Lynch Ryan's weblog about workers' compensation, risk management, business insurance, workplace health & safety, occupational medicine, injured workers, insurance webtools & technology and related topics

January 30, 2008

Cavalcade of Risk #44

Silicon Valley Blogger does a superb job hosting this week's Cavalcade of Risk at The Digerati Life. The intro gives a hint of this week's content: The theme of this carnival is risk management. From disruptive physicians, to Indian IPOs and patents, and even baboons, you’ll find quite a diverse set of articles in this carnival that are tied together by the common thread of risk management and the concept of risk. Quite a smorgasbord - makes for some fun reading!

Posted by Julie Ferguson at 1:29 PM Link to, Comment (0), or E-mail this post
January 29, 2008

Independent Contractors: New Hampshire Defines, FedEx Whines

New Hampshire has come up with their own 12 step program to determine whether contractors are truly independent or just employees. Meanwhile, the IRS has come down hard on FedEx, hitting the company with a $319 million fine for misclassifying drivers as independent contractors.

Let's start in New Hampshire. The state has come up with 12 criteria for determining independence, all of which must be met or the system defaults toward an employer-employee relationship. The criteria include the usual focus on control of the work, but there are a few new wrinkles:

A. The person possesses or has applied for a federal employer identification number of social security number or in the alternative, has agreed in writing to carry out the responsibilities imposed on employers under this chapter.

[This appears to imply that undocumented workers - who cannot have federal id numbers or social security numbers - are automatically employees.]
...
F. The person has continuing or recurring business liabilities or obligations.
G. The success or failure of the person's business depends on the relationship of business receipts to expenditures.

Like Massachusetts, New Hampshire is looking for objective evidence that the independent contractor runs a legitimate business. Both states accept the presence of employees with the IC as compelling evidence - but that will not help the typical sole proprietor without employees. Whereas Massachusetts has stipulated that a subcontractor in the same trade as the contractor is by definition an employee, New Hampshire does not focus at all on the sub's specific trade.

Having issued all this clarification, the states now sit back and let someone else figure out the details. That someone else, alas, is the poor insurance auditor, who has been given the unenviable task of determining the status of each and every subcontractor. You don't suppose that this detective work is contemplated in the current fee structure, do you?

In MA, auditors have some latitude. If the independent contractor/sole proprietor does not have any employees, they are likely to be added to the general contractor's payroll for workers comp. In New Hampshire, auditors are held to a higher standard. They must inspect records and operations of every GC and sub to determine whether the subcontractor meets all 12 criteria for independence. They do this at their own risk: If they make a wrong determination, they are in violation of state law.

Closing in on FedEx
The IRS in December determined that FedEx drivers were misclassified as independent contractors. They slammed the company with a $319 million fine and penalties. Since the fine only covers 2002, FedEx could face additional penalties totaling over a billion dollars after the IRS completes its investigation. FedEx has already lost the argument in a number of states, including California. Now they've lost at the federal level as well. They are going to sit down with the IRS this spring to hash out the implications of their latest losing argument. (For our numerous postings on this important case, just enter "FedEx" in the search box.)

FedEx managers are apparently hanging their hopes on a 1995 agreement between FedEx Ground's predecessor company (Roadway Package System) and the IRS, which reads in part: "The Service agrees that it will not reclassify the RPS owner-operators as employees, except upon a determination after audit, that RPS has exercised control over the RPS Owner-Operators in a manner that conflicts with the 1994 Operating Agreement, Letter of Assurance and Exhibits." Unfortunately for FedEx, there is a growing body of evidence that the company exercises rigid control over every aspect of the relationship with their "independent" drivers, from uniforms and length of hair to schedule of pick up and delivery.

Much has been made of the liability facing FedEx in the area of employee benefits, but little attention has been paid to workers comp. We can safely assume that hundreds of current and former drivers have been injured on the job. When they come up with a total cost for violating fair labor standards, the comp costs will have to be added in. This long-profitable enterprise appears on the verge of accepting retroactive responsibility for as many as 17,000 employees. That's a lot of drivers and a truckload of liability.


Posted by Jon Coppelman at 2:03 PM Link to, Comment (0), or E-mail this post
January 28, 2008

Weblog roundup: recession and WC; cost of physicians; undocumented workers; and heath & safety

Recessions effect on WC - Joe Paduda offers his analysis of what the recession will mean for workers comp. Citing a 2002 Minnesota study, he notes that costs rise during recessions for two reasons: claims rates and disability duration both increase. He notes that other factors may well have a larger impact on costs than the recession. Some of these include rising drug costs, a de-emphasis on loss prevention, the soft market, and declining investment returns.

