April 2011 Archives

April 28, 2011

 

Don Taylor, Aaron Carroll, and Austin Frakt of the Incidental Economist have just posted the "Spring Has Sprung and Mud Still Flung" Edition of Health Wonk Review - run, don't walk, to get your biweekly dose of health wonkery!

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April 28, 2011

 

Today is the annual day devoted to memorializing all those who died at work and honoring their memory by committing to work for safer conditions for the living. April 28 was chosen because it is the anniversary of the Occupational Safety and Health Administration and the day of a similar remembrance in Canada.

Each year, to coincide with this day, the AFL-CIO issues
Death on the Job - The Toll of Neglect (PDF) - A National and State-By-State Profile of Worker Safety And Health In the United States. This is the 20th Edition. It offers a detailed breakdown - here is a brief into:

In 2009 (the latest figures available), 4,340 workers were killed on the job--an average of 12 workers a day--and an estimated 50,000 died of occupational diseases. More than 4.1 million workplace injuries and illnesses were reported in private and state and local workplaces. But the report says the 4.1 million "understates the problem," and the actual number is more likely 8 million to 12 million.

The safety report estimates that since the OSH Act become law 40 years ago tomorrow, it has saved an estimated 431,000 lives. The nation's two mining laws, the 42-year-old Coal Mine Health and Safety Act and the 34-year-old Mine Safety and Health Act, have saved thousands more.

Last year's string of major workplace tragedies, however, shows the desperate need for stronger safety and health rules coupled with tougher enforcement. Those disasters included the Upper Big Branch (W.Va.) coal mine explosion that killed 29 miners, an explosion at the Kleen Energy plant in Middletown, Conn., that killed six workers, another at the Tesoro Refinery in Washington State that killed seven workers and the BP/Deepwater Horizon Gulf Coast oil rig explosion that killed 11 and caused a massive environmental and economic disaster. Says the report:

The nation must renew the commitment to protect workers from injury, disease and death and make this a high priority. Employers must meet their responsibilities to protect workers and be held accountable if they put workers in danger. Only then can the promise of safe jobs for all of America's workers be fulfilled.

The number of workers killed on the job fell in 2009 and the rate of on-the-job deaths dropped, 3.3 per 100,000 workers, down from 3.7 per 100,000 workers in 2008. But the U.S. Bureau of Labor Statistics says the economy was a major factor as the recession resulted in declines in hours worked, particularly in construction and other industries that historically have experienced large numbers of fatalities.

A state-by-state breakdown of job deaths and injuries in "Death on the Job" finds that Montana led the country with the highest rate of worker fatalities in 2009, with Louisiana, North Dakota, Wyoming and Nebraska following close behind. The report also finds that Latino workers continue to be at increased risk of dying on the job, with a fatality rate of 3.7 per 100,000 workers in fiscal year (FY) 2009.
(More at AFL-CIO)

For more on Worker Memorial day events:
AFL-CIO - about and 2011 events & resources
Weekly Toll
Statement By John Howard, M.D., Director, National Institute For Occupational Safety And Health (NIOSH)
Workers' Memorial Day * 28 April on Facebook

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April 27, 2011

 

Edwin Graning drove a van for the Capital Area Transportation System (CARTS), which serves the public in the communities surrounding Austin, Texas. He is also an ordained minister. He was sent to pick up two women and deliver them to the Planned Parenthood office in Austin. He was "concerned" that the customers were going to Planned Parenthood for an abortion, so he called his supervisor and told her that in good conscience, he could not carry out the job. He was instructed to return to the garage, where he was promptly terminated for this refusal to follow orders.

Graning, supported by lawyers from the American Center for Law and Justice, alleged a violation of the Civil Rights Act of 1964. (Goodness, quite a bit of irony in that!) He sued his employer for discrimination based upon religious beliefs. In the lawsuit, he sought reinstatement with backpay, payment for his pain, suffering and emotional distress.

Surely, there is no basis in the law for this claim. Surely, Graning is the one who should be sued. Then again, this is the Lone Star state that some would transform into a sovereign nation.

