November 2010 Archives

November 30, 2010

 

On a recent drive through rural Ohio, I was startled by an unusual image: a horse and buggy crossing over the interstate on a bridge. Later, at a rest stop, a long line of Amish folks, dressed as if from central casting, stood patiently in line at the Burger King. When they departed, I went up to the counter and asked what they had ordered. "Burgers and biscuits, mostly." The Amish get biscuits from Burger King?

This memory came to mind when reading at Philly.com of a clash involving roofers in the western suburbs of Philadelphia. It seems that the Amish have an unfair advantage when bidding for roofing jobs against non-Amish contractors. The latter must factor in the costs of social security and workers compensation when bidding for work - and as comp practitioners know, the cost of comp for roofers is, well, through the roof. Under federal law, the Amish are exempt from social security; their religion rejects any form of insurance other than Divine. Under Pennsylvania law, they may opt out of workers compensation as well (though some Amish contractors do not). When you factor the costs of these coverages into the work, it's no surprise that Amish bids are routinely 30% or more lower than non-exempt contractors.

In the good times (remember those?), these differences did not matter much, as there was plenty of work for everyone. Today, however, there is a hard-scrabble search for work. Non-Amish contractors complain that the Amish have an unfair competitive advantage.

Lifestyles of the Not-So-Rich and Famous
The Amish also have a lifestyle advantage. They reject many aspects of modern culture. Many, though not all, refuse to operate machinery. Most do not use electricity. They do not have to worry about flat screened TVs, cable, iPods, iPads, cell phones, etc. They cling to a simple lifestyle that explicitly turns its back on what most people think is essential and necessary.

This brings to mind one more image during my brief encounter with the Amish in Ohio. As I was entering the rest stop, an Amish family was exiting. The father, with his wife a few steps behind, led his six children (their families tend to be large). One of the daughters held the hand of the youngest, a sweet blond 4 year old, who was blind. Bringing up the rear came another daughter, about 16, in a long, plain cotton dress that covered her from neck to ankles, over which she wore big, clunky work boots, laced half way up. Her gaze was indefinite, as if she were oblivious to the prosaic surroundings. She was strikingly beautiful.

I could not help but wonder whether she would remain with the culture that nurtured her, or whether she would yield as most of us do to the temptations of the beckoning world, a world full of greed and gadgets, where insurance is an absolutely necessity ...and by no means divine.

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November 29, 2010

 

Some of the year's busiest travel days just passed with little event, despite widespread threats of massive disruption in protest of the new screening procedures recently implemented by the Transportation Security Administration (TSA). In response to numerous personal anecdotes about invasive searches, irate consumers planned an Opt-Out Day for November 24, historically the busiest flying day of the year. On that day, those opposed to the new measures were encouraged to opt out of the scanning machines, requesting instead the more time-consuming physical pat-down. But Opt-Out day came and went with little fan-fare or disruption - some reports indicate that about 99% of the passengers opted for the advanced imaging technology screenings over patdowns.

Some think that the public opposition was overblown and overhyped by the media. Public polls continue to show that support for the full-body scanners is strong and that most travelers value protection over privacy (although there was less support for the more invasive pat-downs). In The New York Times, David Carr dissects the false alarm over the TSA, saying that "If a squadron of mad scientists surrounded by supercomputers gathered in a laboratory to try to conjure a single news topic that would blow up large, they could not touch the T.S.A. pat-down story."

From the trenches
Meanwhile, one little discussed aspect of the story is the impact that the new procedures are having on the front line TSA employees themselves, a group of workers who may well have rapidly edged out lawyers and politicians on the scale of reviled professions. In response to public anger, the TSA's union - The American Federation of Government Employees - issued a statement calling for the TSA to provide better protection for employees and more public education.

Steven Frischling, who runs a blog about flying and traveling, took a sampling of TSA employee opinions to get their reaction to the new procedures and their role in the new security measures. Not only did he find that his respondents universally disliked the new procedures, he discovered a severely demoralized and stressed-out work force.

All those responding to Frischling expressed discomfort with the personal nature of the pat-downs. As one explains:

"It is not comfortable to come to work knowing full well that my hands will be feeling another man's private parts, their butt, their inner thigh. Even worse is having to try and feel inside the flab rolls of obese passengers and we seem to get a lot of obese passengers!"
But more than the discomfort with the responsibilities, TSA worker morale seems to be suffering from a heightened level of verbal abuse which is directed at them. They speak of being called everything from molesters to Nazis:
"I served a tour in Afghanistan followed by a tour in Iraq. I have been hardened by war and in the past week I am slowly being broken by the constant diatribe of hateful comments being lobbed at me. While many just see a uniform with gloves feeling them for concealed items I am a person, I am a person who has feelings. I am a person who has served this country. I am a person who wants to continue serving his country. The constant run of hateful comments while I perform my job will break me down faster and harder than anything I encountered while in combat in the Army."
You can get a sense of the intensity of the anger in many of the 800 comments posted to Frischling's article.