The cost of physician services Maggie Mahar of Health Beat has been examining the issue of health care spending, specifically how much we spend on physicians services (and part 2). Of the $2.1 trillion that we spent on health care last year, 22 percent year went directly to doctors. Maggie notes that is up from 19.4 percent in 1960. She raises the question as to whether the expenditures for physician’s services need to be redistributed. She makes the case that the perverse financial incentives in our fee-for-service system mean that we are paying physicians for the quantity of work that they do rather than the quality, leading to overtreatment. She uses data from physicians in other countries as a point of comparison:

Stowe, a research fellow at Americans for Generational Equity, points out that primary care doctors and other “generalists in the United States earn on average $173,000 a year or 4.2 times gross domestic product (GDP) per capita. In other countries of the Organization for Economic Cooperation and Development (OECD), generalists earn roughly half as much – or $94,000 on average –based on purchase power parity dollars.” Thus, Stowe puts the salaries in the context of what these earnings can buy in each country.
Meanwhile, he continues, “specialists in the United States earn an average of $274,000 a year or 6.5 times GDP per capita. In other OECD countries, specialists earn on average less than half that at $129,000 or 4 times GDP per capita.” So, Stowe concludes, “even adjusted for higher wealth and earnings in the United States, the gap between what physicians earn here and elsewhere in the developed world is large, as is the gap between physician earnings and the average American’s earnings.” (Stowe recognizes that American doctors pay more for malpractice insurance than their peers abroad, but in his comparisons, this is already factored into the numbers.)

These small snippets and summaries of her thoughtful posts don't do them justice - there's much food for thought. It's well worth setting aside the time to read them both.

Undocumented workers and workers comp - We've blogged about Edgar Velázquez and Billy G’s Tree Care, an undocumented worker seeking workers compensation from a rather unscrupulous Rhode Island employer. Now, Peter Rousmaniere of Working Immigrants brings us the news of a $30,000 settlement awarded to Velázquez in a groundbreaking case against his former employee. One highly unusual aspect of this case was the matter of an injured undocumented worker having been allowed to return to the U.S. to face an employer in court. In commenting on the ruling, Chief Workers’ Compensation Judge George E. Healey Jr. said the settlement should put employers on notice.

“I think that it’s important that employers realize they cannot employ undocumented workers without consequence,” Healey said.
“My concern in this whole process is that unscrupulous employers will assume that they don’t have to provide a safe workplace and don’t have to be answerable for injuries which occur in the workplace,” he said. “And the resolution of a case like this demonstrates otherwise.”

This is the second recent case of state courts upholding undocumented worker rights to compensation for work injuries. last week, Peter reported on South Carolina's Supreme Court unanimous ruling in favor of benefit eligibility for an illegal immigrant.

Health and safety - The Pump Handle is fast becoming one of our important weekly reads for occupational health and safety issues. In a recent post, Celeste Monforton follows up on with more information on December's massive explosion at the T2 Laboratories plant in Jacksonville, Florida. The Chemical Safety Board recently issued a report that in addition to the 4 fatalities, 33 people were injured, more than double the number originally reported. And in another post, occupational health news roundup, Liz Borkowski links to a variety of news reports about problems that injured veterans face in getting appropriate services and care for injuries. She also links to a story about injured soldiers being redeployed to Iraq on "light duty. "

Posted by Julie Ferguson at 5:32 AM Link to, Comment (2), or E-mail this post
January 25, 2008

Poncho Rules: Spanking is not Discriminatory

Back in April of 2006 we blogged the strange story of Alarm One, a security company with an odd way of motivating employees: to stimulate sales, they routinely punished low performers by throwing pies at them, feeding them baby food, making them wear diapers and even spanking them in front of their colleagues. Hey, it worked for the Three Stooges, didn't it? It did not work for Janet Orlando, a 53 year old woman who felt humiliated by the public thrashing.

Orlando sued the company for $1.2 million. She won. She was awarded $10,000 for economic loss, $40,000 for future medical costs and $450,000 for emotional distress, pain and suffering. She was given an additional $1.2 million in punitive damages for sexual harassment.

So far, Orlando has not been able to collect a penny. Now, on appeal, the company's lawyer, Poncho Baker, has prevailed. His argument is that the spankings were part of a "voluntary program" to build camaraderie and were not discriminatory because they were administered to both male and female workers. This is called the "equal opportunity harassment" defense. A three-judge panel of the state Court of Appeal has overturned the verdict, ruling that the jury was given improper instructions. The judges said the jury wasn’t instructed that one vital element of proving that sexual harassment occurred is showing the action was directed at a woman because of her gender. Orlando cannot prove that the humiliation was directed personally at her. She was one humiliated person among many and gender was not a factor.