Unsettling Settlement
Lawyers for CART advised them to settle. Blanco County Commissioner Paul Granberg said that the attorneys "advised the board that it would cost a lot more in attorney fees than it would cost to settle." So they wrote a check to Graning for $21,000. Is there any such thing as principle in law these days? Did CART's attorneys even consider doing what is right and just?

CART, which did nothing wrong, has changed its hiring procedures, to prevent a recurrence of this ludicrous situation. David Marsh, CART general manager, said officials have begun making it clear when drivers are hired "that we have a job to do and we don't decide what destinations are." Boy, that must be a revelation (no pun intended) to people applying for jobs as drivers.

Graning has been amply rewarded for his discriminatory and prejudice-laden act. He had no way of knowing why the customers were going to Planned Parenthood, which offers a wide range of health services, by no means limited to abortion. He was represented in this crackpot lawsuit by attorney Thomas Brandon, Junior, of counsel to Whitaker, Chalk, Swindle & Sawyer. Chalk it up as a Swindle, indeed.


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April 26, 2011

 

Kudos to the American Society of Safety Engineers (ASSE), whose 32,000 members will be celebrating the organization's 100 year mark during the annual North American Occupational Health & safety Week (or NAOSH week, for short), which runs from May 1 to May 7. Annually, ASSE teams up with the Canadian Society of Safety Engineering (CSSE) in the first week of May to raise public awareness about safety.

Here's a few of the resources that are available

NAOSH Week Toolkit
Safety Through the Decades chart
May 4 - Occupational Health and Safety Professional Day

ASSE's 100th Anniversary

ASSE's 100th Anniversary from jon schwerman on Vimeo.


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April 20, 2011

 

Risk roundup - Check out this week's Cavalcade of Risk.

Americans with Disabilities - This week's must-read is Dan Reynold's essay in Risk & Insurance: Disability in the Second Act. He says, "... it's not that the amended act, which goes into effect on May 24, represents a new game. It's that the amended act has returned the ADA to its original, intended scope." The article offers advice for employers to prepare for the changes.

OSHA gets tough on distracted driving - If your employees are texting while driving, the stakes just got higher. Jon Gelman posts about OSHA's plan to fine employers for distracted driving accidents. This is part of OSHA's initiative to reduce transportation accidents, the top cause of worker fatalities. Gelman says, "OSHA will investigate motor vehicle accidents, including cell phone records, and will issue citations and fine employers where an accident involved texting while driving. While OSHA has jurisdiction over employers, and not employees, it hopes to encourage all employers to declare motor vehicles a "text free zone." More information and resources at the OSHA Distracted Driving page.

Fraud - to paraphrase the common horror film trope, "the fraud is coming from inside the house. When people refer to workers comp fraud, more often than not they are talking about employees. But as we've noted many times, employer fraud such as misclassification, is also a huge and costly problem. There are other players too - such as doctor mills, dishonest agents, and this week, Roberto Ceniceros points to a fairly egregious example of TPA adjuster fraud.

Limits on comp for PTSD? - SafetyNewsAlert talks about legislative efforts to curb permanent workers' comp coverage for mental distress. A bill that is currently under review in Maine is drawing opposition from first responders. Here's more on the proposed Maine legislation.

Dangerous technologies - In the new and emerging health risks department, we bring you Facebook Depression. Add this to the many other emerging technology-related maladies: Blackberry Thumb, Cell Phone Elbow, IPod Ear.

News briefs

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April 19, 2011

 

Last September we blogged the sorry saga of Illinois trooper Matt Mitchell. He was heading toward an accident scene, siren blazing, texting his girlfriend and weaving in and out of traffic at a mind-boggling 126 miles per hour. (There was no urgency, as other troopers were already at the scene.) He crossed the median and slammed into a car coming the other way, killing teenage sisters Kelli and Jessica Uhl. Three days after pleading guilty to criminal charges, he filed for workers comp benefits. We expected that he would be able to collect; after all, comp is no fault and Mitchell was certainly in the "course and scope of employment."

