Workers Comp Insider

Cavalcade of Risk Plus Frisky Risk Management

2012-05-16T13:43:28Z

The latest edition of Cavalcade of Risk, hosted by Dennis Wall at Insurance Claims and Issues, is up. It's the risk-free option for checking out a potpourri of interesting posts related to risk.

And while we are on the topic of risk, let's give a Bronx cheer for Jamie Dimon, CEO of JP Morgan Chase, for the work of his risk management team. The bank's $2 billion plus loss was the result of "sloppy" and "stupid" trading, a "mistake" which involved "bad judgment," and which caused losses that are "very unfortunate" and that come at an "inopportune time," but which in any case are not "life threatening." The risk management team is supposed to prevent such problems, not perpetrate them. Oh, well, that's just the risk you take when your frisky risk managers manage risk.

Too Much Sitting Plus Comorbidities = Big Trouble

2012-05-15T14:42:16Z

For those who seek risk conundrums, workers comp is fertile ground. From a micro perspective, the unfortunate Ronald Westerman, a paramedic for a California ambulance company, embodies many of the elements that result in sleepless nights for claims adjusters and actuaries: Westerman had an inordinately long commute (2.5 hours each way!), a sitting job with periodic lifting (inert patients and medical equipment), along with the comorbidities of hypertension, obesity and diabetes. In two years of ambulance work, Westerman gained 70 pounds, thereby compounding the co-morbidity issues.

In March 2009 Westerman returned home from a 36 hour shift and suffered a stroke. His doctor determined that the stroke was work related and that Westerman was permanently and totally disabled. He was 50 years old. While there was some dispute over the cause of the stroke, an independent medical evaluator surmised that it was caused by a blood clot moving through a hole in Westerman's heart to his brain, otherwise known as in-situ thrombosis in his lower extremities - a direct result of too much sitting. (We blogged a compensable fatality from too much sitting here.)

At the appeals level, compensability centered on the performance of a shunt study - an invasive test - that would have determined whether the blood clot caused the stroke. Westerman was willing to undergo the test, but his wife refused to authorize it, due to his fragile health. If there was no hole near the heart, the entire theory of compensability would be disproven; the stroke would not have been work related.

Had the defense attempted to force the test issue, it would have given rise to yet another conundrum: was refusing an invasive test the equivalent of "unreasonable refusal to submit to medical treatment"? Indeed, does a diagnostic test, by itself, meet the definition of "treatment"? Fortunately for Westerman, the defense requested - but did not attempt to require - the shunt test.

Managing Comorbidities
Our esteemed colleague Joe Paduda, who blogs over at Managed Care Matters, provides the macro perspective, one which is unlikely to aid in the sleep patterns for actuaries. He reports on the impact of comorbidities on cost from the recent NCCI conference:

The work done by NCCI was enlightening. 4% of all claims (MO and LT) between 2000 - 09 had treatments, paid for by workers comp, for comorbidities, with hypertension the most common. These claims cost twice as much as those without comorbidities [emphasis added].

It is beyond doubt that comorbidities make work-related injuries more expensive. But what, if anything, can claims managers do about this? In the Westerman case, there is not much to be done, as the stroke resulted in a permanent total disability. But in other cases where there is a path to recovery and even return to work, adjusters should flag these claims for early, intensive intervention, including psychological counseling and support for weight loss and other life style adjustments. To be sure, this would increase the upfront costs, but these steps just might go a long way toward mitigating the ultimate cost of the claims.

As is so often the case in workers comp, it's "pay me now" and "pay me later." To which I can only say to my claims adjuster and actuary friends, "sweet dreams!"

When it Comes to Safety, This is Just Ducky...

2012-05-15T01:22:43Z

We begin the week on a somewhat bizarre note, as Donald Duck does safety in this vintage 1959 cartoon clip entitled "How to Have an Accident at Work." When it comes to safety, Donald is everyone's nightmare worker. For those of us in the workers comp field, this may seem more horror film than cartoon, but Donald, unlike ordinary workers, is literally indestructible.

This clip was a sequel to "How to Have an Accident in the Home"

Health Wonk Review Hath Sprung

2012-05-10T13:01:46Z

Hank Stern of Insure Blog has hosted the latest edition of the health work review. It's a bouquet of wildflowers, well worth a few minutes of your time. And if you think palliative care is just for the terminally ill, check out Diane Meier's inspiring post, which reads like a sprig of lilacs in a mason jar on the kitchen table.