The "equal opportunity harasser" defense immediately gives rise to a compelling "quality of worklife" issue. Why would anyone choose to work for a company that routinely humiliates its employees? Perhaps the Animal House atmosphere appeals to some people. But this approach to a career would wear thin pretty quickly. The alarm bells should have gone off at Alarm One - and Orlando should have walked right out the door.

Posted by Jon Coppelman at 10:21 AM Link to, Comment (1), or E-mail this post
January 24, 2008

Health Wonk Review and some handy new tools

A new edition of Health Wonk Review is being hosted by Vince Kuraitis at e-CareManagement blog, including posts about in-store clinics, physicians, problems and solutions in health systems, and cats, dogs and kangaroos. Suffice it to say that this is the first time kangaroos have surfaced in HWR, and I will leave it to you to discover why. This edition is Vince's debut as HWR host, and he carries out his duties with style and grace. His blog focuses on issues and trends in chronic disease management and technology. While there, you might check out his take on Disease Management Megatrends for 2008, a post which is also available in a 20-minute podcast version.

New tools for our sidebar
In other matters, here are a few handy tools that have recently come to our attention - we'll be adding them to our sidebar:

Health care - HealthExecLynx is a huge compendium of links related to all things health care - an absolute must for your bookmarks. It lists thousands of links, including health care news sources, blogs, associations, governmental concerns, career resources, and more - an excellent resource.

Safety signs - Safety Sign Builder 2.0 - this free service includes a number of web-based tools that facilitate the creation of custom general and safety signs. Each Sign Builder tool has unique options designed to make the creation of any custom sign quick and easy. Build Hazmat signs, ANSI signs, or OSHA-compliant Lockout Tags in English and in Spanish. Safety Sign Builder 2.0 is sponsored by St. Claire, Inc.

OSHA - OSHA recently announced eight new OSHA Training Institute (OTI) Education Centers. Current OTI Education Centers offer training courses on OSHA standards and occupational safety and health issues. The Centers provide safety and health training to private sector and federal personnel from agencies outside OSHA.

Posted by Julie Ferguson at 8:42 AM Link to, Comment (0), or E-mail this post
January 23, 2008

Shooting Lawyers the Bird: The Tribune's Employee Handbook

If it isn't clear by now, the Insider believes in a sense of humor. A few laughs help us get through the working day. So it is with some ambivalence that we tackle the issue of the Tribune Newspaper's new Employee Handbook. Written by a non-lawyer, the handbook attempts to present the myriad issues contained in a handbook in a light, rather flippant tone. It's a fun read. But alas, it's like "shooting the bird" at a policeman: it might be protected as "free speech," but it's still not a very good idea.

Sexual Harassment
The Handbook opens the section on harassment with a warning to people who might be sensitive to the actions of others:

4.1 Working at Tribune means accepting a creative, quirky, intelligent, odd, humorous, diverse, opinionated and sometimes annoying atmosphere.
4.2 Working at Tribune means accepting that sometimes you might hear a word that you, personnally, might not use. You might experience an attitude that you don't share. You might hear a joke that might not consider funny. That is because a loose, fun, non-linear atmosphere is important to the creative process.
4.3 This should be understood, should not be a surprise and is not considered harassment.

Any joke? In any context? The Tribune is basically telling employees to chill out. The sublimely tasteless Borat would love it. This "values statement" is far too general. It could make anyone squirm, not just a labor attorney.

Drug Policy
Here again, you will find language that is unprecedented for an employee handbook:

7.1 If you use or abuse alcohol or drugs and fail to perform the duties required by your job acceptably, you are likely to be terminated. ..Coming to work drunk is bad judgment.
7.2 If you do not use or abuse alcohol or drugs and fail to perform the duties required by your job acceptably, you are likely to be terminated.

The first section seems to imply that being stoned at work is ok, as long as you can still do your job. Yikes! The second section has nothing to do with drug abuse and certainly does not belong in this section of the handbook. It seems to imply that you'd be better off stoned at work and doing your job well - as opposed to sober and performing badly. That certainly reflects the Hollywood version of the newspaper business, but it does not belong in a handbook.

Disability and Workers Comp
The disability statement is pretty straight forward, although it places the burden squarely on the employee:

3.1 Tribune will make reasonable accommodations if you have a disability and are otherwise qualified to perform your job.
3.2 If you need an accommodation, tell your supervisor.

Here is the complete section on workers comp leave:

17.1 State law dictates how Workers' Compensation is handled.
17.2 Please let your supervisor know immediately if you're hurt on the job.
17.3 If this injury is also considered to be a serious health condition under FMLA, Workers' Compensation Leave will be counted as, and run at the same time as FML.

This a bit thin, to say the least. The handbook should emphasize the importance of working safely, reporting all hazards and management's commitment to speed return to work through the use of temporary modified duty.