We guessed wrong. An arbitrator found him ineligible, saying he neglected his duties as a trooper by taking "unjustifiable" risks. He was ineligible, in effect, because he knowingly and willfully put himself and others at risk. Mitchell is appealing the arbitrator's decision.

Carved in Stone
In an effort to make sure that the ugly circumstances of this incident are not repeated, the Illinois senate recently passed a bill (S 1147) denying any workers comp claim for injuries or death incurred while committing a crime, with crime defined as "a forcible felony, aggravated driving under the influence, or reckless homicide that resulted in the death or injury of another."

It's not unusual for a legislature to fashion ad hoc solutions to very specific situations. Prior to Matt Mitchell, there would have been little if any support for this particular bill. But once the possibility arose that Mitchell might actually be able to collect comp, the legislature was motivated to change the statute. Usually judges and arbitrators act with some discretion. In these egregious circumstances, the legislature wants to make its intent crystal clear.

The bill requires a conviction; on the other hand, acquittal or dismissal of the charges will not create a presumption that the claim is compensable.

As for Mitchell, the former trooper has left the state and now resides in New Jersey. Perhaps his dreams are troubled by images from that fateful day, when the dreams of two young sisters were obliterated by his negligence. He probably still experiences difficulty with his damaged legs, but one thing now appears fairly certain: there will be no indemnity checks in the mail to ease the pain of his work-related but non-compensable injuries.

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April 18, 2011

 

The NCCI Annual Issues Report is out and it is available as an online flipbook, you can download each article in PDF, or you can request a hard copy.

Most who work in the industry realize the significance of these reports but for employers, a brief side note is in order. NCCI stands for the National Council on Compensation Insurance, Inc., a rating and data collection bureau specializing in workers' compensation. because NCCI manages the nation's largest database of workers compensation insurance information, it is in authoritative position to analyze industry trends and upcoming legislation, to offer insurance rate recommendations, and to provide a variety of services and tools to a variety of constituencies, including state insurance bureaus, insurers, insureds, the media and others with an interest in workers comp.

The Issues Report provides an industry snapshot of where we've been, along with some trending and analysis that point to where we are likely heading. While all the articles have merit, for industry financial trending we point you to these three cornerstone documents:

While the property casualty market is generally positive and has performed better than most other sectors during the economic downturn, the same cannot be said for the segment of the market that is workers compensation.

The workers compensation combined ratio continues in an upward direction. This is never good. The combined ratio is a barometer of an insurer's profitability. It indicates how much an insurer pays out for each dollar it takes in (incurred losses + expenses ÷ earned premium). For most businesses, it's a problem if you pay out more than you have coming in, but for insurers, investment income on reserves (money held for claims costs) is also a significant component in overall profitability. So an insurer can still realize a profit even if it pays out more in losses than it takes in when investment income is factored in.

Hartwig says that in 2010, the combined ratio is approaching 115. To put this in some historical perspective, the combined ratio at the peak of the crisis in 2001 was 122% percent, and the historic low in recent years was 93% in 2005. In 2009, we saw about 110%, the the worst combined ratio since 2003.

Other significant issues:

  • Investment gains associated with workers compensation have seen some improvements, but are still on the low side.
  • Workers comp written premium eroded significantly as jobs were shed, and although the employment situation is leveling off, it is hardly booming. It's expected that employment may be fairly flat through 2011.
  • Medical inflation has slowed but medical costs are still on the increase.
  • Uncertainty abounds: about the economy, about the direction of healthcare, about bank & housing market, about financial reform. Plus, there is a broader regulatory environment with OSHA and DOL, and there is policy uncertainty given the volatile political environment.

The pressure is on and the challenge for insurers is clear: the only way to make money under current conditions is through rigorous underwriting and tight expense control. Employers with marginal records may have limited options come renewal time. It's always a good idea for employers to control losses, but never as important as in a tight underwriting climate.

