Recently in News roundups Category

January 29, 2015


Jason Shafrin, our favorite Healthcare Economist, is hosting Health Wonk Review: Super Bowl Edition, the best of the recent postings from blogging health policy wonks. Jason cuts right to the chase in a compact, digest version of posts that will keep you up to date on issues related to healthcare costs, policies, IT developments and safety. Oh, and kindness - which should be a de facto component of healthcare, no?

Speaking of football ... we hate to be the Debbie Downer of the sport's big weekend, but a new study on concussions was just released to coincide with the Super Bowl - it sheds more light on the seriousness of concussions In youth football, demonstrating that NFL players who began playing before age 12 are more susceptible to cognitive difficulties. "The difficulty faced by the former players, who reported an average of nearly 400 concussions each during their lifetimes, is separate from the problem of chronic traumatic encephalopathy, which can only be diagnosed after death."

Is the focus on concussions having an impact on football? Justin Rodriguez of the Times Herald-Record reports on how the concussion crisis is a big blow to football.

| Permalink | No Comments

January 15, 2015


Hot off the press - Vince Kuraitis posts the first Health Wonk Review of the new year, "Shake the Winter Blahs" Edition at the e-Care Management Blog. There's the usual grab-bag of topics from some smart heath policy bloggers: Did you know that there's a brouhaha over Hepatitis C Drugs? You can find out more about it in this edition. You can also get the latest in digital health trends, an update on how ACA and Medicaid expansion are playing out, and much more.

| Permalink | No Comments

January 12, 2015


Senate Passes TRIA; Bill Goes to President Obama's Desk - "In addition to reauthorizing the TRIA program for six years, the bill raises the trigger
amount needed in total losses before the TRIA program kicks in from the current $100 million to $200 million, over five years, beginning in calendar year 2016. Also over five years, starting Jan. 1, 2016, the mandatory recoupment rises from $27.5 billion to $37.5 billion, increasing by $2 billion each year. For all events, the bill raises the private industry recoupment total from the current 133 percent of covered losses to 140 percent of covered losses."

Additional sources:
Risk & Insurance: Congress Quickly Changes Course on TRIA

Business Insurance: Senate approves federal terrorism insurance backstop

PropertyCasualty360: Senate passes TRIA, sends bill to Obama's desk

What Happens To Uber Drivers And Other Sharing Economy Workers Injured On The Job?
Ellen Huet inForbes: "As much as workers like Omar may think of themselves as employees of peer-to-peer marketplaces like Uber, Lyft, TaskRabbit, Instacart, Postmates or Homejoy, they're not, legally speaking. Companies are under no obligation to provide the same worker protections for independent contractors as they are for employees -- protections like overtime, paid sick days, health insurance and workers' compensation."

Do Not Fail to Care, Roberto Ceniceros, Risk & Insurance: "With the predicted spread in pricing -- as some insurers reduce policy prices to gain market share while others tighten up their offerings -- it stands to reason that those employers that manage their claims experience well will receive the better policy renewal deals and a broader range of coverage choices when arranging insurance.

Employers that fail to support safety programs that prevent injuries, or fail to take care of their workers once they are hurt, will eventually pay the cost of more complex claims and the increased services those claims require."

MSHA Says Coal Mining Deaths at Historic Low - "Preliminary data released by MSHA show 40 miners died in work-related accidents at the nation's mines during 2014, two fewer than the previous year, according to the agency's news release. Coal mining deaths dropped from 20 in 2013 to 16 in 2014, the lowest annual number of coal mining deaths ever recorded in the United States." Related - Ken Ward, Coal Tattoo: Is a record low for mining deaths enough?

OSHA orders pilot to be reinstated after being illegally fired for refusing to fly unsafe medical transport helicopter - "Faced one night with a trip over mountainous terrain in a medical transport helicopter with a faulty emergency locator transmitter, a pilot refused to fly the unsafe aircraft and was later terminated in retaliation for doing so. An investigation by the U.S. Department of Labor's Occupational Safety and Health Administration followed. As a result, Air Methods Corp. was ordered to reinstate the pilot, pay $158,000 in back wages and $8,500 in damages, and remove disciplinary information from the employee's personnel record. In addition, the company must provide whistleblower rights information to all employees."

Quicker Care with Telemedicine, Katie Siegel, Risk & Insurance - "Telemedicine can help combat an impending physician shortage and possibly lower cost of care for workers' comp payers. "

Florida repackaged drug payments to physicians dropped in 2013: Report - Stephanie Goldberg, Business Insurance: "Physician repackaged drug payments in Florida fell by nearly 39% in 2013, according to a recent report by the state Division of Workers' Compensation."

NH: Final Report of the Commission to Recommend Reforms to Reduce Workers' Compensation Costs (PDF) Related: NH Governor Hassan Issues Statement on Workers' Comp Commission Report

721 Hospitals Penalized For Patient Safety - "Medicare is penalizing 721 hospitals with high rates of potentially avoidable mistakes that can harm patients, known as "hospital-acquired conditions." Penalized hospitals will have their Medicare payments reduced by 1 percent over the fiscal year that runs from October 2014 through September 2015."

Did agents go too far in trying to catch a claimant in workers' comp fraud? - "A federal judge in Portland chided government agents Friday for running a series of elaborate ruses to catch a U.S. mail carrier they accuse of fraudulently obtaining workers' compensation benefits." Perhaps setting up a phony business, luring a claimant into a deep sea fishing expedition, posing as a vocational rehab specialist and setting up 1,000 hours of surveillance is a bit over the top?

Another New Opioid: Cheeky, This One

Vying for Market Share, Companies Heavily Promote 'Me Too' Drugs

How States Rate on Insurance Regulation, 'A' to 'F'

P/C Industry Financials and the Catastrophe Factor

State liquor store manager deserves workers comp over trauma from armed robbery, Pa. court says

CRS Publishes "The Cost of Iraq..."

Frigid Weather Heightens Ice Hazards

Q&A: Lockout Procedures At Shift Change

Pop Quiz: Test Your Knowledge of OSHA History

2015 Forecast & predictions

Recapping 2014

| Permalink | No Comments

December 29, 2014


Hank Stern of InsureBlog is hosting the Swan Song Edition of Cavalcade of Risk ... please check it out, it's a great holiday edition with an eclectic roundup of posts from some of our favorite bloggers.

It's also the end of an era that launched back in 2006. For 224 biweekly editions of this risk roundup, Hank has been the leader, the inspiration, the organizer, the spam wrangler and the person who generally kept things chugging along. Managing these carnivals is a big job - one that he did expansively, graciously and with good humor! Kudos and many thanks to Hank, who has become a dear friend to us over the years!

| Permalink | No Comments

December 18, 2014


Image source: Christmas gifs

We're happy to host this year's holiday edition of Health Wonk Review. Before we present the best of the recent health policy blogosphere, we wanted to offer a shout out to the hard working man of the season, Santa Claus. This year, we learn that "an industrial engineer managing a North Pole toy factory" would merit an annual salary of about $139,924. This is based on BLS data - you can see how arrived at that figure via the 2014 Santa Index. We think he probably also deserves a hazard pay factor based on this ergonomic risk assessment. The hazards are rife ...think chimney obstructions, dog bites, exposure to children's bodily fluids, fire hazards, elf mutinies, collisions with aircraft. There's probably insurance to cover those risks but if Santa is looking for any coverage for terror-related events, he is out of luck since the Senate failed to renew Terrorism Insurance

Image source: Christmas gifs

OK, now on to our submissions from the Health Wonkers.

Dr. Roy Poses finds a "naughty, not nice" candidate in his post about the Hospital CEO as Scrooge at Health Care Renewal. He documents how the Erlanger Health System's CEO and other top managers are getting bonuses after a recent freeze of employee retirment and vacation benefits. He notes that, "Most of health care, perhaps just reflecting the larger society, now seems to be run for the benefit of the insiders, usually managers/ administrators/ bureaucrats/ executives (MABEs ?) hardly the patients, or those who actually take care of them."

Louise Norris of Colorado Health Insurance Insider finds a a glitch in Connect for Health Colorado's catastrophic plans. While plan eligibility is supposed to encompass people age 18-29, the quote tool provides Catastrophic plan quotes for 30-year-olds. Oops.

Health Affairs Editor-in-Chief Alan Weil offers five reasons why he opposes payment reform at his Once in a Weil blog. In this first of a two part series, he lists the problems with current versions of payment reform. At the end of the piece, he reveals that he doesn't really oppose payment reform -- but that there are things we must do to make payment reform work -- which he will tackle in part 2.

Joe Paduda offers another perspective on PPACA at Managed Care Matters. He notes that, "Overall, things are improving, rather dramatically - but not without pain." He enumerates some of the good, the bad and the ugly.

At InsureBlog, Henry Stern looks at some of the moral dilemmas involved in genetic screening. For example, if you agree to participate in a genome study, who owns the data and results of your test? See his post It's in the Genes

Neil Versel posts about how the hype around healthcare wearables is running into reality at his Forbes blog. He offers a reality check on the rah-rah attitude surrounding wearable monitoring devices put forth by some analysts, researchers and vendors. His post sparked a lively discussion on LinkedIn's Digital Health group.

Many patients have gained insurance through the Medicaid expansion within the Affordable Care Act. However, have these patients been able to access adequate medical care? Jason Shafrin investigates in his post Insurance does not equal health care at Healthcare Economist.

Peggy Salvatore asks just who accountable care is accountable to in her post at Health System Ed. She says that ACOs have the potential to achieve their full potential when all the systems are in place to deliver both real-time patient data to treat the patient in front of you and retrospective data to decide if the methods to treat achieved their goals. Are we there yet? Check out the post for Peggy's assessment.

David Williams of Health Business Blog offers a podcast interview with Evolent CEO Frank Williams on transforming healthcare. Williams aims to help provider systems succeed financially as they transform from volume-driven to value-driven payment models. He discusses ACOs, consolidation, and how Evolent makes money.

At, Harold Pollack posts about the Affordable Care Act's Medicaid expansion, in which he discusses reasons why states might reasonably worry about the ACA. In the final analysis, the President and the governors need to get along.

David Harlow hosts a seasonally related roundup, HealthCare SocialMedia Review No. 19 - Festivals of Lights Edition at HalthBlawg that's worth checking out.

Here at Workers Comp Insider, we delve into our archives to present a closing Santa-related post. We opened with discussion of Santa's pay -- but no matter what he is paid, there are never any good reasons for shortchanging worker safety. Is he? Santa's workshop: "OSHA problems galore" say whistleblowers

Have a happy and safe holiday. We have a brief holiday hiatus - the next issue of Health Wonk Review will be on January 15, hosted by Vince Kuraitis at e-Care Management Blog.

Image source: Christmas gifs

| Permalink | No Comments

December 10, 2014


The inimitable Bob Wilson of Bob's Cluttered Desk is hosting this week's Cavalcade of Risk, and get this -- it rhymes. It's Out, It's Plentiful, and It's Free. It's the Cavalcade of Risk Number 223. This is not simply a poetic tour de force, there's some meat and potatoes in the posts, too. We remain in awe of Bob, who is not afraid to handle the controversial topics that others are afraid to tackle. If you aren't familiar with his blog, take some time to enjoy his wit and wisdom.

In other news of note:

IAIABC Launches Education Program for Work Comp Agency Professionals
The International Association of Industrial Accident Boards and Commissions (IAIABC) has developed a formal education program. IAIABC Foundations of Workers' Compensation Administration Program will offer 10 courses in 2015, starting Jan. 12. Kudos to Safety National for supporting this initiative as a sponsor.

Blankenship case gag order
We'd love to be updating you on the court goings-on, but a gag order has been imposed on the case. In fact, even the indictment has been removed from public view. Ken Ward tells us that The Charleston Gazette is among a group of news outlets taking legal action to get access.

2015 Predictions for work comp
As the year winds to a halt, many are looking to the new year. At Manage Care Matters, Joe Paduda offers a roundup of predictions for the coming year, along with his own thoughts.

Dave DePaolo looks at the state of the state in California's work comp scene and sums it up in on word. Actually, he has a lot more thoughts on the matter, well worth your attention.

Eyes on Texas
Joan E. Collier of WCI's Work Comp Nation Blog says that the Texas Division of Workers' Compensation has issued its biennial report to the Legislature, declaring that "while additional improvement can always be made, the system as a whole is stable." She's got the lowdown in her post.

Down to the Wire on Terrorism Risk Insurance Renewal
Could Super Bowl XLIX be under threat if DC legislators can't come to agreement on an extension? That and a lot more - New England Insurance Agent Blog breaks it down.

Captives under Scrutiny
In Risk Management Monitor, Robert Myers tells us that, "Thirty-nine states have some form of captive or self-insurance law. Captives are now part of everyday life for regulators and the result is more scrutiny." He highlights pending issues related to captives.

Opinion analysis: No overtime pay for after-work security check
Lyle Denniston of SCOTUSblog weighs in on the Supreme Court's decision on Integrity Staffing Solutions, Inc. v. Busk. The court found in favor of the employer. Employers had been suing for overtime pay after the company instituted an anti-theft check requiring all workers to go through an end-of-shift screening. Workers say this process can add as much as 25 minutes of unpaid time per day.

Here are some other discussions of this case:
Michael Fox at Jottings By An Employer's Lawyer
Jon Hyman Ohio Employer's Law Blog
If standing in line for 2+ hours a week is a job requirement, then it should be paid as part of the job

Wage Theft Costs American Workers as Much as $50 Billion a Year
Christopher J. McKinney of Texas Employment Law Blog
"Wage theft is a nationwide epidemic that costs American workers as much as $50 billion a year, a new Economic Policy Institute report finds. In An Epidemic of Wage Theft Is Costing Workers Hundreds of Millions of Dollars a Year, EPI Vice President Ross Eisenbrey and EPI intern Brady Meixell examine incidences of wage theft--employers' failure to pay workers money they are legally entitled to--across the country."

The Whole World Is Fat! And That Ends Up Costing $2 Trillion A Year
The McKinsey report estimates the economic impact of obesity around the world at $2 trillion a year. Part of that figure is the cost of caring for diseases that are linked to obesity, like Type 2 diabetes. But there's an even bigger cost in "the loss of productivity," Dobbs says. "People suffering from obesity often work less. They have to take more time off sick. They retire early or even die early."
The United States has the highest obesity rate in the world: 34.9 percent. And while Americans are known for enjoying fast food and being "big," the other countries in the top five fattest nations might surprise you: Saudi Arabia, the United Arab Emirates, Mexico and South Africa.

New Briefs

| Permalink | No Comments

December 4, 2014


Hank Stern has posted a lively Health Wonk Review: Post-Turkey Day edition at InsureBlog - and rest assured, it's not leftovers, it's stuffed with meaty issues! This biweekly best of the health policy blogosphere is a good way to keep up with the wonkery.

Hank is one of our long-term hosts. He and I were waxing nostalgic over his first time at bat back in 2006. To check out other past editions visit the Health Wonk Review archives

Also, as long as you are making the blog carnival news rounds, check out last week's Cavalcade of Risk #222 hosted by Van Mayhall at Insurance Regulatory Law. We were goofing off over a long holiday weekend, so we didn't get around to posting it yet, but it deserves a look-see. .

| Permalink | No Comments

November 20, 2014


Check out a freshly posted Health Wonk Review: The Turkey Edition at HealthBlawg. David Harlow hosts and it is chock full of good content and some fun seasonal links to boot - mosey on over to take a gander, pilgrim!

| Permalink | No Comments

November 13, 2014


Cavalcade Of Risk #221,: Birds of a Feather - Claire Wilkinson of Terms + Conditions hosts this weeks' biweekly roundup, and it's a good one!

First up: Peril, and Daring, at 1 World Trade Center as Window Washers Are Trapped - Dramatic photos and reports of yesterday's rescue via the New York Times. Today's report: Workers Rescued From Dangling Scaffolding "Doing Well", which includes footage of the rescues. Good job, first responders!

Wrangling With John Burton Over the Future of Workers' Comp
A workers comp must-read. The International Association of Industrial Accident Boards and Commissions (IAIABC) featured a "point-counterpoint" type presentation in its annual Peer Review Journal. This edition features John Burton, Professor Emeritus at Rutgers and Cornell, and presidentially appointed Chairman of the 1972 Federal Commission on Workmen's Compensation and Robert "Bob's Cluttered Desk" Wilson, workers comp internet entrepreneur/visionary and President and CEO of Burton's article "Should There Be a 21st Century National Commission on Workers' Compensation Laws?" suggests a direction for the future and Wilson's article "The Case for Workers' Recovery" suggests a philosophical change for the industry. Download and read the series of articles.

WorkCompWire: NCCI Publishes Workers Compensation Financial Results Update - NCCI's State of the Line report indicated favorable industry results for 2013. Industrywide statutory data for 2013 indicates little difference between NCCI's preliminary estimates and the final results for most of the major financial measures. For Calendar Year 2013, NCCI initially estimated workers compensation premium volume net of reinsurance to be $37.0 billion for private carriers. This compares to the actual data reported by the industry of $36.7 billion. NCCI estimated an industrywide workers compensation combined ratio of 101 for 2013; actual data reported by the industry indicates a combined ratio of 101.3. 9. (You can access and download the full report free: NCCI Workers Compensation Financial Results Update.

ARAWC: A New Force for Change
Chris Mandel is SVP, strategic solutions for Sedgwick. "This new national organization was formed by a coalition of employers and workers' compensation system providers after many realized the benefits achieved in Texas and those anticipated in Oklahoma. The board and ARAWC's members have an intense interest in seeing employees better cared for by a more optimally designed and managed system. By seeking options to traditional workers' compensation, the organization has a goal of also driving economic development through the attraction of employer savings."
Related: Roberto Ceniceros - National Employers Push for Comp Options

Court to rule on health care subsidies
SCOTUS Blog: "The Supreme Court, moving back into the abiding controversy over the Affordable Care Act, agreed early Friday afternoon to decide how far the federal government can extend its program of subsidies to buyers of health insurance. At issue is whether the program of tax credits applies only in the consumer marketplaces set up by sixteen states, and not at federally operated sites in thirty-four states."
- Ezra Klein: The huge new threat to Obamacare, explained in 2 minutes
- Jonathan Cohn: Obamacare Returns to the Supreme Court
- Republicans to Chip at Obamacare by Redefining Work Hours
- Report: Healthcare premium increases 'quite low' in 2015
- Bob Laszewski: Is the Administration Low-Balling Their 2015 Obamacare Enrollment?

The American public is skeptical about workers' comp
Julius Young of WorkersCompZone reviews the results of a Harris Interactive poll on attitudes to workers compensation. "Instead of celebrating the social bargain that created workers' comp, too often the perception is that the system is out of control. And that stakeholders are only out to aggrandize their share of the pie. / Ultimately this has made it hard for injured worker advocates to gain much traction in the court of public opinion."

NPR investigation: Injuries and violations continue at coal mines that owe millions in fines
Keb Ward, Coal Tattoo: "Our friends at NPR News and the Mine Safety and Health News -- Howard Berkes and Ellen Smith -- have just posted some remarkable new work from a year-long investigation of what happens when coal mine operators never have to actually pay the safety fines that are assessed for violations of federal standards."

Who insures short-duration work-injury caused absences?

Terry Bogyo: "Without data, it is hard to estimate the number of work-related absence cases that are going uncompensated because of waiting periods. Without measurement, it is hard to see if this burden is shrinking or growing. Without a financial implication, the case for prevention may be less than it might otherwise be."

'Open' in Texas Causes a Workers' Compensation Roadblock
Joan E. Collier, wci360: "Well, here's an interesting item from Texas. An investigative reporter with CBS Dallas/Ft. Worth radio station KRLD has uncovered what he says "may be a loophole that blocks anyone who has ever used workers' compensation in Texas from getting Medicare claims paid."

Workers comp controversy grows as more business owners complain of bills from the state (NY)
Jim Kenyon, "...Michael T. Berns, former Commissioner on the State Workers Comp Board, now runs a website critical of the way the Board operates. He blames the Board for allowing the self-insured trusts to run up multi-million dollar debts. "The State of New York allowed what I would call a Ponzi scheme to take place and therefore the State of New York should take the responsibility of making these people whole." Berns said."

Elite Doctor Network Targets Florida for Medical Tourism

"Inbound (to the US) medical tourism is a $5 billion industry with an estimated 1 million patients each year travelling to the United States to access some of the world's best medical care. While much of that revenue has historically gone to major hospitals, new technologies - like Telehealth - have made it feasible for individual doctors in private practice to participate. HelloMD has an international strategy, with translation of its growing body of content into five languages, and strategic alliances in China and elsewhere."

Brief Takes

| Permalink | No Comments

November 7, 2014


Waiting for your biweekly dose of health wonkery? Wait no more - Jennifer Salopek has a fresh post at Wing of Zock - Health Wonk Review: The Election Week Edition. Topics include the ACA, Ebola, MD kickbacks, venture capital healthcare investments & more - check it out.

| Permalink | No Comments

October 30, 2014


It's the All Treats No Tricks Cavalcade of Risk this week! Louise Norris is hosting over at Colorado Health Insurance Insider. You may recall that Louise just hosted Health Wonk Review too, whew - she's in demand!

| Permalink | No Comments

October 23, 2014


Louise Norris has posted the falling leaves edition of Health Wonk Review at Colorado Health Insurance Insider. It's a packed, pre-election edition covering a smorgasboard of topics, from open enrollment and the continuing saga of Obamacare to Ebola and prayer groups. Many thanks to Louise and Jay Norris for hosting.

Don't know about where you are, but here in New England, the "falling leaves" theme hits the mark. After a glorious foliage season, a multi-day deluge is taking its toll on the seasonal color. Driving in the wet, fallen leaves will be precarious today so take care!

| Permalink | No Comments

October 15, 2014


Russell Hutchinson has posted the 219th edition of Cavalcade of Risk at moneyblog. Catch up on various risk-related issues, including reports from New Zealand. Russell is our ongoing global correspondent!

| Permalink | No Comments

October 10, 2014


Joe Paduda has posted this week's Health Wonk Review at Managed Care Matters. In keeping with the overall mission of HWR, he says that there's "lots of health policy stuff, all right here!"

While at Joe's blog, also check out his post on drug formularies . He makes the case that despite progress that payers and PBMs have made in curbing runaway opioid costs, new drug-related issues keep emerging (eg compounding) and tighter controls are needed.

| Permalink | No Comments

October 2, 2014


David Williams hosts this weeks Cavalcade of Risk #218 at Health Business Blog - check it out!

| Permalink | No Comments

September 25, 2014


Billy Wynne has posted the "Thank God It's Recess" edition of Health Wonk Review at Healthcare Lighthouse, a bi-weekly best of the health policy bloggers. Go there now to find out the latest scoop on the Affordable Care Act as the rubber hits the road. Plus, assorted other health policy issues.

In other news:

Happy birthday to us! Worker's Comp Insider is 11 years old this month. Follow us on Twitter too

National Employers Push for Comp Options
Roberto Ceniceros, Risk & Insurance
"National employers already benefiting by opting out of Texas' workers' compensation system are now pushing for "free market alternatives" to traditional state systems across the nation.
They launched a new organization called the Association for Responsible Alternatives to Workers' Compensation. ARAWC plans to lobby state legislators to allow employers to develop new options for delivering medical and wage replacement benefits to injured workers.
Its members include nationwide companies such as Wal-Mart Stores Inc., Lowe's Companies Inc. and Sedgwick Claims Management Services Inc."

Workers' Comp - Feeding the Heroin Dragon
Risk & Insurance, Jason Beans:
"When you start doing some back-of-the-napkin math, you realize that the workers' compensation system's potential contribution to the heroin problem in America is staggering. Bottom line, we need to take ownership - our industry is creating addicts who are creating a massive recurring demand for heroin and other illegal substances."

Drugs and Drinking on the Job in New Mexico
Joan E. Collier, WCI360
"My home state of Florida has a law on the books that says workers' compensation benefits can be denied if an employee is found to have been intoxicated on the job at the time of injury. I've always thought that was sound public policy, so I was surprised to learn that we are decidedly in the minority on this."

Clinical Connections: What's So Special about Specialty Managed Care in Work Comp?
Shelley Boyce, CEO, MedRisk:
"As consolidation limits marketplace choices and as specialization is replaced by generalization, it is critical that buyers remember that expertise and ongoing clinical oversight is more important than ever. Service-specific guidelines, care oversight and outlier identification and management are still the answers to achieving the best patient outcomes. Outcomes, which, in the long-run, will continue to be the right answers for the carriers and payers, for their customers and their injured workers."

Accountable Care and Workers Compensation: Are They Compatible? (PDF)
Jacob Lazarovic, Chief Medical Officer of Broadspire
"Do these alternative medical models offer opportunities to redesign the prevailing model
of delivery and financing in workers compensation? It would seem that bundled arrangements would be easier to implement than population‐based models, and furthermore they would more closely match the nature of WC events which are inherently episodic, not holistic.
Several barriers to WC application of these models exist. Historically, WC has been a volume‐driven, fee‐for‐service model, and expectations and attitudes would need to be reformed. A pattern of micromanagement of all medical services would need to be altered, by increased delegation to provider entities. And the plethora of state regulations, dealing with reimbursement and direction of care, among others, would need to be overhauled to facilitate these approaches."

It's the diagnosis...
Joe Paduda, Managed Care Matters
"If the diagnosis isn't right, there's a pretty good chance the treatment won't be right.
A while back I had an interesting conversation with folks from Best Doctors about this issue, and they provided some interesting statistics about the incidence of misdiagnosis."

Severe black lung reaches near-record levels
Ken Ward, Coal Tattoo
"There's a new paper out this morning that has some scary news about the continued resurgence of black lung disease in the Appalachian coalfields. It focuses on progressive massive fibrosis, or PMF, an advanced, debilitating, and lethal form of coal workers' pneumoconiosis with few treatment options and no cure."

California is the tail that wags the dog
Dave DePaolo, DePaolo's Work Comp World
"Injured workers in California received nearly 20% of the $181.4 billion in medical and indemnity benefits paid by state and federal workers' compensation programs between 2010 and 2012.
In looking at the NASI numbers, the California Workers' Compensation Institute noted that the $11.5 billion paid in medical and indemnity benefits in California was "by far the highest in the nation, exceeding the combined total of New York, Pennsylvania and Florida, which ranked second, third and fourth among all states."

Related: Mark Walls, PropertyCasualty360
The current state of California workers' compensation and a look forward

Insurance Carrier Fraud: Know the Signs
Bill Byington, Missouri Employers Mutual WorkSAFE Center
"When you hear about workers compensation fraud, you usually think about employees and employers filing false claims or falsifying premium. It is important to know that insurance companies can also commit fraud. There are red flags and indicators that policyholders and injured employees need to be aware of when dealing with insurance companies."