While worker turnover has been a persistent problem for the agency, TSA had more recently been reporting some progress on that front. In addition, TSA managed to make great strides in improving its workers compensation program. In a November 2009 story in Risk and Insurance, Melissa Turley writes about the "Cinderella story" of how TSA turned around its workers' comp program, slashing both the number of injuries and lost time. We'll have to see if TSA can tackle this new challenge to worker morale.

If you fly frequently, you will get a front row seat to this evolving drama. There are large issues at play, many of which will be more appropriately addressed in the courts than in the airport screening lines.

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November 22, 2010

 

The GAO has issued an interesting report on the implications for increasing the retirement age. As the American workforce ages (the Insider is all over that one), and as the pressures on retirement funding increase, the various payers are all looking for ways to shift the costs to someone else. Who are the payers? Social Security, SSDI, the states, private insurers and self-insured employers. As the feds tinker with the retirement age, they are very much in the solve one problem, create another mode.

At first glance, it seems pretty simple: to reduce pressure on the social security retirement system, make people work longer. But it's one thing for a white-collar bureaucrat (or consultant!) to work into his or her late 60s, it's something else altogether for modestly educated workers with physically demanding jobs. As the feds slam the door on social security, the door on SSDI flies open. The GAO notes that about 2/3 of those who work report having a job that is physically demanding. In addition, disability rates increase with age, with the result that workers who postpone retirement face the increasing likelihood of becoming disabled. Thus the ever-aging workforce, unable to perform the physically demanding work, may be forced to apply for disability retirement - which, after all, pays better than ordinary social security.

The State of the States
This federal-level debate is taking place parallel to what is happening at the state level, where workers comp systems designed to accommodate retirement at 65 or sooner are confronted with older and older workers. How should workers comp estimate the working life of an older worker? To the degree that state systems curtail benefits of these aging workers, the pressure will build on the federal social security and SSDI systems.

One thing is certain: every payer sits in an isolated silo, doing their best to make someone else cut the checks. Every successful shift in cost creates pressure somewhere else. And at the center of this developing storm sit the aging workers themselves: not necessarily wanting to work, not necessarily wanting to qualify for disability, but suffering the slings and arrows of time, with nothing much saved for retirement and an increasingly ominous future close at hand.

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November 18, 2010

 

As we head into winter, alas, let's cast a fond look back at the balmy days of summer, when a dish of ice cream is never far from our thoughts. We read in the Vancouver Sun of a workers comp claim related to scooping. An unnamed convenience store employee served ice cream in the spring of 2009. She had a pre-existing shoulder problem, for which she had received cortisone shots. During one two-day period, she scooped $1,500 worth of ice cream cones. The pain in her shoulder flared up, to the point where she had to quit her job.

She had surgery on her shoulder and filed a workers comp claim, which the provincial board initially denied. She prevailed on appeal. Despite the pre-existing condition, her work certainly aggravated her shoulder through repeated scooping, bending and reaching, presumably with her wrist at an awkward angle. Scooping ice cream is not a risk-free endeavor.

Ergonomics at Ben & Jerry's
I called Ben & Jerry's (make mine Cherries Garcia), to learn about their approach to safety. They are well aware of the potential problems. Their employees are taught the mechanics of scooping: aligning themselves in front of the containers; using arm muscles (as opposed to the wrist); taking frequent breaks with stretching. Several of the folks I talked to in corporate began as scoopers in a local store, so their awareness came from personal experience. This is no surprise, given the proactive corporate culture.

The next time you indulge in a frozen treat, check out the mechanics of the scooper: do they move right in front of the bucket or do they reach across? Are the buckets placed so that reaching can be minimized? How well is the arm aligned? Is the wrist bent? Is the ice cream really hard and resistant?

Ok, I know, I sound like a killjoy, but once you look at the world through an ergonomist's eyes, there is no turning back. By all means indulge (moderately) in your pleasures, but try to do no harm.