Hartwig offers some positives about the employment scenario:

" Last year's stubbornly high unemployment gives the misimpression that no progress has been made in reducing joblessness. In reality, as shown in Exhibit 2, private sector jobs were created every month in 2010, for a total of 1.3 million net new jobs. While job creation so far is at a pace too slow to bring down the overall jobless rate, it remains an extraordinary reversal from the hemorrhaging of jobs and associated payrolls in the two prior years. At the height of the crisis in early 2009, private employers were shedding more than 700,000 jobs per month. Private employers eliminated a staggering 4.7 million jobs in 2009 and 3.8 million in 2007. The unemployment rate remains high today in part because workers, sensing improving labor market conditions, are streaming back into the labor force."

And on payrolls, the basis for premium:

"... The latest data indicates that aggregate wage and salary disbursements have recouped about half of what was lost during the recession. It is quite likely that those losses will be fully recouped by the second half of 2011."

He also offers some perspective on other factors beyond payroll that are eroding written premium:

"The economy will clearly exert a major influence on workers compensation insurers' growth opportunities in 2011 and beyond.Exhibit 3 suggests that other factors are playing an important, if not dominant, role when it comes to explaining the precipitous 29% drop in premium written over the past several years. Workers compensation premium began to fall in early 2006, long before the start of the Great Recession in December 2007. Aggressive pricing, along with the increased popularity of large deductible programs, captives, and self-insurance alternatives have all taken their toll, as have a surge in return premium. The loss of exposure due to the economy was actually one of the more recent contributors to the fall. On net, pricing is likely responsible for about half the decline."

All in all, the NCCI reports reflect negatives that many of us have been seeing or living through, and while the patient is still in guarded condition, there are reasons for cautious optimism.

And don't skip the other articles in the Issues Report just because we did not address them here - there is always good information in these reports!

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April 15, 2011

 

Health Wonkery - At Health Business Blog, David Williams hosts a concise compendium of assorted health policy news at this week's Health Wonk Review. He notes that judging by the quality and quantity of entries received for this edition, it's a wonderful time to be a wonk. These bi-weekly digests are a good way to keep current on healthcare trends - important, given that the medical portion of comp is now accounting for more than half of every claim dollar.

OSHA's residential fall protection upheld in court challenge - the U.S. Court of Appeals for the Seventh Circuit backed OSHA in a court challenge to its directive to require fall protection measures for residential construction. The directive faced a challenge by the National Roofing Contractors Association's (NRCA), which sought to maintain an option for residential construction to use alternative protection measures that bypassed some fall protection requirements. Falls are the number one cause of fatalities in construction. BLS shows that about 40 workers are killed each year as a result of falls from residential roofs. "One-third of those deaths represent Latino workers, who often lack sufficient access to safety information and protections. Latino workers comprise more than one-third of all construction employees."

Trucking & misclassification - The National Conference of Insurance Legislators adopted the Trucking and Messenger Courier Industries Workers' Compensation Insurance Model Act to address employee misclassification. It would establish six standards, and employees that do not meet the standards would be considered employees. There was wide participation in formulating the standards. Parties offering input to the model law included state insurance and workers' comp regulators, American Insurance Association (AIA), American Trucking Associations (ATA), Dart Transit Company, FedEx, International Brotherhood of Teamsters, Leadership Conference on Civil and Human Rights, Messenger Courier Association of America (MCAA), National Council on Compensation Insurance (NCCI), National Employment Law Project (NELP), Property Casualty Insurers Association of America (PCI), and United Parcel Service (UPS).

Social media - at Legal Talk Network, two respected & knowledgeable workers comp attorneys - Alan Pierce and Jon Gelman - join forces in a half hour podcast on Privacy, Clients and Social Media. Even if you aren't an attorney, this is worth a listen. See Gelman's related article: Facebook Becomes a Questionable Friend of Workers' Compensation.