Employee Rights: No Laughing Matter
Employee Handbooks are generally regarded as quasi-legal contracts, primarily designed to outline the rights and benefits of employment and limit the employer's exposure to lawsuits. Handbooks are rarely read, and when they are, it's not for the entertainment value. The Tribune's attempt to have their handbook mirror the creativity valued in the workplace is well intentioned, but incredibly risky. It won't take long for labor attorneys to pounce and when they do, the Tribune will have to back-pedal furiously to contain the damage. This particular handbook may get a "high five" from Borat, but it's no way to define the employment relationship.

Posted by Jon Coppelman at 1:21 PM Link to, Comment (7), or E-mail this post
January 22, 2008

Morbid Obesity and the Essential Job Functions of a Cop

When Paul Soto joined the NYPD in 1993, he was 25 years old and weighed 250 pounds. Ten years later, his weight ranged well above 300 pounds. As you might expect, he was having difficulty performing the essential functions of his job. He applied for disability retirement; pending review of his application, he was placed on light duty, which kept him in the precinct house on desk duty. During the year his application was under consideration, he tripped and fell on the way to his ortho specialist, injuring his knee to the point where he no longer could work at all.

The issue here is not Soto's eligibility for disability benefits. At age 40, he is collecting half his pay, taxable. Soto contends that because he was working at the time of his fall, he should be able to collect job-related accidential disability benefits, which are higher than ordinary disability: he claimed that his fall on the way to the doctor was a work-related accident, because it occurred while he was on light duty. His case reached the NY Supreme Court, where Justice Judith Gische upheld the pension board's rejection of the request. The justice ruled that the fall was due to morbid obesity and not to Soto's functioning as a cop. Had Soto prevailed, his benefits would have increased to 75 percent of his former pay and would not have been taxable. There was a lot of money on the table.

The unfortunate Mr. Soto, who now weighs in at 500+ pounds, has been the subject of ridicule in the media. He inspired one of David Letterman's Lists: Top Ten Signs a Police Officer is Too Fat. (The not-very-funny list can be found here.)

Essential Job Functions
The over-riding issue is one of functional capacity. Unlike firefighters, NY cops are not required to pass periodic physical exams. They are tested as job applicants, but once in, there are essentially in forever. Police administrators, like everyone else, operate in the shadow of the Americans with Disabilities Act. In addition, police unions severely constrain any actions taken against veteran cops. Too bad. When you take into account the public safety dimension, it's pretty clear that some objective physical (and mental) standards for cops are needed - at the time of hire and throughout their careers.

As for Paul Soto, once he was unable to perform his job duties, he should have been given an ultimatum: lose weight or lose your job. Every reasonable effort to help him lose weight should have been made. Unless you accept the argument that his weight gain was something totally beyond his control, he should have been held accountable for his conditioning. That would have been better for the NYPD and ultimately, better for Soto himself. The system that now pays him to do nothing has done a disservice to the taxpayers and to a once productive citizen.

Posted by Jon Coppelman at 12:47 PM Link to, Comment (1), or E-mail this post
January 17, 2008

Heartburn in Tennessee

The Tennessee Restaurant Association (TRA), as you might expect, is a lobbying group for restaurants. One of the benefits of membership is access to special insurance programs. Around 500 members participated in a workers comp program run since its 1993 inception by the TRA's charismatic director, Ronnie Hart. Unfortunately, as we read in the Tennessean, Mr. Hart had no experience in insurance - he was a lobbyist by trade. So he learned "on the job" for the first few years and then hired a company called Hospitality Management Plus to administer the program. The "plus" was apparently the routine doubling of management fees and unauthorized dipping into the reserves. The minus, alas, is that neither Hart nor Hospitality Management knew how to run an insurance operation. Both are now bankrupt.

The state's Department of Commerce & Insurance took over the fund in 2005. They originally estimated the shortfall at $1.5 million. The revised number is $4.8 million, which has upset the stomachs - and wallets - of the 500 or so members on the hook for payment.

Randy Rayburn, owner of the renowned Sunset Grill and Midtown Cafe, is very angry. He is also a bit circumspect: "In hindsight, what does a lobbyist know about running an insurance company?"

Frank Grisanti, a restaurant owner and trustee of the fund, says he knew that Hart was making a profit running the trust, but he did not see it as a conflict at the time. "I guess it turns out that it was poor judgment..." Grisanti is facing a $60,000 assessment as his part of the trust's liability. That's a lot of surf and turf.

I'm sure the restaurant owners now appreciate the need for a little due diligence in the insurance area. Just as they would not hire a plumber to be a lead chef, they might think twice about asking a lobbyist to run an insurance company. It looks simple enough, but on-the-job training is not the way to go. Now the owners are stuck with the bill. They'll need more than extra strength Tums for this severe case of "Hart-burn" in Tennessee.