NIOSH Celebrates National Farm Safety and Health Week
September 21-27, 2014, is National Farm Safety and Health Week. The National Institute for Occupational Safety and Health (NIOSH) marks this year's theme, Safety Counts: Protecting What Matters, by announcing the new Agriculture, Forestry and Fishing directory page.

Meetings & Conferences
Safety National has a new blog called Conference Chronicles

Register for Business Insurance' 5th annual virtual conference focused on workers comp and safety solutions is scheduled for October 8, a full day of webinars, audience Q&A and networking with peers that can help you better understand and manage the drivers for success in your workers comp and safety programs.

Don't miss out on a discount if you are planning to attend the National Workers' Comp & Disability Conference - if you register by tomorrow, you can save $275. You can learn more about the Nov. 19-21 Las Vegas event at the link above, or follow on Twitter at @wcconf or #NWCDConf

News Briefs

| Permalink | No Comments

September 17, 2014


Cavalcade of Risk #217 is live, covering such wide-ranging topics from the Audacity of Dope to the state of the residual property market. Rebecca Shafer hosts at the WC Roundup blog - check it out!

| Permalink | No Comments

September 5, 2014


Tim Dodge makes his CavRiskhosting debut with an impressive collection of risky posts: Cavalcade of Risk #216: Workers' Comp, Cat Losses, Kayaks, and Did a Doctor Prescribe That Joint?

As always, there's sure to be something that strikes your fancy, so do check it out.

| Permalink | No Comments

August 14, 2014


Are you feeling a little out of touch on your health policy wonkery over the summer? Wondering how things are progressing with ACA and other health policy issues? Catch up on your reading at Health Wonk Review: August Recess Edition. Brad Wright posts a substantive issue at Wright on Health - check it out!

| Permalink | No Comments

August 7, 2014


Catching up on our summer reading post vacation, we have a number of pointers to noteworthy news. First we note that according to a recent RIMS survey, the total cost of risk for businesses rose 2% in 2013. To segue on that, we turn to Cavalcade of Risk - a few of our friends have hosted recent issues: See The Italics and Dot-Dot-Dot Edition of the Cavalcade of Risk at Jaan Sidorov's The Population Health Blog, plus the prior edition Cavalcade of Risk #213 hosted by Jason Shafrin at Healthcare Economist, which kicks off with a great TED video clip on our relationship with fear from Sebastien Foucan.

,,, and here's more recent news in the world of workers comp

NCCI's Workers Compensation Claim Frequency--2014 Update - "According to preliminary estimates, workers compensation lost-time claim frequency declined by a relatively modest 2% in Accident Year 2013. The Great Recession of 2007-2009, which was the most serious and long lasting economic contraction since the Great Depression, had a considerable effect on claim frequency changes. Frequency increased in Accident Year 2010 and has declined in each subsequent accident year."

Frequency, high finance, and the future of work comp managed care - Joe Paduda talks about the impact of the drop in claim frequency on the work comp managed care industry: "Fewer claims = fewer services needed = fewer bills; less need for UR, case management, and related services." He discusses the likey impact, noting that, "Meanwhile the supplier market is consolidating, and managed care vendors are scrambling to capture enough of the shrinking market to survive the coming shakeout."

The Outsourcing Universe - For more on managed care, check out Peter Rousmanier's thoughtful column on specialized work comp services in Work Comp Central: "The workers' compensation insurer is for many the centerpiece of a mature industry. ...Within this industry, however, specialized services as an extension of claims management grew since 1990 from about $4 billion in total costs to about $18 billion today. This service universe expanded dramatically and changed repeatedly in products, organization, and leadership. Let's review this evolution and ask if two decades-plus of growth is coming toward an end."

8 revealing WCRI state studies on workers compensation - Bill Coffin of PropertyCasualty360 notes: "The studies measure five specific worker outcomes: recovery of physical health and functioning, return to work, earnings recovery, access to medical care, and satisfaction with medical care.
These metrics are measured to help public officials, payors and health care providers, among others, to identify how state-level systems are performing, and identifying where and what kinds improvements or reforms they might need."

Paying for Detox - At Risk & Insurance, Roberto Ceniceros notes that in response to the opioid crisis, workers comp payers are increasingly turning to detoxification programs and other multidisciplinary treatment modalities to address the problem. He discusses the opportunities and challenges in substance abuse treatment.

Zero PPE: The Future of Safety in Construction? - Scott Schneider of the The Laborers' Health and Safety Fund of North America issues a safety challenge. He notes that, "too often the first solution proposed to achieve this goal of zero injuries is to put all workers in personal protective equipment (PPE)" but wonders if the emphasis is misplaced: "Personal protective equipment is at the bottom of the hierarchy of controls for a reason."

Obamacare Update: On this topic, we follow Jonathon Cohn's writings, among others - here are two of this noteworthy recent articles: How Much Is Obamacare Raising Your Insurance Rate? Depends on Which State You Live In and Obamacare's Impact on the Uninsured, State by State.

News Briefs:

| Permalink | No Comments

July 17, 2014


Catch up on your Health Policy Wonkery for the summer - Jennifer Salopek has posted Health Wonk Review: Polar Vortex Edition at Wing Of Zock. It's a great edition and one of only two to be published during the abbreviated summer schedule, so get your wonk fix now!

Up? Down? Sideways? What's up with health care costs? - Joe Paduda: "First, let's not confuse "costs" with "insurance premiums". Unfortunately, many mass media outlets don't understand that insurance premiums are not costs...which certainly contributes to the confusion ... Second, let's not confuse "price" with "cost", as this report does."

NCCI data reveal need for new model for workers' comp claims management - "What's easy to notice and applaud is the industry's improvement. Not only is the 2013 workers' comp combined ratio of 101 far from the 2001 peak of 122, it is also a seven-point improvement over the previous year. However, the improvement represented in this data must be considered carefully, as the second, more telling story highlights a systemic problem the industry has yet to reconcile."

It's Just Work Comp - DePaolo: "...why is there so much controversy in workers' compensation?"

Can You Link Insurance Premiums To Smoking? - "Another recent study found that smokers missed an average of 6.16 days of work per year as opposed to the 3.86 days missed by non-smokers, and that a smoker taking four 10-minute smoke breaks actually worked one month less over the course of a year than a non-smoking employee. The Centers for Disease Control (CDC) estimate that each smoking employee costs a company an additional $3,391 per year - including $1,760 in lost productivity and $1,623 in excess medical expenses. So, smoking employees seem to be an excellent target to help an employer manage its costs, and not just the cost of providing healthcare."

CDC: Opioid Painkiller Prescribing Varies Widely Among States - "Health care providers wrote 259 million prescriptions for opioid painkillers in 2012 - many more in some states than in others - according to a Vital Signs report recently released by the Centers for Disease Control and Prevention that highlights the danger of overdose. The report also has an example of a state that reversed its overdose trend."

News Briefs

| Permalink | No Comments

July 14, 2014


R.J. Weiss of Weiss Insurance hosted last week's Cavalcade of Risk #212 - check it out! And while in the neighborhood,. check out his blog, too.

| Permalink | No Comments

June 25, 2014


We're pleased to be hosting the 211th edition of Cavalcade of Risk and we give you the Lightning Round edition in honor of Lightning Safety Awareness Week. If you are struck by lightning, your odds are apparently pretty good of surviving the encounter - see the story of the Georgia man who was recently jolted out of his boots but lived to tell the amazing tale. Take a few minutes this week to learn how to lower your risk of a similar encounter because even tho survival rates are high, most lightning strike survivors suffer lifelong maladies from the experience.

OK, on to our other risk-related issues - here are our blog submissions of the week:

First up, a good news entry from Hank Stern of InsureBlog: A report on
a medical breakthrough for folks with diabetes which promises to reduce the risk of insulin crises. See: Hi-Tech Diabetes news

Bob Wilson of From Bob's Cluttered Desk fame brings us another good news item about how loving parents and an excellent support network can make the difference between living a life of disability and a life well lived. See: Rachel Mast's Second Coolest Program of the Day

At Health Business Blog, David Williams looks at the Veterans' Administration medical mess, noting that the data that the organization collects and uses for internal benchmarking and quality improvement is ironically part of what got them in trouble. While the numbers look pretty bad, he notes that we have no idea how private sector facilities would compare, since they don't collect or report such information. See: Are we picking on VA hospitals too much?

Jason Shafrin of Healthcare Economist says that after Obamacare passed, the rate of uninsured in Minnesota fell by almost half. What is responsible for this decline in uninsurance rates? He takes a look: Health Reform in Minnesota.

We have a pair of posts that talk about risk mitigation through insurance, describing some specialized needs. At Insurance Thought Leadership, Nancy Germond looks at the insurance coverages a consulting firm needs . And at Workers Comp Roundup, Michael Stack notes that volunteering can be mutually beneficial to employer and employee alike, but he offers this caveat: Don't Overlook Workers Comp Needs for Volunteers.

Newcomer to Cavalcade Alan Whitton - aka "Big Cajun Man" talks about Atrociously Dangerious Investment Advice at the Canadian Personal Finance Site.

And here at Worker's Comp Insider, we point you to a pair of posts on the theme of this issue: Lightning Stike Survior Stories and The one in a million club you don't want to join.

That's it for this issue. The next host - two weeks from today - is RJ Weiss. Just in time for your poolside reading!

| Permalink | No Comments

June 13, 2014


Jeff Root has posted this week's risk roundup at Rooftin blog - check out Cavalcade of Risk #210.

| Permalink | No Comments

June 6, 2014


Joe Paduda has posted an excellent edition of Health Wonk Review over at Managed Care Matters - check it out!

And on this, the 70th anniversary of D-Day, we take a minute to honor the nation's heroes.

Original Associated Press Report On D-Day Landing Re-Issued

D-Day on

| Permalink | No Comments

May 30, 2014


Claire Wilkinson hosts the most recent risk roundup at Terms + Conditions blog: Cavalcade of Risk #209 - check it out. And if you aren't familiar with Claire's blog, she writes for the Insurance Information Institute and her blog has been one of the pillars in the insurance community since 2006

In other news ...
Fatalities - Company 'willfully ignored' safety standards in worker's death - Megan Woolhouse of the Boston Globe and Michael Grabell of ProPublica cover the 2011 death of Daniel Collazo while working on a machine at the Tribe hummus plant in Taunton, MA. Although Tribe paid a $540,000 fine to OSHA for 18 serious violations - one of the biggest fines in New England in at least a decade - the article discusses the limitations of OSHA penalties, which are often less costly than taking preventative measures. Prior to Collazo's death, Tribe had been cited previously for failure to enact the lockout-tagout procedure that would have prevented this death.

Tribe is not some small, local food plant struggling to keep up with safety regulations - it is part of a large multinational food conglomerate, the owner being Israeli-based Tivall 1993 Ltd. The article notes: "Tivall 1993 Ltd. is a subsidiary of OSEM Investments Ltd., one of the largest food companies in Israel. Last year, it made $109 million in profit on $1.2 billion in revenue. The majority owner of OSEM Investments is the Swiss food products conglomerate Nestle SA, which earned about $10 billion in profit last year on sales of more than $100 billion."

Related: Worker Fatalities Show Importance of Safety Training

The pot chronicles =Reimbursement for medical marijuana authorized under New Mexico workers' comp law = Kathleen Kapusta, J.D. at Wolters K;uwer discusses the case: "Agreeing with a workers' compensation judge (WCJ) that New Mexico's Workers' Compensation Act and its attendant regulations authorize reimbursement for medical marijuana, a state appeals court affirmed the judge's order requiring an employer to reimburse an injured employee for medical marijuana used under the Lynn and Erin Compassionate Use Act. Rejecting the argument that the judge's order was contrary to federal public policy, the court noted that the Department of Justice has recently offered "equivocal statements" about state laws allowing marijuana use for medical and even recreational purposes, and has even informed the governors of two states that voted to legalize possession of the drug and regulate its production and distribution that it would defer its right to challenge those laws.

Related: Joe Paduda at Managed Care Matters: Medical marijuana in work comp - take a deep breath, folks... and Michael Gavin at Evidence Based: Medical Marijuana: The Decision that Never Should Have Happened

What's going on? Bob Wilson of had been following the strange termination of John Plotkin, let go from his job as CEO of SAIF after just a few months - and under vague circumstances. See his recent post: Governor Kitzhaber, Is Oregon the New North Dakota?

Mining - At Coal Tattoo, Ken Ward reports that MSHA pushes proximity detection rule back again. The rule would require coal-mine operators to install life-saving proximity detection systems in underground mines.

ACA - I.R.S. Bars Employers From Dumping Workers Into Health Exchanges: Robert Pear reports in the New York Times: "Many employers had thought they could shift health costs to the government by sending their employees to a health insurance exchange with a tax-free contribution of cash to help pay premiums, but the Obama administration has squelched the idea in a new ruling. Such arrangements do not satisfy the health care law, the administration said, and employers may be subject to a tax penalty of $100 a day -- or $36,500 a year -- for each employee who goes into the individual marketplace. / The ruling this month, by the Internal Revenue Service, blocks any wholesale move by employers to dump employees into the exchanges."

Fraud - 12 year sentence for $400,000, multi-state workers' comp fraud: "According to evidence presented at the sentencing and guilty plea hearings, between January 2011 and February 2014, Perry developed a scheme in which he defrauded six different insurance companies of workers' compensation benefits using false business and fictitious employees."

News Briefs

Health & Safety
Annual summer campaign to prevent heat-related illnesses launched by US Labor Department

Be Smart with Sharps

NIOSH: Safe Handling of Hazardous Drugs

Laundry Risk Factors and Best Practices part 1, part 2, part 3

| Permalink | No Comments

May 23, 2014


Hank Stern has posted Health Wonk Review: Life's a Beach Edition at InsureBlog. HWR is the biweekly digest of the best of the blogosphere's opinions from the health policy wonks - a must read! Many thanks to Hank, long-time HWR participant and all-round internet nice guy for a great hosting job!

And as we enter the holiday weekend, just a little reminder ...


| Permalink | No Comments

May 8, 2014


Health Wonk Review - Jason Shafrin hosts a not-to-be-missed HWR fit for a King at his blog, Healthcare Economist. Find out what's on LeBron James' mind, among other things! Lots of good links to the best of the health wonk blogosphere in this edition.

Challenges - In this week's Insurance Journal, Andrea Wells has an excellent article on 10 Challenges Ahead for Workers' Compensation. It's a must-read overview of key issues: Industry experts weigh in on technology, opioids, ACA, terorism, safety & more. We are pleased that our own Tom Lynch is featured discussing how the work comp industry is lagging in technology and his vision for what could be.

Case Law to Watch - At Risk & Insurance, Roberto Ceniceros talks about a case involving a drug-related death that is scheduled to be heard by the California Supreme Court in his post Drug and Death Connection. He says, "the court will determine whether a commercial insurer should be financially responsible for the death of a worker who died from an accidental overdose a year after being injured on the job."

Accountability - Rousmaniere: Who Protects Workers from Injury? - "This messy mix of private and public sector parties engaged in work injury risk is similar, a risk consultant told me, to how risks are dealt with in other areas of the economy. Too bad the parties don't talk with each other that much."

Travesty - Crisis of veterans' suicides is too often ignored - "The Veterans Administration says 22 veterans kill themselves every day. Think about it. In March, not a single American service member was killed in action in Afghanistan or Iraq. But during that month, almost 700 veterans committed suicide."

The Future Workplace - Emerging tech is transforming the workplace - "While smart mobile devices, SaaS, and social software ushered in a wave of major change in the workplace, that's nothing compared to what's coming."

Language - At the WorkCompEdge Blog, Kory Wells asks Are You Using These Five Words When You Talk About Workers' Comp? She cites a study of the 5 most persuasive words in the English language and looks at how this language relates to the world of work comp.

Trust - If I Could Teach The World to Sing - Dave DePaolo talks about trust and gratitude in the world of workers' comp. His thoughts remind us that despite our focus on the process, we need to remember that at the very heart of things, workers comp is about a human event: a person got injured at work.

Safety Advances - Collision Avoidance Systems Can Decrease Accidents 44% - no small prospect given that vehicular injuries / fatalities consistently rank right up there in terms of work exposures.

More News of Note

| Permalink | No Comments

May 1, 2014


Your biweekly risk roundup is posted and ready for your review: Cavalcade of Risk #207 is hosted by Rebecca Shafer at the AMAXX blog - there's a smorgasbord of topics, including Wounded Warriors and venture capitalists, Aristotle and ERM.

| Permalink | No Comments

April 25, 2014


Biweekly roundup of health wonkery - Louise Norris posts Ways the ACA Could Be Improved Edition of the Health Wonk Review at Colorado Health Insurance Insider, a robust roundup of links and opinions from some of the best health wonks on the web. It could also be titled the "hopeful signs of spring" edition - check out the great local photos.

Reminder: April 28 - Workers Memorial Day is coming up. April 28 is dedicated to, remind us that every death, injury, or illness on the job represents a human tragedy. For a toolkit or list of events, see the AFL-CIO Workers Memorial Day site. Yesterday was the one-year anniversary of Bangladesh's Rana Plaza factory which killed 1,129 garment workers. The New York Times looks at the past year's battle for a safer Bangladesh.

Spine Surgery - CBS News features an important story on the increase in spinal fusion surgeries: Tapping into controversial back surgeries. CBS examined the number of spinal fusions each doctor in the country billed to Medicare from 2011-2012, finding that 5% of spine surgeons performed 40% of riskier fusion surgeries. The data analysis was the starting point to a deeper investigation raising questions about disparities in treatment and whether many such procedures are performed unnecessarily. "The data shows that a small group of doctors performed these procedures far more frequently than their peers. While the national average was 46 surgeries over the two year period, some did more than 460. While the average spine surgeon performed them on 7 percent of patients they saw, some did so on 35 percent." They also offer a database to look up a surgeon,

Terrorism backstop - As the renewal of terrorism insurance winds its way through the legislative process, the industry is fairly unified in reaffirmation of the importance of renewal. The current bill is slated for expiration on Dec, 31. A newly released 2014 Terrorism Risk Insurance Report by Marsh makes the case for renewal, stating that the law offers a stable underpinning to ensure availability and affordability of coverage. Last year's Boston Marathon bombing sparked demand among smaller and midsized firms -- and also raised the issue of a need for clarity about just what constitutes a terror event.

CA Opioid Guidelines - Joe Paduda posts a detailed take on the strengths and weaknesses of California's new Opioid Guidelines. His opinion? Underwhelming.

Claims - Dave DePaolo has a post on Mental Claims & Boundaries, in which he looks at a PTSD claim that is being contested in Florida.

Opioids- Lab-based Urine Drug Monitoring, Interventions Improve Outcomes for Injured Workers on Chronic Opioid Therapy - Clinical interventions performed in conjunction with laboratory quantitative drug testing and monitoring reduced injured workers utilization of high risk medications, according to a clinical study released by Progressive Medical/PMSI and Millennium Laboratories. The study showed a decrease in all measures of utilization, driven primarily by opioids (32%) and benzodiazepines (51%), as well as a 26% reduction in total utilization of all medications, regardless of drug class.

Quick takes

Just for fun

| Permalink | No Comments

April 11, 2014


Check out the freshly posted Health Wonk Review - The April Fools' Edition at Healthcare Lighthouse. Think we're a little late on the date? Nope. Host Billy Wynne says the spirit of April Fools' lives on as the blogosphere's smartest health wonks gather to correct foolish notions and misconceptions floating around in certain pockets of our national dialogue.

Billy has been contributing to Health Wonk Review for some time now but this is his first time at bat in hosting, so be sure to give him a a visit. While you are visiting this edition, take a minute to explore other resources at Healthcare Lighthouse beyond the blog. Billy is the CEO and founder - he has gathered an impressive advisory board.

| Permalink | No Comments

April 3, 2014


Nancy Germond hosts a new edition of Cavalcade of Risk #205 at her blog. Check it out. You can also follow Nancy at Twitter: @insurancewriter

March 28, 2014


Chris Fleming has posted A March Madness Health Wonk Review at Health Affairs Blog. As might be expected, Obamacare is a big focus in the submissions, as well as some stellar entries on the healthcare scene in Massachusetts. There's also a grab bag of assorted topics. Health Affairs Blog and the parent publication Health Affairs is one of the nation's leading journals of health policy thought and research. If healthcare is a topic on your radar -- and if you are an employer, it should be -- it's worth dropping by to keep up to date.

Other notable news:

A bit of humor
You had one job: Funny on-the-job flubs

Bronze Age Orientation Day

The Electronic Morale Booster - How things have changed since 1951

...if you missed the video of the dramatic rescue of a construction worker by the Dallas Fire Department, we've posted it below.

| Permalink | No Comments

March 5, 2014


This week's host of Cavalcade of Risk - #203 is Bob Wilson of and of the highly esteemed "Bob's Cluttered Desk" blog where a spoonful of humor always makes the medicine go down. In this issue of Cav, he offers a roundup of posts across the risk spectrum - check it out. And while you're visiting, if you haven't read any of Bob's greatest hits yet, set aside a few minutes to do so. How many insurance blogs do you read that have the temerity to cover flatulence?

| Permalink | No Comments

February 27, 2014


Check out the excellent Health Wonk Review, In like a Lion edition posted by David Harlow at HealthBlawg. It's a robust issue with no shortage of Obamacare updates and opinions, along with other policy issues. Plus, he offers interesting trivia notes between postings - if you've ever wondered why February has only 28 days, here's your chance to find out.

By the way, in addition to being a stellar, long-time healthcare blogger, David is also one of the prime movers behind another blog carnival, Health Care Social Media Review - so if you don't get your fill of health care from the wonks, be sure to drop by the bi-weekly SMR.

Medical Marijuana - Now that 21 states have legalized medical marijuana and two states - Colorado and Washington - have legalized the possession of small amounts of marijuana for recreational use, Darrell Brown of Sedgwick looks at marijuana and workers' compensation. He reminds us that the drug it is still illegal in federal law, he looks to some case law on the matter and states Sedgwick's policy. Plus, he also points us to the related whitepaper, Spotlight: How will medical marijuana laws impact workers' compensation claims handling? (PDF)

Transparency - At Risk & Insurance, Roberto Ceniceros poses the question, How About a Flat Fee?. He notes: "More employers wanting predictability in the fees they pay workers' comp third-party administrators are negotiating to pay a single, flat fee for bill-review services, sources tell me. The arrangements follow from criticisms some employers, their brokers and consultants have heaped on TPAs, saying traditional TPA charges for bill-review services obscure the ultimate cost of those services."

Egregious conduct - At The Pump Handle, Celeste Monforton takes a principled stand: When employers are reckless with workers' lives, they have no right to remain in business - and we'd have to agree. Part of being in business is being responsible to all your stakeholders. Monforton notes:

"Last week, Labor Secretary Tom Perez announced that OSHA has proposed penalties of $697,700 to Wire Mesh Sales. Eight of the violations were classified as "willful," and OSHA recommends a $70,000 penalty for each. They relate to the employer's failure to have an effective procedures in place to ensure that equipment is de-energized and pad-locked off. These "lockout/tagout" violations were found on other pieces of equipment in the Jacksonville plant.

A slew of other violations, more than 20, involve hazards related to electrical systems, respiratory protection, blocked passageways, cranes, and overhead slings. Noise exposures in the plant were extreme and well above the permissible level, repeat violations for the company. And one violation reflects the employer's utter disrespect for the workforce: There was a "bathroom with a sink that had been clogged for months with maggots swimming in standing water."

Trucking - Truckers take note: New Study Shows Significant Health Risks for Long-haul Drivers - "A new study from the National Institute of Occupational Safety and Health (NIOSH) shows that long-haul drivers have significant health risks. Obesity tops the list at 70%, this is compared to 31% of other workers who are considered obese. Morbid obesity is also twice as high, 17% versus 7%. Exacerbating the issue is that over half of drivers are cigarette smokers."

Yet More Healthcare - OK, for those of you who aren't Obamacare aficianados, avert your eyes as we link to these items - we don't want to be the cause of any utilization spikes due high blood pressure, we know we have a few readers who are passionate "non-fans." A recent Insurance Journal talks about a study by the Insurance Research Council: How ACA Healthcare Law Could Affect P/C Insurance Costs and Claims. Meanwhile, we learn that Enrollment Reaches 4 Million and Joe Paduda offers thoughts on Exchange enrollment - the big picture. Wendell Potter discusses a study of the Massachusetts health law, which cited a reduction in financial stress, including personal bankruptcy reduction, fewer delinquencies, and improved credit scores.

Other noteworthy items

| Permalink | No Comments

February 5, 2014


Russell Hutchinson, proprieter of the "down under" Chatswood' moneyblog, is hosting Cavalcade of Risk Number 201. It's a roundup of some of the usual suspects and a few new-to-us participants, too.

Don't miss the important advice offering guidance for revising and implementing your organization's emergency plans in the event of a nuclear detonation!

| Permalink | No Comments

January 30, 2014


There's a fresh new Health Wonk Review posted and it's a good one! Brad Wright is hosting Health Wonk Review: The New Wright on Health Edition . With the Affordable Care Act implemtation process in full swing, it's an exciting time to be a health polcy wonk. Whether you're in the "pro" or "con" camp, there's something for everyone in this roundup. Plu,s Brad alerts us that his blog will be expanding and taking on new bloggers and an enhanced mission. Check out his post!

And in other ACA news:
Jonathon Cohn: Rumors of Obamacare's Death (Spiral) Are Greatly Exaggerated
Bloomberg News: Economists See Little Effect on Hiring From U.S. Health-Care Law
Sarah Kliff: The four most important states to watch on Obamacare's Medicaid expansion

Union Members 2013 - Bureau of Labor Statistics: "In 2013, the union membership rate--the percent of wage and salary workers who were members of unions--was 11.3 percent, the same as in 2012, the U.S. Bureau of Labor Statistics reported today. The number of wage and salary workers belonging to unions, at 14.5 million, was little different from 2012. In 1983, the first year for which comparable union data are available, the union membership rate was 20.1 percent, and there were 17.7 million union workers."

Risk & Insurance - Check out the sleek new look at Risk & Insurance - it's a verry appealing layout. Here's a summary of some of the changes you can expect to find. Plus, it's a responsive design which makes it show up really well on whatever device you are vieiwing it on - it looks great on my iphone. And while there, be sure to vist the column by our friend Roberto Ceniceros: The Benefits of Change.

Tough times ahead for workers' comp: Report - "According to a new report from Standard & Poor's Ratings Services, revenues for the US workers' comp sector will likely decline in 2014. The report identifies the continued high unemployment rate, coupled with potential gridlock in Washington over the reauthorization of the Terrorism Risk insurance Program Reauthorization Act, as the main drivers behind this trend."

Combine Wellness with Risk Management to Help Curb Work Comp Costs - "A recent report from Lockton Insurance Brokers Wellness Programs: The Positive Impact on Workers' Compensation Claims examines the role that health-risk (or "co-morbid") factors, such as obesity play in workers compensation claims, and the steps that companies can take to reduce claims costs by improving employees' health."