WC rate relief? - MarketScout reports that the commercial market is hardening, with workers comp rates either flat or rising. That is borne out in Massachusetts, where a deal was struck to keep rates flat until 2012. This puts a halt to the long-term trend of rate decreases in MA.

More transparency for OSHA rules process - Celeste Monforton at The Pump Handle calls the Obama administration on the carpet for a lack of transparency in safety rulemaking when it comes to meetings with industry representatives. "The President's own Office of Information and Regulatory Affairs (OIRA) has hosted two meetings with industry representatives who are opposed to an OSHA regulation on crystalline silica, but OIRA fails to disclose these meetings on its website (screenshot 4/11/11.) This is the second time in as many occasions that this OMB office has failed the transparency test when it comes to extra-curricular meetings on OSHA rules. OIRA did the same thing last summer on OSHA's proposed minor change to its injury recording log. Others have identified even more serious infractions by OIRA, but have yet to receive a response from the White House."

Reality TV - While we've been joshing about upcoming fictional portrayals of workers comp on TV, Roberto Ceniceros at Comp Time points us to an interesting case of reality TV catching mining safety violations in action. A spike TV program about West Virginia coal mining - created by the same folks who do the "dangerous jobs" series - revealed violations that prompted citations from Mine Safety and Health Administration inspectors. It's an interesting story - Roberto offers the full scoop complete with links.

Legal matters - At LexisNexis Larson's Spotlight offers another round of Five Recent Cases You Should Know About, with cases spanning the Going and Coming Rule, heat-related illness, a COPD claim, and more.

Disability redefined - Complex Care Blog keeps us updated on bionic legs and other miracles that demonstrate the power of the human spirit and technology to overcome the odds.

Kudos to NAIC - National Association of Insurance Commissioners (NAIC) 2010 Annual Report Pillars of Strength offers "a testimony to the fundamental strength of our national system of state-based insurance regulation." NAIC has been actively involved in the Patient Protection and Affordable Care Act, including the creation of Medical Loss Ratios, a rate review process, and working with federal and state authorities to establish health care exchanges. The organization has also been active in financial regulatory reform, including a Solvency Modernization Initiative to update US insurance solvency framework, market regulation, and more. NAIC is also noted for its excellent consumer information and fraud awareness initiatives. This includes a great insurance primer for for owners of small companies and home-based businesses: Insure U for Small Business.

Of note - HR Daily Advisor features a great article on six ways attorneys will attack your investigation - not workers comp specific, but a good backgrounder of any potentially litigious employment situation.

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April 13, 2011

 

In the ever-useful Oregon rankings, Montana has the dubious distinction of being the second most expensive state for workers compensation. Alaska, with its vast spaces and compelling views of the former Soviet Union, is number one. Gov. Brian Schweitzer recently signed HB 334, a bill designed to lower the mountainous rates. Only time will tell...

It's always interesting to see how a state legislature tackles high comp costs. In Montana, they set out to take a balanced approach, narrowing eligibility but enhancing benefits. While the legislators are patting themselves on the back for achieving their goals, unions have complained that too much of the cost reduction comes at the expense of workers. It usually does.

Here's a glimpse of the bill in action, trying to reduce employer liability for specific exposures:

(2) An injury does not arise out of and in the course of employment when the employee is:

(a) on a paid or unpaid break, is not at a worksite of the employer, and is not performing any specific tasks for the employer during the break; or

(b) engaged in a social or recreational activity, regardless of whether the employer pays for any portion of the activity. The exclusion from coverage of this subsection (2)(b) does not apply to an employee who, at the time of injury, is on paid time while participating in a social or recreational activity or whose presence at the activity is required or requested by the employer. For the purposes of this subsection (2)(b), "requested" means the employer asked the employee to assume duties for the activity so that the employee's presence is not completely voluntary and optional and the injury occurred in the performance of those duties.

At times the revised law reads like a monologue, with legislators trying to anticipate the circumstances of an injury and limiting the comp system in its ability to award benefits.