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November 17, 2010

 

For your biweekly risk roundup, check out the Thanksgiving Cavalcade Of Risk posted by Louise at Colorado Health Insurance Insider. Louise always does a great job curating the carnivals.

Is claim frequency on the upswing? - At Comp Time, Roberto Ceniceros says that claims data gathered by Liberty Mutual Group shows frequency trending up.

Another extension for Medicare Secondary Payer requirements - National Underwriter reports that The Centers for Medicare and Medicaid Services has agreed to delay certain mandatory reporting requirements for workers' compensation cases under the Medicare Secondary Payer law until January 2012. These requirements had previously been extended to January 2011. The exemption is for liability claims that do not involve on-going medical responsibility, according to officials at the American Insurance Association.

Wheelchair checklist - at Complex Care Blog, Zack Craft offers checklist for wheelchair accessibility in the home for adjusters, nurse case managers and others who are involved in managing the care of injured workers. It's intended to be used as a starting point for a review at the onset of a claim to to ensure the claimant's needs are met and to minimize costs and legal issues over the life of the claim.

10 years of preventing needlestick injuries - Over at The Pump Handle, Liz Borkowski informs us that it is the 10th anniversary of the Needlestick Safety and Prevention Act. Her post includes links to current standards as well as an update of progress since the act's passage.

Collision course At Today's Workplace, Roger Bybee has posted a great article on an issue that is heating up: NFL Collision: Management Control vs. Player Safety. He tackles the issue of chronic brain injuries vs an industry with a culture that has touted its violent collisions as a feature. One interesting aspect that Bybee points out is that as advanced helmets got harder, the collisions became more dangerous, not less.

Cool tool of the week - If you've been frustrated that you can never access American Medical Association studies, research, and news directly, there's some good news. Last week, the AMA announced it will open its 10 years of American Medical News archives to the general public. They say: "It represents a rich resource on issues confronting physicians and trends in medicine. Content includes in-depth reporting on the business and regulatory sides of health care, practice management and hot issues in public health and patient care."

Pigeon poop safety - We admit that pigeon poop is a safety hazard we have never given much thought to, but that doesn't mean it's not an important issue. Safety Daily Advisor recommends proper personal protective equipment to protect workers from exposure to serious conditions, including histoplasmosis and cryptococcosis.

Florida's Sinkhole Belt - OK, it's not comp-related - at least not so far, but Emily Holbrook of Risk Management Monitor has a fascinating post on how Florida sinkhole claims are skyrocketing. "According to a new state report, for the years 2006 through 2010, sinkhole claims have cost Florida property insurers $1.4 billion -- a number that could reach $2 billion by the end of this year." She links to the state report and a video clip that offer more info about this problem which is one of the state's major premium cost drivers. Yikes. (We confess that we have been inordinately fascinated with sinkholes since seeing reports of this Guatemalan monster last spring.)

Tweet this - Claire Wilkinson of III's Insurance Industry Blog posts about a recent research report that notes a big uptick in Fortune-500 insurers who are using Twitter - up from 13 in 2009 to 20 in 2010. That's either a sign that Twitter is here to stay or that it has jumped the shark, you be the judge. If you aren't on Twitter yet, what are you waiting for? The following video is more than a year old so already outdated, but it is elucidating about the speed of change in the way we are communicating.


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November 15, 2010

 

Last week, our nation honored its veterans for service rendered to the country. Although belatedly, we join in offering thanks. One could make the case that our nation's gratitude should be a 365-day-a-year tribute rather than largely confined to a single celebratory day. On returning home, many veterans face an enormous hurdle, the day-in-day-out battle of finding employment, a formidable challenge for any vet but made even more difficult in the current economy. Beyond an expression of appreciation, there are many good reasons why employers should hire vets. The U.S. Department of Labor has collaborated with Office of Disability Employment Policy (ODEP), the Veterans' Employment and Training Service (VETS), and other federal agencies to offer a Step-by-Step Employer Toolkit for Hiring Veterans.

In addition to their military service, there is another debt that we owe to our vets, particularly those who have been wounded physically or psychologically. It is one of life's great ironies that war, which is responsible for so much death and destruction, is also a catalyst for the advance of medicine and medical technologies.

Just as weapons become more sophisticated, so too do the medical technologies designed treat the wounds that these weapons exact. From wars in ancient times to the present, civilian medicine has been advanced by battlefield medicine, first practiced on wounded warriors.

advanced-prosthetics.jpg

Wired Magazine has been one of the ongoing sources we turn to get our fix about battlefield advances in medical technology. A recent article - Military's Freakiest Medical Projects - is a fascinating case in point, highlighting advances in prosthetic limbs, skin grafts, burn repair, bone cement, suspended animation, and more. The article's intro explains that "Some of the Pentagon's extreme medical innovations have already debuted in the war zone. And with myriad applications outside of combat, these advances in military medicine mean that revolutionary changes for civilian care aren't far behind."