NCCI Experience Mod Changes: The (Ominous) Future is Now

2012-05-09T16:17:35Z

These are the calm days before the coming storm. For most employers, workers comp falls under the "business as usual" category. If a worker is injured, the standard protocols are followed: secure medical treatment; report the claim; if it's convenient and not too difficult, bring the worker back on temporary modified duty. Sure, you will eventually pay for the losses in the form of higher premiums. But rates have been low for a long time. As for the experience mod, how high could it possibly go?

Pretty high! NCCI's new rating plan will roll across the country throughout 2013, beginning in January in a handful of states and finishing up in Utah at the year's end. Employers who pay attention to these things know that primary losses - the most expensive dollars in every claim - are doubling from the current cap of $5,000 to $10,000 in 2013, and eventually going up to $15,000 by 2015. It sounds a bit ominous, but it's still way off in the future, right?

The future is now. Most employers are currently operating in policy year (PY) 2012, which began sometime between January 1 and today. The losses under this policy will not be included in the experience mod until PY 2014 and they will remain in the calculations through PY 2016. In other words, the increased primary losses in these calculations have already been incurred - not only for PY 12, but going back as far as PY 09. The future rating plan, in other words, is not only with us, it's behind us!

What Should Be Done?
Employers who want to stay on top of their insurance costs need to ratchet up their loss control programs. The best injury is the one that never occurs. And for those moments when a safety program fails, employers need to enhance their post-injury management programs, which should include:
- Employee awareness on hazards and safety
- Supervisor training in immediate post-injury response
- A relationship with a quality occupational medical provider
- Prompt reporting of all injuries to the insurer
- An effective and aggressive temporary modified duty program
- Accident analysis to prevent recurrence

To be sure, these key elements are no different from what was needed under the current rating system. But the situation is about to change dramatically. With primary losses doubling and eventually tripling, the need to manage claims from day one has become much more important. Under the current system, the "heavy losses" end at $5,000. Going forward, the heavy losses push much deeper into each claim and will come back to haunt employers in future experience mods.

Waiting Periods: No Time for Waiting!
For employers in states managed directly by NCCI, there is an opportunity to reduce primary losses substantially. If injured employees can be brought back to work - in regular or modified jobs - before the end of the waiting period, the medical-only costs associated with the claim will be discounted by 70%. Waiting periods vary from state to state, with the shortest running for three days and the longest for seven. Once the waiting period is over, out-of-work employees are eligible for indemnity (lost wage) payments and the discount disappears.

So here is some free - and, if I must say so, extremely valuable - advice: do everything humanly possible to bring injured workers back to work before the end of the waiting period. Even if medical bills run to thousands of dollars, the total amount of these primary losses will be reduced by 70% - if, and only if, return to work occurs before indemnity kicks in.

This may not seem important today, but once the experience rating sheets for PY 2014 and beyond start to hit the your desk, you will see the wisdom of this preventive action. The experience rating changes may still be months away, but you are already operating under the new rules. For those who remain oblivious to what is already happening, the future may be dark and ominous indeed.

Compensability of a Crooked Nose

2012-05-07T15:18:25Z

Imagine the scene at the Pennsylvania Workers' Comp Appeal Board earlier this year: the judges each carefully examined the nose of Rhonda Walker, to determine just how crooked it was and whether Walker was entitled to disfigurement benefits. Prior to the appeals hearing, a judge had awarded Walker 45 weeks of compensation for scars and disfigurement on her nose.

WorkCompCentral (subscription required) tells us that Walker was a meter reader for Health Consultants. In May 2007 she fell down a flight of stairs and fractured her nose. She was cleared for full duty in August, at which time her indemnity payments were halted. She resigned her position soon after and then filed for permanent disfigurement benefits; she considered herself to be "deformed" because her nose had scars and the tip was crooked.

Following their close and individual examination of Walker's nose, the judges determined that there was "a slight crookedness" but this was "not noticeably disfiguring." The alteration in her nose did not "rise to the level of creating an unsightly appearance." They reversed the award of disfigurement damages. Walker may be self-conscious about her transformed nose, but the changes are not compensable.

Aesthetics and Self-Image
With all the emphasis on personal appearance in this culture, with the myriad options for changing one's appearance, it is easy to become obsessed with what we see in the mirror. (I often wonder where that aging man in the bathroom mirror came from.) A few years back we blogged the interesting case of Penny Rumple Richardson, one of whose breast implants was damaged in a work-related auto accident. In the understandable interests of symmetry, her doctor replaced both implants. In the similarly related interests of compensability, the comp insurer paid for one implant and denied the other as not being work related.