Posted by Jon Coppelman at 10:53 AM Link to, Comment (0), or E-mail this post
January 16, 2008

Cavalcade of Risk #43

rock climbing

We're pleased to be hosting this week's edition of Cavalcade of Risk. Participants have submitted a wide spectrum of analysis, tips, tricks, and tools to help manage risk, both in the public and the personal arenas. It's a hefty issue, so let's jump right in.

First, a few brave souls take a look at the landscape. Blogging at the RGE Monitor, Rachel Ziemba reassesses the risk management climate in the financial sector for 2008. Leon of Sox First takes the pulse of some financial experts as to whether the the subprime crisis will drag us into a recession and Ian Welsh of The Agonist offers his thoughts on why we can expect that financial crises will keep happening. With that backdrop, let's look at what our other participants have had on their minds over the last few weeks.

Our bloggers have thoughts on managing your personal finances in this challenging environment. Jeff Miller of A Dash of Insight suggests that understanding risk and reward means knowing to what extent prices already reflect the risk. Dorian Wales stresses the importance of diversifying your risk in the stock market at Personal Financier.
In a post at The Skilled Investor's Personal Finance Blog, Larry Russell suggests that Fund Authority Scores are tools that can take the snake oil out of investment. Offering advice from experience, Fire Finance Blog shares their views on 7 mutual fund investing mistakes. Malaysian financial planning blogger Kclau offers a huge roundup of his personal finance articles from 2007. And after the chips fall, the Silicon Valley Blogger opines about why the rich keep getting richer.

Health, health care, and health insurance
Health care is occupying much of the mind share for risk bloggers these days. Health Savings Accounts (HSAs) seem to be a hot topic again this week. In a post at Colorado Health Insurance Insider, Louise notes that there is not a lot of opportunity for comparison shopping yet. And sparks fly at Managed Care Matters when Joe Paduda describes HSAs as thinly-disguised tax breaks for the well-to-do. In other financing mechanisms, Jonathan Pletzke of Consumer's Health Insurance Blog looks at the matter of health insurance for the self-employed, while Joe Kristan of Tax Update Blog considers the tax implications of S corporation owner-employee health insurance.

Also in the health care arena, Zagreus Ammon discusses the risk that retail clinics pose to the public hospital system (part 2) at his blog The Physician Executive. Of course, with a presidential campaign in the offing, the health care landscape could change in other ways, as well. Jason Shafrin of Healthcare Economist looks at the health care reform positions for both Reuplican and Democratic presidential candidates. And Bob Laszewski of Health Care Policy and Marketplace Review, who has had an ongoing series examining candidates' positions, this week offers an in-depth analysis of Senator Hillary Clinton's Health Care proposal.

When it comes to managing health risks, we often talk about risk in terms of our own behaviors, but what about the behaviors of those who treat us? InsureBlog's Bob Vineyard has a thoughtful (and disturbing) item on questions we should be asking to minimize our own risk of a bad outcome. David Williams of Health Business Blog demonstrates the importance of due diligence with some chilling examples of how medical quality can take a wrong turn. And on the issue of health care quality run amuck, here at Workers Comp Insider, my colleague Jon Coppelman presents another example in the story of Dr. Chan, a neurosurgeon who amassed a small fortune taking kickbacks for surgical implants.

On the matter of managing our own personal health risk, bloggers offer some news. On the matter of cardiovascular disease, Barbara Duck, hostess of the Medical Quack Blog, tells us that strawberries might lower the risk and Dick Hanneman, president of the Salt Institute informs us that salt is not necessarily as bad for us as we've been led to believe. But not all news is good. According Mahdi Ebrahimi of Organic Agriculture, cooking certain foods at high temperatures may increase the risk for breast cancer.

Other risk matters
Over at CNET's NewsBlog, Chris Soghoian reports on a major irony: the TSA's own website may be putting travelers at increased risk of ID theft. Data integrity is an increasingly important issue for consumers. At the Security and Risk Management Blog, Jen Mulligan has some disturbing news about data privacy. Some recent news from England serves as a springboard for some great tips on reducing your own risk of ID theft.

Tired of working for "the man" and thinking of striking out on your own? Conventional wisdom holds that 80% of all small businesses will fail within the first 5 years of operation. Matthew Paulson of American Consumer News looks at common mistakes in his post entitled How to Start a Small Business and Fail Miserably At It. But if your endeavor requires negotiating a contract, you might learn something from the sports world. James Mirtle looks at the risks involved in high-dollar professional sports contracts. And if worse comes to worst, Karen Halls offers advice on how to recover at Bankruptcy Lawyer's Blog.