Another recent article - Exoskeletons, Robo Rats and Synthetic Skin: The Pentagon's Cyborg Army - focuses on technologies that foster recovery, such as neurally controlled prosthetics, or that enhance performance, such as wearable exoskeletons that amplify amplify troop strength and endurance.

As exciting as these developments are, not all effective treatments rely on advanced technology - some are reassuringly "old-school." A case in point is this heartwarming story about vets with PTSD who train service dogs as companions for vets in wheelchairs. The dogs do double duty, serving as therapy dogs for those with PTSD while they are being trained, and later as helper dogs for those confined in wheelchairs. You can learn more about this most excellent program at Paws for Purple Hearts.

And if you doubt the healing and restorative power of dogs, we leave you with this evidence: an incredible compilation of clips of dogs welcoming home soldiers. One warning: have a box of tissues nearby!

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November 12, 2010

 

The Veteran's day version of Health Wonk Review is up. We apologize for our delay in linking to this ever-valuable forum for health-related issues. One of the links involves Jon Morgan's experience with long-term back pain: check out his blog on his experience with spondylosis. He regrets not beginning an exercise regimen much earlier in his life. May his word to the wise prove sufficient.

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November 8, 2010

 

On February 19, 2008, Rachel Moltner, a 76 year old New Yorker, went into the Starbucks at 80th Street and York Avenue and ordered a "venti'-sized" tea. Her tea was served to her double-cupped and lidded. She took it back to a table and tried to remove the lid to add sugar. She had difficulty with the lid, and in the course of her attempts to pry it off, the tea spilled onto her left leg and foot. Moltner suffered severe enough burns to require a skin graft. To compound her woes, during her hospital stay she suffered from bed sores and a fractured sacrum and herniated discs caused by a fall out of bed.

Moltner sued Starbucks. In a follow up to the suit, Starbucks asked how much Moltner was seeking, to which she responded, "not more than $3 million." (Even at Starbuck's prices, that's a lot of tea...)

The suit accused Starbucks of serving tea that was too hot and that the serving in a doubled cup was inherently dangerous. She also said Starbucks should have warned her the tea could spill.

The appeals court rejected her case, saying "double-cupping is a method well known in the industry as a way of preventing a cup of hot tea from burning one's hand." Hm. Mitigate one risk, expose another...

Moltner also lost a subsequent appeal, based upon Starbuck's slow response to her initial suit.

Tea Time
David Jaroslawicz, a lawyer for Moltner, said Tuesday's ruling probably ends his client's case.

"The other side presented an old lady knocking over her tea," he said. "The case was really about that Starbucks has a directive to employees that you should not double-cup because it changes the center of gravity and can cause the cup to tip over."

Note to engineers: Does double cupping really change the center of gravity?

Note to risk managers: Double cup to spare the hand or single cup for steadiness?

Better yet, how about taking your afternoon cuppa in a big white reusable porcelain mug? Still risky, to be sure, but slowing down is the best way to prevent bad things from happening, and slowing down is what tea used to be about.

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November 3, 2010

 

This week's Cavalcade or Risk is posted by Ironman at Political Calculations. This biweeky roundup of risk posts is a sampling or "carnival" or topic-related posts. Ironman grades the entries for topicality, quality and readability - check it out.

Election results - Washington's Initiative 1082 to privatize workers' comp was soundly defeated last night, as about 58% of the voters opted to keep the system that has operated since 1911 in place. Obviously, this is a disappointment to private insurers and independent agents that hoped to open the state.

In Louisiana, it looks like Amendment 9 passed, but news reports we found are still vague. This change would require that claims would have to be re-argued before a panel of at least five appeals court judges before an agency's decision could be reversed or changed.

In Arizona, Oklahoma and Colorado, voters cast ballots on constitutional amendments that would bar healthcare reform's mandate that individuals buy insurance. Opt-out measures were passed in Oklahoma and Arizona, but was defeated in Colorado. Missouri had rejected the mandate in August, but not by a a state constitutional amendment.