Rhonda Walker is sensitive to the imperfections that greet her every time she looks in the mirror, but she will not be reimbursed for her troubles. In a mysterious footnote, President Judge Dan Pelligrini dissented without opinion. Given his silence, we will never know what he was thinking, but it appears that he bought Walker's argument. In the inherently subjective matter of compensability, who knows whose nose meets an elusive standard?

Workers' Comp Annual "Must-Read" Doc: The NCCI Issues Report

2012-05-03T13:01:21Z

Workers' comp geeks and nerds, your wait is over: NCCI's 2012 Workers' Compensation Issues Report is out. For the uninitiated, NCCI stands for "National Council on Compensation Insurance, Inc." NCCI manages the nation's largest database of workers compensation insurance information, supplying data to more than 900 insurance companies and nearly 40 state governments.See the NCCI state map for a quick glance of states that use NCCI as their licensed rating and statistical organization. NCCI describes the services it offers as "analyzes industry trends, prepares workers compensation insurance rate recommendations, determines the cost of proposed legislation, and provides a variety of services and tools to maintain a healthy workers compensation system."

So the Annual Issues Report is a rather big deal - arguably one of the most important workers' comp documents of the year. It offers an annual checkup on the health of market, along with discussion of trends, legislative changes, and the like. Plus, informed commentary on hot topics from various industry leaders.

The cornerstone document in the report is President and CEO Stephen Klingel's annual update, this year entitled Workers Compensation Market Struggles to Identify a Direction (PDF). Klingel notes that it's no easy matter offering any forecasts because we are in a time of uncertainties and adjustments as we make the long, slow climb from the recession. A few of his observations we found noteworthy:

In what is referred to as "the most surprising and disturbing negative
development," claims frequency saw its first increase in 13 years.
After 6 years of decline in the residual market (aka, "market of last resort" or "the pool"), NCCI is seeing initial signs of an increase.
Direct written premium is showing some growth.
State results show deterioration, with the ratio of increases in loss costs to declines doubling in just two years, a trend that is expected to continue in 2012.
Key quote: "With investment yields at historic lows, the current levels of underwriting losses are not sustainable. Even with what appears to be a temporary increase in investment gains, the combined ratio needs to decline substantially to earn a reasonable return on capital."

Goring forward, uncertainties prevail. There are many wild cards that make forecasting difficult, with two big ones being the effect of the economic recovery and the 2012 election. And while there have been both troubling indicators (a rise in frequency, signs of residual market growth) and more positive indicators (improved investment scenario, growth in written premium), it is too soon to say if any of these are the beginnings of a trend.

Here's an overview of other articles included in the Issues Report - all available for download, and all worth your time.

Robert P. Hartwig looks at the labor market recovery and the impact on insurers
Harry Shuford talks about the economy and what it will take to get us moving again
Peter Burton offers a legislative outlook, in which he recaps some of the major changes in 2011 and looks ahead to 2012
Joe Paduda looks at some key issues driving medical costs, opioid overprescribing and physician dispensing
Nancy Grover offers an overview of the state of insurance technologies
Tanya Restrepo and Harry Shuford write about the aging workforce and its effect on comp
Jim Davis and Yair Bar-Chaim examine the first rise in injury claims frequency in more than a decade
Dennis Mealy and Karen Ayres discuss the history of ratemaking in workers compensation
Charles Tenser examines four of the most discussed legal challenges involving workers comp

Risk roundup of the week

2012-05-03T12:45:42Z

Hot off the press, the current edition of Cavalcade of Risk is posted at Free Money Finance blog!

Not-So-Great Scott: Punitive Drug Testing in Florida

2012-05-01T16:49:12Z

The courts have been giving Florida Governor Rick Scott a few lessons in the Bill of Rights. He does not appear to be listening, but perhaps the voters of Florida are. Scott wants the state to require drug testing of all welfare recipients and all state employees. A temporary injunction put a stop to the welfare testing and now federal judge Ursula Ungara has ended Scott's bizarre vision of every state employee peeing into a cup.

The state argued, in part, that the program was voluntary: people don't have to do it, they'll just lose their jobs if they don't. Some definition of "voluntary"!

There are times and circumstances where drug testing is useful and necessary. For jobs involving public safety and genuine risk, drug testing should be mandated. But courts remain sensitive to the constitutionally guaranteed right to privacy. Under the "probable cause" standard, courts look for specific risks and exposures, not for blanket policies that cover everyone. There should be evidence of a problem, possible harm if drug abuse takes place and an over-riding safety interest. This may well describe the situation of a police officer or firefighter, but not a clerk in the Registry of Motor Vehicles.