Rate Pain
The Oregon study illustrates some of the exorbitant (2008) rates paid by Montana employers. For a point of reference, we compare these rates (per $100 of payroll) to those in Massachusetts. (The MA rates are in brackets):

Carpentry shop (2802) $17.85 [$4.53]
Plumbing NOC (5183) $10.44 [$4.10]
Carpentry NOC (5403) $26.91 [$11.80]
Clerical (8810) $0.85 [$0.13]

Massachusetts employers, in a state with six times the population of Montana, spend about $650 million for comp premiums. Montana's current tab - $400 million - is expected to drop about 25 percent as a result of the new law. Even if you reduce the above Montana rates by 25 percent, employers are still confronted with big premium bills. Mount Comp might be substantially lower than it was, but it's still a grueling climb.

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April 12, 2011

 

Events at the damaged Fukushima plant continue to deteriorate. Today we learn that Japan's nuclear regulatory agency has raised the Fukushima accident rating level to a 7, the most serious level. Chernobyl is the only other nuclear accident to have been rated a Level 7 event.

U.S. authorities and the news media have been quick to try to stem any public panic about the levels of radiation exposure here in the U.S. This is more than just spin - while many aren't aware of it, there is a national network of radiation monitors called Radnet. It is operated by the Environmental Protection Agency and includes at least 200 monitoring stations spread across the country. It measures radioactive substances in air, precipitation, drinking water, and milk. Reports are that only trace amounts of radiation have surfaced here in the U.S.

People may still have questions and heightened anxiety as the news plays out in alarming daily headlines. Many employees may also have questions about potential exposures related to their specific jobs. Employers would do well to stay informed and be prepared to address concerns.

For example, employees who travel for their jobs may have questions about exposure, particularity if work takes them to Japan or Southeast Asia. Employees in manufacturing firms that get parts or cargo from Japan may have concerns. Airline personnel, mail carriers, and package handlers may have concerns. People who work in or live near domestic nuclear facilities may have concerns.

OSHA and NIOSH have paired up to produce resources for both employers and workers. These include an OSHA resource on Radiation Dispersal from Japan and the Effect on U.S. Workers and a NIOSH page on worker information, which specifically addresses some of the concerns posed above.

Here are some additional resources:


Everyone reacts to news of national and international crises differently. With proper information and facts, most people should be able to put concerns in perspective. But for whatever reason, some people "get stuck" in worry and anxiety mode. Sometimes that can be the result of prior post-traumatic stress, or related to a particular health concern. Be sensitive to the potential for high anxiety - if information and facts don't relieve the stress, it may be a good time for a referral to your organization's EAP.

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April 11, 2011

 

We have long puzzled over a peculiar and cruel stipulation in Virginia's workers comp statute that denies coverage to workers with brain injuries, where the injury had no witnesses and the injured could not testify on their own behalf. We first encountered the issue with a trucker named Arthur Pierce, who was found unconscious beside his truck with multiple skull fractures, a sinus facture and head trauma. Had Pierce been found dead at the scene, the injury would have been compensable. But because survived the accident only to die later at a hospital, the system invoked the rule that the claimant must provide direct testimony.

In their denial of benefits, the workers comp commission wrote:

The circumstances surrounding the claimant's injury and death are tragic, and we are certainly sympathetic to the loss his family members have experienced. We are also mindful of the difficulties in obtaining and introducing sufficient evidence to support those claims...It would be purely speculative to infer that the only rationale (for the accident) was a workplace risk.

Purely speculative?. Sure, he might have been knocked off the truck by space aliens (which, to my mind, would still be compensable as he clearly was in the course and scope of employment).

Ever-So-Gradual Justice
We are pleased to report that the Virginia legislature - through a unanimous vote in both house and senate - has corrected the statute, which Governor Bob McDonnell has signed into law. Title 65 of the Code of Virginia now reads:

In any claim for compensation where the employee is physically or mentally unable to testify as confirmed by competent medical evidence and where there is unrebutted prima facie evidence that indicates the injury was work-related, it should be presumed in the absence of a preponderance of evidence to the contrary that the injury was work related.