Work exposure? At least four Marlboro Men have died of smoking-related diseases. KevinMD asks: Are e-cigarettes creating new generation of smokers?. The Robert Wood Johnson Foundation presents a fascinating interactive look at 50 Years of Tobacco Control.

EHS Study: Effectiveness of Adjuster Decisions Regarding Medical PreAuth Requests - " Effective Health Systems recently released a study that evaluated the effectiveness of experienced workers' compensation claims adjusters at determining whether a medical treatment request should be approved or escalated to a higher-level review. The study found the effectiveness of adjusters in making a correct decision was less than would be expected from flipping a coin."

And on the lighter side, we spotted this great "Bad Lip Reading at the NFL" clip over at New England Insurance Agent Blog
and thought it was perfect for the Friday before the big game.

If you enjoyed it, you can find an earlier NFL bad lip-reading clip here.

| Permalink | No Comments

January 22, 2014


Jeff Root of Rootfin hosts Cavalcade of Risk #200. I repeat, 200! That's a lot of risk covered over the year. Kudos to Jeff for a great issue and also to Hank Stern of InsureBlog for steering the ship for these many years. It's no small task. These topical blog "carnivals" -- as the roundups are sometimes called -- are valuable because they expose readers to new blogs, new writers and new topics.

Hats off to Jeff not just for content curation but also for a very attractive and well-designed blog. Jeff's area of expertise is life insurance and he appears to be doing the social media thing right - check out his Google+ page and we also find him over on Twitter talking about how he just got his Google glass invitation - so we expect a future risk report on the pros and cons of Google glass!

| Permalink | No Comments

January 16, 2014


In the first edition of the new year, David Williams kicks of Health Wonk Review with the Health Wonk Review: Half glass edition posted at Health Business Blog. Check it out. Plus, if you aren't doing so already, David is a good person to follow on Twitter: @HealthBizBlog.

Speaking of Twitter - do you use it?

We're big Twitter fans but we find a lot of people who have misunderstandings about the service. Some people think of it as irrelevant to business but those people are wrong ;-) In the news, you tend to hear only about the crazy, wacky celebrity things or the news about someone caught posting something rash or naughty. But Twitter is large and contains multitudes, including some thriving business communities. It can help if you think of it as microblogging. Even if you don't want to post yourself, it can be useful to have an account to use as a news feed - there are excellent workers comp, insurance and health care accounts to follow. Following someone's Twitter feed doesn't imply endorsement so it's a good way to keep track of your competitors, too.

Plus, it can be fascinating and fun to follow breaking stories. Twitter is, after all, the new way that news breaks. You can follow business leaders, topic experts, news media, state and local governments, athletes and other celebrities and even the occasional joke account. During a big news or sporting event, following along can be something like being in a big, fast moving live chat. Check out 2013 Year on Twitter for a sampling.

Some people prefer to keep their work and their personal life separate and keep more than one account for that reason.

Here are a few resources to get you started

The Beginner's Guide to Twitter
Twitter, the Basics
The Twitter Glossary
16 Creative Ways to Use Twitter for Business

Here's a list of Twitter accounts we gathered that might be useful: US Government Agencies accounts - we selected resources that are helpful to health, safety & labor in the workplace. You can subscribe to this list or pick and choose accounts to follow.

And be sure to follow us here @workcompinsider and our fearless leader, Tom Lynch can be found ar @lynchryan. To find people related to workers comp, just browse through the list of people we are following or who are following us.

TIME's 140 Best Twitter Feeds of 2013
Top 100 Business, Leadership and Technology Twitter Accounts You Must Follow

| Permalink | No Comments

January 8, 2014


It's the first full week back to work for many, but some are stranded by the frigid temps gripping the nation. Whether you're at home or at work, grab a cup of the hot beverage of your choice and hunker down with a fresh Cavalcade of Risk #199 (posted by Michael Stack at Workers Comp Roundup) - it's a good way to catch up with what's been happening in the blogosphere over the last few weeks - and to take a peek at what's in store for 2014.

| Permalink | No Comments

December 30, 2013

| Permalink | No Comments

December 19, 2013



Hello Santa! -- You're surely a busy guy this season -- it's no small task sorting out the naughty from the nice all over the globe! Good thing you're such a wise soul because there are a lot of folks who could really try your patience. Just take the rogues gallery down in Washington DC, for example -- everybody has a long wish list and they don't see eye to eye at all. In fact, for all the talk about keeping the real spirit of Christmas in the holiday, it seems like everyone's forgetting about the "peace on earth" and "goodwill to man" parts of the deal. Some people are even getting hung up on whether you are black or white, can you believe it? Here's hoping you can sort it all out!

We've collected some healthcare thoughts & wishes from the wonky blogosphere hoping that it will make your job a little easier. These are some devilishly smart and very nice people, so a little special consideration would be appreciated!

Dear Santa - Are some holiday revelers drinking too much egg nog and getting cloudy thinking? Joe Paduda seems to think so. At Managed Care Matters, he finds that some of the "repeal and replace" crowd are getting loud and fighty but not making a lot of sense. He dissects the various ideas advanced by those looking to repeal Obamacare to determine the viability. You be the judge: Repeal and replace Obamacare - making the case.

Dear Santa - When you're sorting people into the naughty or nice rosters, can you be sure that Professor Tim Jost gets put in the "nice" list? At the Health Affairs Blog, he's done a detailed and extensive analysis of the health exchange enrollments to date. He looks beyond November's dramatic enrollment increase to other interesting trends that the metrics hold. Check out his analysis of November's Exchange Enrollment Report and see if you don't agree that he deserves some special consideration.

Dear Santa - As we near the holiday, it appears that some folks have been rushing around at the eleventh hour to try to look good after a disappointing year. Billy Wynne, one of our newer and very welcome health wonkers, has been observing the year-end flurry of legislative activity in DC and offers a breakdown of some of the most significant developments and what they might portend for the future, noting that if this week is any indicator, we're in for more fun in the new year. Check out The Doc Fix is Real - And Other Lessons Learned Last Week posted at the Healthcare Lighthouse blog.

Dear Santa - Before you decide whether the DC legislators deserve coal or candy on the issue of the pending Doc fix - the one that has been bumped into the new year - you might check in with Brad Flansbaum's post at The Hospital Leader. In The Problem That Won't Go Away, he looks at how the rubber meets the road in terms of the impact on hospitalists. (And in a noteworthy post unrelated to the political goings on, Brad looks at the issue of whether the use of hospital readmissions as a lone metric for post-discharge health care quality is incomplete without considering the role of the ED. Check out his take on the matter.)

Dear Santa - Did you catch wind of the widely circulated AP story saying that people with insurance coverage are angry at ObamaCare? At Health Business Blog, David Williams digs through the news narratives and finds some skewed polls and faulty reporting. He notes that despite a botched Obamacare rollout, the public still trusts Democrats on health care by a wide margin. Could it be that people are not as unhappy as the media would have us think? Sounds like you may need to stock up on coal for lots of reporters' stockings!

Dear Santa - In further considering the matter of naughty reporters, we may have a solution. Insurance industry insider Wendell Potter has developed an excellent checklist for reporters, which he thinks would help them in avoiding the pitfalls of being duped while covering Obamacare "horror stories." Can you make some room in that big sack of presents? If you could drop the checklist off at newsrooms while you are on your pre-Christmas publicity tour, it would likely make him happy. You can check out his 5 question reporter checklist at's blog.

Dear Santa - When you're checking your list this year, please check it twice to be sure that you notice the issue Dr. Roy Poses raises. He has put in a request for some teeth. Oh, not the dental kind - it seems he is hoping that healthcare reform will deliver real accountability when it comes to patient protection -- something with real bite that will take organizations to task for bad behavior. Could you put this on the fast track because he has apparently been waiting for some time. Over at Health Care Renewal, he posts about yet another Johnson and Johnson settlement -- it would appear that some enforcement is sorely lacking.

Dear Santa - As long as we're on the topic of teeth, could you be sure to leave a special present under the tree for Louise Norris? At Colorado Health Insurance Insider, she has done some hard work and heavy lifting in sorting out how pediatric dental coverage will be impacted by ACA and HHS regulations.

Dear Santa - Can you settle the matter of whether health insurance improves health? Healthcare Economist Jason Shafrin notes that in most cases, the answer is likely 'yes' -- but a study in Burkina Faso found that the answer was 'no'. In considering this question, Peggy Salvatore wonders if we are all asking the wrong question and focusing on the wrong things: she asks the fundamental question of whether we are trying to provide health insurance or health care for all?

Dear Santa - Not everyone is feeling all that jolly this year. Some folks are looking to the future and seeing an ominous ghost of Christmas Yet to Come. Check out John Goodman's Health Policy Blog - he's sounding an alert about a severe doctor shortage that's looming and he explains why he sees this in the cards. And at InsureBlog, Patrick Paule sees a future with a lot of disappointment for a lot of people. He thinks that even those folks who find an insurance plan they like in 2014 shouldn't count on it -- he thinks they are likely to find a blue Christmas in years to come.

Dear Santa - - Dr. Jaan Sidorov sees another looming peril and would like your thoughts on the matter. At the Disease Care Management Blog, he asks if the bureaucrats responsible for implementing Obamacare are falling victim to the dreaded condition of "credibility trap," where government begins to doubt itself. He identifies various symptoms of this condition. Is he over-reaching? You be the judge.

Dear Santa - Some are troubled by other matters than the ACA: it appears that medical education is no longer the unique purview of academic health centers. That's an issue that Dr. James E. Lewis raises at Wing Of Zock in noting the opening of the Medtronic Surgical Technologies training facility in Florida, which aims to train 750 surgeons and health care professionals annually. Are income streams becoming inextricably intertwined in academic medicine?

Dear Santa - Here at Workers Comp Insider, we're really not asking for anything for ourselves, but we'd like you to please look after the health and safety of the workers. Lately, we've been particularly concerned about the health and wellbeing of the healthcare workers. It's not bad enough that they face all the stress of a changing healthcare environment, their jobs are downright dangerous, too. And now it would appear that many of the perils they face are not from patients but are are self-inflicted. Can you help?

| Permalink | No Comments

December 11, 2013


Our colleague David Williams hosts the Cavalcade of Risk #198: Short and sweet edition. He always does a terrific job hosting the roundups - and if healthcare is on your radar, his blog should be a regular read.

Group Health Plans Pay for 'Zero-Cost' Workers' Compensation Claims
- study by Abay Asfaw, PhD, and colleagues of the National Institute for Occupational Safety and Health published in the December Journal of Occupational and Environmental Medicine, official publication of the American College of Occupational and Environmental Medicine (ACOEM).

Businesses Object To Posting On-Job Injuries Online - OSHA wants to make records of on-the-job injuries by employer easily available on a website. It says that would lead to safer workplaces. Manufacturers and businesses are objecting, arguing the data could be misinterpreted.

The other ways health care will change - Joe Paduda recaps some of the points he is making at a talk before the New York Academy of Medicine. In other ACA news, Jonathon Cohn talks about The Obamacare Flaw That Worries Me the Most; Sarah Kliff reports that Since October, 1.2 million have gained Obamacare coverage: 803 via Medicaid and 365 via exchanges. In Medicaid, here are the next 5 battleground states. This is significant because there are reports that hospitals are closing in states that blocked Medicaid expansion. In other news, three states are implementing transparency measures: More healthcare cost transparency for MA, NH [and NC] consumers.

Severity Trends by Undeveloped Size of Loss - NCCI research report.

10 Strategies to Combat the Rx Abuse Epidemic - An Insurer's Perspective - In October 2013, the Trust For America's Health (TFAH) issued a report titled, "Prescription Drug Abuse: Strategies to Stop the Epidemic" identifying ten strategies being employed at the State level.This article provides a brief recap of the strategies and shares some insurance company considerations.

In this one year anniversary of the horrific shooting at Newtown, how are we doing? USA has made slight progress on mental health since Newtown; Meanwhile, Two-thirds of gun laws passed since Newtown massacre eased gun regulation - and in that year, about 8-10x the number of children killed in Newtown have been killed by guns. The New York Times issues a report Children and Guns: The Hidden Toll, which attempts a census of accidental gun deaths of children but finds a pattern of underreporting due to idiosyncrasies in the way deaths are recorded. They looked at 259 deaths of children under age 15, while a report from Mother Jones documents 194 children under the age of 12.

News Briefs

| Permalink | No Comments

December 5, 2013


Our favorite Healthcare Economist, Jason Shafrin, is hosting this week's compendium of posts from the health policy wonks: Health Wonk Review takes on - get up to speed on what the experts think about the ACA rollout.

The Warning Signs of Violence - Security and student safety have always been strong concerns for educational institutions - and heightened to the nth degree after the shooting massacres of Virgina Tech and Sandy Hook. There's a good article recently posted on Campus Safety magazine on The Warning Signs of Violence, which includes a sidebar on the continuum of violence. This model - developed by Holmes and Holmes in 2001 - has three levels. Level 1 is intimidation, Level 2 is escalation and Level 3 is further escalation. The article also talks about the tactics of manipulation and how to trust your instincts. It's useful reading matter for HR, risk and safety managers - as well as supervisors.
Related: 8 Verbal Indicators of Violence

Workers Comp Navigation - We really liked this article by Sarah Tayts in WorkCompWire: On the Road to Recovery: Who's Driving? Her essay talks about many of the themes that we at Lynch Ryan long seen as vital to a positive outcome for all: maintaining good communication and treating the injured employee with respect and concern. Here's a sampling: "We're not dealing with claimants. We're not dealing with plaintiffs. We're dealing with people who have sustained a disabling event. Maybe they weren't financially set before the injury, and a twenty-one day compensability determination period is really throwing a wrench into things. Maybe their boss reacted poorly to their report of an injury."
Related: Top 10 reasons injured workers retain attorneys

NCCI - with Thanksgiving vacations, you may have missed NCCI's latest Financial Update. One of the key findings: "At this year's Annual Issues Symposium (AIS) , NCCI estimated an industry wide combined ratio for 2012 of 109. Actual data reported by the industry indicates a Calendar Year 2012 combined ratio of 108.1. The nearly one-point improvement was due to a small improvement in the underlying loss ratio as well as a slight decline in the dividend ratio. "

And the survey says... - Global pandemics are the the most important extreme risk that the global insurance identifies as a long-term worry, according to a Towers Watson survey. At the III blog, Terms + Conditions, Clarie Wilkinson fills us in on the issues that weigh in as #2 and #3 in concerns, as well as other details about the survey.

Recapping the conference - Joe Paduda offers his thoughts on some of the key trends and takeaways from the recent National Workers Comp and Disability Conference: Recapping the NWCDC. We appreciate the wrap-up but were hoping for some conference tchotchkes, too!

A Christmas Story - You can always count on the inimitable Bob Wilson to ferret out the not-to-be missed news. This week, he has a seasonal offering: My Holiday Advice for Santa: Don't Grope the Elves.

People notes - One happy, one sad. First, we congratulate our friend Roberto Ceniceros on joining LRP Publications as the editor for all workers' compensation content. He'll writing the workers' compensation column and feature articles for Risk & Insurance and co-chairing the National Workers' Compensation and Disability Conference, writing and editing the soon-to-be re-launched WorkersComp Forum website.

Our second note is quite sad. We extend our condolences to the family, colleagues and friends of Dave Albertson on his recent passing. We first met Dave in his editorial role at Employee Benefit News - a true professional and a very nice human being who left us far too young. The write up on Dave has the very fitting title "A life well lived."

News Briefs

| Permalink | No Comments

November 27, 2013


Louise Norris had posted a Thanksgiving Cavalcade of Risk at Colorado Health Insurance Insider. The ACA rollout issues play heavily in the topic list, but there are also posts about disability insurance, remembering our vets and corporate social media risks. Don't miss the outstanding winter landscape photos illustrating the issue, nice!

Have a safe and risk-free holiday - if you plan to fry up a turkey, William Shatner has some advice for you. And unless those turkeys are on your plate, watch out for those pesky birds!

Warm Thanksgiving wishes to all!

| Permalink | No Comments

November 21, 2013


Hank Stern has posted a fresh edition of Health Wonk Review at InsureBlog - and it's a special one: Health Wonk Review: Pre-Thanksgivukkah edition.

Hank created an excellent and thoughtful theme to frame this news-and-analysis-packed edition of excellent entries. He's also included an eclectic selection of truly inspiring quotes between entries. Check it out - good reading matter for your lunch hour.

| Permalink | No Comments

November 13, 2013


At his finance blog with the homey name of Mom and Dad Money, Matt Becker makes his hosting debut with Cavalcade of Risk - Separating the Good Risks from the Bad. Check it out!

| Permalink | No Comments

November 7, 2013


Brad Wright hosts a fresh edition of Health Wonk Review which dishes up the good the bad & the ugly on the ACA rollout and more; See his post at his Wright on Health blog: If You Like the Health Wonk Review You Currently Have, You Can Keep It

Opioids Webinar - Out friend Joe Paduda, Principal of Health Strategy Associates, is hosting a free webinar next week: Uncapping the Truth: First Annual Survey of Opioids in Workers' Compensation. It's sponsored by CID Management and will review results of the Opioid Management Survey recently conducted by his company. It's scheduled for November 12, 2013 at 2PM EST. Seats are limited, register here.

Workers Comp Report - Those of us in the workers' comp field are used to getting our news from trade journals and the web, but it's rare to find a story in the so-called mainstream media - unless things have blow up to crisis level or reform sparks political posturing. Sot we were delighted to see a major feature in CFO magazine: Special Report - Cutting Workers Comp Costs. In the intro, David Katz says that "workers' comp-related costs are still relegated to the dark corners of financial statements," but he makes the case that potential drains on cash flow and perverse medical and legal incentives make workers' comp worthy of CFO scrutiny. He authors two parts of the series, Should CFOs Care About Workers' Comp? and The Safe Way to Slash Workers' Comp Costs. WCRI's Richard Victor authors the third article, Do Financial Incentives Spur Unneeded Medical Care?.

Football - Two more professional football players are suing the NFL and helmet makers for brain injuries and concussive brain trauma. We've written about this issue numerous times in the past, including NFL and Dementia: A Changing of the Guard and A Bullet to the Heart. Also see: Junior Seau's suicide raises the issue of traumatic brain injuries and this dramatic New York Times feature, Images of Brain Injuries in Athletes.

View Frontline's full 2-hour investigative report on this issue: League of Denial: The NFL's Concusssion Crisis. Plus, the site has running news reports and stories on football and concussions.

Also in football news: Workplace Bullying - Even the NFL Isn't Immune

News Briefs

| Permalink | No Comments

October 31, 2013


Jason Hull of Hull Financial Planning has posted this week's risk roundup: Risk: It's Not Just a Board Game. It's Jason's debut as a host plus he has a nice write up on how to deal with risk and how to plan for potentially bad outcomes. Check it out.

| Permalink | No Comments

October 25, 2013


There's been a lot going on since the debut of the Affordable Care Act and the health wonk pundits are on it. Jaan Sidorov has posted The President Says You Should Ignore This Health Wonk Review at Disease Management Care Blog - a great compendium of opinions and prognostications. Check it out!

While on the topic of the ACA's rollout, see Everything you need to know about Obamacare's problems. Sarah Kliff of the Washington Post offers a guide to the problems with the ACA rollout. For further developments as things evolve, the healthcare section on Ezra Klein's Wonk Blog is a good source.

In other news:

Busy time for deals - Joe Paduda is your go-to guy when it comes to mergers, acquisitions & other deals in the work comp and managed care arena. See the latest in The deal of the century about Apax Partners buying spree; the completion of the PMSI-Progressive deal and MedRisk's aquisition of imaging company MDIA. If you aren't following Joe's blog, you are missing some important information.

It's All About Expectations - While attending a trade show, Dave DePaolo is reminded of some essential fundamentals: "Various people from different walks of the industry randomly commented without conscious coordination of their presentations on how much education needs to be a part of the workers' compensation claims process. / And not just education for the injured worker - who of course needs a lot of hand holding through the entire ordeal as that person is thrust into the vast unknown with little say or control over the course of his or her claim life./ Employers need to be educated on how the process deals with the work injury, how important their participation is relative to the injured worker, the physician, the claims administrator and the impact of all of this on their premiums."

Pepper-spray cop gets $38K in workers' comp - "The former Marine will receive retirement benefits for his 11 years of campus employment. He was being paid an annual salary of $121,680 at the time he was fired."

NSC Report: Only Three States Adequately Addressing Prescription Drug Abuse - WorkCompWire discusses and links to the National Safety Council recently released report, Prescription Nation: Addressing America's Prescription Drug Abuse Epidemic. "In the report, NSC examined state efforts in four areas: state leadership and action, prescription drug monitoring programs, responsible painkiller prescribing and overdose education and prevention programs. / Kentucky, Vermont and Washington were the only states that met standards in all four areas."

Can You Require Flu Shots for Employees? - Mike Halberman, "The HR Compliance Guy," says that "it depends" whether or not you can require employees to have flu shots. He offers guidance on various scenarios when it might or might not be a problem.

OSHA's Proposed Crystalline Silica Rule: How You Can Participate - OSHA's notice-and-comment rulemaking process relies heavily on input from the public, including the regulated community and other stakeholders. OSHA encourages members of the public to participate in the silica rulemaking by submitting comments on the proposal and by providing testimony and evidence at the informal public hearings that the Agency will hold after the comment period ends.

News briefs

| Permalink | No Comments

October 2, 2013


David Wall of Insurance Claims & Issues Blog has posted the most recent issue of Cavalcade of Risk: Concentrated Blog Carnival 193: The Rich Get Richer in the Great Recession .... - check it out!

| Permalink | No Comments

September 26, 2013


Check out the latest Health Wonk Review
At Healthcare Talent Transformation, Peggy Salvatore has posted The 700th Anniversary Blog Question Is....Will a Government Shutdown Stop ObamaCare? lots of opinions from various sources. (And while on the topic of stopping Obamacare, don't miss Joe Paduda's take on the Ted Cruz affair. )

Prescription Drugs
New research on prescription drug expenditures from NCCI reveals that prescription costs per claim continue to grow, with utilization being a major driver of total cost changes; the share of Rx costs for physician dispensed drugs continues to increase; narcotics account for 25% of drug costs; and more than 45% of narcotics costs are for drugs with Oxycodone HCL as an active ingredient. For the full report: Workers' Compensation Prescription Drug Study, 2013 Update. (PDF)
Related - See CompPharma's 1oth Annual Survey Summary on Prescription Drug Management in Workers' Compensation - for an overview, see Joe Paduda's summary. Also the Workers Compensation Research Institute recently issued The Prevalence and Costs of Physician-Dispensed Drugs - a 24-state reference book that allows policymakers and others to see how their state compares with other states as well as what actions other states have taken with regard to this issue.

In what has become a familiar routine, the insurance industry finds itself trying to persuade legislators of the importance of the Terrorism Risk Insurance Act (TRIA), the federal backstop that allows insurers to provide coverage for unpredictable acts of terrorism. It's schedule to expire at the end of the year - the last two times this occurred, there were eleventh hour "saved by the bell" approvals, but not without wreaking the havoc of uncertainty in a busy renewal season. Think that TRIA has outlived its usefulness? See the terrorism threat map from the Property Casualty Insurers Association of America to see threat events (actual and thwarted) since September 2001 - click by state. The American Insurance Association (AIA) makes the point that TRIA enables a stable terrorism risk insurance market for a peril that would be otherwise uninsurable. "TRIA enables insurers to cover what would otherwise remain an uninsurable risk because unlike weather events, it can't be modeled. See their full statement on TRIA. Also, check out what Robert Hartwig had to say in his testimony before the U.S. Senate Banking Committee on Future of Terrorism Risk Insurance Act (TRIA) Program

Emergency Planning
The Boston Marathon bombing, the recent Navy Yard shooting, the horrific Nairobii shopping mall attack ... these events pose a challenge for risk managers. The September cover story of The American Society of Safety Engineers' (ASSE) Professional Safety journal focuses on Emergency Response & Business Continuity: The Next Generation in Planning PDF), a timely topic for September as National Preparedness Month.

Immigrant workers
At Working Immigrants, Peter Rousmaniere makes the case for why we must address immigrant work safety now. One compelling reason? "Foreign-born workers (including legal and undocumented) comprised about one tenth of the country's workforce in 1990. Today they amount to about 17 percent, and are much more widely distributed geographically. " His post addresses various ways that, as an industry, we've been failing to address the problems.

Cool tools

Other noteworthy news

| Permalink | No Comments

September 18, 2013


Nancy Germond hosts a great edition of Cavalcade of risk posted on her Insurance Writer blog: Cavalcade of Risk #192 Gallops Into View. We echo her suggestion to take a few minutes, grab a cup of coffee and visit with the contributors!

| Permalink | No Comments

September 12, 2013


Tinker Ready is hosting this week's edition of Health Wonk Review at Boston Health News: Data, medicine, insurance reform and a round up of health policy blogs. It's a tasty smorgasbord from some of the best minds in the health policy blogosphere.

Tinker opens her post talking about the Knight News Challenge. To learn more about this, be sure to click the last entry in the roundup. It's Tinker Ready's idea submitted to the Challenge: HealthDecider: Using data to stay healthy and get well - we think it's an excellent concept and if you do too, sign up and give her a vote.

The Knight News Challenge is pretty interesting with a stated goal to "...accelerate media innovation by funding breakthrough ideas in news and information. Winners receive a share of $5 million in funding - and support from Knight's network of influential peers and advisors to help advance their ideas. Innovators from all industries and countries are invited to participate. Winners include leading Internet entrepreneurs, emerging media innovators and legacy newsrooms."

Check out past winners and see submissions for this year's Challenge, to date.

If you have an idea, you'll need to act fast - there are only 5 days left to get an entry in to his year's Challenge before the feedback phase begins.

| Permalink | No Comments

September 4, 2013


We're happy to be hosting Cavalcade of Risk #191. Risk is a topic that we think about a lot, so a recent post about risk on the group blog Metafilter caught our attention. It pointed to Jared Diamond's excellent essay, The Daily Shower Can Be a Killer. The author shares a risk management lesson that he learned in 50 years of field work on the island of New Guinea: the importance of being attentive to hazards that carry a low risk each time but are encountered frequently. He notes:

"Studies have compared Americans' perceived ranking of dangers with the rankings of real dangers, measured either by actual accident figures or by estimated numbers of averted accidents. It turns out that we exaggerate the risks of events that are beyond our control, that cause many deaths at once or that kill in spectacular ways -- crazy gunmen, terrorists, plane crashes, nuclear radiation, genetically modified crops. At the same time, we underestimate the risks of events that we can control ("That would never happen to me -- I'm careful") and of events that kill just one person in a mundane way."

The Metafilter post also included a link to this fun video on the topic of risk management. I nominate it as the Cavalcade of Risk official theme song.

With that preamble on risk management, we delve into this week's submissions.