Insubstantial and Speculative Risk
Judge Ungaro pointed out the fundamental flaw of Scott's executive order: it infringes privacy interests in pursuit of a public interest which is both insubstantial and speculative. She writes that "the proffered special need for drug testing must be substantial- important enough to override the individual's acknowledged privacy interest, sufficiently vital to suppress the Fourth Amendment's normal requirement of individualized suspicion."

By trying to lump all state employees into one big drug testing net, Governor Scott displays his contempt for government and the people who carry out its work. Beyond that, his drug testing obsession runs contrary to a fundamental premise in the Bill of Rights. Someone needs to remind the governor that his job is to protect the rights of every Florida citizen, not compromise these rights in the interests of punitive and ill-conceived policies.

A Random Note on the Original "Great Scott"
The origin of the phrase "Great Scott" is unclear, but Wikipedia surmises that the reference is to U.S. Army, General Winfield Scott, known to his troops as Old Fuss and Feathers. He weighed 300 pounds in his later years and was too fat to ride a horse.

OSHA Announces National Emphasis Program for Nursing and Residential Care Facilities

2012-04-30T13:24:36Z

According to the U.S. Bureau of Labor Statistics, nursing and residential care facilities experienced some of the highest rates of lost workdays due to injuries and illnesses. In response to this, OSHA has announced a new National Emphasis Program for Nursing and Residential Care Facilities to protect workers from serious safety and health hazards that are common in medical industries. These hazards include exposure to blood and other potentially infectious material; exposure to other communicable diseases such as tuberculosis; ergonomic stressors related to lifting patients; workplace violence; slips, trips and falls, and exposure to hazardous chemicals and drugs. See OSHA's complete directive PDF).

Safe Lifting
Injuries resulting from patient transfer and patient lifting are a particular area of concern. According to OSHA:

"The incidence rate for cases involving days away from work in the nursing and residential care sector was 2.3 times higher than that of all private industry as a whole, despite the availability of feasible controls to address hazards. The data further indicate that an overwhelming proportion of the injuries within this sector were attributed to overexertion as well as to slips, trips and falls. Taken together, these two categories accounted for 62.5 percent of cases involving days away from work within this industry in 2010. For this NEP, OSHA will target facilities with a days-away-from-work rate of 10 or higher per 100 full-time workers."

According to the American Nurses Association, 12% of nurses leave the profession due to back pain. Nursing is one of the top 10 most hazardous jobs for injuries to muscles and joints. Many heavy labor industrial jobs have weight lifting limits of 50 pounds, yet nurses routinely bear many times that weight when transferring, repositioning or lifting patients. Nursing home workers in particular are at higher risk of injury than underground coal miners, construction workers, and tire manufacturers. Of the 16 million US workers employed in health care and social assistance, more than 3 million are employed in US nursing and residential care facilities.

NCCI study on safe lifting programs for long-term care facilities
A few years ago, an important NIOSH study on nursing home lifting equipment demonstrated that the benefits outweigh the costs. In addition to recapping the equipment investment in less than three years, NIOSH found a 61% reduction in resident-handling workers' compensation injury rates; a 66% drop in lost workday rates; and a 38% decline in restricted workdays. Plus, the rate of post-intervention assaults during resident transfers dropped by 72%. Study authors found that the initial investment in equipment was recovered in less than three years based on post-intervention savings in workers' compensation costs

More recently, further evidence was released via a study by NCCI: Safe Lifting Programs at Long-Term Care Facilities and Their Impact on Workers Compensation Costs (PDF). The study was a collaborative effort with the University of Maryland School of Medicine. It was limited to facilities that have had safe lift programs in place for more than three years. Originally, researches intended to compare the experience of facilities with and without such programs, but during the course of the research, the rate of adoption of safe lifting devices was so great that close to 95% of facilities had them and about 80% of those used them regularly.

NCCI summarizes the study results:

"After controlling for ownership structure and differences in workers compensation systems across states, the statistical analysis performed as part of this study shows that an increased emphasis on safe lift programs at long-term care facilities is associated with fewer workplace injuries and lower workers compensation costs. More precisely, higher values of the safe lift index are associated with lower values for both frequency and total costs. The safe lift index captures information on the policies, training, preferences, and barriers surrounding the use of powered mechanical lifts. The institution's commitment to effectively implementing a safe lift program appears to be the key to success."

According to the earlier NIOSH study, training alone is ineffective as a prevention strategy because "lifting the weight of adult patients is intrinsically unsafe." It's also important to note that the equipment alone won't do it - workers also need to be trained how to use the equipment and management must implement and enforce a "zero lifting" policy.

