and is working to strengthen their trainer authorization program. They will be conducting more surprise visits to independent training centers to check for compliance with program requirements. Trainers are authorized to teach and to do outreach training only after completion of a one-week course in an OSHA Training Institute Education Center. Learn more about training certifcation: OSHA Outreach Training Program.

H1N1 - Lloyd's warns that pandemics continue to pose a threat to companies - Many feel the flu publicity and warnings earlier in the year were overstated because up until now, the manifestations of the flu have been very mild. According to WHO, there have been 429 fatalities out of 95,412 cases. Yet Lloyd's points out that it has been having a devastating economic impact on some businesses and notes that, "Up to now flu cases have been relatively mild; however, Lloyd's warned that "health officials worry that swine flu could mutate during the southern hemisphere winter and return in a more virulent form in the northern hemisphere this winter." Keep up to date on any developments at Flu.gov.

Waste treatment fatalities - More on last week's three fatalities at Regal Recycling: Old Story in Waste Removal: A Worker Collapses, Then Rescuers Do: "Dr. Hendrickson and two co-researchers found that in 42 incidences of workers' dying of hydrogen sulfide toxicity between 1993 and 1997, more than one-fifth involved multiple deaths, including co-workers killed while trying to rescue a colleague. In all, 52 workers died over that period. The deaths have mounted despite strict standards governing work in confined spaces set by the federal Occupational Safety and Health Administration."
And in another waste treatment plant, a worker recently died of burns suffered in an explosion that occurred while he was cleaning a tanker at CES Environmental Services in Houston. The death was the third at a regional CES operation since December, unleashing criticism from area residents, activists and city officials, who are looking to shut down the plant.

Useful Twitter feeds
@govsites - A searchable directory of any nation's Government sites on Twitter
@NIOSH - The National Institute for Occupational Safety and Health
@usdol - Jobs, employment, workforce, safety, labor, government 2.0 issues & regulations news and information from the US Department of Labor
@Disabilitygov - Official U.S. Government Web site for People with Disabilities
@CCOHS - Canadian Centre for Occupational Health and Safety (CCOHS)
@FluGov - One-stop access to U.S. Government H1N1, avian and pandemic flu information
@VHAVeterans - Veterans Health Administration in the U.S. Dept. of Veterans Affairs
@usfire - Official Twitter account of the U.S. Fire Administration - Working for a Fire-Safe America

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July 8, 2009

 

Serious workplace injuries often turn spouses into caregivers. So the question becomes, are their services compensable under workers comp? As is so often the case, it depends upon where you live.

The Supreme Court of Arizona recently decided a case in the spouse's favor (Sabino Carbajal v.Industrial Commission of Arizona). In 1999, Sabino, working for Phelps Dodge, suffered a serious injury, resulting in cognitive problems and partial paralysis on his right side. He required full-time supervision and intermittent attendant assistance. The carrier paid for nursing aides during daylight hours. At all other times, Sabino's wife took charge of his care: this included giving him his medication in the morning; specially preparing his food; cleaning him when he was returned from day care soiled; and moving him between his wheelchair and his bed, the toilet, or his recliner.

In their deliberations, the Arizona Supremes examined practices in two other states. They looked first at Virginia, where the courts have denied reimbursement to spouses for home health care services (Warren Trucking v. Chandler, 277 S.E.2d 488). In Warren, the claimant's wife helped him bathe, shave, and put on braces, and she prepared his meals, drove the car, and maintained the household. When the claimant lost consciousness, his wife revived him.

The Virginia court concluded that under the statute, to qualify as compensable "medical attention," the spouse's care must, among other requirements, be "performed under the direction and control of a physician" and be "the type [of care] usually rendered only by trained attendants and beyond the scope of normal household duties." The court rejected the spouse's claim because the care rendered by the wife was not prescribed by a doctor and was not "of the type usually rendered only by trained attendants." I suppose that when the wife revived her husband, she was just acting as a good samaritan.

NOTE: Workers in Virginia may well wonder whom the comp statute is designed to protect. We recently blogged an absurd provision of the law which precludes payment to brain injured employees who have the misfortune of surviving catastrophic injuries. Virginia seems to go out of its way to construct "rigid frameworks" that preclude compensation for the families of seriously injured workers.

Empathy in Action
Arizona justices also looked at case law in Vermont, where a similar set of circumstances led to a very different conclusion. In Close v. Superior Excavating Co. (693 A.2d 729), the claimant received a severe head injury and required 24-hour supervision. The claimant's wife cared for him at home, including "administer[ing] and monitor[ing] his medications[,] . . . alter[ing] the doses [of medication,] . . . log[ging] . . . her husband's behavior[, and] monitoring her husband's seizure activity and responding appropriately."