Life Insurance - First up to bat, we offer a nod and shout out to Hank Stern of InsureBlog, our fearless leader who has been managing the Cavalcade's biweekly efforts for close to 200 issues now. Kudos and thanks, Hank. He poses the question: What if you're diagnosed with cancer while buying new life insurance? Well, as it turns out, there may actually be a decent chance of obtaining coverage. Read how in Underwriting Cancer.

ACA spin vs. reality - Louise Norris of Colorado Health Insurance Insider is on the front lines when it comes to implementing ACA in the real world so we always take particular note of her opinions on the matter. In her post
Early Renewal Provides a Good Alternative for 2014, she takes on some of the misinformation and spin from both the right and the left that can make things confusing for consumers. She cites misinformation about the Aetna plan as one example of spin not matching reality.

Technology - Our colleague Bob Wilson can always be counted on to offer a unique and often humorous take on things at his eponymously named blog Bob's Cluttered Desk. He notes that mobile technology is making tremendous advances that will speed treatment and lower medical costs, which is critical for those of us paying the bills and managing claims -- but he questions the wisdom of having Siri as a Medical provider, and whether she can be trusted to stay on the straight and narrow.

Oral Chemotherapy Parity - David Williams knows his stuff when it comes to the ins and outs of the business of healthcare, and if that is on your radar, there is no better guide than his Health Business Blog. This week, he talks about the oral anticancer parity law, noting that while it's not necessarily a bad idea to require health plans to charge the same out-of-pocket costs for oral anti-cancer drugs as they do for infused products, the law has unintended consequences, including rolling back co-pays on generic chemo meds used for other indications

Investing - At the blog Mom and Dad Money, Matt Becker says that investing in the stock market carries with it a very large risk, one that is rarely talked about in the financial media. In his post The Real Risk of Investing in the Stock Market, he challenges some of the conventional wisdom about investing, noting that success and failure may not be the only outcomes we should measure.

Risk of incarceration - Here at Workers' Comp Insider, we recently assessed the risk of jail time for workers comp lawbreakers and advise any claimants with felonious intent to steer clear of Wyoming. Corporate malfeasants, not so much...

That's it for this week's Cav. The next host -- two weeks from today -- will be Nancy Germond at Insurance Writer Blog.

| Permalink | No Comments

August 28, 2013


Bucking the trend - There is good news in the Census of Fatal Occupational Injuries Summary, 2012: Worker fatalities in 2012 was the second lowest preliminary total since the census was first conducted in 1992. A preliminary total of 4,383 fatal work injuries were recorded in the United States in 2012, down from a revised count
of 4,693 fatal work injuries in 2011. But bucking this positive trend, there were a few troubling indicators:

  • Fatal work injuries involving workers under 16 years of age nearly doubled, rising from 10 in 2011 to 19 in 2012--the highest total since 2005
  • Fatal work injuries in the private construction sector increased 5 percent
  • Fatal work injuries in the private mining sector rose in 2012, led by an increase in fatal injuries to workers in oil and gas extraction industries. Fatal work injuries in oil and gas extraction industries rose 23 percent to 138 in 2012, reaching a new high for the series

Opioids Research - An article by Richard Victor of WCRI is featured in CFO - Five Ways to Curb Workplace Drug Risks - "Significantly reducing the use of unnecessary narcotics in the treatment of injured workers is the task of all stakeholders in the workers' compensation system: employers, labor, physicians, hospitals, insurers and public policymakers. But reforming a statutory system like workers compensation takes time. Fortunately, employers can take some beneficial actions immediately. A look at the latest research provides the insight needed for all to do the right thing. The WCRI study, Longer-Term Use of Opioids, identified a number of states where workers were most likely to be taking opioids long after their injury." Also see: Preliminary data from Joe Paduda's Opioids in Workers' Comp survey.

Healthcare violence - NIOSH offers free free on-line Violence Prevention Training for Nurses. NIOSH partnered with nursing and labor organizations, academic groups, other government agencies, and Vida Health Communications to develop the training, which incorporates text and videos depicting workplace violence incidents, testimonials from real nurses, and module quizzes. Nurses can also receive free continuing education credits for completing the online course. The course has 13 units that take approximately 15 minutes each to complete.

Extreme Heat - What links these workers: a Medford, Massachusetts US Postal Service employee; a farm worker in Tulare County, California; an employee of a plumbing and HVAC company in Louisiana; a landscaping company employee in Wisconsin; a construction worker in Indiana; a recycling company employee in New York City, and a spa employee in New Jersey? They all died of heat exposure this summer while on-the-job. OSHA lists 16 possible heat fatalities between June 6 and July 26, 2013, when a heat wave engulfed much of the US. OSHA says that heat has killed, on average, more than 30 workers a year since 2003. Elizabeth Grossman posts
Heat Kills: As temperatures climb, workers succumb to heat at The Pump Handle.

Foreign-born workers - Peter Rousmaniere makes the case for cultural competence in healthcare facilities in his post about foreign-born workers in in Risk & Insurance: "Foreign-born workers (including legal and undocumented) comprised about one-tenth of the country's workforce in 1990. Today, they amount to about 17 percent, and are more widely distributed geographically. The rise in immigrant labor has resulted in heightened work injury risk, which is complicated by language and legality issues."

Journalism and ethics - Pia Christensen of the Association of Health Care Journalists' blog posts how journalists were taken aback by AP's tweets about pharmaceutical company: "Journalists on Twitter were surprised, even dismayed, on Tuesday when tweets from The Associated Press prompted followers to "Visit AstraZeneca's YouTube channel."

Intoxication and Workers Comp - New Hampshire Court Outlines Drunk Defense in Workers' Comp Claims - intoxication must be determined to be the cause of an accident for it to be a defense against a workers' compensation claim. Roberto Ceniceros discusses more on this case at Comp Time and raises some additional issues. He notes that the claimant's argument was that the employer should have known he was drunk because he is an alcoholic. The claimant is now also a quadriplegic as a result of the accident.

More news briefs below, but first we thought we would offer this newly restored documentary of seismic events from 50 years ago today: The March - 33 minutes of truly remarkable history.

Workers Comp and other news briefs:

| Permalink | No Comments

August 26, 2013


Check out the recently posted Cavalcade of Risk #190 - August 21st, 2013 Edition posted at the My Personal Finance Journey blog. And watch this space for the next risk roundup, which we'll be hosting here!

| Permalink | No Comments

August 15, 2013


Catch up on your Health Wonkery - David Williams has posted Health Wonk Review: Dog Daze 2013 over at Health Business Blog. Judging by the number and variety of entries, it would seem the health wonkers have not been vacationing!

Violence Prevention for Nurses - Free Training - According to NIOSH: "On average, over the last decade, U.S. healthcare workers have accounted for two-thirds of the nonfatal workplace violence injuries in all industries involving days away from work [2]. Healthcare workers face the risk of both physical violence and non-physical violence, such as verbal abuse, on the job. These numbers represent only the assaults that resulted in time away from work and not the less severe physical injuries or the psychological trauma that HCSA workers experience from workplace violence. Additionally, these data only capture the reported incidents. The literature suggests that the number of assaults reported by healthcare workers is greatly underreported." NIOSH worked with various partners - including nursing and labor organizations, academic groups, other government agencies, and Vida Health Communications, Inc. - to develop a new free on-line course aimed at training nurses in recognizing and preventing workplace violence. The course has 13 units that take approximately 15 minutes each to complete and includes "resume-where-you-left-off" technology. Learn more about the courses at Free On-line Violence Prevention Training for Nurses and the actual course can be accessed here: Workplace Violence Prevention for Nurses CDC Course No. WB1865

Opioids, Workers Comp & iPad Minis - Are opioids a workers compensation issue for your organization? Joe Paduda is seeking participation in his online Survey of Opioids and Workers' Compensation. You can further our industry knowledge in this area - and potentially win an iPad Mini for your participation. Who should participate? Industry vendors, Insurance Carrier/Providers, Managed Care Organizations, Medical Communities, Third Party Administrators.

Hotshot Firefighters & Workers Comp - At Comp Time, Roberto Ceniceros discusses workers comp issues related to the Arizona Firefighters who recently lost their lives in this year's mega fire. There are coverage issues of part-time vs full-time workers at issue - one surviving widow is challenging the denial of benefits. In his post, Ceniceros also pointed us to this excellent article: Deaths in Idaho and elsewhere prompt agencies to reform how they protect firefighters.

Safety & Discipline - In a two-part series, Chris Kilbourne examines the issue of safety and discipline. He cites a survey conducted by the law firm Fisher & Phillips, that found "...most companies make little consistent effort to train supervisors on when and how to discipline employees. Too often, Mavity adds, the only time an employer learns that an employee was working unsafely is in the course of a postinjury investigation." He notes that, "This is a problem for several reasons, including the fact that without a record of disciplinary action, an employer might not be able to demonstrate to OSHA that it is operating an effective safety program." In part 1, Kilbourne looks at the question of whether employees should be disciplined for safety violations and in part 2, discusses the right way to use discipline to promote safety

Other items that caught our eye this week

| Permalink | No Comments

August 9, 2013


Happier times ahead? - Joe Paduda says that if higher total premiums are your barometer, things are looking decidedly sunny: Brighter days for workers comp. And related to these happier times that Joe notes is the resurgence of manufacturing. See : Are Engineering Schools the Unsung Hero in America's Industrial Rebound?

WV "epicenter of the Oxycontin epidemic" - Ken Ward talks about Coal's role in Appalachia's drug problem. His post also points us to the documentary Oxyana, which is described as. " A portrait of Oceana, WV, an old coal mining town that has become the epicenter of the Oxycontin epidemic, earning the nickname Oxyana." You can see the Osyana trailer here and click through to watch the entire documentary online for $3.99. Related: At CompTime, Roberto Ceniceros recently wrote about Heroin and the Work Comp Connection. He's also written about about a shift away from OxyContin use toward heroin abuse.

Obesity and workers comp study - In light of the recent AMA classification of obesity as a treatable disease, the California Workers' Compensation Institute (CWCI) has issued a report that examines the effect on California workers' compensate. "Using data from 1.2 million claims from accident years 2005 to 2010, the Institute found that claims with an obesity co-morbidity have had significantly higher rates of lost time from work, permanent disability, and attorney involvement, and have been much more likely to involve additional co-morbidities such as arthritis, hypertension and mental health issues, as well as prescriptions for opioid painkillers and psychotropic drugs - all of which are associated with higher claim costs. Indeed, after case-mix adjustment, the study found that paid losses on claims with the obesity co-morbidity averaged $116,437, or 81.3% more than those without; and that these claims averaged nearly 35 weeks of lost time, or 80% more than the 19 week average for claims without the obesity co-morbidity. The Institute notes that to the extent that such differences continue in the future, these results suggest that any increase in the number of job injury claims in which obesity is treated could have significant cost implications for workers' compensation." Access the full 8/7 report at CWCI.

ACA - State Premium Watch: Pricing In The New Insurance Marketplaces - a good update from Kaiser Health News, who note that: "A growing number of states have released approved 2014 premiums and other details about individual and small group insurance plans that will available on the marketplaces, also called exchanges. Those rates do not take into account the federal tax credits that many people will be eligible for. In addition, the federal government must give final approval to the plans in September."

Emerging risks - You've heard of distracted driving - anyone who works in workers comp and has seen the devastating impact of slips trips and falls will not be surprised that this is now a thing: Distracted walking is no joke

Aftermath of a disaster - 9,640 Fukushima plant workers reach radiation level for leukemia compensation - "According to figures compiled by plant operator Tokyo Electric Power Co. in July, 9,640 people who worked at the plant between March 11, 2011, when the nuclear accident started, and Dec. 31 that year were exposed to 5 millisieverts or more of radiation. Workers can receive compensation if they are exposed to 5 millisieverts or more per year and develop leukemia one year after they began working at the plant. TEPCO figures showed that 19,592 people worked at the Fukushima No. 1 plant during the nine-month period and were exposed to 12.18 millisieverts on average."

FMLA - Think that including a description of your FMLA policies and procedures in an employee handbook will protect you in court? Think again: Failure to Provide FMLA Notice Dooms Employer's Effort to Terminate Employee for Excessive Use of Leave

Fraud corner Jon Gelman reports on an Illinois first: Employer Convicted of a Felony for Failure to Have Workers' Compensation Insurance.

Ohio delivers $55 million fraud smackdown

Risk Roundup - Cavalcade of Risk # 189: What's Going On In The World Of Risk - Check it out!

New Briefs

| Permalink | No Comments

July 25, 2013


Nina Kallen hosts the 188th Cavalcade of Risk at Insurance Coverage Law in Massachusetts. It's a varied roundup - Nina notes: "I was struck by their technical and detailed nature. I learned from the posts about the history of health insurance in China, how the MTA in New York City is planning for the next storm surge, and who serves on the Massachusetts Board of Registration in Pharmacy. "

And while we're on the topic of the Cavalcade, we extend appreciation the the Cavalcade's founder and chief-cook-and-bottle-washer, Hank Stern of InsureBlog. We note that his colleague Bob Vineyard just received an honorable mention in the The 2013 National Underwriter Industry Elite Awards for the Life and Health insurance industry. Kudos, Bob!

| Permalink | No Comments

July 18, 2013


Health Wonk Review - Louise and Jay Norris have posted the newest
Health Wonk Review: A Midsummer Wonk's Dream at Colorado Health Insurance Insider . This is a double-plus good issue because HWR is only posted monthly during the summer so wonks have unleashed their best posts. Plus, Louise always does an excellent job summarizing and hosting. Catch up with your health policy issues now - next issue isn't until mid-August.

Obamacare - As long as we're delving into health policy, we point you to Joe Paduda's excellent series on health care reform. He is more than midway through his postings on Obamacare and Workers' Comp (Part 1). Here are links to updates in the series: overview; Part 2: the impact of increased group and Medicaid insurance coverage; Part 3: More implications of increased covered; Part 4: Cost shifting, and Part 5: IPAB and ACOs.

Trucking - The U.S. Department of Transportation's Federal Motor Carrier Safety Administration announced new federal trucking regulations designed to reduce driver fatigue and improve safety for the motoring public. The rules, which took effect on July 1, 2013, retain the current 11-hour daily driving limit and 14-hour work day, but impose other restrictions: they limit the maximum average work week for truck drivers to 70 hours, a decrease from the current maximum of 82 hours. If the maximum 70 hours of driving within a week is reached, drivers may resume if they rest for 34 consecutive hours. Rules also require drivers to take a 30-minute break during the first eight hours of a shift.

Homicides - Taxicab drivers face one of the highest homicide rates of any occupation: 7.4 per 100,000 employed vs 0.37 for the general working population. New research from NIOSH examines the effectiveness of partitions and security cameras in reducing homicides among taxicab drivers. The study found a three times lower homicide rate in the cities where taxicabs use security cameras than the control cities and a seven times lower homicide rate when compared to the rates before installation of the cameras. There was no statistically significant difference in homicide rates for cities where the taxicabs used partitions compared with control cities.

Brave new world Does your organization have a "wearable tech" policy? Probably not, but you may need one in the not-too-distant future. HR expert Sharyn Lauby posts about What Google Glass Means for Workplace Policy. Google Glass is wearable computer that allows the wearer to take pictures, record video, get directions, send messages, share what they're looking at and much more. There are many potential privacy-related issues - and for an employer, many workplace issues. If you aren't up on the technology, see Google Glass: what you need to know. While Google says that these devices will be built to ethical standards so that you can tell when someone is recording, but hackers may have other ideas.

Obesity as a Disease and the ADA - Employment law attorney Eric B. Meyer says that despite the AMA's recent declaration that obesity is a disease, the courts may not necessarily agree. He discusses a recent West Virginia Supreme Court ruling in a case involving a charge of disability discrimination for a termination. But Meyer cautions that despite the ruling, "employers should err on the side of caution and continue to provide reasonable accommodations to morbidly obese employees as well as those with other conditions that may arguably fall within the scope of the ADA."

Guns & WC - In Lawyers, guns & money, Dave DePaolo takes a look at workers comp as it relates to shooting sports establishments. While gun demand is high and sales are skyrocketing, "the current boom in sales is being countered with a shortage in available workers' compensation coverage." He notes that the insurer reluctance seems to bear little relation to the industry's loss experience, which is excellent.

Bad faith - Workers' Comp & Bad Faith: Unacceptable Oversights - At PropertyCasualty360, Everette Lee Herndon offers an excellent overview on the issue of bad faith claims. While workers comp is the "exclusive remedy", some states offer recourse in cases "When benefits are not properly (and promptly) rendered." While not all states have "bad faith" provisions in the laws, those that do typically provide for penalties and fines while still retaining the exclusive remedy provision. Herndon draws lessons from the case of Romano v. Kroger/Sedgwick, invloving a claimant who had surgery for a shoulder and spine injury, and who subsequently contracted an MSRA infection and later died of conditions related to this infection.

"In May of this year, the state Workers' Compensation Appeals Board (WCAB) referred Sedgwick CMS to the Division of Workers' Compensation's Audit Unit for "unreasonably delaying or denying treatment for a patient who was dying from an infection he contracted after undergoing surgery for a compensable work injury.
In the decision, Romano v. Kroger Co., the WCAB charged that Sedgwick demonstrated "blithe disregard for its legal and ethical obligations and a callous indifference to the catastrophic consequences of its delays, inaction and outright neglect."
The WCAB upheld penalties imposed against Sedgwick CMS in the amount of the maximum penalty allowed by law--$10,000 for each of 11 instances of unreasonably delaying medical care."

Herndon suggests that whether your state allows bad faith lawsuits or not, "the workers' compensation claim should be handled in such a manner as to preclude any allegations of improper conduct." He offers additional thoughts on how to avoid bad faith claims.

Low interest yields & P/C insurers - Strained investment returns are translating into property and casualty rate increases. The National Association of Insurance Commissioners puts the net yield for insurance carrier invested assets at an all-time low of 3.68%.

Coal mining - At Coal Tattoo, Ken Ward notes that a key MSHA rule related to Black Lung has been delayed again. In another matter, he points to a report about the November 2012 CONSOL Energy coal-slurry impoundment that took the life of miner Markel Koon. He notes that the report raises "... some serious questions about how well one of the nation's largest coal producers managed a particularly dangerous sort of operation."

Other noteworthy news

| Permalink | No Comments

July 12, 2013


Yay - our friend Bob Wilson has joined the Cavalcade of Risk crew and he is hosting his first issue at Cavalcade of Risk #187 at Bob is an early web pioneer - he had the foresight to buy the best work comp URL ever and to build a valuable service - starting back when everyone in insurance was still saying "I'm not sure about this new-fangled web thing." In addition to being a visionary, he's also an awfully nice guy - as anyone who's talked to him on the conference circuit knows.

When you stop by to visit his blog, make sure you check out From Bob's Cluttered Desk - sometimes serious, often hilarious, always an enjoyable read.

| Permalink | No Comments

June 20, 2013


Health Wonkery - Sarah Sonies and Jennifer Salopek have posted Health Wonk Review: Rhetorical Question Edition at Wing of Zock, covering such topics as such topics as costs, insurance, policy, money, and more. Get your fix of health wonkery now - the next edition won't be until mid-July.

Aging workforce - Poor eyesight was the likely culprit in fatal 2012 train wreck. which claimed the lives of 3 Union Pacific crew members in Oklahoma. The driver - who repeatedly complained about his vision over the years - was one of the fatalities. Among his complaints: "... the engineer suffered from glaucoma and cataracts for much of his life, and in the three years leading up to the crash, he made about 50 visits to eye doctors and underwent about a dozen procedures. He had even complained about not being able to distinguish between the red and green stop and go signals that govern train traffic." The National Transportation Safety Board determined that poor eyesight was the probable cause of the collision. "The board also proposed 16 safety recommendations for the railroad industry, unions and oversight agencies. Many of the recommendations deal with beefing up the frequency and quality of medical screenings for workers who have safety-sensitive positions. It also proposed implementing a workplace culture in which safety is placed above silence."

There's an App for That - NIOSH recently announced a new Ladder Safety smart phone app, saying that "This new app uses visual and audio signals to make it easier for workers using extension ladders to check the angle the ladder is positioned at, as well as access useful tips for using extension ladders safely." it's free and available for iPhone and Android devices.

Health Reform updates - For health reform updates with a slant to the impact on workers comp, you can't do better for a guide than our friend Joe Paduda's informed commentary on his blog, Managed Care Matters. His most recent post on the topic: Implementing health reform, random report 1. If this is an issue on your radar, check back with him often.

Health Care Innovation - We're fans of Dr. Atul Gawande on this blog so we were pleased to learn that he is launching a health care innovation lab. If you are unfamiliar with Dr. Gawande, this excerpt from the link offers a bit of insight: "Gawande, a surgeon at Brigham and Women's Hospital, has been named one of the world's most influential thinkers. The surgical checklist he promotes has been gaining traction worldwide since 2008, when it's use in a World Health Organization project reduced deaths during surgery by nearly 50 percent. The list is a set of questions everyone in an operating room answers, starting with: Do we have the correct patient? What operation are we performing? And is the site marked?" We look forward to developments. (Hat tip to Tinker Ready for the pointer - her Boston Health News blog is worth keeping an eye on.)

Women & comp - At CompTime, Roberto Ceniceros has a post on Working moms and workers compensation, citing a recent Pew Research Report on "Breadwinner Moms." The implications of the report are significant, Ceniceros notes, because according to the National Institute for Occupational Safety and Health "women face different workplace health challenges than men."

Massachusetts employers take note - Employment law attorneys Paul G Lannon and Matthew Mitchell post that Massachusetts employers may be liable to out-of-state employees misclassified as independent contractors on JDSupra Law News. They look at a decision issued May 17, 2013, Taylor v. Eastern Connecticut Operating, Inc.. They offer several lessons employers should take from this ruling - first and foremost being awareness that Massachusetts independent contractor and overtime pay statutes may apply to non-residents working outside the state.

Lead-poisoned workers - At The Pump Handle, Celeste Monforton provides accumulating evidence that thousands of workers are poioned by lead each year, and a preponderance of those who are sickened are hispanic workers. The exposure is highest in battery manufacturing, secondary smelting/refining non-ferrous metals, and painting. She cites recent related cases from OSHA inspections and violations as well as a recent report by the California Department of Public Health, along with the most recent national assessment.

More on Lab Safety - Following up on yesterday's post about academic lab safety, we point to this article in Chemistry World on Laboratory Safety Goes Digital. The article talks more about the Dow Lab Safety Academy.

From the "Bad Idea" file - Reports from Japan say that some companies are using banishment rooms as an alternative to termination.

More news of note

NIOSH issues a video alert on counterfeit and altered respirators

| Permalink | No Comments

June 6, 2013


New Health Wonk Review - Jason Shafrin has posted Health Wonk Review: Jeopardy Edition at Healthcare Economist. Put your health wonkery to the test.

Cost shifting - A recent study by NIOSH researchers reports that many work-related injuries treated in emergency rooms aren't being billed to workers comp. The figure approaches 40%, according to Celeste Monforton, who discusses this study in a post at The Pump Handle, Hefty portion of work-related injury costs not paid for by workers' comp, others picking up the tab. "The analysis involves four years of data from the National Hospital Ambulatory Medical Care Survey (NHAMCS), a representative sample of U.S. emergency room visits. An estimated 458 million emergency department (ED) visits occurred between 2003-2006, based on the representative sample of 146,296 cases. The researchers specifically examined the subset of emergency room visits which were coded as a work-related injury or illness." She notes that while not all workers are covered by workers comp, other may prefer private insurance out of fear of some disciplinary action. The impact of the study is enormous, both in terms of the economic cost-shifting implications and the accuracy or work-related injury data.

On the case - Joe Paduda looks at The next revenue-generator for work comp profiteers.

Healthcare hygiene - "With drug-resistant superbugs on the rise, according to a recent report by the federal Centers for Disease Control and Prevention, and with hospital-acquired infections costing $30 billion and leading to nearly 100,000 patient deaths a year, hospitals are willing to try almost anything to reduce the risk of transmission." Anemona Hartocollis of the New York Times writes about the lengths that hospitals are going to and the strategies they use to get workers to wash their hands. She notes that the incentives for action are strong because under new federal rules, hospitals stand to lose Medicare money when patients get preventable infections. In a related initiative, NIOSH is looking to improve poor compliance with respiratory protection requirements and proper use recommendations in healthcare settings. NIOSH issues an invitation to be part of formulating a solution: Improving Respirator Use and Compliance in Healthcare

NFL vs CA - Roberto Ceniceros of Business Insurance offers an update on the ongoing California-NFL court battles about work comp indemnity rights. "A California appellate court has given a temporary victory to 32 insurers that are battling the National Football League over defense and indemnity rights under 187 commercial general liability policies purchased over 45 years."

The Modern Claims Adjuster - At Risk & Insurance, Peter Rousmaniere looks at the image myths vs reality of the modern claim's adjuster, and in the process, offers some clues as to what a savvy TPA shopper should be looking for in measuring performance.

Patriot Coal - Trouble ahead: What the Patriot Coal ruling means for the future of Southern West Virginia's coalfields - Ken Ward talks about the recent federal bankruptcy judge ruling which approved Patriot Coal's plan to dump its union contract and its retiree health-care plan. He looks at what this decision and other issues might signify about the viability of the industry.

Defense Base Act - "The final withdrawal of U.S. military forces from Iraq in December 2011 may have brought to a decisive conclusion an almost decade long conflict in the region, but much remains in question when it comes to how U.S. Government Contractors are protected from tort liability should their employees be injured, become ill or die in country while on company business. U.S. corporations should be aware of which form of workers' compensation applies to their employees should a work-related incident occur." Michal Gnatek of the Lockton Companies offers a whitepaper: After the Fire: Status of Defense Base Act in Postwar Iraq.

PEOs - In his post Surprise! PEOs Not As Bad As Thought, Dave DePaolo talks about the recent NCCI report on PEOs. Despite a few high profile bankruptcies, "...the NCCI report suggests that non-PEO employers might do better if they managed risks as well as PEOs do. / "The conventional but untested wisdom has been that PEOs are a problem," NCCI Chief Economist Harry Shuford tells WorkCompCentral. "Our analysis suggests that this is not supported by the data."

The Most Dangerous Job in the World? - How did 900 bus drivers end up dead in Guatemala City? - a riveting read about the mind-boggling dangers some workers face just to put bread on their family's table.

Risky Women - When it comes to women in the senior ranks, Lori Widemer says that the United States is lagging far behind most other countries. "The proportion of women in senior management in the United States paled by comparison to countries such as Russia, with 36% of all senior execs being women, and Thailand, which topped Grant Thornton's survey with 45% of senior managers being women." She looks at the tea leaves, and makes the case for Why Women Should Lead Risk Management in Risk Management magazine.

Call for Evangelists - Annmarie Geddes Baribeau issues a call for more work comp evangelists to convert CEOs to the cause of worker's comp. We agree - every organization's priorities are set in the corner office and if you don't have deep-rooted employer commitment to make comp a priority, it won't be.