Many states have safe patient handling laws
In recent years, a number of states have enacted legislation mandating safe patient lifting - and that no doubt has contributed to the rapid adoption rate noted by NCCI researchers. According to the American Nursing Association, a strong advocate for such legislation, 10 states have implemented safe patient handling laws. These include California, Illinois, Maryland, Minnesota, New Jersey, New York, Ohio, Rhode Island, Texas, and Washington, with a resolution from Hawaii. In addition, they are tracking 6 states with pending legislation currently: California, Illinois, Maine, Massachusetts, Missouri and Vermont.

Tools & Resources

NIOSH: Safe Patient Handling and Movement Principles
OSHA: Nursing Homes and Personal Care Facilities
ANA: Safe Patient Resources
ANA Safe Patient Handling Tip Sheet
Facility Guidelines Institute Patient Handling and Movement Assessments: A White Paper (PDF)
CAL-OSHA A Back Injury Prevention Guide for Health Care Providers (PDF)
States with Safe Patient Handling Laws - Map
Safe Lifting Portal
Ohio BWC Lifting Guidelines

Health Wonk Review, Worker Memorial Day, OK, Obesity, Appendectomies & more

2012-04-26T13:04:15Z

Health Wonk Review - Jennifer Salopek and Sarah Sonies have posted Health Wonk Review: Shiny Happy (Mostly) Edition, an excellent hosting debut at Wing of Zock, a blog sponsored by the Association of American Medical Colleges for practitioners of academic medicine. Make sure you click through to learn the origins of the fanciful name of the blog.

April 28 is Worker Memorial Day - an event dedicated to remembering those who died on the job from workplace injuries and diseases. It's also a time to commit to doing better, to renew efforts for safe workplaces. The National Council for Occupational Safety & Health has a list of Workers Memorial Day events throughout the country, as well as fact sheets and resources in both English and Spanish.

Oklahoma decides against "alternative workers comp" - Last week, the Oklahoma Senate gave the nod to a bill that would allow some employers to opt out of workers comp system by offering a comparable alternative, but the OK House rejected the opt-out measure. Last week, Senator Harry Coates had issued an editorial discussing the opposition viewpoint: Be careful what you ask for. See Dave DePaolo's take on OK's non-subscription model and the recent Walmart opt out in Texas.

Is it OK to discriminate against obese people? - In what may be a first among hospital hiring restrictions, Victoria Hospital in Texas has stated they won't hire very obese workers. HR pro Suzanne Lucas (also known as "Evil HR Lady") asks if it is okay to discriminate against obese people, offering 5 reasons why she feels it is a bad policy. In addition to potential illegality, another issue she raises is that many health professionals consider the BMI or Body Mass Index a faulty indicator of health. The first link quotes a physician as noting that "A professional football player might have a body mass index of 32, which is technically obese, but only have 7 percent body fat." (Be sure to check out the Flickr gallery of real people and their BMIs that Lucas links.) Now whether or not this is the wrong "solution," the fact that obesity is a workplace problem is not at issue. A new Cornell study says that obesity accounts for almost 21% of U.S. healthcare costs, and "An obese person incurs medical costs that are $2,741 higher (in 2005 dollars) than if they were not obese."

Usual and customary? - How much will an appendectomy cost you in a California hospital? It might depend on your insurance coverage. In one hospital, the cheapest procedure was $7,504 and the highest cost in the same hospital was $171,696. See more in Merrill Goozner's post on the Anatomy of A Walletectomy.

Jail time for scofflaws/ - Jon Gelman notes that North Carolina is raising the stakes for employers that don't carry workers comp - "the first contempt hearing is scheduled for May 22 when 125 uninsured employers have been noticed to appear in court." The state says pay up or go to jail.

Sex, workers comp & horseplay - Joe Paduda posts about compensable sex on the road, an Australia case where a worker was injured while in flagrante delicto. My colleague discussed this case previously in his post Compensable Sex, Down Under? We don't get to talk about sex very often on this blog, although there was a spanking incident a number of years ago (sadly the link to the news item appears broken.) The spanking post dealt with an instance of horseplay - an issue that Cassandra Roberts poss about at LexisNexis in her post A Roll In the Hay: Delaware's Horseplay Defense and Australia's Sex Romp Case Revisited, where she lists an array of quirky cases in which the horseplay defense failed.