Posted by Julie Ferguson at 10:30 AM Link to, Comment (1), or E-mail this post
January 15, 2008

Kentucky: Age and Benefits Collide

The Insider continually tracks the impact of an aging workforce. There's no lack of material! Here's an interesting case from the Bluegrass state, where the issues of working past retirement age and the calculation of disability benefits collide.

Charles Lickteig was a deputy sheriff in Jefferson County, Kentucky. He was eligible for retirement age at 55, but chose to continue working, in order to better support his school-aged children. At age 61 he was unable to continue, due to a deteriorating vertebra, arthritis, nerve damage, and Parkinson's disease. (His disability is apparently not directly related to the law enforcement work he carried out for 18 years.) He filed for the special disability retirement benefits available to public employees engaged in "high hazard" work. Kentucky Retirement Systems denied his request for disability retirement, granting him instead the retirement benefits available to workers engaged in ordinary work. Under the state system, only workers under 55 are eligible for disability retirement benefits.

Lickteig's Attorneys brought his case to the EEOC, arguing that the Kentucky plan violates the Age Discrimination in Employment Act (ADEA) of 1967. Under the Kentucky approach, the benefits for employees who become disabled would vary by age: two employees, each with the same total time of service but of different ages, would receive different benefits. A worker below the age of 55 would always receive benefits at least equal to and in most cases greater than those granted to workers over 55.

The District Court and a panel of the Sixth Circuit at first concluded that the Kentucky plan did not violate the ADEA. While the approach took age into account to determine benefits, it did not attach any stigma to age itself. The Sixth Circuit reheard the case en banc and reversed, holding that the simple act of treating younger disabled retirees better than older ones was sufficient to make out a prima facie ADEA violation. (Four of 12 judges dissented.)

At this point, Kentucky has been ordered to revisit the calculation of Lickteig's benefits and to remove the traces of age discrimination from its retirement system. Kentucky has appealed, asserting that the EEOC and Court rulings violate state sovereignty. Now the case moves to the U.S. Supreme Court, which will sort out the territorial and age issues. (The EEOC brief can be found here.) As with every issue reaching this particular court, it will be fascinating to see how they rule.

Posted by Jon Coppelman at 10:34 AM Link to, Comment (0), or E-mail this post
January 14, 2008

Hi-tech wheelchairs improve life for the disabled

If you haven't seen some of the recent progress being made in wheelchair technology, you may be in for surprise. This feature from deputydog, a "cool and interesting things" weblog, features photos, video clips and links to various hi-tech wheelchairs. While some selections fall more under the category of "personal transport systems" than wheelchairs, most are designed to offer a better experience for disabled persons in various ways:

  • Better mobility - affording the user access to uneven terrain and non-paved surfaces, as well as the ability to maneuver curbs and stairs
  • Smaller footprint - reducing the size of wheelchairs to make them easier to navigate through normal doors and and fit better in public spaces
  • Better balance - improving stability and allowing users to be more agile in navigating turns
  • Better ergonomics - allowing a user to switch heights to experience the world at eye level, or to lower seat height to fit under standard tables and desks

One of the most exciting developments is the iBOT Mobility System based on the same technology as the Segway. Its development came about as a partnership between Dean Kamen's research firm and Johnson and Johnson's Independence Technology division. It is a four-wheeled chair, but it can convert to and operate on two-wheels. We've seen this chair being demonstrated at industry trade shows and an immediate sense of empowerment is conveyed when a user switches from normal use to two-wheeled eye-level use - it's quite remarkable. The iBOT can also maneuver curbs and stairs. Sensors and gyroscopes give the chair stability and balance. If you haven't see these in operation, you might enjoy some of the videos showing the iBOT in operation.

Medgadget (which, incidentally is a very cool weblog to visit every now and again for the latest in medical technology) recently reported on the NOA wheelchair from Tekniker-Ik4, which features " ...additional functions which go beyond the mere transport of users and aimed at facilitating the activities of their daily lives." One of the goals was to design a chair that would function as a single purpose chair since many users have two chairs designed to meet the differing needs of internal and external use. The design also allows expanded vertical positioning, giving the user the ability to reach high or low objects, to converse at various heights, and to facilitate transfers at different heights.

There is even hope on the horizon that may revolutionize life for some of the profoundly disabled who have been largely immobile. Wired reports on the development of a wheelchair that reads your mind, a thought-controlled robotic wheelchair for disabled patients who suffer from disease or injury that leave them unable to move. This initiative is being developed in Spain and the first working prototype is expected in 2008 or early 2009. Here's more information on how thought-controlled wheelchairs work.

With the number of disabled veterans returning from war, there is, unfortunately, a growing market for assistive technologies so we can expect to see advances in wheelchairs, prosthetics, and other device designed to help the disabled lead a more functional life.