It's too late for Claire Pierce, Arthur's widow, to benefit from a law that she diligently lobbied for. And while the Virginia legislature would never thumb its nose at the comp board, it would have been nice to call Title 65 the "Arthur Pierce Provision." This grotesque loophole has finally been closed. Unwitnessed brain injuries may now be compensable. It appears to be a no-brainer, but it took the brains of Virginia a rather long time to reach this just conclusion.

Thanks to Workcompcentral(subscription required) for the heads up on this item.

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April 7, 2011

 

Russell Chatwood, our riskmeister from New Zealand (... or as some have put it "down under the Down Under") is our host for this week's edition of the 128th Cavalcade of Risk. It's a substantive issue -- and don't miss the oddball features.

System spillover - In a recent column in Risk & Insurance, Peter Rousmaniere takes a look at workers' comp and finds leaks in the system. He talks about how many nonoccupational disability and health problems find their way into the comp system, while many work injuries leave the work comp system to roost elsewhere.

Federal shutdown? - If tomorrow brings a government shutdown, the Federal Times reports that some 800,000 federal employees will be furloughed, and discusses the likely impact. Federal Times is a news and information service for Federal Managers, so might be a good source to follow along if worse comes to worst. Related: CNN also has a government shutdown FAQ.

One year later - EHS Today takes a look back at the Big Branch mining disaster on the one year anniversary. Reporter Ken Ward of the WV Gazette raises the questions that linger about Massey's mine disaster on his Coal Tattoo blog, and points us to a tribute to the miners composed by one of his colleagues. Also see Faces of the Mine, a moving community-driven, interactive memorial for those affected by the Upper Big Branch mine disaster.

Rhabdomyolysis & athletes - If athletes are among your employees, you may want to note that the recent post about rhabdomyolysis that ran in the L.A. Times health blog, Booster Shots. This is a type of overexertion illness in which muscle tissue is so overworked it breaks down and floods the bloodstream with a protein that can impair kidney function.

Medicare: FAQs on ACOs - the folks at HealthLawProf Blog have compiled some good resources on Accountable Care Organizations: Your ACO Primer Links and Getting up to speed on ACOs.

Lights, camera, action... - Bet you thought our item about a sitcom called Workers Comp was an early April Fool's joke ... nope, here is a news update: 'Sopranos' actor added to cast of Bradenton-shot TV show. The show is described as a "comedy about zany employees dealing with weird insurance claims." Get your popcorn ready.

Briefs from the Blogosphere

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April 6, 2011

 

Nearly a year ago we blogged the issue of a medical fee schedule in Maine. The legislature mandated the creation of a fee schedule way back in 1991. Twenty years later, there have been a few reports, a few changes in the membership of the committee trying to establish the fee schedule and, to date, no fee schedule. We now wonder whether neighboring New Hampshire will follow Maine's example, climbing a slippery mountain trail into a deep fog.

New Hampshire, like Maine, has a two tiered system: in the first tier are managed care networks, which negotiate fees with doctors and hospitals. Everyone in the second tier - those outside the networks, the self-insured, smaller carriers, etc. - are stuck with paying the "usual and customary fees." Medical costs account for 71% of total costs - a truly staggering number when compared to the national average of 58%.

Dr. Gary Woods, an orthopedic surgeon and chair of the NH Workers Comp Advisory Council, thinks that the high percentage of medicals is the result of good medical care, combined with a strong return-to-work focus: in other words, indemnity is relatively low because workers are not out of work very long. Well, doc, show me the numbers. I expect that New Hampshire - ranked 14th highest among states for comp costs - is spending too much on indemnity and way too much on medical services. It's no bargain for anyone.

The Fix is (Not Quite)) In
The New Hampshire legislature is contemplating SB 71, which would impose a fee schedule on medical services. The bill proposes that hospitals be reimbursed at a uniform conversion rate of up to 150% of Medicare rates. While somewhat on the high side for such linked payments, it would probably bring down the overall costs of medical services in the state.