More Noteworthy News

Virginia: Fixed Law in Need of Fixing

2012-04-25T17:39:57Z

We thought we had heard the last of the bizarre Virginia workers comp statute that denied benefits to workers who suffered brain injuries: under the old statute, if a worker survived an accident but was unable to testify about the incident, no benefits were to be paid. We blogged two cases where the injuries were clearly work related, but where the testimony of the worker was not available. The claims were denied.

Last year the legislature revised the statute to read in part:

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.

Reporter Dan Casey of the Roanoke News is on the case again: With the new statute's protections in place, a roofer named Herman Blair fell from a ladder and suffered multiple skull fractures. He filed a claim for indemnity and $350K in medical benefits. When he appeared for his workers comp hearing, he had no memory of the incident, but he was able to state his name and talk about other aspects of his life. On the basis of his ability to talk, Deputy Commissioner Phillip Burchett ruled that the injury was not compensable. Despite testimony from a co-worker, who heard a noise and saw Blair fall, Blair's ability to speak nullified the presumption in the revised statute. Burchett writes:

The only thing we can determine is that the claimant was on the roof some several feet above the ground and he fell; however, that in and of itself does not establish that the fall arose out of the employment.

Commissioner Burchett has set a very high standard, indeed. The man is on a roof installing tile. He gets onto a ladder to descend, and ends up on the ground. What does Burchett think he was doing - texting? surfing the net? In the commissioner's interpretation, if Blair had ended up in a coma, he would have had a compensable claim. But because he was conscious and able to talk, the claim had to be denied. [Burchett's nitpicking ruling can be found at WorkCompCentral, subscription required.]

The Fix is Not Quite In
There was an effort to amend the statute to include a presumption for workers able to testify about some things but not "about the circumstances of the accident," but the usual suspects (business and insurance advocates) pushed back by saying that this might open the door to abuse, with workers deliberately falling silent on the circumstances of their injuries. This, of course, is reminiscent of the original fear that workers would fake brain injuries. Sigh.

At some point Virginia will get this right and Herman Blair, having suffered insult after injury, will eventually collect his benefits. This fiasco illustrates how hard it is to get the language of a statute just right. You fix one problem and another arises. The only thing lacking in all of this is common sense and a little dignity: it should not require a legislative committee to determine that Herman Blair was injured on the job and is entitled to the life-enhancing benefits of the workers comp system.

Cost Containment Piracy

2012-04-23T15:41:38Z

When looking for cutting edge activities in workers comp abuse, it's a good idea to start in California, where key stakeholders occasionally function like pirates in the Gulf of Aden. We have frequently focused on the burgeoning costs of opioids in the workers comp system. As we learned at the Workers Comp Research Institute conference last November, too many doctors who prescribe opioids have no idea what they are doing, no idea how to manage opioid-based treatment and no clue about the potential for harm.

In the entrepreneurial free-for-all that is California, we see the latest trend in opioid abuse: turning the "best practice" of drug testing into an opportunity to milk the system. (The details are available in Greg Jones's article at WorkComp Central - subscription required.)

Here's how it works: doctors who tend to over-prescribe opioids are jumping on the drug testing bandwagon: either through their own testing, or through contracted services, they are able to parlay a simple $200 drug test into a bill for $1,700 or even $3,000. The labs are playing with billing codes, performing the less expensive qualitative tests but charging for the more expensive quantitative tests. It's a clever scam: first over-prescribe, then drug test and over-bill.

The WorkCompCentral article quotes Howard Appel, president of Millennium Laboratories of San Diego: "I'm offended when workers' comp is paying $3,000 for a drug test that cost $200." Appel's company operates under a "responsibility pledge" where explicit ethical standards are used for drug testing and billing.

Genuine Best Practices
We remind Insider readers of the best practices that should accompany virtually any prescription for opioids:

1. Above all, use opioids sparingly; most prescriptions for opioids in the comp system are unnecessary, ill-advised and poorly managed.
2. Virtually all injured workers prescribed opioids should be evaluated for dependency issues prior to beginning an opioid regimen, drug tested prior to receiving opioids and throughout the course of treatment. Without these pre-conditions, opioid use is full of uncertainty and fraught with danger.
3. Ideally, opioids should come with a written contract and a User's Manual. Workers should be tested on their knowledge of the benefits and the risks.

Note that drug testing is a necessary component of the treatment protocol. The problem in California - and probably elsewhere - is that drug testing is of little value where opioids have been mis-prescribed in the first place. Under best practices, opioids are a last resort, rarely used and carefully managed. Under California scheming, they are over-prescribed, over-monitored and over-billed. All of which goes to show that you don't need a fishing boat and a few automatic rifles to become a pirate. A nice white coat and a plastic cup can work just as well.