The Job Accommodation Network has an accommodation and compliance guide for employers for Employees Who Use Wheelchairs (PDF), as well as an accomodation process flow chart (PDF). Also, the The Wheelchair User's Work Environment has some practical tips for improving wheelchair access at work.

Posted by Julie Ferguson at 1:34 PM Link to, Comment (0), or E-mail this post
January 10, 2008

Health Wonk Review and news roundup

Bob Laszewski of Health Care Policy and Marketplace Review has posted the first Health Wonk Review of 2008, and it's a good one because people had to save up their best posts over the last month since we had a short hiatus. Many entries focus on analysis of the presidential candidates' positions on health care, which will be one of the hot-button issues for the coming election.

A deadly year for public servants - Celeste Monforton of The Pump Handle tells us that 2007 was a deadly year for law enforcement officers, with a 28 percent increase in on-the-job fatalities compared to 2006. Shooting deaths were up 33% and traffic fatalities up 10%. And Occupational Hazards reports that 115 on-duty firefighters died in 2007. Fire Administrator Greg Cade labels 2007 it “one of the most tragic years for firefighters in recent memory.”

High cost of chronic disease - An Unhealthy America - the economic burden of chronic disease - is a good reference site to bookmark. Find specific prevalence and costs by disease or by state.

From the courts - Peter Rousmaniere at Working Immigrants posts about a recent South Carolina Supreme Court ruling upholding the right for illegal immigrants to receive workers comp benefits. Courts continue to protect workers who are injured on the job, regardless of legal status. Justice James E. Moore stated that “...disallowing benefits would mean unscrupulous employers could hire undocumented workers without the burden of insuring them, a consequence that would encourage rather than discourage the hiring of illegal workers." In making its decision, the court cited prior decisions by North Carolina, Florida, Georgia, Maryland, and Minnesota.

Laptop safety - By their very design, laptops force users into awkward positions so prolonged use can result in muscular fatigue in various body parts and may lead to repetitive stress injuries. Laptop Ergonomics discusses the particular safety hazards related to using laptops and offers recommendations to help help reduce the risk of developing injuries. Hat tip to Ergonomics in the News for the pointer.

Weighty matters - Study links obesity to absenteeism - Occupational Hazards reports on a recent study that links increased rates of absenteeism to morbid obesity, putting the cost at $4.3 billion per year in the United States.

Posted by Julie Ferguson at 3:50 PM Link to, Comment (1), or E-mail this post
January 8, 2008

New Hampshire Backpedals on Contractors

Back in December we blogged a legislative remedy that backfired in New Hampshire: House Bill 471 eliminated the exemption for corporate officers and directors from workers comp coverage. Given the state's extremely high costs for comp, this created an immediate outcry. We compared it to the weather on top of Mount Washington, which at the time was minus 13 degrees with the wind howling at 93 miles per hour.

Well, today things look a lot milder. Mount Washington is enjoying relatively mild weather (38 degrees, with a modest wind of 42 mph). And the newly reconvened legislature has already amended House Bill 471 by restoring the exemption for corporate officers and directors.

Governor Lynch jumped on the bandwagon: "I will sign this law as soon as possible and I applaud the bipartisan leadership of the House and Senate for listening to the concerns of small business..."

Lasting Solutions
As we mentioned in our previous blog, New Hampshire still has a very big problem, driven by its disproportionately high rates for comp coverage in the construction trades. The legislature would do well to figure out why these rates are among the highest in the country. It's fine to exempt business owners from coverage, but that does not address the burdensome costs faced by contractors with employees. These folks are being hammered by costs that are twice as high as their competitors in neighboring states. By allowing business owners to opt out of the system, New Hampshire has bought itself a little time. But just as the mild conditions on Mt. Washington are soon to end, they had best start focusing on long-term solutions that bring rates into alignment with other states. Anything less would be like climbing Mt. Washington in January with nothing more than a backpack and an extra layer of clothes. A very bad idea indeed!

Posted by Jon Coppelman at 4:54 PM Link to, Comment (1), or E-mail this post
January 7, 2008

Surgical Implant/Ethical Bypass: The Story of Dr. Chan

The Insider has often speculated about the thought process of medical providers, so we are very interested in case of Dr. Patrick Chan, a neurosurgeon working out of Searcy, Arkansas. The Canadian trained doctor has pleaded guilty to charges of demanding and accepting kickbacks from surgical implant maker Blackstone Medical of Springfield MA, a subsidiary of Orthofix International. Dr. Chan used the (expensive) devices in back surgeries. He was a very busy fellow, billing about $200,000 a month. He has amassed a $10 million nest egg (minus the court-assessed penalty of $1.5 million plus substantial legal fees).

The kickback scheme initiated by the doctor raises two compelling issues: one involves how a doctor determines which medical device to use. Dr. Chan reduced that decision tree to its barest branches. "I use the device that pays me the most money."