SB 71 is going nowhere, at least for the moment. The bill will remain in committee while the lawmakers appoint a study group to review the proposal and make further recommendations.

Ultimately, the details of the fee schedule will be in the hands of the comp advisory council, of which Dr. Woods is the chair. Hmm. This brings to mind the stalemate in Maine, where Dr. Paul Dionne was for a long time chair of the committee responsible for implementing the fee schedule. The group just couldn't come up with a number that would satisfy the doctors. (How would a doctor define a fair fee schedule? "Usual and customary." ) Last June, facing allegations of a conflict of interest, Dr. Dionne finally stepped aside.

Perhaps the good folks in New Hampshire could speed up the fee schedule project by asking Dr. Woods to step aside. No doctor is going to embrace a cut in reimbursement rates. Dr. Woods would have a choice: he could sit on the sidelines and watch the committee hash out the details, or, with his health and well-being in mind, he could put on his hiking boots and climb one of the Presidentials. I recommend the latter, even if the peak is momentarily obscured by the fog.

Thanks to Work Comp Central for the heads up on this issue (subscription required).

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April 5, 2011

 

Remember playing those "what's wrong with this picture" games in activity books when you were a kid? Well WorkSafe BC has adapted the concept as a safety tool. Every issue of WorkSafe Magazine includes a photo that has been staged to show at least six hazards or dangerous work habits - you can interact with the photo to position pushpins on identified hazards, describe the hazards, and then submit your response to WorkSafeBC for a possible prize (although it's likely that only B.C. residents are eligible). In each issue, they include the winning entry from the last issue, along with responses from other readers. Neat.

One of the really cool and useful things is that they keep an archive of all past photos online - you can either take the challenge online and then check the answer key, or you can print the photos and the answer keys and use them in safety meetings or toolbox talks.

Here's one example: Can you spot the safety hazards in this commercial kitchen? Note: the image below is only a sample pic - the online interactive version is accessible at Kitchen Safety and here's the commercial kitchen answer key to check your responses.

WorkSafeBC.jpg

Archived "What's wrong with this photo" tools
There's a pretty good array of work scenarios representing a variety of industries. Here are direct links to each:

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April 1, 2011

 

We last encountered Brock Hopkins back in June of 2010, when he had secured workers comp benefits for severe injuries incurred while feeding bears. He was a bit stoned at the time. Russell Kilpatrick, owner of Great Bear Adventures in Montana, contended that Hopkins was a volunteer. Judge Jeremiah Shea found in Hopkins's favor. Now the Supreme Court of Montana has weighed in, finding that Judge Shea got it right.

There were three major issues in determining compensability: whether Hopkins was an employee; whether he was in the course and scope of employment when attacked; and whether his marijuana use precluded payment of benefits.

Hopkins frequently worked in the park, performing minor repairs and, yes, feeding the bears.The pay was informal, but Kilpatrick would slip him some money now and then. This "exchange of money for favors" is, well, employment. Thus, Hopkins was an employee, working under the admittedly informal and ad hoc supervision of the laid-back Kilpatrick.

While it is not clear that Kilpatrick wanted the bears fed on the fateful day, he did not tell Hopkins not to feed them. And as Judge Shea deadpanned in his ruling: "...presumably, customers are unwilling to pay cash to see dead and emaciated bears." Hopkins, in other words, was working when he mixed up the feed, set down his marijuana pipe on a fence post and entered the enclosure.

Finally, the judge opined that smoking marijuana while working among bears was "ill-advised to say the least and mind-bogglingly stupid to say the most," being high was not a factor in the attack. Red, the attacking bear, was an "equal opportunity mauler" and likely would have gone after anyone, stoned or sober.

So Brock Hopkins, a loser by most accounts, wins in the courts. He collects indemnity for his (considerable) troubles and has all his extensive medical bills paid through the Montana uninsured fund. Kilpatrick's legal woes continue, as he did not carry workers comp insurance for the employees he didn't think he had. So much for clear thinking in the good mountain air of Montana.


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