In concluding that the wife's services were compensable, the Vermont court rejected the "rigid framework" of Warren, noting that "it "would . . . conflict with [its] longstanding practice of construing the workers' compensation statute liberally."

The Arizona court restated the aim of workers comp: rather than pushing the notion of spousal duty deep into the area of custodial care, the court "places the burden of injury and death upon industry." The Arizona court overturned rulings at the commission and Appeals court levels. They found that Mrs. Carbajal routinely performed work that others were paid to perform and that these duties were necessitated by workplace injury. Therefore, she is entitled to reimbursement. It will be interesting to see how the comp commission comes up with a dollar value for her services: will she be reimbursed for "time on task" or is she "on call" and working whenever other paid help is not available?

When workers suffer catastrophic injuries, their families suffer loss beyond measure. The quality of life changes for everyone, not just the injured worker. If the question is "to pay or not to pay" for the onerous burdens placed on spouses, the answer, in Arizona and Vermont at least, is to pay.

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July 6, 2009

 

Over the last twenty years, medical costs have gradually, but steadily, replaced indemnity wage replacement as the engine driving the workers' compensation train. This is the same period during which our nation's health care costs have grown from average among OECD countries (Organization for Economic Cooperation and Economic Development) to double the average (PDF). In other words, workers' compensation medical cost increases reflect similar increases within the general public. The only surprising thing here is that during the last decade or so, the steady increase in workers' compensation medical costs has happened at twice the rate of those eye-popping group health increases.

The National Council on Compensation Insurance (NCCI) has convincingly demonstrated that the rise in workers' compensation medical costs is due primarily to over-utilization of physical medicine services, especially those for chronic, soft tissue claims. (See here (PDF) and here (PDF ). And now, Atul Gawande, writing in the June 1, 2009 issue of The New Yorker, has demonstrated even more convincingly that over-utilization of medical services, including testing, surgery and hospitalization, is the metastasizing cancer in America's health care system.

Dr. Gawande's lengthy article, The Cost Conundrum, for which he should win the Pulitzer Prize, is the most trenchant argument yet for why costs in America are so appallingly high, but outcomes merely mediocre. He reduces the problem to its simplest terms. In essence, our American health care house that Jack built has turned the once noble profession of medicine into nothing more than assembly line piecemeal work, and our physicians both in primary care and the specialties, have been economically incentivized to over-prescribe in all areas. And, as Gawande's article clearly shows, the areas of the country that produce the highest costs with all that over-prescribing also produce the poorest health care results.

Dr. Gawande examines health care in McAllen, Texas, a town within Hidalgo County, the County with the lowest household income in the country, but, after Miami, the second most expensive health care costs. He wanted to know why. He also wanted to know why health care costs in El Paso County, eight hundred miles to the north with similar demographics to Hidalgo's, were 50% lower.

He wanted to know why the Mayo Clinic, in Rochester, Minnesota, with the best medical technology on the planet, produced some of the highest quality medical care in the nation, but with costs that rank in the lowest fifteen percent of the nation. And why the Mayo was able to replicate that achievement when it opened its hospital medical center in Florida, one of the country's highest cost states for health care?

His answer? Because in the pockets of excellence he found around the country doctors work together in teams, peer-reviewing each other's work. In these low-cost, high-quality areas, physician income is neutralized. At the Mayo, for example, the doctors are all on salary. Whether they order ten procedures or none, they get paid the same. This is central to understanding how to fix the problem. As Gawande writes:

"Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coordination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the country's best electrician on the job (he trained at Harvard, somebody tells you) isn't going to solve this problem. Nor will changing the person who writes him the check.

This last point is vital. Activists and policymakers spend an inordinate amount of time arguing about whether the solution to high medical costs is to have government or private insurance companies write the checks. Here's how this whole debate goes. Advocates of a public option say government financing would save the most money by having leaner administrative costs and forcing doctors and hospitals to take lower payments than they get from private insurance. Opponents say doctors would skimp, quit, or game the system, and make us wait in line for our care; they maintain that private insurers are better at policing doctors. No, the skeptics say: all insurance companies do is reject applicants who need health care and stall on paying their bills. Then we have the economists who say that the people who should pay the doctors are the ones who use them. Have consumers pay with their own dollars, make sure that they have some "skin in the game," and then they'll get the care they deserve. These arguments miss the main issue. When it comes to making care better and cheaper, changing who pays the doctor will make no more difference than changing who pays the electrician. The lesson of the high-quality, low-cost communities is that someone has to be accountable for the totality of care."

The Cost Conundrum, by Atul Gawande, should be required reading for anyone interested in understanding and participating in American health care reform. And that should be all of us.