Safety Nets, Hard-Boiled Hard Hats & The Halfway to Hell Club: Safety Innovations in the Golden Gate Bridge Construction

2012-04-20T12:46:25Z

In an era when one death per million dollars spent on bridge construction was axiomatic, chief engineer of the Golden Gate Bridge Joseph Strauss decided his project would be different. He refused to accept the conventional wisdom that worker deaths were just a normal cost of doing business and introduced a series of safety innovations - you can see an overview in this brief video clip:

More on his commitment to safety during construction is presented in the PBS American Experience documentary "Golden Gate Bridge." Perhaps the innovation that was most touted was the introduction of a safety net, "... similar to a circus net -- suspended under the bridge. The safety net extended ten feet wider than the bridge's width and fifteen feet further than the roadway's length." While there was one deadly accident when a scaffold platform fell and broke through the net resulting in 10 fatalities, there is no doubt the net saved many other lives. Nineteen survivors whose falls were stopped by the net became de facto members of "The Halfway to Hell Club."

Strauss employed many other fascinating safety innovations, ranging from sauerkraut juice "cures" for men suffering from hangovers to special hand and face cream to protect against winds. But next to safety nets, the other noteworthy safety practice that emerged during the bridge's construction was the reliance on hard hats. The hard hats of the era were called "hard-boiled hats," and were made of leather and canvas. You can read more about the history of the hard hat at the Bullard site. Edward W. Bullard first introduced the hats in 1919, based on a doughboy hat he had worn in WWI. His hats were originally created to protect miners. The Bullard history says:

America's first designated "Hard Hat Area" was set up at the San Francisco Golden Gate Bridge construction site. "The project's chief engineer, Joseph B. Strauss, shared a vision with my grandfather that the workplace could be a safer environment for the worker. One problem the bridge project faced was falling rivets, which could cause serious injury," said Bullard. "My grandfather transformed the mining helmet into a durable industrial hard hat."

We would be remiss if we did not note that the status of being "the first official hard-hat area" is under some dispute - some contest that the Hoover Dam construction was the first work site to mandate hard hats:

The Bullard Company asserts that the first official "Hard Hat Area" was the Golden Gate Bridge project in San Francisco. The project's chief engineer, Joseph B. Strauss, beginning on January 5, 1933, directed all the workers to wear hard hats to protect themselves from falling rivets and other materials. However, the Six Companies constructing Hoover Dam first required all its workers to wear hard hats by November 1931.

Here's a picture of the vintage "Bollard hard boiled hats" of the era, courtesy of Hal's Lamp Post, a site with an excellent and very interesting collection of mining artifacts.

Original image source

Creating a safety culture: Prioritizing health & safety yields results

2012-04-19T11:57:52Z

We've long held that safety starts in the corner office. Many safety and health programs are little more than window dressing - lots of banners and lip service, but scant in managerial support. A recent study demonstrates that employers who prioritize workplace health and safety in a meaningful way by creating a safety culture can yield positive results and reduce losses. The study showed that "workers who believe they work in a safe environment experience 32% fewer injuries."

David Shadovitz of Human Resource Executive reports on the study conducted by researchers at the University of Georgia's College of Public Health in his article The Value of Safety Climates. As opposed to focusing on one industry or occupation, this study used data from the 2002 General Social survey and the NIOSH Quality of Work Life module, encompassing "a broad spectrum of employment situations."

One of the survey authors says that the findings "...put hard numbers behind a long-held perception: that there's a correlation between safety climate and workplace injuries."

One other interesting factor that the study revealed is that work/life issues matter: "In situations in which work interfered with family life or family demands affected job performance, the researchers find that the risk for injury increased 37 percent."

Study authors say that the findings point to the need for efforts to be more closely coordinated between Human Resources and health & safety, and to break down the barriers that so often exist in organizations. Study authors call for a "a more comprehensive and integrated approach to safety."

What is a "Safety Culture"?
At its very essence, a safety culture is a pervasive core, shared organizational value. Here are two definitions that we like:

Safety Culture is the way safety is perceived, valued and prioritised in an organisation. It reflects the real commitment to safety at all levels in the organisation. It has also been described as "how an organisation behaves when no one is watching". (Source: Skybrary).

The enduring value and priority placed on worker and public safety by everyone in every group at every level of an organization. It refers to the extent to which individuals and groups will commit to personal responsibility for safety; act to preserve, enhance and communicate safety concerns; strive to actively learn, adapt and modify (both individual and organizational) behavior based on lessons learned from mistakes; and be rewarded in a manner consistent with these values. (Source: Safety Culture: A Concept in Chaos).