At Comp Time, Roberto Ceniceros took a pre-election look at what gubernatorial wins might mean in California and New York. He notes that Jerry Brown was very quiet on the issue of workers compensation in California, but in New York, Andrew Cuomo has employee misclassification on his radar screen. As the state's Attorney General, he recently joined attorneys general from Montana and New Jersey in an intent to sue FedEx.

And as long as we are on politics, it seems like a good time to bring up today's news that the Treasury expects to earn a profit on AIG investments. Overall, despite the controversy, the Troubled Asset Relief Program (TARP) bailout looks as though it is earning a healthy return.

CT Commissioner resigns - somewhat upstaged by yesterday's election brouhaha was news that Connecticut's Insurance Commissioner resigned abruptly. National Underwriter reports that Thomas Sullivan resigns amid pressure over healthcare rate hikes. He faced criticism after approving a 47% rate hike by Anthem BC/BS of CT.

Workers Comp Insider again named to top WC blogs
We were gratified and pleased to be named to 2010 roster of the LexisNexis Top 25 Workers Compensation and Workplace Issues:

"Consistently at the top of the heap when it comes to workers' comp blogs, the Workers' Comp Insider is a rare combination of breadth and depth. Now in its eighth year, the Insider covers comp issues, risk management, business insurance, and workplace health and safety from Anchorage to Miami. It provides in-depth analysis concerning workplace legislation, occupational medicine, and best practices from Maine to Hawaii. It should be in the "favorites" folder of every comp attorney's web browser."
We thank you, our readers, for your continued interest and support. We were happy to see many friends and colleagues on the list as well - we're honored by the company in which we find ourselves. Be sure to check out some of the other fine blogs on the list. Also, if you haven't discovered the gem that is the LexisNexis Workers' Compensation Law Community, we urge you to check that out, too.

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November 2, 2010

 

In the interests of doing our part to foster good citizenship, we're providing some election day resources to help you with last minute voting preparation and tracking results. While there are only two ballot initiatives involving workers comp that hit our radar (let us know if you are aware of others), electing public officials has a downstream effect on both employers and employees. We've compiled a list of some of our favorite online voting resources.

Google Election Center - or simply enter "vote" into the Google search box.

Facebook Polling Place Locator

Vote 411 is a non-partisan source that offers a polling place finder. You can also select by state to find out about your state ballot and the election rules and process in your state.

Ballot Measures - a database from the National Conference of State Legislators

Guide to state ballot measures - from Stateline.org, a nonprofit, nonpartisan online news site.

Ballotpedia is a free, collaborative, online encyclopedia that focuses on state elections and ballot measures that typically receive less attention.

Open Secrets is an independent research tool that tracks the influence of money on U.S. politics. The site sheds light on who is paying to finance a candidate or an issue.

Election Forecasts: Five Thirty Eight - we like to follow statistician Nate Silver, who achieved acclaim in the 2008 election for correctly predicting the winner of 49 of the 50 states and all 35 Senate races that year.

Election Polls: Real Clear Politics - is an aggregation of the latest polls from various sources, which can be sorted by Senate, House or Governor races.

Watching results
All the major TV news and cable stations and their online websites will be providing coverage of the election results. Here are a few less obvious resources:

C-Span Politics will provide live election coverage beginning at 7 PM. This is our choice for bipartisan viewing without high drama.

NY Times Election Results will have live updates, including state-by-state and county-by-county maps, and exit polls.

Twitter Vote Report - voters can share and map their experiences and resources with one another. Learn more about how to participate. We're not sure how this will actually play out, but it's a real-time initiative that looks interesting.

Workers Comp on the ballot
Washington - Initiative 1082 would privatize workers comp. The state is one of four in the US that offers workers comp through a government agency. Business groups, insurers and agents support this privatization while attorneys and labor unions oppose it, and local news sources report there is sharp divide among voters. Fact Check Washington reports on the initiative's top funders. You can also find more information at BallotPedia's page on Initiate 1082.

Louisiana - Proposed Amendment No. 9 - Act 1051 of the 2010 Regular Legislative Session
"To provide that, in civil matters only, when a court of appeal is to modify or reverse an administrative agency determination in a workers' compensation claim and one judge dissents, the case shall be reargued before a panel of at least five judges prior to rendition of judgment, and a majority shall concur to render judgment. (Amends Article V, Section 8(B))"

Labor & employment initiatives - Labor and Employment issues - Go to the center column and select "Labor and employment" and then search either "all" or select your state. This will call up any labor and employment related ballot initiatives.

State legislative activity - The Insurance Information Institute tracks many significant state initiatives on their workers compensation page, which is updated several times a year. This is a good resource to bookmark!

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