OSHA - OSHA introduces a new campaign for fall protection in construction

First Responders - The Boston Marathon Bombings: Lessons Learned for Saving Lives - a video featuring first responders, sponsored by WBUR and Harvard in the Harvard School of Public Health's Forum series.

Pro-tip to fraudsters - If you are going to commit fraud, it's probably a good idea to avoid TV game show appearances. (hat tip to Hank at InsureBlog for the pointer.)

Brief Takes

| Permalink | No Comments

May 23, 2013


Health Wonkery - At Wright on Health, Brad Wright has posted the Sardonic Edition of Health Wonk Review. He takes a bit of a tongue in cheek approach to the seriousness of our usual wonkery. Harumph, harumph. Check it out.

Station Nightclub Fire Fine in Dispute - Michael and Jeffrey Derderian, owners of the Station Nightclub, are protesting a $1 million fine levied for not having workers' comp coverage. A 2003 fire at the Warwick, RI nightclub resulted in the deaths of 100 people, including four employees. They claim that they did not know they needed to cover part-time employees and are asking for a review by the state's Supreme Court. The Providence Journal reports that the Department of Labor and Training is unsympathetic - according to DLT lawyer Bernard P. Healy: "The Derderians, he says, have benefited by the almost nine-year delay in finalizing the $1.066-million penalty since interest hasn't been accruing. If the brothers had made efforts to compensate "their employees so grievously harmed," the penalty most probably would have been entirely suspended, he says."

Don't Fry Friday - May 24 - Jon Gelman tells us that workers need to be aware that skin cancer is the most common cancer and they need to take preventative action to protect themselves from the sun's rays. The EPA, CDC, FDA, National Council on Skin Cancer Prevention have declared May 24 as Don't Fry Friday and offer sun safety tips. Also see Safety Daily Advisor: Skin-Deep Training to Prevent Skin Cancer from the Sun

The future of manufacturing - Joe Paduda posts Where's manufacturing going - and why should you care? He says you should care because "manufacturing jobs drive workers comp premium." He reports on a recent talk at the NCCI Issues Conference which predicted the growth of manufacturing in the US. Related: see our December post: Insourcing: A positive trend for U.S. manufacturing and Joe's post Manufacturing's coming back.

Different perspectives - At WorkCompEdge Blog, Kory Wells posts Employers and the Work Comp Industry: Failure to Communicate?. She reports on the disconnect between the industry insiders and employers as evidenced in Zywave's 2013 P&C Workers' Compensation & Safety Survey with over 3,100 participants. Topics that are heavily covered in workers comp media and widely under discussion by work comp professionals aren't as high on employers' radar. Only 28% of employers say they are very or somewhat concerned about opioid issue and only 36% of employers report being very or somewhat concerned about comorbidity issues such as obesity and diabetes complicating recoveries. And although 42% of survey participants were very or somewhat concerned about this year's change in the experience rating formula, only 15% of employers say they know the value of their company's loss-free rating, or minimum mod. This raises the issue: are we in the industry communicating enough with employers?

Rocket Science & Workers Comp - fresh from the NCCI Issues Conference, Dave DePaolo opines on all the moving parts that keep the workers' compensation system working as well as it does in his post It's Not Rocket Science, But Close - a thoughtful and interesting look at the industry. Some commenters pushed back on his reference to a front end and a back end, and he clarified in another post, Workers' Compensation Finance 101: "The point that I was making is that there are two distinct processes involved in the worker's compensation game that are extraordinarily complex and require a good degree of coordination, forecasting and soothsaying in order to operate reasonably efficiently. / Another point that I was making is that workers' compensation is a cash flow system. By this I mean that money comes into the system through employer assessments; and money flows out of the system by benefit distribution."

Opioids - Michael Gavin at Evidence Based posts that abuse-deterrent opioids are a great solution but the wrong problem. He says, "The problem as we see it is lack of medical necessity. In most cases, it doesn't matter if the patient's opioid is abuse-deterrent or not. If it's medically unnecessary, if it's leading to loss of function, if it's leading to dependence and addiction... it needs to go away. The doctor will be better educated. The patient will get better. The cost of care will go down. Everyone wins. Abuse deterrent technology is great, but if we focus on technology over medical necessity, we will have missed the mark and the crisis will continue."

Foreshadowing ACA? - At Employee Benefit Adviser, Gillian Roberts reports on recent study released by PricewaterhouseCoopers that shows that employer health coverage actually increased from the time the health care law took effect in Massachusetts seven years ago. In Deconstructing Mass. employer health insurance increase, she notes that while this is not a true indicator of what will happen with the Affordable Care Act, industry insiders say it could point to some overall trends. She reports: "Between 1999 and 2011, PwC's report says "employer coverage in Massachusetts rose from 70.8% in 2006 to 72.1% in 2011. Nationally, during the same period, employer coverage fell from 68.2% to 58.3%." PwC's report also says that qualitative evidence, interviews with HR executives at companies in the state, show that more employees were interested in coverage. The results were of course that 98% of the state became coverage by health insurance."

Still a problem - While black lung may sound like a disease from a bygone era, that is unfortunately not the case. At Coal Tattoo, Ken Ward Jr. reports that autopsies confirm black lung at Upper Big Branch - it remains a serious concern in today's coalfields.

Other noteworthy news

| Permalink | No Comments

May 15, 2013


Our New Zealand blogger pal Russell Hutchinson lends a global perspective to this week's Cavalcade of Risk #183 - check it out!

Austerity's impact on public health
- over at Managed Care Matters, Joe Paduda looks at the impact that financial austerity measures in Greece and Iceland have had on public health, suicide rates, hospital admissions, and other measures of morbidity and mortality.

Implementing Health Reform: Employer Coverage Option Notices - At Health Affairs Blog, Timothy Jost posts about recently released guidance from the Department of Labor's Employee Benefits Security Administration regarding notices that employers must give to employees concerning their coverage options under the Affordable Care Act. He notes that "Employers must provide the notice if they are subject to the FLSA. The FLSA applies generally to employers who employ one or more employees and have a volume of at least $500,000 in annual business. It also applies to specific listed types of employers. Employers must provide the notice to each employee, including part time employees. "

Are Women Really Making It? - an article by Rachel Bennett Steury in Industry Week looks at the status of women in manufacturing and the picture is not good: "Certainly the past decade has revealed a decline in manufacturing employment for everyone but women bore the brunt of job loss in three of the four highest paying manufacturing sectors. According to a recent report by the National Women's Law Center (NWLC), women's employment in chemicals, petroleum & coal products, and computer & electronics products manufacturing decreased while men's employment increased."

Marsh Report Shows Continued Demand for Terrorism Coverage - the current Terrorism Risk Insurance Act (TRIA) is scheduled to expire December 31, 2014. Is this backstop still needed? In Risk Management Monitor, Nathan Bacchus looks at a recent Marsh Report that offers some interesting stats about how prevalence of terrorism coverage by industry sectors and geographic regions. "The take-up rates are highest among companies with total insured value (TIV) over $500 million, but even those companies with less than $100 million in TIV obtained terrorism insurance at a 59% rate in 2012." Meanwhile, many Boston merchants are hoping the recent Marathon bombing won't be labeled as terrorism : "Illogical as that may seem, such a declaration might be the only way these businesses -- many of which did not have specific coverage for terrorism -- can get reimbursed for their losses by their insurance companies."

Extraterrestrial workplaces - And from one of the coolest workplaces ever, International Space Station commander Chris Hadfield offers us a musical interlude. Congratulations to Chris & his crew from the on a successful return to earth - but not without first addressing some safety maintenance issues.

Short Takes

Finally, we can't resist sharing a video of this incredible and bizarre weather-related oddity that recently occurred in Minnesota. It's doubtful that many homes are insured against "ice tsunamis."

| Permalink | No Comments

May 9, 2013


Joe Paduda has a not-to-be-missed robust edition of Health Wonk Review posted at Managed Care Matters. It covers health care cost trends, reform implementation, motivations and more. Get your biweekly dose of health wonkery from the best in the blogosphere to stay current on the trends.

And in other news ...

Texas tragedy & insurance matters
Dallas News reporters Doug Swanson and Reese Dunklin report that West Fertilizer was insured for only $1 million in liability. The explosion killed 15, injured several hundred, and caused an estimated $100 million in property losses. According to state insurance authorities, fertilizer facilities are not required to have liability insurance that would compensate for damage they might cause. The article includes this observation: "A million dollars is a pathetic amount for this type of dangerous activity," lawyer Randy C. Roberts said. "If you want to drive a truck down the interstate, you've got to have $750,000 in coverage, even if you're just carrying eggs," Roberts said. "But if you want to put this ammonium nitrate into this town next to that school and that nursing home and those houses, you're not required to carry insurance."

According to Property Casualty360's Arthur Postal, workers comp for the deceased first responders and injured city workers will be covered by the state's Large Loss Fund. The only West Fertilizer employee involved was a first responder killed in the blast who was covered by the fund -- the company itself has an "alternative benefit plan" since workers comp is not mandatory in Texas -- an issue that raises more questions. See Postal's related article: The Assault on State-Regulated Workers' Comp, which talks about Texas, Ohio, New York and Oklahoma.


Boston Marathon Bombing
Surgeon-journalist Atul Gawande has a must-read insider's account in The New Yorker, which explains Why Boston's Hospitals Were Ready to cope with the emergencies created by the Boston Marathon bombing.

Here's to the Nurses
While on the topic of excellent medical care, it's a good time to note that this is National Nurses Week. It runs through May 12, which is the birthday of Florence Nightingale, widely recognized as the founder of modern nursing. One of the key issues facing nursing -- and one that has an impact on patient safety, too, is staffing levels. See: Nurses Fighting State By State For Minimum Staffing Laws.

State of the Unions
Differences between union and nonunion compensation, 2001-2011 (PDF) - BLS reports: "Union workers continue to receive higher wages than nonunion workers and have greater access to most employer-sponsored employee benefits; during the 2001-2011 period, the differences between union and non-union benefit cost levels appear to have widened."

Cool Tool
The National Conference of State Legislatures offers a Workers Compensation -- Enacted Legislation Database

Worker Memorial Day Followup
Compliance and Safety Blog featured an excellent roundup of links, tributes, historical information, and the 1994 Documentary by Robert Cotter that tells the story of the Hamlet fire in the Imperial Chicken Plant that killed 25 workers, with the story told From The Eyes Of The Survivors. This was an egregious incident - 19 of the deceased workers were mothers with young children. The plant owner locked the emergency exit to prevent theft.

Belated Risk Roundup
While yours truly was off on vacation last week, the risk bloggers weren't: Here's last week's roundup: Cavalcade of Risk #182, posted by Jeff Root of Rootfin, A Texas resident who passed through West, TX within 15 hours of the blast.

Belated Kudos
Hats off to Michael Fitzgibbon, Ontario labor and employment attorney, on his 10 year blogging anniversary at Thoughts from a Management Lawyer - it was a lonely landscape for business bloggers back then, as we well know. He was one of the early links in our sidebar, and is still there today. He names a few other early pioneers in his post.

Other noteworthy news

| Permalink | No Comments

April 17, 2013


Jason Shafrin has posted Cavalcade of Risk #181: The 'What If' Edition at Healthcare Economist. In addition to a good roundup of risk-related posts, he talks about events at the Boston Marathon from a risk perspective.
Security expert Bruce Schneier puts the risk in perspective, too: The Boston Marathon Bombing: Keep Calm and Carry On

Boston's our neighbor so it has been quite the week here. Although, really, the world is Boston's neighbor this week. You know things are really tough when the New York Yankees pay tribute to their arch-enemy.

Many people want to do something for victims but officials warn: Be on alert for the inevitable Charity scams. Courtesy of the Consumer Insurance Blog, we're issuing some legitimate ways that people can help the folks in Boston:

The One Fund - Massachusetts Governor Deval Patrick and Boston Mayor Tom Menino have announced the formation of The One Fund Boston, Inc. to help the people most affected by the tragic events that occurred in Boston on April 15, 2013.

American Red Cross - You can always donate funds or blood to the American Red Cross - but you may want to wait a few weeks. Right now, the Red Cross says it has sufficient funds and blood supply to deal with events in Boston, but the need for blood is constant. People often rush to donate to a specific tragedy but donating on a regular basis can be more helpful.

Boston Children's Hospital continues to aid in the recovery following the explosions. You can support the hospital's efforts with a donation to the Marathon Program, which supports the hospital's areas of greatest need, or the Emergency and Trauma fund, which helps kids and families get the emergency treatment they need when tragedy strikes.

Another donation resource that might be of interest: Children's Hospital Boston's Amazon wishlist

Here are some other items of note related to Boston marathon events.

First, a hat tip to the courage and professionalism of the workers: Mayors Menino, Giuliani Praise 'Brave' First Responders in Boston Bombing. Also, the volunteers: Marathon medical tent 'transformed into trauma unit', and the random citizen heroes. Without these folks, things might have been much, much worse.

Insurers offering free counseling after Boston Marathon explosions. It's also a good time to point employees to an EAP service. Here's a helpful resource: Managing traumatic stress: Coping with terrorism. And this: Harvard EdCast: Discussing Tragedy with Children.

Identifying Who Survives Disasters -- And Why

Roundup of related stories from insurance publications
Business Insurance:
Boston bombing presents big unknown for insurers

Risk Management Monitor:
For Boston

Property Casualty 360:
A Human Race
Boston Terror Attack 'Bound to Have Impact' on Event Cancellation Coverage

Insurance Journal:
Insurance for Sporting Events Could Be Affected by Marathon Bombings: RMS Expert
Boston Bombing Investigators Gather Evidence: Backpack, Pressure Cooker, Ball Bearings

| Permalink | No Comments

April 12, 2013


Louise Norris posts an excellent edition of health wonkery this week at Colorado Health Insurance Insider: Health Wonks Tackle New Questions in Healthcare Reform. She notes that the range of topics is far-reaching, but that most are at least loosely associated with some aspect of health care reform. She offers a graphic summary, which we've taken the liberty of reproducing here - but click through to access the posts.


Quick news notes
Grab a coffee and pull up a chair - here's a pretty hefty link list to other news items we found noteworthy this week:

| Permalink | No Comments

April 3, 2013


Biweekly Risk Roundup - Cavalcade of Risk #180 is now posted by Michael Stack at the AMAXX blog - check it out.

Dispensing Docs - New study casts doubt on benefits of physician-dispensed meds - According to the findings of a recent research study conducted by the California Workers' Compensation Research Institute, even after controls to curb price differentials, the practice costs more and is associated with more days away from work. Quoting from a report of the study in Risk and Insurance:

Part of the controversy around physician dispensing of repackaged drugs concerns the price. Prior to reforms in 2007, reimbursement for repackaged drugs "often exceeded the amount paid for equivalent pharmacy-based prescriptions by 500 percent or more," noted the authors.
The reforms adopted by the California Division of Workers' Compensation to the pharmacy fee schedule "largely eliminated the differential pricing," the authors said. "The effect was immediate, as both the volume of physician-dispensed repackaged drugs and the amounts paid for these medications declined by more than 90 percent by 2011."
Despite the change, overall amounts paid and days away from work increased after the reforms.

Rx Summit - Joe Paduda is posting reports on the second annual national Rx drug abuse summit at Managed Care Matters. Although attendance numbers are good, he notes that actuaries and C-suite execs are conspicuous for their absence. Joe says, "That is precisely why opioids are the single biggest problem in workers comp."

Prevention Tips from a Pro - In Top 10 loss control tips for 2013, Dennis Truitt, a 20-year occupational safety veteran, reveals his list of the most important steps companies can take to mitigate risk and control loss.

Dark Ages - What did people do before Twitter, Facebook and LinkedIn - how did people communicate? Take a look: Vintage social networking.

Fee Schedules - Successes and Failures of Fee Schedules: How Medical Providers Circumvent Fee Schedule-Related Revenue Losses - John Stahl reports on a panel presentation at the Workers' Compensation Research Institute's recent annual conference. He discusses the session of "Unnecessarily High/Low Medical Prices and Fee Schedules"in some depth.

Ergonomics, A to Z - Mark Middlesworth of Ergonomics Plus has compiled an excellent Ultimate Guide to Workplace Ergonomics. His extensive list of resources covers everything from ergonomic assessments, training, and design to success stories. Its worth bookmarking!

Early Reporting - Jennifer Frederick offers five good reasons why reporting workers compensation claims ASAP should be your standard operating procedure.

Career Options - Looking for a career path with a good future? A new NIOSH report says that the future demand for occupational safety and health services will significantly outstrip the supply. "Although employers plan to hire at least 25, 000 occupational safety and health professionals over the next five years, only about 12,000 new graduates are expected to be available from the academic programs that provide the needed pool of expertise nationally. Hiring estimates include new or replacement positions, some of which may be filled by persons without occupational safety and health training."

More Noteworthy News

| Permalink | No Comments

March 28, 2013


We open this weeks edition of Health Wonk Review with a breaking news alert: The criminal indictment against Punxsutawney Phil has been dropped. Despite the fact that spring appears elusive, the rascally rodent won't have to look for his shadow from a jail cell next year. The Ohio prosecutor who filed suit says that he is done with animal cases, inviting some other prosecutor to take on the Easter Bunny. There may well be grounds for suit - check out the hilarious Sketchy Bunny site.

We couldn't help but think of the other Groundhog Day when we read Joe Paduda's post taking on the tin-foil hat brigade. He tries to put one myth to rest at Managed Care Matters: there is NO OBAMACARE RFID CHIP! We suspect that RFID chips are on the same continuous loop as death panels, and that no amount of dispute will put them to rest.

Leaving behind the Easter Bunny, the RFID chip and other myths, we think prosecutors should stop worrying about dereliction of duty on the part of groundhogs and perhaps turn their sights instead to more serious matters, like dereliction of duty on the part of our elected officials. Surely there is something criminal about the ongoing gridlock in DC, no? Which brings us to a jumping off point for this weeks edition.

At HealthBeat, Maggie Mahar takes on the sequestration, looking at what it means for health, education and the exchanges. Will "Looking Stupid" eventually motivate legislators to compromise? (Editorial note: that ship has probably already sailed over the horizon.) Maggie offers her thoughts on why the GOP won't compromise on taxes.

Wendell Potter had a chance to see some of the DC action up close and he appears less than impressed. At Blog, he describes his testimony at an 'Unaffordable' congressional hearing, where he learned that House Majority lawmakers wanted to hear only that reform law makes health insurance unaffordable.

On the issue of affordability, Anthony Wright of Health Access Blog says don't believe rate projections about how health insurance rates might go up because there are a number of variables these projections don't take into account. And he notes that because everyone is starting from a different place, the impact will likely be different: Lots of people will pay less; some will pay more.

John Goodman isn't buying any of it. In his post Bait and Switch at his Health Policy Blog, he strongly disputes the administration's budget projections on health reform.

We pause in this edition to bring you a timely public service announcement: Louise Norris of Colorado Health Insurance Insider is thinking about the looming tax deadline and a few technicalities that might help to prevent uncomfortable moments in a tax audit. She reminds us that you have to have an HSA Qualified Health Plan in order to set up an HSA - something that many people wouldn't know if they set up their HSA through a financial institution rather than through their health insurance carrier.

A deeper dive into costs
At The Hospitalist Leader, Bradley Flansbaum explains that an AHQR-sponsored database examines both commercial and government health costs, allowing an analysis of measurements in a comparative manner. In his post HCUP: Hospital Costs, Not Prices, he looks at inpatient costs and payers.

Are regions with above average Medicare spending per beneficiary more likely to provide high quality care? Are regions with above average Medicare spending per beneficiary likely to have above average Medicaid spending per beneficiary? Healthcare Economist Jason Shafrin provides an overview of his report written for the Institute of Medicine: Geographic Variation in Health Care Spending

Henry Stern of InsureBlog looks at the reception one employer's attempt to rein in health insurance costs. CVS implemented a a health-screening program for its covered employees, causing some to cry foul. In his post Paying The Piper, Hank calls such protests out as hypocritical.

In his post at the Interdisciplinary Nursing Quality Research Initiative's blog, Mark Pauly looks at the the challenging business case in which spending more on nurses improves quality, but wonders whether even when a more costly program passes the cost-benefit test, we be confident that buyers will be willing to pay for those costs.

The next generation
Much attention is given to the health care system, much less so to the educational institutions that breed future health care leaders. Roy Poses picks up the slack. At Health Care Renewal, he discusses the recent NYU Faculty No Confidence Vote in their President - another sign that, "faculty at large American universities, in which most of the country's medical schools and teaching hospitals are embedded, are becoming increasingly concerned about the leadership and governance of their organizations, and whether the universities are putting their academic (and clinical) missions ahead of other concerns, like making money and rewarding top executives."

At Wing of Zock, James E. Lewis looks at the projected physician shortage and asks, "Even if new and larger medical schools accept enough students to abate the projected physician shortage in this country, where will we get the clinical faculty to teach them?

Technology may save us
Health Business Blog's David Williams recently attended HIMSS (Healthcare Information and Management Systems Society, for the uninitiated), where he interviewed Kaiser CIO Phil Fasano about Transforming Health Care, his new book. Fasano believes health IT can help empower consumers and can completely transform the relationship between patients and providers.

At Healthcare Talent Transformation, Jonena Relth thinks there's untapped potential in technology. She asks why EMRs aren't making use of existing technologies to improve care delivery in her post How come Spock's computer was so far advanced beyond today's EMRs?

In closing
Here at Workers' Comp Insider, we focused more on the past than the present, taking a look at obsolete occupational maladies such as Bagpiper's Fungus and Cheesewasher's Lung.

Here's wishing you all a happy holiday weekend and an imminent shift to spring-like weather. Watch out for sketchy bunnies and check back to Health Wonk Review on April 12, when our friends at Colorado Health Insurance Insider will host.

| Permalink | No Comments

March 20, 2013


Risk Roundup - Check out this week's Cavalcade of Risk #179 - March 20th, 2013 Edition posted at My Personal Finance Journey

Taking care of business - At WorkCompWire, Joe Paduda poses the question What business are you in?" He hazards a guess that most of us would say "the insurance business" but he argues that we are really in "the medical and disability management business - with medical listed first in order of priority." He suggests that, "Senior management misunderstands their core deliverable - they think it is providing financial protection from industrial accidents, when in reality it is preventing losses and delivering quality medical care designed to return injured workers to maximum functionality." We could quote the whole thing, he makes a compelling argument so be sure to check it out. It echoes one of the Lynch Ryan founding tenets. When many of us got into this business, we did not come with insurance backgrounds. We felt at its core, managing injuries required a focus on the human event and not the dollars. We believed then and still believe now that if you took excellent care of the injured worker, got them quality medical care and helped them get well and back to work, the dollars would follow.

Smile - it's March 20 - Did you know that March 20 is International Day of Happiness? Now you do. It's also the first day or Spring, and if, like us, you wondered why Spring isn't commencing on the usual March 21 date, Joe Rao at explains Why Spring Begins Early This Year.

New State Fund in Illinois? - Illinois Bucks Trend in Other States; Looks to Establish Competitive Workers' Comp State Fund - "Illinois state legislators are running counter to a national trend by proposing creation of a state workers' compensation insurance fund that would compete with the private system. The development is generating deep angst amongst Illinois insurers and industry trade groups."

Other state news

New Citizenship Verification form - As of 3-8-13, a revised US Citizenship & Immigration Service (USCIS) Verification Form I-9 has been issued. There is a 60-day grace period to come into compliance - new USCIS I-9 Formsforms must be in use by May 7, 2013.

When healthcare workers are unsafe, patient quality suffers - "Many medical work environments are unsafe for health professionals, adding stress and distraction that can expose patients to harm," according Kevin B. O'Reilly who writes about a recent report by the National Patient Safety Foundation's Lucian Leape Institute. In an article in entitled Warning sounded on demoralized health care work force, he cites a high injury rate that is 33% higher than private industry as one factor, as well as "the lingering problem of disruptive behavior in health care, which can create a culture of fear and intimidation that inhibits safe, high-quality care."

Fatalities Report - The March Monthly Labor Review has a report on Hispanic/Latino fatal occupational injury rates (PDF). The fatality rate for Hispanic/Latino workers is much higher than that of other demographic groups. Studies also show that, "... foreign-born Hispanic/Latino workers have higher rates than native-born Hispanic/Latino workers in certain occupations, a statistic that is explainable by differentials in employment between the two groups."

Worker Costs - According to the latest Department of Labor report, the Northeast leads the U.S. in worker costs. "Hourly costs per employee in the Northeast - which includes the New England states, New York, New Jersey and Pennsylvania - averaged $33.10 in December, higher than the national average of $28.89. The next costliest region was the West, which consists of the mountain and Pacific coast states, at $30.29. The average hourly wage in the Northeast was $22.85, while the average per-hour employer cost in benefits was $10.25, both the highest in the U.S."

More news of note

| Permalink | No Comments

March 14, 2013


Chewy Health Wonk Review - David Williams has posted Health Wonk Review: A Lot to Chew On at Health Business Blog. - and he is right, with the Affordable Care Act implementation proceeding, he notes that it is "the golden era for health wonks." When you stop by David's place, drop a note of congratulations - he is celebrating his 8 year blogiversary, which, in Internet years, is very old indeed.

Compensability - Risk & Insurance features an interesting case study by Jared Shelly that deals with compensability as it relates to business travel in From Russia, Without Love. After his business was completed, 60-year-old American executive decided to see "the sights" in Moscow and mayhem ensued. Are injuries sustained in a shady barroom compensable? Click to see the adjuster's decision. And for another interesting study in compensability: She got food poisoning in the company break room; does she get workers' comp?

Accommodations - Jon Hyman of Ohio Employer's Law Blog offers tips for what to do if you doubt an employee's disability. It's worth checking out - a Los Angeles waste disposal company made the wrong choices and was awarded $21.7 million by a jury.

Caveat Emptor - Sarah Kliff of Washington Post's Wonkblog looks at how much anankele MRI costs in the D.C, area and finds that prices range from $400 to $1,861. She talks to John Driscoll, president of Castlight Health, a firm that studies and is dedicated to improving healthcare cost transparency.

Changing workforce - In the United States, 10,000 baby boomers reach 65 every day, and many retire, taking with them valuable experience, skills and loyalty to their employers. Ed Pound looks at global labor trends and the impact on the insurance industry in his article The Stagnant Labor Pool, which appears in this month's Leader's Edge.

Blankenship Addendum - earlier in the week, we posted about the ongoing criminal investigation into the UBB mine disaster. Since that posting, Ken Ward has updated his site with a transcript of proceedings which was recently made available.

Fraudster of the week - Boston Bus Driver Convicted In Staged Shooting. Her actual criminal conviction was not for the related workers' comp, but for deliberately misleading an investigator, which is a felony under the state's witness intimidation statute.

More News of Note

| Permalink | No Comments

March 6, 2013


Risk Roundup - David Williams hosts Cavalcade of Risk #178: Little bit of everything edition over at Health Business Blog. David's a good blog citizen - he'll be hosting next week's Health Wonk Review, too!