The second dimension of Dr. Chan's thought process involves utilization: when should a specific device be used? Apparently, Dr. Chan went out of his way to find opportunities to use his preferred surgical implants. His work is being reviewed to determine whether the surgical procedures were in fact needed. One suit, filed in Arizona, alleges that in 2005 Dr. Chan told his patient, a young trucker, that if he did not agree to implantation of a spinal device, he was at risk of becoming a quadriplegic. After the surgery, a worker's compensation evaluation of the MRI done prior to the procedure showed that it was medically unnecessary. [NOTE to insurer: Speed up the utilization review process!]

Breakthroughs, Innovations...and Scams
Blackstone Medical touts itself as the home of "Breakthrough Thinking." Parent company Orthofix is "always innovating." Unfortunately, high level thinking and innovation, along with overly ambitious marketing goals, have led the companies into an ethical morass.

Dr. Chan is currently under house arrest and awaiting sentencing. He faces up to five years in prison. We can assume that he is under considerable pressure to testify against his former suppliers. It's ironic, of course, that Dr. Chan and the people at Blackstone began with the same goal in mind: helping people in pain. They intended no harm, but, alas, much harm has apparently been done.

Thanks to fellow blogger Joe Paduda at Managed Care Matters for the heads up on this interesting story.

Posted by Jon Coppelman at 10:05 AM Link to, Comment (1), or E-mail this post
January 3, 2008

Cavalcade of Risk's first edition of 2008

Jonathon Pletzke of Consumer's Health Insurance Book Blog does a fine job hosting this week's back-to-work edition of Cavalcade of Risk - the first edition of the New Year. We'll be hosting the January 16 edition here at Workers' Comp Insider. Also, Health Wonk Review had a brief holiday hiatus but will be returning to its regular schedule a week from today with a stop at Bob Laszewski's great blog, Health Care Policy and Marketplace Review.

Posted by Julie Ferguson at 12:43 PM Link to, Comment (0), or E-mail this post
January 2, 2008

2007 insurance year in review

Here at Workers Comp Insider, we're digging out after a holiday hiatus, and getting back into the swing of things with recaps of top insurance news from 2007 as presented by some of the leading insurance publications. While few of the major insurance stories in 2007 were specific to workers compensation, nothing in the insurance world lives in a vacuum. Anything that affects major property casualty insurers can be expected to have a spillover effect on workers comp.

Business Insurance's Year in Review offers top 10 lists for news related to risk managers and benefits managers in 2007. While most offer links to more detail, here's a summary of BI's picks for the top 10 risk management stories for 2007:

  1. Rates for property/casualty insurance begin to decline
  2. Congressional lawmakers launch efforts to extend the federal terrorism insurance backstop.
  3. Some brokers and insurers float new compensation plans.
  4. Marsh management woes
  5. Private equity expands buyouts of publicly held brokers
  6. AIG sues former executives, including Maurice Greenberg, to recover settlement payouts
  7. IRS moves to limit tax breaks for captives
  8. Supreme Court limits punitive damage awards
  9. A real estate developer and insurers settle on World Trade Center coverage
  10. New York proposes easing reinsurer collateral rules

Insurance Journal offers a rundown of the top insurance stories for 2007. More commentary about each item can be found in the article, but here's a summary:
  1. Climate Change
  2. Hurricanes Hardly Happen
  3. Soft Market … Everywhere
  4. Subprime Mortgage Credit Crunch
  5. Terrorism Coverage
  6. 'Made in China' Loses Its Luster
  7. Agency Compensation
  8. Fires and Floods
  9. Regulation Rumbles
  10. Marsh Meltdown Hits MMC

Sam Friedman of National Underwriter offers his top 10 story picks on his blog A View From the Press Box. More detailed stories can be accessed via links - here's the summary:
  1. Prices Plummet, With No Letup In Sight
  2. Critics Fry Insurers Over Katrina Claims
  3. TRIA Extension Goes To The Wire
  4. Floridians On The Hook For Billions
  5. A New Sheriff Cleans Up New York
  6. Bermuda Sitting Pretty, But For How Long?
  7. ‘Sicko’ Exposes Health Insurance Ills
  8. Real Time: It’s Now Or Never!
  9. IRS Attack Blindsides Captives
  10. California Fires Burn Insurer Reputations

Terrorism update - One of the stories that appears on all three lists was the pending renewal of a terrorism insurance bill. In an eleventh hour move before its expiration, on Dec. 26, Bush extended the terrorism insurance backstop with his signing of the Terrorism Risk Insurance Program Reauthorization Act of 2007 (TRIPRA). This will extend protection for seven years under similar terms as the current program.

Posted by Julie Ferguson at 8:30 AM Link to, Comment (0), or E-mail this post