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July 2, 2009

 

There are certain aspects of civilized life that few of us want to experience directly. Once our garbage has disappeared from the curbside, we are unlikely to give it any further thought. We have little curiousity about the desolate environments where this garbage is taken. But some folks work in these places, such as the ironically-named Regal Recycling Company on Douglas Ave, Jamaica, Queens. New York Times writer Robert McFadden describes the location as "an ugly street of waste plants, garbage scows and sheds enclosed by chain-link and topped by fluttering American flags."

A manhole-size, 18 foot deep well at Regal was the sight of a terrible accident earlier this week. S. Dahan Piping and Heating Corporation was hired to clean the manhole. They apparently were not alerted to the hazard of poisonous gases in the well. First, Harel Dahan, son of the owner, climbed into the well's three foot diameter opening and disappeared. His father - we can only imagine his desperate concern for his son - followed him down and did not return. Finally, a Regal employee named Rene Rivas entered the well to help out.

All three workers were quickly killed by the high level of hydrogen sulfide in the confined air of the well. Hydrogen sulfide is a highly toxic and flammable gas. Being heavier than air, it tends to accumulate at the bottom of poorly ventilated spaces. Although very pungent at first, it quickly deadens the sense of smell, so potential victims may be unaware of its presence until it is too late. Exposure to 50 parts per million can be lethal within 10 minutes. The level in the well measured an astounding 200 parts per million.

A Firefighter from the rescue squad named Robert Lagnese recovered the bodies. He wore protective clothing and an enclosed breathing apparatus.

Hydrogen sulfide is a by-product of decomposing organic matter. (Here is a five page MSDS sheet for anyone interested.) At this point, no one is sure how the gas accumulated in the well. When trucks enter the facility, they empty their contents into two categories of waste: "putrescible" and "non-putrescible." It is the former that generates the poisonous gas.

When Shlomo Dahan arrived at Regal, he expected to find a routine job of pumping out a well. He was not aware of any immanent danger. It's clear that Regal employee Rene Rivas was also unaware of - and untrained in - the danger. Regal handles tons of "putrescible" waste, but apparently had no awareness of the accompanying dangers.

We are left with a chain of doomed, heroic actions: Harel Dahan's collapse in the well, followed by the rescue attempts of his father and of Rivas. It should never have happened. But let's face it. We all want the debris of our civilized lives to be removed from our sight as quickly as possible. No one wants to look at - or smell - garbage. What happens to it after it's removed is someone else's business.

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July 1, 2009

 

Cavalcade of Risk #81 is posted at Jaan Sidorov's Disease Management Care blog. Check it out, covered topics include health care, information technology, personal risk, market risk and more.

Confined space - three sanitation workers died when they were overcome by hydrogen sulfide gas in an 18 foot hole at Regal Recycling Company in Queens. The deceased included a father and son. The three were draining waste from the hole when one fell in and was overcome. As is so often the case in confined space deaths and trench deaths, his would-be-rescuers also became victims. OSHA: Confined Space

Insurance industry - According to the ISO and the Property Casualty Insurers of America, the first quarter of 2009 was the worst on record for the property casualty industry. Of course, it should be noted that records only go back to 1986, but since then, this is the industry's worst net loss - some $1.3 billion - and its worst net written premium growth. Net written premiums dropped $4 billion, or 3.6%, in the first three months of 2009 from $110.4 billion in the first three months of 2008.

Independent contractor vs employee - Roberto Ceniceros of Business Insurance tells us that 8 attorneys general -- from Iowa, Kentucky, Missouri, Montana, New Jersey, Ohio, Rhode Island, and Vermont -- have expressed their concern to FedEx about potential misclassification of workers. We've blogged on this issue numerous times - here are a few past posts related to the new administration , shareholders , NH, CA, CT, federal courts, and MA.

OSHA - Acting Assistant Secretary of Labor for OSHA and erstwhile blogger Jordan Barab recently outlined key challenges that OSHA is addressing and urged safety professionals to get involved when he spoke before a group from American Society of Safety Engineers (ASSE). He emphasized that workers will have a voice and that " ...unions and safety professionals like you will have a seat at the table." Some of the priorities include developing a Severe Violators Program, addressing critical problems with construction fatalities and injuries, and developing a National Emphasis Program (NEP) for the chemical industry.

Hazmat - Training programs and tools developed by the Agency for Toxic Substances and Disease Registry (ATSDR) to help communities develop sound, evidence-based assumptions in preparing for hazardous materials (HazMat) emergencies and disasters: HazMat Emergency Preparedness Training and Tools for Responders

Arc Flash - Safety Daily Advisor tells us that more than 2,000 workers a year are treated for severe burn injuries from arc flash, a short circuit through the air. In a follow-up post, they discuss arc flash prevention and related safe work practices.

Disability - What's your PDQ? Find out now.


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