Transitions - Isaac Asimov said "The only constant is change." We are pleased to see that Marsh has named Mark Walls Workers' Compensation Market Research Leader. Kudos for Marsh - they will have a great champion in Mark, who has been a social media pioneer with his leadership in founding the ever-popular Work Comp Analysis Group. Hopefully, he'll have room in his new role to do much more in this vein. And in another notable industry transition, we see the passing of the torch at California Workers' Compensation Institute as J. Michael Nolan retires and Alex Swedlow takes the reins. Our colleague Joe Paduda does a nice job explaining why Swedlow's appointment is such a smart move on CWCI's part.

Mental Anguish - There's currently a bill before Connecticut legislators that would expand workers' comp to include post-traumatic stress under specific circumstances - think first responders and Newtown. Unsurprisingly, the Insurance Association of Connecticut is opposing the bill on the basis that the language and circumstances are too vague and it would undo many of the reforms put in place in 1993. The issue of stress, trauma and PTSD is a tough one in workers' comp - and although CT has been spurred by the recent tragedy, it's an issue that surfaces frequently with first responders. See: S.C. Police Traumatized By Shocking Work Left Out Of Worker's Compensation.

Repeat offenders & government contracts - Should a company that repeatedly and willfully flouts OSHA safety standards be eligible for federal contracts? At The Pump Handle, Celeste Monforton posts this question about Houston-area excavation firm SER Construction Partners in light of a recent citation for for willfully failing to comply with standards for safe excavation practices. She documents that this is one in a series of violations - in two instances, workers died following serious injuries related to OSHA violations. Fines are pretty negligible for a large company -- and as we've noted before, more often than not, fines are bargained down. There should be some more serious consequence for serial offenders -- withholding state and federal contracts seems appropriate to us.

Good read - Don't miss Dave DePaolo's post, A word that's both a noun and an adjective, on the role that language plays in the aftermath of a worker's injury. In any other setting, they would be "a patient" rather than a claimant. We often fall back on industry jargon without thinking through the effect on others. A few years back, the managed care industry was raked over the coals for calling patients "covered lives." Language matters. DePaolo identifies the jargon as a way to make things less personal - and that is likely true. All too often, workers comp is viewed more as a financial event than a human event, which it really is. Someone got injured. At Lynch Ryan, we've always found that if you take care of the human, first and foremost, the financial outcome is generally better too.

Safety - Sandy Smith has a thoughtful piece about Safety After the Fact in EHS Today. It's the sad story of one worker's injuries that led to his death at a too-young age. Simple safety procedures might have prevented the injury. In contrast, Steve Yahn has written an interesting profile of a company that appears to be doing things right -- Cirque du Soleil's risk management and safety program -- in Risk & Insurance. They take a rigorous, multi-disciplinary approach to prevention.

Other Noteworthy News

| Permalink | No Comments

February 28, 2013


Health wonkery - Dr. Jaan Sidorov presents the February Edition of the Health Wonk Review: Insightful Nuggets From the Best Health Policy Blogs at his Disease Management Care Blog. He's organized the posts by topic: "Obamacare's key reforms, various health economists' latest divinations on health care costs, hospitals, Medicaid, the internet, California, medical education and some British humor." Check it out!

FMLA - Update your info - By March 8, employers need to update policies and replace FMLA posters with a newer version that reflects recent updates to the law related to military family leave, military caregiver leave and eligibility standards for airline flight crew members and flight attendants. You can get a copy of the updated FMLA poster and more information about the changes.

State-by-state barometers - Joe Paduda posts about medical care variation among states as reflected in the latest Dartmouth Atlas of healthcare, presented in yesterday's WCRI Annual Meeting. Joe looks at some of the findings and questions that the report raises. And in another state-by-state comparative indicator, the Robert Wood Johnson Foundation issued an interactive map that charts death rates and how states rank in 10 key indicators, such as drunk driving, prescription drugs, domestic partner abuse, and seat-belt use. It's a pretty interesting tool - but we'd encourage them to add on-the-job deaths to the list.

Terrorism risk insurance - the current Terrorism Risk Insurance Program Reauthorization Act of 2007 will expire at the end of 2014 and some are already looking at the need for renewal. Brokers say the backstop coverage is still needed and while it may seem early to be looking at something that will expire in 2014, it is not - the article notes that "...any delay past the end of this year causes problems for 12-month insurance contracts and the stress that comes with uncertainty of the program's future."

Opioid sausage making - You know the old quote about how laws are like sausages - it's better not to see them being made... Marc Gavin of Evidence Based thinks that the there has been an abject failure on the part of IAIABC on dealing with the opioid crisis after the executive committee of IAIABC sidelined and he is not alone in his opinions. The blogosphere has been abuzz about the curious backtracking - people were anticipating leadership with the issuance of model rules and legislation on opioid use in the workers' compensation industry. Gavin tells us there is some hope in that the National Conference of Insurance Legislators (NCOIL) is taking up the cause at its spring meeting.

Ergonomics - What is early intervention in the context of preventing musculoskeletal disorders (MSD)? ErgonomicsPlus offers a checklist and tips.

Disease Detectives - We haven't tried it yet but note with interest that the CDC offers a Solve the Outbreak i-Phone app. The descriptive copy says: "Get clues, analyze data, solve the case, and save lives! In this fun app, you get to be the Disease Detective. Do you quarantine the village? Talk to people who are sick? Ask for more lab results? The better your answers, the higher your score - and the more quickly you'll save lives. You'll start out as a Trainee and can earn badges by solving cases, with the goal of earning the top rank: Disease Detective."

Noteworthy News

| Permalink | No Comments

February 14, 2013


Peggy Salvatore posts a sweet Health Wonk Review - Valentine's Day Edition: Here's Your Heart! at Healthcare Talent Transformation blog. The compendium of posts from some of the brightest minds in the health policy blogsphere is a good way to take a biweekly pulse of healthcare policy developments if the topic isn't on your radar every day!

Valentine's Day - As long as romance is in the air today ....Taking the pulse about workplace romance on Valentine's Day and 5 Tips To Avoid Legal Fallout From Workplace Romance. Also, February is heart health for women month: Check out (and circulate) the Mayo Clinic's Heart disease in women: Understand symptoms and risk factors. And on the silly side, see Cupid urges you to Insure Your Love

You may be older than you think - Kevin Ring of PropertyCasualty360 offers the first installment of a two part series discussing NCCI's recent reasearch on aging: For Older Workers, The Game Has Changed: Part 1. One of the interesting points is that at least in terms of claim costs, the research suggests that redefining "older" as workers over aged 35 makes more sense.

The business case for safety - Drew Greenblatt, president of Marlin Steel, offers this advice to employers: Stop thinking of safety as an obligation. The rewards are greater than you think. Marlin Steel, a U.S.-based manufacturer of wire baskets and sheet-metal fabrications that has grown 25% over the past three years, just passed 1,500 consecutive days without a safety accident. Related: Calculating the ROI of corporate social responsibility

If your RTW program is broken, check these common mistakes - EBN has features a good slideshow that covers 10 costly return-to-work mistakes - it encompasses everying from failing to account for the effect of comorbidities to failing to understand the requirements of FMLA, ADA and other laws. See if your program measures up.

OSHA leadership - Wondering if there will be any OSHA leadership changes at OSHA in President Obama's second term? Not according to Jordan Barab, deputy assistant secretary, who recently said that he and David Michaels will stay in place. No successor has been named for uutgoing Labor Secretary Hilda Solis yet. (Hat tip to Tammy Miser of The Weekly Toll).

Rise in "questionable claims" - The National Insurance Crime Bureau (NICB) recently released its 2012 questionable claims report. Over the period from 2010 to 2012, NICB saw a 26.7% percent overall increase in referred questionable claims, and a 15.7% increase from 2011 to 2012. Questionable claims are those claims that NICB member insurance companies refer to NICB for closer review and investigation based on one or more indicators of possible fraud. Here is the full Analysis of National Insurance Crime Bureau 2010, 2011, 2012 Questionable Claim Referrals (PDF) or view the executive summary via press release.

Noteworthy News

| Permalink | No Comments

February 6, 2013


Study-Palooza - Joe Paduda offers his analysis of work comp hospital costs as reported in WCRI's recently released 20-state study on outpatient hospital costs. And Joe is really letting his nerd side show with a report on two other workcomp-related research studies, one dealing with back surgery outcomes and the other, the use and cost of compound medications.

Health data - While on the topic of research, you may want to bookmark the Pew Research Center's Health research page. It offers excellent insight as to how people are using the Internet to access health-related information. A recent study shows that seven in ten (69%) U.S. adults track a health indicator for themselves or a loved one and many say this activity has changed their overall approach to health.

20 Years Today - Today is the 20th anniversary of the Family Medical Leave Act (FMLA). Occupational Health & Safety features a story on a survey conducted by the Department of Labor to learn how the law has affected employees and employers. The survey showed 16 percent of workers took FMLA leave within the last year, 56% of whom were women. More than half took leave for their own illness (57%), for new child-related reasons (22%) or to care for a family member with a serious health condition (19%). While the law is praised as "the first step in creating a more family-friendly American workplace" by many and hailed as a boon to families, there are some employees who would not agree. Plus, many employers would cite abuse, problems and confusion in implementing and complying with the law. Noncompliance can be costly - see Failing to Train Supervisors in FMLA: $1.2 Million Loss to Employer. One of the best resources we have found for keeping up with FMLA emerging issues, case law and changes is employment law attorney Jeff Nowak's FMLA Insights. Jeff has comments about the FMLA anniversary and the DOL survey results, which he calls "curious."

Terminations - Sharon Lauby hosts a blog delightfully name blog, HR Bartender, well worth keeping on your radar. She recently posted about How to fire an employee. This week, she followed up with Terminating Employees: How To Fire Right, which includes a valuable guide from employment law attorney Mark Neuberger, which you can download at no cost, and with no registration required. The first line in this guide gives a reason why you should go there and download it now: "Every termination decision should be based on the assumption that it will be challenged before an administrative agency, a court or both."

Out-of-This-World Twitter posts - Some people's work environments are a little more interesting than yours and mine. Canadian astronaut Chris Hadfield stunning images taken from the international space station. You can follow his Twitter feed for more: @Cmdr_Hadfield.

News Briefs

| Permalink | No Comments

February 6, 2013


This week's risky roundup is posted at Dennis Wall's Insurance Claims & Issues blog. Check out Cavalcade of Risk #176: Healthy Risks, Risky Health.

| Permalink | No Comments

February 1, 2013


Maggie Mahar has posted a fresh edition of health policy wonkery in the Health Wonk Review: Waste, Warnings and the Future edition at Steve Anderson's Blog.

As many Workers' Comp Insider readers are aware, "carnivals" are a roving compendium of posts on a given theme - in this case, health policy issues. Our friend and colleague Joe Paduda founded Health Wonk Review - we were happy to help him launch and have been an active participant since. (We also participate in Hank Stern's Cavalcade of Risk.) Health Wonk Review is hosted at a different blog biweekly and includes some of the best bloggers on the topic of health policy, from physicians and consultants to insurance agents and academics, all of whom bring their particular spin to the posts they host. As a financial journalist and author of the book Money-Driven Medicine: The Real Reason Health Care Costs So Much, Maggie is a savvy commentator on the healthcare scene.

Check out past issues of Health Wonk Review.

| Permalink | No Comments

January 25, 2013


Research & Studies
New NCCI Report: Medical Services for Claims 20 or More Years Old - "According to NCCI, it is likely that more than 10% of the cost of medical benefits for the workplace injuries that occur this year will be for services provided more than two decades into the future. That percentage has been growing and might continue to grow." Related: In workers' comp, it's the tail that'll kill you - Joe Paduda

Prior Relationship Common Factor in Workplace Homicides: Study Offers Guidance - At LexisNexis, John Stahl reports on a study that addresses the related phenomenon of workplace homicides in which the assailant has a relationship with either the business or an employee.

Study on Fatal Falls Among Older Construction Workers - from CPWR-The Center for Construction Research and Training, Silver Spring, Maryland.

Putting a price on the hassle of preauthorization - "The first study of its kind attempting to document the true cost to physicians of insurer-mandated prior authorizations has delineated what researchers say is most likely just the tip of the iceberg."

How Much Can Workplace Wellness Programs Save? - 18 percent -- and even more for older workers, reports a study in the January Journal of Occupational and Environmental Medicine.

News & Views
Upper Big Branch Mine superintendent sentenced - "A former Upper Big Branch Mine superintendent was sentenced to nearly two years in jail for his role in a plot to skirt safety rules and cover up the resulting hazards at the Raleigh County operation where 29 miners died in an April 2010 explosion."

Work Comp and Independent Counsel - Dave DePaolo

Inside A.I.G.'s Decision Not to Sue

Charts: Suicide, PTSD and the Psychological Toll on America's Vets

Women Account for 72 Percent of the Decline In Union Membership from 2011 to 2012

On Being awesome: Who can you delight today?

The High Cost of Taking a Sick Day

A Look at New Insurance Laws Taking Effect in 2013

Medical groups praise Obama's gun-control plan

Health & Safety
Reminder: OSHA Logs MUST Be Posted Feb 1

The Painful Subject of Progressive Disciplinary Policies for Drivers - "This policy addresses steps to take following accidents or incidents as well as how to respond to new convictions you find during your annual MVR checks."

Portable Fire Extinguishers: Part 1: Identification & Visibility and Part 2: Maintenance & Recordkeeping.

Retailers Launch Safety Data Sheet Initiative - The Retail Industry Leaders Association (RILA) has launched a safety data sheet initiative to streamline the process for the safe handling of chemical products

What Can You Do to Prevent Accidents Caused by Worker Fatigue?

| Permalink | No Comments

January 23, 2013


Life is just plain risky. Welcome to the biweekly grab-bag of risk related issues. We are pleased to be hosting this week's 127th roundup. As a theme, we've chosen to intersperse our entries with a humorous look at risk via a few clever clever insurance commercials from the Netherlands insurance firm Centraal Beheer (hat tip to Consumer Insurance Blog for the levity.)

We open this week's posts with an entry from our fearless leader and Cavalcade founder, Hank Stern. What's on his mind this week at InsureBlog? Risky Bulbs. He highlights (ahem) reports that those newfangled curly bulbs may be a lot more dangerous than we'd thought, increasing one's risk of burns and exposure to UV radiation.

If you require any medical treatment after your encounter with the hazardous bulbs, you may be in fro sticker shock. Jaan Sidorov of The Disease Management Care Blog posts about hos The $5 Billion Price Tag for medication errors and injectable drugs.

The good news is that even if your treatment is expensive, at least you should be able to get good care. At Health Business Blog, David Williams dispels the myth that there is a nursing shortage. He tells us that there's oversupply right now and with technological change there's reason to believe no shortage will ever arise.

In thinking about hospital care, one might wonder how they manage their own costs for healthcare... Jason Shafrin, The Healthcare Economist investigates how much money hospitals spend insuring their own workers.

At Colorado Health Insurance Insider, Louise takes a sobering look at health insurance costs to the individual under the ACA. She explains in detail why it is likely that costs will go up substantially.

My Wealth Builder looks at his own experience in maximizing insurance benefits and minimizing out-of-pocket costs, sharing what he's learned in Insurance Out-of-Pocket Cost Management.

Moving away from medical and healthcare risk and into other insurance and finance matters...

This week, we celebrated the pageantry of the presidential inauguration - an event that pleased many but not all of our fellow citizens. Democracy is messy. But Russell Hutchinson, our favorite blogger from down-under, gives us an object lesson in why we should be grateful that we live in a democracy in his post Supervision of the Insurance Industry - Fijian Style.

Not that our own insurance system isn't sometimes very flawed. At his Insurance Claims and Bad Faith Law Blog, Dennis Wall posts that refusing to pay valid Sandy claims is just bad faith. He notes that at least one Representative changed from a nay to a yea vote after seeing with his own eyes how Sandy made needy victims out of so many people and businesses.

Insurers can improve their chances of a good outcome when following the Boy Scout motto of being prepared. At Workers Comp Roundup , Rebecca Shafer posts about implementing electronic claims management systems to gather all information necessary for high quality claims management.

And here at Workers' Comp Insider, we deal with the risks of getting old. At My colleague Jon points out that our century-old workers' comp system is poorly equipped to handle the increasing numbers of older workers in the modern workforce.

In this final segment of our risk review, Ken Faulkenberry of the AAAMP Blog suggests that a good risk control approach is to focus on what you can control, good advice for life in general, as well as for your investment portfolio.

At the eponymously named Life Insurance By Jeff blog, Jeff Rose reminds us that coverage needs change throughout fluctuations in jobs and life situations. A 15-year term life policy might be a better option than a lifetime policy.

Does everyone need life insurance? What about someone who has no income to replace? Jacob @ My Personal Finance Journey makes the case for why homemakers should have life insurance - and plenty of it!

That wraps up this edition. Keep an eye out for the next issue of Cavalcade of Risk, which will be hosted by Dennis Wall at Insurance Claims & Issues.

| Permalink | 1 Comment

January 17, 2013


Health Wonk Review: The Inauguration Edition is freshly posted by Chris Fleming at the Health Affairs Blog. Here's a preview: 2013 predictions, healthcare spending, risky behaviors, nursing workforce projections and more. A good and substantive edition: Get your wonk on.

Electric car crashes could pose new risk for first responders - With the proliferation of hybrids and new technologies, emergency workers that respond to the scene of an auto accident could be subject to shocks from batteries that have not powered down. See our prior post on Electric Vehicle Safety Training for first responders.

Are the flu & Tamiflu overhyped? - At Managed Care Matters, Joe Paduda casts a skeptical eye on the hoopla over the flu and the media's propensity to blow everything up into a crisis. If it's not shark month or killer bee week, we need some fear-factor issue to fascinate, worry, and horrify us. Don't miss his comments on Tamiflu. But if you do need some workplace guidance, see Influenza tools & tips for you & your employees at HR Web Cafe. Also of interest: NIOSH Research on Airborne Influenza Transmission

A Primer on Fee Schedules - Peter Rousmaniere's most recent column in Risk & Insurance is a good bookmark. He offers an overview and a rundown on the status quo on this complex and important managed care issue of how doctors get paid.

Internet-Use Disorder: The Newest Disability? - There's apparently a growing catalog of technology related maladies - we've previously discussed Blackberry Thumb, Cell Phone Elbow, IPod Ear. But this one is actually included in the DSM-5 - although as a condition that requires further research. Jon Hyman of Ohio Employer's Blog thinks it bears watching because if it is deemed a psychiatric disorder, then employees who suffer from it may be protected by the ADA. See his post for more on this.

For Americans Under 50, Stark Findings on Health - "Younger Americans die earlier and live in poorer health than their counterparts in other developed countries, with far higher rates of death from guns, car accidents and drug addiction, according to a new analysis of health and longevity in the United States." Access the full report.

Drugs & Guns: Arming Investigators - Dave DePaolo posts that the Texas Medical Board (TMB) has asked the state's attorney general to rule on whether the board may authorize its investigators to carry concealed handguns as private citizens when investigating pill mills. Drugs are a big and dangerous business. Ohio recently approved such a measure so the request is not without precedent.

CT officials hope to change workers comp law for Sandy Hook responders - Some lawmakers are looking to extend benefits to first responders for PTSD related to incidents like Sandy Hook (although it is unlikely any legislation would be retroactive). Currently, state law extends workers compensation benefits only to those who had a serious injury/fatality but not PTSD. We've seen this issue before: (Uncompensable) Nightmare at Work.

News Briefs

| Permalink | No Comments

January 10, 2013


Nina Kallen hosts the biweekly smorgasbord of risk at her blog Insurance Coverage Law in Massachusetts - the 174th Cavalcade of Risk. You should be sure to check out this issue, and while you'te there, sample a few of Nina's other posts.

As the name of her blog implies, Nina's law practice focuses on insurance-related matters and her blog covers a wide range of issues from sexual harassment to restraint of trade.

Thanks for hosting, Nina. We'll be hosting the next issue here at the Insider.

| Permalink | No Comments

January 3, 2013


Get back into the news groove with Brad Wright's Health Wonk Review: Baby New Year Edition over at Wright on Health..

2012 Review Roundup
Business Insurance In Focus Video: 2012 Year in Review

Insurance Journal: Events that Topped World Insurance News in 2012

Insurance Journal:10 Insurance Ins and Outs, Ups and Downs of Year of Dragon 2012

PC360: Rebuilding Year: Top 10 Stories of 2012

Joe Paduda: So, how'd those predictions for 2012 turn out?

Bob Wilson: Apparently I Suck At [2012] Annual Prognostications

Jon Gelman: Top Ten Workers' Compensation Fraud Cases For 2012

Terms + Conditions: Annual Tally of Most Ridiculous Lawsuits

Top 10 Developments in California Workers Comp in 2012

Risk Management: Year in Risk 2012

The Largest Natural Hazard Risks of 2012

Top 10: Safety Daily Advisor Year in Review

The Daily Briefing's 12 top issues of 2012

Health Affairs Top 10 List

The Best Of CommonHealth: Our Top Picks From 2012

The Best of Medgadget 2012

Top 10 HR Stories of 2012

Top 10: HR Daily Advisor Year in Review

Top 10 Best Insurance Commercials on TV in 2012

2012 Best Places to Work in Insurance

2013: What's Ahead
Predicting P/C Rates in 2013

Top 5 Trends in Workplace Safety Management for 2013

Top 5: What's ahead for workplace safety in 2013

Deloitte: 2013 Industry Outlook - Trends to watch, strategies to consider

Ernst & Young
2013 US property/casualty insurance outlook

Health Care Predictions for the New Year

9 insurance resolutions to ring in the New Year

10 Best Insurance Stocks for 2013

| Permalink | No Comments

December 28, 2012


Did you survive the holidays? You may have thought that your calorie count was your biggest worry, but actually the Mayan Apocalypse was looming. We dodged that bullet, but what's around the corner? Van Mayhall of Insurance Regulatory Law talks about assorted risky matters in Cavalcade of Risk: Surviving the Mayan Apocalypse Edition.

| Permalink | No Comments

December 20, 2012



via Sam Glynn

We are happy to be ho-ho-hosting this holiday edition of Health Wonk Review. Before we advance to this week's best of the best of the health policy blogosphere, we have a few administrative notes. The first is an urgent news alert we received yesterday concerning the big guy: Risk Managers Find Santa Exposed, Urge $1 Billion Coverage Plan. The second note of less urgency but some seasonal healthcare-related interest is a scholarly research report that appears in this month's British Medical Journal: Why Rudolph's Nose Is Red. We'll let you ponder these weighty matters and move on to submissions from our regulars. This week's entries appear in the order in which they were received.


Via Nicolas Ménard

In Unclear - Breathlessly Unclear - On the Concept, Mike Feehan ruthlessly fisks a recent LA Times article on California's Blue Cross proposed rate increases.

Managed Care Matters
Joe Paduda points to $200 billion in easy-to-make cuts in federal spending, which, for some reason, neither President Obama or Speaker Boehner seem willing to discuss.Since these cuts would get the two much closer to an agreement, and do so without cutting any benefits or raising any taxes, Joe asks -- what's the hold up?

Healthcare Economist
Jason Shafrin reviews how United Health evaluates physicians for its physician designation program: How do commercial insurers evaluate physician quality?

The Disease Management Care Blog
Jaan Sidorov tackles the inconvenient truths that will be confronting Obama in making good on his promise to address the horrific Newtown shooting. Rather than take gun control head on, Sidorov recommends doctors lead a national discussion on reconciling the privacy rights of persons with mental illness against the public interest in minimizing mass shootings, confront how the electronic health record could be used against gun owners and address a badly broken mental health care system.

Health Care Renewal
In Pfizer's 13th Legal Settlement - Will it be Enough to End the Impunity?, Roy Poses takes on Pfizer, noting the company has not suffered any significant negative consequences for any of its actions, despite its "amazing record of unethical behavior in the 21st century." This, despite a new calls to end to impunity in the wake of giant bank HSBC's alleged money laundering and transferring for drug cartels and sanctioned regimes.

The Hospitalist Leader
In his post "Less Than One Percent of Pain Sufferers Become Addicted", Bradley Flansbaum notes that the medical system teaches doctor not to fear narcotics when treating non-cancer pain but "Little did we know the wisdom had little basis in fact."

Health Business Blog
When hospitals buy physician offices they sometimes add a nasty surprise for patients: large facility fees to office visits. David Williams says that there's no real justification for such fees, but until now hospitals have gotten away with it. That's changing though as patients start to push back.

Colorado Health Insurance Insider
In her post What Should Health Insurance Cover?, Louise Norris says that health insurance is purchased to protect against the things we don't expect to happen and explains why, despite its high cost, deductibles and copays are still required.

Health Access California
Anthony Wright notes that the new federal guidance on Medicaid's ACA coverage expansion gives states like California and others the ability to move forward and take advantage of the huge new benefits and funding under Obamacare -- and quickly, given the ten short months to starting to enroll people in Medicaid.

Maggie Mahar explores the concept of The Empowered Patient through the real-life experiences of Julia Hallisy, who has authored a book and started a nonprofit foundation to impart what every patient and every patient's advocate needs to know about staying safe in a hospital. Hallisy learned the hard way during her daughter's decade-long journey through the health care system and some of the San Francisco area's finest hospitals -- a journey that included medical errors, misdiagnoses, inexperienced medical providers, and more. Hallisy's daughter Kate died in 2000 at the age of 11.

Health Affairs Blog
In their post Out Of The Blocks: Meeting The Challenge Of Transforming Health Care, Don Berwick and Clifford Marks summarize recommendations and thoughts from health care leaders at the "Out Of The Blocks" Conference held two days after the election by the Institute for Healthcare Improvement. It brought more than 100 health care leaders together, including many of the nation's foremost health policy experts, such as Senators William Frist and Tom Daschle, as well as panelists from all corners of the health care world. The post explores and summarizes some of the recommendations that were collected in a 14-page report.

Health AGEnda
Chris Langston posts about a national survey showing that depression care is still lacking some ten years after IMPACT, a $10 million depression treatment project. Chris examines what the findings of the new poll mean, and what we need to do to improve mental health services for those most vulnerable.

It's a carnival within a carnival as David Harlow hosts the current edition of Health Care Social Media Review. David founded HCSM this year to "serve as a hub for posts from the best and the brightest health care social media writers, thinkers, users and proponents worldwide, to contribute to better understanding and adoption of social media in health care."

Innovative Health Media Blog
In Keeping it All Together: An Unexpected Benefit of Medicare's Annual Wellness Visit, Charles Smith shows how implementing simple modifications to daily procedures, such as Medicares new AWV, practices can improve patient care and save money. This not only increases patient satisfaction with the visit, but it may also help improve patients chances of staying healthy.
Harold Pollack notes that with the Affordable Care Act's Medicaid expansion, the President and the governors need to get along. He thinks the governors will eventually embrace the Medicaid expansion and demonstrates why the economics are just too compelling to ignore. But states and the federal government must cooperate to solve a host of difficult implementation problems and glitches already-arising under ACA. He suggests that one vehicle of compromise and accommodation might be to work through both Democrats and Republicans in the National Governors' Association.