For a more in-depth analysis, we point you to the Conference Board's research report, Driving to "0": Best Practices in Corporate Safety & Health (PDF), which conducted a study on how leading companies develop safety cultures.

Key Components of a Safety Culture
In the original article cited in this post, one of the study authors said, ""If you talk to people who do safety inspections, they will often tell you that the first impression they get when they walk into a factory or construction site -- how neat it is and whether employees seem to be actively engaged -- tells them whether or not a worksite is safe or not." We've had the same experience - the truly excellent companies stand out: safety is a pervasive value that you notice from the minute you walk in the door until you leave. Based on our experiences with thousands of employers, we've compiled some of the best practices that we've observed among organizations that do things right:

Does health & safety commitment start at the top? Here's one quick check: Is health & safety included in your organization's mission statement? Does the President/CEO articulate the health & safety vision? Everyone knows that what the head honcho wants done is what gets done. If it isn't on his or her radar as a top-tier priority, it won't be on the radar for managers either. "Captain Sully" Sullenbeger speaks about how values start at the top and require "authentic action."

Are sufficient resources allocated? Management must back the corporate commitment with dedicated budgets, staff, and resources commensurate with the goals. This includes maintaining equipment and facilities and allocating training resources.

Are there written policies and procedures? Are essential functions and physical demands of each job documented? Management should also capture the company's commitment to safety in a written policy that is distributed to all employees and regularly reinforced.

Are health & safety goals on the "managerial dashboard"? The old adage about "what gets measured gets done" has more than just a grain of truth to it. Is health & safety included in annual business plans and goals? Are health & safety goals addressed and progress measured in concrete metrics? Does health & safety get reported on in business reviews the way any other critical business process would be addressed?

Is there accountability? You won't be able to take a bite out of losses without teeth in your program. Health & safety goals should be a part of every job description and every performance review at every level of the organization.

Are comprehensive inspections for hazards and behaviors conducted regularly? Do senior managers participate in walk-throughs and inspections? Does the CEO?

Do managers and supervisors "walk the walk"? In all-too-many many organizations, safety is just something expected of the line staff. Do managers and supervisors keep the rules themselves? Are visitors and vendors indoctrinated to safety rules at the onset of any visits?

Is health & safety addressed in a meaningful way in employee orientation? Studies show that new hires are at greater risk of injury than experienced workers. Is job safety training the first thing addressed in any new hire training? Does the worker have hands-on training in not just how to do the job, but how to do it safely? Is particular care taken with workers who pose risk challenges, such as young workers and workers who don't have strong command of the English language? Peer-to-peer buddy systems that monitor new employees for safety can be particularly effective.

Is safety training and communication ongoing process? In good organizations, training is not a "once and done" affair and safety value communication isn't relegated to an annual speech. Employees are retrained, processes are re-evaluated, and expertise is shared on a continual basis via team meetings, newsletters, company intranets, formal training sessions, and more. Remember to offer training when employees change jobs or get assigned new responsibilities. And don't forget to "train up": Many middle and senior managers don't know the real day-to-day hazards inherent in their own business or appreciate the role they play in fostering - or perhaps sabotaging - a safe work environment.
Is there strong employee involvement? At minimum, employees should be involved in in safety committees, inspections, and shaping corrective measures for eliminating hazards. Good organizations help to imbue a sense of ownership in employees at all organizational levels and encourage workers to share ideas that eliminate unsafe acts and working conditions for themselves and others. Employers need to create a climate that allows frank and open feedback from employees and must work to overcome the perception that giving safety-related feedback creates interpersonal conflict.

Is there a process for analyzing all accidents and near misses? We favor the term "analysis" over "investigation" to emphasize that the exercise is not about assigning blame but getting to the root cause of the breakdown, to understand where things broke down to learn from errors, incidents, and accidents. Immediate remedial actions should be taken.

Is progress recognized and acknowledged? - Mark safety milestones and progress to goals. Recognition can be simple - congratulating a work team in a meeting, free donuts in the morning or a pizza lunch to show employees that their efforts are valued. Employees sincerely appreciate recognition, which in turn increases motivation and commitment to work safely.

Additional Resources
OSHA: Safety & Health Management Systems eTool

OSHA: Creating a Safety Culture

For an abstract and a link to purchase the full study cited, see Occupational Injury in America: An analysis of risk factors using data from the General Social Survey)