Workers' Comp Insider
In a recent post here on our blog, we posted Storm Clouds Ahead: Hackers, Healthcare Data & Medical ID Theft, citing recent cases of data hacking and the growing threat to consumers, employers, insurers and TPAs of data breaches and medical ID theft.

That's it for this edition! Our next edition will be hosted early in the new year - Brad Wright will host an edition on 1/3/13 at Wright on Health. Until then, wishing you all the best of the season!


via Laura Gentry

| Permalink | 1 Comment

December 6, 2012


Holiday Health Wonkery - Just a spoonful of latkes makes the medicine go down? Hank Stern hosts a Chanukah-themed Festival of Lights edition of Health Wonk Review at InsureBlog - it's fun, interesting, and contains substantial wonkery.

Claims Webinar - Mark Walls, who many of you may know from his LinkedIn Work Comp Analysis Group fame, is hosting a complimentary 90-minute webinar on Tuesday, December 11: Take your Workers' Compensation Claims Handling from Good to Great. Mark's been plying his profession for 22 years, so you can't get a better claims guide. Click through to see topics or to register.

Firefighter hazards - Stop, drop, and roll: workplace hazards of local government firefighters, 2009 (PDF) - "When compared with all workers, firefighters are injured in similar ways but at a much higher rate, with work-related injuries caused by "stress, exertion, and other medical-related issues" accounting for the largest number of deaths and with risks of fatal injuries 25.7 percent higher and nonfatal injuries and illnesses over two times greater." - BLS report by Gary M. Kurlick, economist in the Office of Compensation and Working Conditions, Division of Safety and Health Statistics, at the Bureau of Labor Statistics.

Chimp attack - Roberto Ceniceros of Business Insurance brings us the most recent development in the sad saga of the CT woman who was attacked by her employer's pet chimp: Woman disfigured in chimp attack settles with owner's estate for $4M. We've written about aspects of this horrific case in the past - see: the crazed chimp case, Exclusive Remedy" for Losing Your Face?, and (Uncompensable) Nightmare at Work.

Depression and Work Comp - Does your organization offer depression screening for injured workers? Risk Scenarios: Down for the Last Time offers case in which missed cues and poorly handled communication made a difficult workers' compensation case much more painful than it should have been.

Mind over Matter - Osteoarthritisis is "the most common joint disorder" and occurs "due to aging and wear and tear on a joint." Will arthroscopic surgery relieve related pain? Read about prior studies in Kneedless Surgery. For more debunking, see Gary Schwitzer's HealthNewsReview, which has a mission of "helping consumers critically analyze claims about health care interventions and by promoting the principles of shared decision-making reinforced by accurate, balanced and complete information about the tradeoffs involved in health care decisions." The site offers commentary, evaluations, and grading on health care journalism, advertising, marketing, public relations and other messages - a great consumer resource.

Fraud - Two pretty large cases of fraud hit our radar this week, proving that work comp fraud perpetrators can come in many flavors, even among those you pay to trust. On WorkCompWire, we learned about $2.7 million Florida fraud case involving a former correctional officer and at Managed Care Matters, Joe Paduda blogs that Pennsylvania County was defrauded by its risk manager to the tune of $490,000.

Telecommuting - In a recent Human Resource Executive, Carol Harnett makes the case that Telework is Good for Business, and she uses the experiences that many businesses had with Hurricane Sandy as examples. At LexisNexis, attorney John Stahl looks at work comp issues related to the mobile workforce and home-based employees.

Workplace Violence - The current issue of Risk Management Magazine has a Time Line of Workplace Homicides and at Risk Management Monitor, Ralph Metzner posts about preventing workplace violence.

News Briefs

| Permalink | No Comments

November 28, 2012


Risk Roundup - Emily Holbrook hosts Cavalcade of Risk #171 at Risk Management Monitor - be sure to check it out.

One to watch: Wal-Mart Class action & WC - In Business Insurance, Roberto Ceniceros writes about a Wal-Mart class action settlement that raises big workers comp questions. Josephine Gianzero et al. v. Wal-Mart Stores Inc. resulted in a settlement for 13,521 plaintiffs. It raises several issues of concern related to workers comp: the case was a breach of the exclusive remedy provision - an issue that is always of some concern to employers - and it raises questions about medical claims management.

According to Ceniceros: "The settlement involving Wal-Mart's claims administration unit and Concentra Health Services Inc. in Colorado also is troubling since it is believed to be the first payout resulting from recent suits alleging that employers' and workers comp service providers' claims management practices violated the Racketeer Influenced and Corrupt Organizations Act, several observers say."

This is quite the hot potato and of concern to TPAs, several of whom declined comment on the case. As Ceniceros reports, "The issue is sensitive because the lawsuit raises the question of how far claims administrators can pursue management of questionable medical treatments found through common practices, such as utilization reviews, without violating the law, the source said."

(Here's a summary of the case when the class action was certified in 2010.

How to keep injured workers from turning to lawyers - In the current issue of CFO, Richard Victor writes about a recent Workers Compensation Research Institute (WCRI) study that sheds light on why injured workers feel the need to hire an attorney: How to Keep Unneeded Lawyers Out of Workers' Comp . It's a good article and worth the read - here's a snippet:

"Not surprisingly, the study found that workers are more likely to seek attorneys when they feel threatened. Sources of perceived threats can take different forms. The character of the employment relationship, for example, was a factor for the 23% who strongly agreed that they hired attorneys because they feared being fired or laid off. Fifteen percent also strongly agreed that they needed attorneys because their employer could perceive their claims as illegitimate.
Miscommunication in the claims process was another significant factor. In fact, 46% said they hired attorneys because they felt the claim had been denied when, in fact, it had not yet been accepted into the process. Attorney involvement among workers with the most severe injuries were 15 percentage points higher than those with mostly minor injuries."

Related: We refer you to one of our favorite articles on the topic by plaintiff attorney Alan S. Pierce: Top Ten List as to Why Injured Workers Retain Attorneys

More Charges; Big Branch Probe Widens - Ken Ward reports that today, federal prosecutors have charged a longtime Massey Energy mine manager with being part of a decade-long conspiracy to defy safety laws and dupe government inspectors. Expect more to come:

But in new court documents, Goodwin and Assistant U.S. Attorney Steve Ruby allege a broader conspiracy by as-yet unnamed "directors, officers, and agents" of Massey operating companies to put coal production ahead of worker safety and health at "other coal mines owned by Massey."
It is the first time in their probe of the Upper Big Branch Mine Disaster that prosecutors have filed charges alleging Massey officials engaged in a scheme that went beyond the Raleigh County mine where 29 workers died in an April 2010 explosion.

Follow the ongoing story and find links to other coverage at Ward's Coal Tattoo blog.

Pharma Costs - Joe Paduda links to and comments on a recent Express Scripts drug trends report. The long and short of it? Pharmacy price increases are driven by brands.

Fighting Fraud - Southern California has 65 billboards warning about work comp fraud. To raise public awareness or criminal penalties associated with fraud, the boards will be placed on billboards and transit shelter posters placed across San Diego County.

Strange Risks - Can you insure against acne attacks or hair loss? Lori Widmer has an entertaining read in this month's Risk Management Magazine: The Stranger Side of Risk.

Other noteworthy items

| Permalink | No Comments

November 15, 2012


It's Cavalcade of Risk week, and you can see the latest roundup by Louise Norris in her Risky Business post at Colorado Health Insurance Insider. Louise always does a thoughtful write-up on submissions, and she has some stunning photos to boot. Check it out!

| Permalink | No Comments

November 12, 2012


Joe Paduda has posted a robust Elections Have Consequences issue of Health Wonk Review at Managed Care Matters. In this post-election issue, many of the blogosphere's best health policy wonks opine about what this means for health reform, discuss some of the health policy issues that are likely to surface over the next four years - and even offer some thoughts about implications for workers' comp. Plus, there's an assorted grab bag of other issues - good reading to start your Monday off. While there, check out some of the other recent posts - there's always thoughtful reading at Joe's blog. If it isn't on your must-read blog shortlist, it should be.

| Permalink | No Comments

November 9, 2012


Obama's election & employment law, insurance, worker safety - Stephanie Thomas of The Proactive Employer posts about Obama's Next Four Years: What It Means for HR and Employment Law. Daniel Schwartz of Connecticut Employment Law Blog weighs in with Four Potential Employment Law Impacts of Obama's Next Four Years. Paul Secunda of Workplace Prof Blog posts about the 2012 Election and the fate of state labor law Initiatives, and John Hyman of Ohio Employer's Law Blog says that it just doesn't matter: "You should still follow the golden rule. You should still treat employees with dignity and respect. You should still pay employees for all the hours they work. You should still avoid discrimination, and harassment, and retaliation." At Property Casualty 360, Arthur Postal weighs in on The Election's Impact on Insurance Issues, and from the public policy and worker safety perspective, Celeste Monforton of The Pump Handle offers a worker safety wishlist for Obama's second term.

Medical privacy - Roberto Ceniceros of Business Insurance reports on a Georgia Supreme Court ruling that gives employer access to health information from an injured worker's treating physician. "The case of Arby's Restaurant Group Inc. et al. v. McRae overturns an appeals court's 2011 ruling that held an employees is not required to authorize such communications in order to receive workers comp benefits." Dave DePaolo discusses this case in his post Privacy and Elections - Cultural Expectations

Texas pill mills - Dozens of health licenses surrendered in pill mill raids - The U.S. Drug Enforcement Administration and 14 local and state agencies have conducted and eight-month probe of pill mills in Texas, which they called Operation King of the Pill. "The raids have already forced three doctors, five pharmacies, four physician assistants and 13 advanced nurse practitioners to surrender their federal licenses for dispensing controlled substances."

Comorbidities - Study finds that heart issues hit employers' bottom lines - "Robert Page, an associate professor with the University of Colorado Denver School of Medicine, found that lost productivity costs from acute coronary syndrome range from about $7,943 for short-term disability claims to about $52,473 for long-term ones. / The report argued that heart problems should be considered a chronic health condition alongside diseases like diabetes and high blood pressure."

New York scaffolding sweep - According to Occupational Heath & Safety, "Top officials of two New York City departments recently announced their personnel had made 30 arrests while confiscating fraudulent scaffold certification and U.S. Occupational Safety and Health Administration safety cards at construction sites in four boroughs. Rose Gill Hearn, commissioner of the New York City Department of Investigation, and Buildings DOB Commissioner Robert D. LiMandri said Oct. 25 that the two-week sweep confiscated more than 70 cards. These are required to work on scaffolding and for workers at major buildings in the city." Scaffolding is an ongoing public and worker safety issue in New York. (See: NY scaffolding: one miracle survivor saved by physics; others not so lucky)

Noteworthy news

| Permalink | No Comments

November 1, 2012


Excess Returns hosts this week's Cavalcade of Risk - #169 - check it out!

| Permalink | No Comments

October 29, 2012


Maggie Mahar posts The Pre-Election Edition of Health Wonk Review: Fact vs. Fiction at her blog, Health Beat. In this weighty issue, she offers her in depth-analysis and opinions of the issues that were raised in submissions she received.

Prepping for Sandy
Batten down the hatches - authorities say that Hurricane Sandy could affect 50 million people on the East Coast. Keep up with Advisories on Hurricane Sandy from the National Hurricane Center. It's getting a little late, but here are some hurricane-related tips to prepare your workplace and protect your technology. And from the National Association of Insurance Commissioners, a Disaster Planning for Small Businesses

State Offices of Emergency Management :

Yes, we are on to this week's disaster, but if you are curious about last week's news, see Claire Wilkinson's overview of the Maine earthquake that rattled New England.

News Briefs
If you're home bound waiting out the hurricane, or even if you're not, here are some links to catch up on your work comp reading:

| Permalink | No Comments

October 22, 2012


We're a bit on the tardy side in getting up a link to Cavalcade of Risk #168 - Jacob or My Personal Finance Journey hosted this edition. Check it out!

| Permalink | No Comments

October 11, 2012


Health Wonkery - David Williams hosts the October Surprise Edition of Health Wonk Review at Health Business Blog - and as might be expected in a pre-election climate, it's a good one - with many submitters weighing in on the debates or other campaign related issues.

State premium rankings - The Oregon Department of Consumer & Business Services announces the availability of the 2012 Oregon Workers' Compensation Premium Rate Ranking Summary (PDF). National premium rate indices range from a low of $1.01 in North Dakota to a high of $3.01 in Alaska. The 2012 median value is $1.88, which is a drop of 8 percent from the $2.04 median in the 2010 study. The authors of the study - Jay Dotter and Mike Manley - say: "One notable trend nationally is that the distribution of state index rates in our study continues to compress--there is less variation between the highest and lowest states, and there are 20 states within plus or minus 10 percent of the study median. This makes the rank values more volatile from one study to the next. I would recommend that states look also to their "Percent of study median" figure for comparisons over time."
See Background information and historical state rankings since 1995. See also: Dave DePaolo on the Oregon study.

Paduda Earns IAIABC Award - At their recent 98th Annual Convention, the International Association of Industrial Accident Boards and Commissions (IAIABC) recognized Joe Paduda, Principal of Health Strategy Associates with the IAIABC Presidents Award for his efforts in raising awareness about opioid abuse in workers' compensation. IAIABC noted that, "Through his weblog, during speeches, and in the course of his ongoing work with workers' compensation stakeholders, Mr. Paduda has urged discussion and action on the growing use of opioids in the treatment of work injury. " Kudos to Joe, who has clearly been a leader on this issue - as well as a driving force in raising awareness about the pricing abuses associated with physician dispensing and drug repackaging. See: IAIABC Award Recipients Uphold a Tradition of Excellence and Dedication.
Kudos also to seven other individuals who were recognized for their contributions and leadership. These include: Glenn Shor, California Division of Workers' Compensation; Dr. Kathryn Mueller, Colorado Division of Workers' Compensation; Ken Eichler of Reed Group; Christine Siekierski of the Wisconsin Compensation Rating Bureau; Gregg Lutz of NCCI; Terry Bogyo of WorkSafeBC; and Mike Manley of the Oregon Department of Consumer and Business Services.
Related: Joe Paduda has good things to say about IAIABC: Mutual Admiration Society.

Breast Cancer Screenings - October is National Breast Cancer Awareness Month - a good time to remind employees about screenings. The CDC's National Breast and Cervical Cancer Early Detection Program make breast and cervical cancer screenings and diagnostic services available to low-income, uninsured, and underinsured women across the United States. Search for free and low-cost screenings in your state. The American Cancer Society offers good resources on dealing with a coworker who has cancer, including helpful tips for supervisors.

Nursing Homes - The Washington State Department of Labor & Industries has introduced a page of resources addressing Nursing and Residential Care Facilities. 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, OSHA has introduced a National Emphasis Program, and Washington's resources gather some helpful tools. See Washington's A-Z list of Safety & Health Topics.

Risky Business - Risk Scenarios are an interesting and noteworthy ongoing interactive feature by editors of Risk and Insurance. A Risk Scenario consists of two parts -- The Scenario, a hypothetical situations that showcases an emerging risk, and The Analysis, which offers a summary of themes, as well as access to relevant articles and resources. They are interactive features that allow readers to decide how they would handle a situation and learn how peers and other industry experts would handle the situation. They cover a range of risks from data breaches and gas explosions to MRSA exposure and complex claims. Browse an archive of Risk Scenarios.

Other items of note from around the web

| Permalink | No Comments

October 3, 2012


Risk roundup - Our Down-Under friend Russell Hutchinson of Chatswood moneyblog posts this week's Cavalcade of Risk, with a global roundup of posts. Check it out.

Costs for Employees - Insurance Journal reports on the latest Bureau of Labor Statistics report on the cost of U.S. employees, noting that the nationwide average cost for private industry employers was $28.80 per hour worked in June 2012. "The costs ranged within each region, with total compensation costs of $24.44 in the East South Central division to $33.47 in New England." The article offers more detail on the report, noting that costs were collected from a sample of 47,400 occupations from about 9,500 establishments in private industry. Data excludes self-employed and farm and private household workers.

Physician Dispensing - Joe Paduda looks at potential conflict of interest issues in a post about ABRY Partners, he asks, "How is it that an investment firm owns stakes in a TPA, MSA company, subrogation firm - and a physician dispensing and billing company?" Is one company cleaning up a mess that another company makes? In other repackaging news, he notes that Miami-Dade Schools has taken a stand on physician-dispensed repackaged drugs - they are refusing to pay the markups, a move that saved more than half a million dollars. Employers take note: Is this a potential area of savings in your comp program.

Narcotics Studies - Rita M. Ayers reports on a recent study by Accident Fund Holdings and Johns Hopkins University that links opioid use to an escalation in overall claim cost in the Tower MSA Blog. She notes that the study reveals that 55% to 85% of injured workers receive narcotics for chronic pain. She says that the study, "...examined the interrelationship between the utilization of short- and long-acting opioid medications and the likelihood of claim cost escalating to a catastrophic level (> $100,000). Analyzing 12,000 workers' compensation claims in Michigan during a four-year period, the study focused on whether the presence of opioids alone accounted for the cost increase or whether costs increased because opioids were associated with known cost-drivers, such as legal involvement and injury severity." Related: WCRI: Nearly 1 in 12 Injured Workers Who Started Narcotics Still Using 3-6 Months Later.

Worst States for Lawsuits - "Lawsuit Climate 2012″ is a study evaluating how fair and reasonable states' tort liability systems are perceived by businesses in the U.S. It was conducted by the U.S. Chamber Institute for Legal Reform. According to those surveyed, Delaware has the best legal climate for businesses.See respondents' picks for the Top 10 Worst States for Lawsuits, along with more on the study's results.

High Costs for Police Dept. - The LA Daily News reports that Los Angeles spends more on LAPD workers' comp claims than for all others combined - some $65 million in 2010-2011 alone. The department averages 250 claims a month. Authorities say that it is " of four drivers of the city budget deficit. Others include the costs of salaries, pensions and health care."

News Briefs

Addendum As a follow-on to yesterday's post about Shackleton's Medical Kit, we found more information and a photo of Shackleton's medical kit at The Science Museum of London, and a related post from NPR's Health Blog: 'Cocaine For Snowblindness': What Polar Explorers Packed For First Aid.


| Permalink | No Comments

September 27, 2012


Being Washington DC denizens, Jennifer Salopek and the folks over at Wing of Zock have had a hard time focusing on anything besides the playoff, but they've taken their eyes off the ball long enough to compile a stellar Health Wonk Review: Nationals Playoff Edition! - check out the biweekly best of the health policy blogosphere.

Work Fatalities - Preliminary results from the Bureau of Labor Statistics show that workplace fatalities declined in 2011. The number of workers who died from on-the-job injuries was 4,609 in 2011, down from a final count of 4,690 in 2010. Good news, but that is still 13 workers too many, on average, who die at work every day. Liz Borkowski looks at what the report does and doesn't tell us.

Flu vaccines & workers comp - Jon Gelman has a good post on Compensating Adverse Flu Vaccine Reaction Victims. He notes, "In many jurisdictions, vaccinations afforded to employees resulting in a benefit to the employer against possible disastrous business consequences, have been considered to be "a mutual benefit." Therefore, any disease arising from such vaccination has been deemed compensable."

Global warming & productivity - Will climate change affect worker productivity? According to recent research, 2% per degree Celsius is the magic number for how worker productivity responds to warm/hot temperatures. In addition to citing specific research on the topic, the poster cites a recent real-life scenario: After the Fukushima earthquake and tsunami knocked out a big chunk of the country's nuclear power, the Japanese government mandated reduced energy consumption, and found that when you lowered the AC, it had an effect on output: "every degree rise in temperature above 25 Celsius (77 degrees Fahrenheit) resulted in a 2 percent drop in productivity."

Litigation - Insurance journalist/blogger Anne Marie Lipold has a good pair of posts on how good communication practices when a worker is inured can minimize the friction that all too often leads to preventable litigation. See Why Injured Workers Hire Attorneys (and What Employers Can Do About It) , part 1 and part 2. In the same vein, we refer you to one of the best pieces we've seen on this topic - written by someone who ought to know, plaintiff attorney Alan S. Pierce: Top Ten List as to Why Injured Workers Retain Attorneys.

Kudos - Congratulations to Bob Wilson and crew -- today marks year 13 for A landmark worth celebration - Bob was quite the visionary to be out there on the web and very smart to have purchased such a great web address! His site has always been in the forefront of what's happening in the work comp arena - it's an online staple. In his post, he waxes nostalgic about some of the developmental highlights over the highlights. Good on you, Bob - thanks for being a steady resource!

More news of note

| Permalink | No Comments

September 19, 2012


The man of the hour - Kudos to Gary Annenberg, whose guest post on Predictive Modeling we featured earlier this week. We were pleased to learn that he was also just named as a 2012 Risk Innovator in Safety and Prevention. The awards are presented annually by Risk & Insurance - see a list of all 2012 Risk Innovators. But that's not the only news item we noticed about Gary - he is also scheduled as a speaker for the 2012 Business Insurance Workers Compensation Virtual Conference on Oct 25. There's no charge to attend, and Gary is one of an impressive lineup.

Cavalcade of Risk - Jeff Rosen makes his hosting debut with the biweekly roundup of risk-related posts at his Life Insurance blog - check it out: Cavalcade of Risk #166.

Recommended reading - Check out Sandy's Corner over at Meddata. It's a forum where Sandy Blunt occasionally opines, most recently on Medical Treatment Guidelines. Among the many hats Sandy wears, he provides consulting services to Medata as a technical subject matter expert in workers' compensation.

Emergency Responders - This month, NIOSH Science Blog focuses on safety and health risks related to emergency workers. The post includes links to a new technical assistance document, Emergency Responder Health Monitoring and Surveillance. It includes specific recommendations and tools for all phases of a response, including the pre-deployment, deployment, and post-deployment phase. The intent is to identify exposures and/or signs and symptoms early in the course of an emergency response.

Mining fatalities higher than last year - At Coal Tattoo, journalist Ken Ward reports on the death of a West Virginia miner last week at a Consol Energy operation in Monongalia County. The week also saw the death of a miner at a Drummond Mining Co. operation in Alabama. Ken notes that the WV death was the state's fifth coal-mining fatality in 2012. To date, mining fatalities through mid-September 2012 are higher (15) than at the same point last year (13).

Fraud - A new report from Deloitte Consulting says that fraud is exploding, with the rate of questionable claims increasing by 19 percent from 2009 to 2011. The report says that workers comp is one of the largest fraud areas. And in a related matter, here are the Top 10 Most Sensational Fraud Stories of the First Half of 2012

$576 billion price tag - That's the annual cost to employers for unhealthy workers, according to the Integrated Benefits Institute. This includes absences ranging from sick days to time lost to workers' compensation claims. IBI researchers attribute 39 percent (or $227 billion) to lost productivity associated with poor health.

News Briefs

| Permalink | No Comments

September 13, 2012


Check out a fun and smart Health Wonk Review - "Football Is Here" Edition posted by Louise Norris at Colorado Health Insurance Insider.

We don't want to step on her toes here, just go read the whole edition, which is a pretty full one -- Louise always does a very thoughtful job in framing each entry -- but we would echo her recommendation to be sure to visit the post from Amy Berman - the first one in this edition. It's so very worth reading and thinking about. Thank you Amy, and best to you!

| Permalink | No Comments

September 5, 2012


Hot off the press: Jason Shafrin hosts this week's Cavalcade of Risk #165: Vegas-Style NFL Kickoff Edition at his Healthcare Economist blog - get the best bi-weekly risk roundup in the blogosphere, replete with Vegas style odds!

| Permalink | No Comments

August 22, 2012


Emily Holbrook does a stellar job hosting Cavalcade of Risk #164 at Risk Management Monitor. A sampling of recent posts on varied topics may tell you why Risk Management Monitor is on our regular reading list and one of our favorite blogs: The Formal Demands of a Somali Pirate, The 3 Most Curious Claims, and Insurance Claims from Colorado Wildfires at $450 Million and Growing.

Industry pulse - At propertycasualty360, Stephen Klingel offers an explanation of conflicting signals in the latest NCCI Workers Comp State of the Line report. He discusses why the market remains "worrisome" despite a number of positive developments. On the plus side, we see that claims frequency is down and written premium is up, but the industry's reserves are deteriorating and the residual market is growing - indicators that bear watching. He cites claim frequency, the underwriting cycle. uncertainties related to healthcare and financial services reforms, and efforts to expand alternatives to Workers' Comp as additional areas of concern that NCCI is monitoring.

Paid sick leave & workers comp study - A recent NIOSH-related study revealed that workers with paid sick leave were 28% less likely to report an occupational injury that needed medical care than workers without paid sick leave. Also, workers in high risk jobs appeared to benefit more. The survey encompassed 38,000 workers and was based on data collected by the National Health Interview Surveys from 2005 through 2008. While survey authors caution that the survey does not establish a a cause-and-effect relationship between paid sick leave and the incidence of workplace injuries, it does raise the issue that workers who do not have paid sick leave may feel economically pressured to work while sick, exposing them to greater likelihood of injury.

Right to safe workplaces - Kevin Jones raises the question of whether safe work is a basic or fundamental human right on the Australian SafetyAtWorkBlog. He raises this question both specifically for Australia, but also from a global perspective.

Healthcare & politics - Wondering about the healthcare implications of Romney's vice presidential pick? Joe Paduda is on the case: At Managed Care Matters, he posts about Paul Ryan's evolving stance on deficits and Medicare spending.

Healthcare workers and mass trauma - Dr. Camilla Sasson was on duty in the Emergency Department of the University of Colorado Hospital on the night of the Aurora shootings. She talks about her experiences that night on the RWJF Human Capital Blog, offering insight into the extreme stress that healthcare workers face during and after a mass casualty event - as well as how patients help the doctors heal.

Other news of note

| Permalink | No Comments

August 16, 2012


Dr. Jaan Sidorov has posted A Brainy Health Wonk Review on Health Reform, the Affordable Care Act and Lots More! at Disease Management Care Blog. Health Wonk Review is on an abbreviated summer schedule but the wonkers still have a lot to share and Jaan does a great job dishing it up - check it out.

Additions to our blogroll
From time to time, we update our blogroll with new blog finds - and we also clear out some of the less active blogs. It's exciting to see such a thriving workers comp and insurance community online - back in 2003, when we started, it was a pretty lonely place! Check them all out under "Business Weblogs" in our right hand sidebar. We also have a variety of other useful tools if you haven't checked them out yet!

| Permalink | No Comments

August 8, 2012


We're delighted to be hosting the 163rd edition of Cavalcade of Risk, which coincides with the Olympic games - a fascinating case study in various aspects of risk. There are so many risk-related angles to this massive event, but none more compelling than the stories of individual athletes - see Oscar Pistorius and 'the Dignity of Risk' for one example.


South Africa's Oscar Pistorius competes in the 400-meter semifinals heat, Sunday, August 5, 2012. (AP Photo/Matt Slocum)

Being insurance geeks, we can't resist pointing to a few items related to risk management. For an overview of the challenges facing the biggest event in the world, see Will Jennings' paper, London 2012: Olympic Risk, Risk Management, and Olymponomics. Despite the scale, some insurance professionals see this as an event much like any other. See Mark Ruquet's story, Insuring the Olympics: Unique Locations, Number of Stakeholders Among Risks Industry Takes On

Continuing on the international theme
Global risks were on the mind of some of our Cavalcade contributors, too. Continuing on in the international theme, first up in this week's edition is a post by Henry Stern of InsureBlog who reports that international commerce just got potentially riskier for insurers. He posts about congressional efforts to loosen up underwriting rules for insurers of folks doing business with Iran.

Russell Hutchinson at Chatswood Consulting -- one of our international contributors based in New Zealand -- reviews a medical insurers report on medical tourism and finds some big holes in the expected demand and looks at the reasons for them. One of the big reasons? "The cheaper the procedure the further you will have to fly to have it, and the higher the perception of risk around that trip."

The risks of travel are not just a concern for medical tourists. Emily Holbrook of Risk Management Monitor posts about a recent study on the concerns of business travelers. Of those surveyed, 31% expressed concern for their personal safety, citing fears related to issues as broad ranging as terrorism and natural disasters to medical need while traveling.

And speaking of medical issues and risks related to travel, we point to our own entry, a post that focuses on travelers whose trips range a little further afield, astronauts and the medical oddities they experience in their extra-terrestial travels.

Health care: another issue theme
Medical care, healthcare, and associated risks seem to be the other great theme that is occupying a large percentage of the mindshare for many regular participants of the Cavalcade. With the Supreme Court decision on the Affordable Care Act behind us and the realities of implementation ahead, this concern is to be expected.

When it comes to risks, it doesn't get any bigger than mortality. Healthcare Economist Jason Shafrin looks at a recent study on the effect that Medicaid health insurance has on mortality.

Louise Norris of Colorado Health Insurance Insider notes that for many Colorado residents, risk goes down as the Colorado Hospital Payment Assistance Act takes effect. The new law requires hospitals to charge uninsured patients earning less than 250% of FPL no more than the lowest negotiated price the hospital has with a private health insurance carrier. Hospitals must also post their financial assistance, charity care and payment plan information so that patients will be aware of the financial options.

At Disease Management Care Blog, Dr. Jaan Sidorov reviews a published study that explores the drivers behind a recent downturn in the amount of expensive "high dollar" medical imaging and finds the sum was greater than the parts. He argues there's an important lesson here: if the U.S. is going to lower health care costs, it's going to take multiple levers: there is no single solution.

David Williams of Health Business Blog notes that while neither rain, nor sleet, nor hail will stop the postman, health care costs might be the real killer. While USPS faces many challenges in Google, Facebook and email, none are more formidable than retiree health care costs.

Special note
Kudos to Henry Stern, who was recently honored in the National Underwriter's 2012 Industry Elite Awards for his role in fostering Industry Awareness. We know him as "Hank," the founder and ongoing leadership for Cavalcade of Risk and long-term "good blog citizen" at InsureBlog. He's also a regular participant in Health Wonk Review, and an all-round nice guy.

| Permalink | No Comments

July 25, 2012


Risk Roundup - Van Mayhall hosts Cavalcade of Risk #162 on his Insurance Regulatory Law blog - check it out!

Florida - From The Palm Beach Post comes this rather unsettling account: Worst TB outbreak in 20 years kept secret: "The CDC officer had a serious warning for Florida health officials in April: A tuberculosis outbreak in Jacksonville was one of the worst his group had investigated in 20 years. Linked to 13 deaths and 99 illnesses, including six children, it would require concerted action to stop. ... "The high number of deaths in this outbreak emphasizes the need for vigilant active case finding, improved education about TB, and ongoing screening at all sites with outbreak cases," Luo's report states./ Today, three months after it was sent to Tallahassee, the CDC report still has not been widely circulated."

Mining - And yet another story about an illness that should be obsolete but is making a resurgence: In Black Lung Makes a Comeback, Underwriters Cough Nervously, Susannah Levine writes, "After years of decline, black lung disease (Coal Worker's Pneumoconiosis) -- once the occupational hazard of career-long coal miners -- is showing up in younger and younger miners, say experts.
The Journal of Toxicology reports rapidly progressive CWP -- the most swiftly fatal form of the disease -- in younger miners, who are often exposed to coal dust and more toxic silica dust over relatively short careers. The CDC has also published several studies finding severe cases of CWP in younger miners."

After the 1969 Federal Coal Mine Health and Safety Act of 1969, Black Lung was almost eradicated. The Black Lung Benefits Act of 2010 increases the employer's liability significantly so this increase represents a huge exposure.

Wellness Incentives - The American College of Occupational and Environmental Medicine, aka ACOEM, has announced the release of Guidance for a Reasonably Designed Employer-Sponsored Wellness Program Using Outcomes-based Incentives, which was published in the July issue of the Journal of Occupational and Environmental Medicine. The work was a collaborative effort with the Health Enhancement Research Organization, American Cancer Society, American Cancer Society Cancer Action Network (ACS CAN), American Diabetes Association, and the American Heart Association. The published guidance provides direction on two key questions: 1. What are the elements of a reasonably designed wellness program that incorporates outcomes-based incentives? 2. How can employers who use outcomes-based incentives be sure that their programs comply with the Health Insurance Portability Accountability Act (HIPAA) guidelines for a "reasonable alternative standard" to those who cannot meet the health standard?

More on Physician Dispensing - You might think that with some of the attention given to the topic of late, states would be clamping down on loopholes that allow egregious profits for physician dispensing. Not the case. Joe Paduda reports on WCRI's recent study of Phsyician Dispensing in Workers' Compensation says that growth is exploding. One example he cites: "In Illinois, physicians' share of all prescription costs increased from 22 to 63 percent of all prescription payments over 07/08 to 10/11. You read that right; growth tripled over three years. Even more revealing, the volume of scripts dispensed by docs grew from 26% to 43%." Apparently, the report hit a nerve because a few days later, Joe posted that WCRI - under assault by physician dispensing company - one AHCS, headquartered in Florida. Hmmm, that name seems familiar. See the NYT: Insurers Pay Big Markups as Doctors Dispense Drugs

Other Items of Note

Seasonal Safety

| Permalink | No Comments

July 19, 2012



We're happy to be hosting this summertime edition of Health Wonk Review - and hopefully, twelfth time is the charm because this marks our time #12 at bat hosting. We're wilting from the heat, but haven't found it as bad here in the Northeast as other parts of the country. The summer has been so darn hot, we're blowing through records left and right. NOAAA likens the recent extreme weather records to a baseball player on steroids. But it's hard to know what's been hotter - the weather or the political rhetoric. The sweltering weather hasn't slowed down our health policy wonks, who have a lot to say about the Supreme Court's recent health care ruling, among other topics. We're taking a slightly different approach to this edition and posting the entries in the order in which they were received. Without further ado, let's dig in.

Joe Paduda says that if Medicaid isn't your business, you may be tempted to ignore the implications of the current kerfuffle over whether or not states should accept free money to expand Medicaid, but that would be a mistake. See his post The Medicaid expansion and political choice at Managed Care Matters.

InsureBlog's Bob Vineyard explores the brave new world of the Medical Loss Ratio (MLR), and why he thinks it's destined to be both insomnia-curing and migraine-inducing in his post How Now Brown MLR?

Gary Schwitzer's Health News Watchdog blog provides a valuable service for policy wonks and consumers alike by holding journalists' feet to the fire in terms of accuracy of health care reporting on medical studies, among other things. Recently, he took a skeptical look at the exuberance with which respected media outlets leapt on research reports about the salutary effects of alcohol intake on arthritis and alcohol intake on osteoporosis.

At Wing of Zock Dr. Joanne Conroy, an anesthesiologist and Chief Health Care Officer at the Association of American Medical Colleges, shares her enthusiasm for the Supreme Court's decision to uphold the Accountable Care Act, including the individual mandate. She draws upon the experiences of friends and family to conclude, "What makes me proud is that we didn't abandon the most vulnerable of our citizens, who lack political voice and economic clout. These underinsured Americans, many on the brink of personal financial insolvency, are our neighbors, co-workers, and friends."

Keeping families healthy is good business sense for any organization. At Corporate Wellness Insights Fiona Gathright posts about the health benefits and ROI that organizations can realize by including dependents in Employee Wellness Programs.

With the increased need for primary care physicians, midlevel providers are increasingly the go to solution to fill the void. Brad Flansbaum of The Hospitalist breaks down all you need to know regarding advanced care nurses -- salaries, training, and the various niches they occupy.

In his usual pull-no-punches style, Dr. Roy Poses of Heath Care Renewal offers a detailed report of why he finds some industry insiders unreliable when it comes to health reform in his scathing post Fool Us Once, Shame on You, Fool Us Twice, Shame on Us - The Untrustworthy Pronouncements of Aetna's Former CEOs. In pointing out the flip-flopping on the issue of the individual mandate, he questions the wisdom of treating self-interested corporate health care CEOs as visionaries.

David Williams of Health Business Blog says that malpractice reform is a key tenet in the GOP's proposals to "repeal and replace," but in his post another reason that malpractice reform is overrated, he shows how it's unlikely to have any real impact: Malpractice payments have declined 8 years in a row, and new reimbursement models will reduce the appeal of "defensive medicine."

At Health Access, Anthony Wright tells us Why California Matters when it comes to the Affordable Care Act: It's not just the biggest state, or the state that has taken the lead in implementation. It also has the distinction as the exception -- the sole "blue" state in the top dozen states with the largest percentage of uninsured. As such, it can be a leader in showing how ACA can directly address the needs of states with high uninsured rates. Bonus: we point you to his Health Reform Quiz 201.

In her reporting on healthcare reform, Maggie Mahar has been focusing on the word "one" and the way that media narratives are not only shaping the public's perception but are also actually shaping events. At HealthBeat, she posts about Self-Fulfilling Media Narratives: How One Man Decided the Fate of Health Care Reform, and at blog, she looks at whether one missing word could kill the ACA.

At at Colorado Health Insurance Insider, Louie Norris notes that in the healthcare reform debates, the lion's share of attention has focused on the health insurance industry. In her post Does GSK Case Show A Need For Profit And Admin Caps In the Rest Of the Healthcare Industry?, she suggests we may want to cast the net wider, to include the pharmaceutical industry, for one.

At his eponymously named Health Policy Blog, John Goodman examines the economic ramification of the Affordable Care Act and raises the question of whether ObamaCare is causing the jobless recovery?

Harold Pollack says that we can expect that the NAACP boos for Romney may only be the beginning. He explains why he thinks the latest GOP rhetoric over the Affordable Care Act will alienate minority communities at the blog.

At New Health Dialogue blog, Justin Jones takes a cue from the new Health Dialogue-ers article on 12 Ways Health Care Could Be Improved If the House Wanted to Hold More Than Symbolic Votes to offer his own tongue-in-cheek look at 31 Things the House Could Have Done... that he thinks might have been more productive than voting to repeal the Affordable Care Act for the 31st time.

And here at Workers' Comp Insider, if you haven't already read it, we point you to a post about one of the reasons why prescription drugs are so much more costly under workers comp than under general health care: Physician drug repackaging, front and center.

Upcoming edition: We're on a slightly relaxed summer schedule so the next Health Wonk Review is scheduled for August 16. Dr. Jaan Sidorov will host at Disease Management Care Blog.

| Permalink | No Comments

July 12, 2012


It's Cavalcade of Risk week - David Williams hosts the week's compendium of risk-related posts, including rugby, robots and rebates, at Health Business Blog.

| Permalink | No Comments

June 27, 2012


Risk news from the front line - Louise from Colorado Health Insurance Insider posts the 160th Cavalcade Of Risk - Colorado Wildfire Season Edition and as per her signature style, she does a great job hosting. Our thoughts go out to her and everyone in Colorado, who are living out a real-life risk scenario this week. Over 32,000 people were evacuated from the path of the Waldo Canyon Fire near Colorado Springs and the U.S. Air Force Academy on Tuesday night, which is just boggling. There are some dramatic photos on BuzzFeed. You can also follow on Twitter #waldocanyon.

Industry pulse - Robert Hartwig is the president and chief economist of the Insurance Information Institute. His industry observations are well worth tracking so we point you to his his midyear Workers' Compensation update, where he tracks significant developments and issues both on the national and the state level. And because workers' comp is only the stubby little tail on the very large dog that is the property-casualty industry, we also recommend his Insurane Industry 2012 - First Quarter Results, of which we offer this brief excerpt:

Through the first three months of 2012, private sector employers added an additional 678,000 workers (and a total of 847,000 through May). Overall payrolls, the exposure base for workers compensation insurance, now exceeds its pre-crisis peak. During 2011, the unemployment rate ranged from a high of 9.2 percent in June to a low of 8.5 percent at year's end. By March 2012, the unemployment had dropped still further to 8.2 percent.
Despite extreme economic pessimism through much of the past two years, including the past several months of 2012, the economy appears to have successfully avoided a much feared and often discussed "double-dip" recession. Although real GDP growth came in at a disappointing 1.9 during the first quarter, economic growth is projected to reach 2.1 percent for full-year 2012 and 2.4 percent in 2013, according to Blue Chip Economic Indicators.

Extreme heat - FEMA / has issued before and during tip sheets on extreme heat in anticipation of the record-breaking temps that are expected to grip much of the country. The National Weather Service Warnings is a handy page to bookmark. The CDC offers Warning Signs and Symptoms of Heat-Related Illness, or see Medline for heat-illness information in multiple languages.

OSHA Training & Temp Workers - In HR Hero, John Hall tackles the issue of OSHA training and temporary workers. Where does the responsibility lie, with the temp agency or the client employer? He notes that OSHA often finds that permanent employees are properly trained as required by a particular standard but their temporary counterparts aren't, which then results in citations and significant penalties. He discusses some of the areas of responsibility that lie with the client employer vs the temp agency. It's an issue worth your attention. Consider the $700,000+ fine for lack of training that OSHA just imposed related to the on-the-job death of a contract worker at Tribe Mediterranean Foods, a Taunton MA subsidiary of Nestle SA. "OSHA's investigation found that Tribe Mediterranean Foods had not trained the deceased worker and six other workers who cleaned plant machinery on hazardous energy control or "lockout/tagout" procedures." OSHA also issued several willful violations, defined as, "... one committed with intentional knowing or voluntary disregard for the law's requirements, or with plain indifference to worker safety and health."

PTSD - Today is PTSD Awareness Day and the National Institute of Mental health is an excellent resource. Also see that National Center for PTSD, which offers resources for veterans, their family members, and others who have gone through trauma and suffer from PTSD.

Noteworthy news briefs

| Permalink | No Comments

June 22, 2012


Joe Paduda waited until the very last minute this week to see if we would get a decision before releasing this week's Health Wonk Review, but looks like we will all be held in suspense for a few more days!

But never fear, our healthcare policy pundits still have a lot to say and Joe does a find job presenting it. Go visit his Health Wonk Review isn't waiting for the Supremes... - and he'll probably have an addendum next week when word comes down from on high!

| Permalink | No Comments

June 13, 2012


Risk Roundup - Cavalcade of Risk #159 - Early Edition is posted at My Wealth Builder. We'd like to highlight Jason Shafrin's post as particularly noteworthy for our readers: Healthcare Costs to Rise by over 7 percent in 2013.

Creeping catastrophics - Our colleague Mark Walls has a good article in Business Insurance on Creeping Catastrophic Claims - How to Spot Them and Stop Them. "These claims start out like any other case, usually with a back, knee or shoulder injury. However, because of a series of events, they end up costing the employer hundreds of thousands of dollars. These developmental claims share many common characteristics that, if identified and addressed in a timely manner, can prevent significant adverse development of the claims."

Big bucks fraud - John D'Alusio unpacks the AIG debacle and explains how it hurts us all in his post Gaming the Workers Comp System at

Ergonomics of obesity - What does obesity look like to a workplace ergonomist? "Increased obesity in the workplace means more arthritis, larger waist circumferences, additional work limitations, compromised grip strength, decreased lower limb mobility and medical risks. Obese employees might be more vulnerable to falls and their manual material handling ability may be compromised. Obesity also can impact self-esteem, motivation, absenteeism, presenteeism, premature mortality and more." More at Ergonomic Strategies for Managing Obesity in the Workplace

Case Law - The Tennessee Supreme Court found for an employer in a statute of limitations case involving PTSD. The employer argued that the statute of limitations clock began ticking when the event that caused the trauma occurred (viewing the bodies of two co-workers killed on the job), but the court found that the statute of limitations does not begin to run until an employee discovers the injury and, in this case, the employee did not know he had PTSD until some time after the workplace deaths occurred.

DOL Transparency - In 2011, the Department of Labor proposed a rule strengthening safety provisions for children under age 15 who work on farms. The rule had a parental exemption so that kids could still work on family farms. Apparently, industry pressure led DOL to withdraw the rule. DOL also removed the proposed rule from its website and Celeste Monforton posts that Government transparency groups are asking the Labor Dept to restore info scrubbed from website.

Texting while driving - Steve Yahn of Risk & Insurance looks at how Companies Fight Against Texting and Driving. He notes, "Gavejian and other experts who work with companies to develop cell phone and texting policies said that businesses need to first assess how technology is used in their workplace on a daily basis."

Food processing hazard - A new report describes two cases of poultry workers who developed chronically swollen knuckles, the hallmark sign of a rare skin condition known as pachydermodactyly: Hand deformities turn up in poultry workers, report finds.

Other noteworthy news

| Permalink | No Comments

June 8, 2012


Maggie Mahar has posted the Voices from the Blogosphere edition of Health Wonk Review at blog. It's a robust edition with talk about individual rights, the upcoming SCOTUS decision, the proposed ban on sugary drinks, and more. Maggie is one of the healthcare bloggers that we follow regularly. She's an author and a financial journalist who has written extensively about the U.S. health care system over her career. Stop by to check out her curated compilation of healthcare policy posts.

Other noteworthy news & views
This is an urgent message if you are using business network LinkedIn: LinkedIn Users: Change Password Now

| Permalink | No Comments

June 4, 2012


Risk roundup - Nina Kallen posts the latest Cavalcade of Risk at Insurance Coverage Law in Massachusetts - check it out.

Mining - Joe Paduda talks about the growth of the mining industry, noting that it is up almost 60% over the last ten years, with an increase of 12% since the beginning of 2011 - a growth rate that looks like it will surpass the BLS ten-year projection of 24%. Joe notes that regulators, work comp executives and providers should be on alert since this growth will have a dramatic impact on selected states, citing North Dakota as one example.

Disparity in healthcare costs - Dave DePaolo has an interesting post on the wide disparity in cost for cash paying patients vs insurance. He points to a recent LA Times article that cited numerous real world examples (routine blood work was charged $782 by the hospital, $415 by the insurer, and $95 if paid in cash.) DePaolo asks: "What would fee schedules look like if those in charge of these pricing decisions shared with payers and regulators all of the data that identified each friction point in insurance based reimbursement schedules versus getting paid cash?"

Florida drug repackaging - Do the people who write the biggest checks to politicians determine the cost of workers comp in Florida? That's a question many keep raising, and it appears so. In the article drug-bill battle is lucrative for lobbyists, legislators, Aaron Deslatte of The Orlando Sentinel talks about how Broward County's Automated Health Care Solutions has invested nearly $6 million into lobbying to protect the practice of drug repackaging by physicians. Why should this issue be of concern to Florida employers and insurers? Joe Paduda offers a primer on repackaged drugs and the effect on work comp costs.

E&O and workers comp - Workers' compensation is the leading cause of agent in E&O claims, accounting for approximately 10% of all claims annually, according to Curt Pearsall. He notes the majority of claims involve the following issues: Questions involving coverage for sole proprietors, partnerships or single-member LLCs; Dealing with a broker to place coverage for that "tough" risk; Dealing with the state workers' comp market to place coverage; Ensuring employees in all states are covered; Placing clients in a trust/alternative program; and U.S. Longshoreman and Harbor coverage.

On reforming SIGS - At LexisNexis Workers' Compensation Law, John Stahl offers a summary and some of the salient points of the International Association of Industrial Accident Boards and Commissions' (IAIABC) recent report on self-insurance groups (SIGs): Regulatory Challenges Regarding Self-Insured Groups: Failures Prompt New Regulation. He notes that employers liked the low cost of joining an SIG but did not realize the potential liabilities associated with that choice, and that many employers made the false assumption that they were protected by state regulation. The full IAIABC report is available for $45: Self-Insured Groups for Workers' Compensation: Effective Regulatory Strategies.

CA protects hair care workers - Jon Gelman posts about a groundbreaking settlement in California that protects hair care salon workers. The settlement was between California's Attorney General and manufacturers of Brazilian Blowout hair smoothing products that contain a cancer-causing chemical. In addition to paying fees and penalties and implementing safeguards for workers, hair care facilities must warn the public about the cancer-causing potential of the chemicals used in the procedure and must cease deceptive advertising.

Poultry workers push back - Citing concerns over worker and public health, poultry workers, safety advocates, and groups ranging from the Southern Poverty Law Center and the National Council of LaRaza, to the American Public Health Association and Nebraska Appleseed all united in opposition to USDA's proposed 'modernization" plan that would shift work from inspectors to workers. At The Pump Handle, Celeste Monforton talks about this issue: Public health officials urge USDA to withdraw plan to 'modernize' poultry inspection, worker and food safety will suffer.

A Request for Help Bob Wilson calls all UR hands on deck for participation in Health Strategy Associates' survey. Learn more here: Your Opinion Needed on Critical Utilization Management Survey.

Migration from Mexico - Peter Rousmaniere posts about a recent Pew Hispanic Center Report on Mexican migration, which states that, "The largest wave of immigration in history from a single country to the United States has come to a standstill. After four decades that brought 12 million current immigrants--more than half of whom came illegally--the net migration flow from Mexico to the United States has stopped--and may have reversed."
Some of the factors cited as contributing to this change include the weakened U.S. job and housing construction markets, heightened border enforcement, a rise in deportations, the growing dangers associated with illegal border crossings, the long-term decline in Mexico's birth rates and changing economic conditions in Mexico.

it would be funny if it weren't so true - Cartoonist Jen Sorenson issues An Open Letter To The Supreme Court About Health Insurance.

Death on the Job The Weekly Toll.

More noteworthy news


| Permalink | No Comments

May 24, 2012


Dr. Jaan Sidorov has posted Health Wonk Review, Come Back, We'll Leave The Light On For You Edition at Disease Management Care Blog. It's a substantive and far-ranging edition which encompasses a broad range of commentary on key healthcare policy issues. Jaan serves as a great guide through this week's many posts. Workers' comp is only a very small sliver of the overall health care marketplace. Because it's a case of the dog wagging the tail rather than the reverse, it's important to keep a finger on the pulse. The biweekly digest from HWR is a good way to do that.

| Permalink | No Comments

May 3, 2012


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

| Permalink

April 26, 2012


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

| Permalink | No Comments

April 18, 2012


Jaan Sidorov has an excellent edition of Cavalcade of Risk #155 posted at his Disease Management Care Blog. Jaan describes the Cavalcade well - "think of it as a linked collection of the latest observations from a variety of blog authors on the broad topics of insurance and business risk." Check it out!

| Permalink | No Comments

April 12, 2012


Brad Wright of Wright on Health tees up all the health wonkery this week as he hosts Health Wonk Review: A Masterful Edition.

Texas - Texas does things differently and their work comp program is true to course. Employers are not mandated to have workers comp insurance - they can opt out. According to a 2010 survey, 15% of businesses with 500+ employees choose to opt out. And now Walmart is opting out of work comp in Texas. See more on this at PropertyCasualyt360, including a graph of market share for the top 10 insurers comparing 2010 to 2011: Concerns Arise over Texas Workers' Comp. State System After Walmart Drops Out

Mississippi reform - Mississippi is working on workers comp reform and we note that one provision about "medical proof" establishes a pretty high bar to hurdle for some injuries; for example, a back injury: "It also would require a worker to provide the employer with medical proof that an injury or illness is a direct result of the job if the worker's claim is contested."

Dirty Business - Is workers' comp dirty? Some people seem to think so and Dave DePaolo considers whether there's more to the frequent use of the term than coincidence. See Work Comp and Dirt - Do They Have to be Synonymous?

Florida drug wars - Tampa Bay Times says that drugstores are the new focus of painkiller investigations. From the article: "The U.S. Drug Enforcement Administration says that in 2009 no Walgreens retail pharmacies were listed among the DEA's top 100 Florida purchasers of oxycodone -- a key ingredient in OxyContin, Percocet and Percodan. / By 2011, 38 Walgreens made the list. By February, the total reached 53 of the top 100. So says a warrant filed last week in U.S. District Court for the Middle District of Florida. / In Fort Myers, the DEA says one Walgreens pharmacy sold more than 2.1 million oxycodone pills in 2011. That's more than 22 times the oxycodone sales at the same pharmacy two years earlier."

Healthcare's 1% - Who are the chronically costly? The costliest 1% of patients consume one-fifth of all health care spending in the U.S., according to federal data. Doug Trapp of amednews digs into the data to profile the most costly patients and where so much of the medical spend goes.

From the courts - Fred Hosier of SafetyNewsAlert has an interesting post about whether workers comp will be on the hook for prescribed drug's side effects. He cites a case related to a West Palm Beach police officer who has filed for additional workers' comp benefits for the treatment of his gynecomastia, an excess growth of breast tissue, a side effect of medication he was prescribed to treat a work-related injury. Initially denied, an appeals court has reopened his claim for review by an expert medical advisor.

Occupational Medicine - It's been a bit since we visited the American College of Occupational and Environmental Medicine (ACOEM) site. ACOEM offers up a few new guides, and a revision of an older guide - Fatigue Risk Management in the Workplace (PDF), Guidance to Prevent Occupational Noise-Induced Hearing Loss and Guidance for the Chronic Use of Opioids.

Affordable Care Act - At Health Care Policy and Marketplace Review, Bob Laszewski looks at what individual health insurance might cost if the court strikes the mandate down and still requires insurers to cover everyone. Hint: a lot.


| Permalink | No Comments

April 4, 2012


Ken Faulkenberry of AAAMP Blog hosts the latest risk-related roundup: Cavalcade of Risk #154 - Healthcare Mandate Edition. Check it out!

| Permalink | No Comments

March 30, 2012


March 21, 2012


Healthcare Economist Jason Shafrin is this week's riskmeister - he hosts Cavalcade of Risk #153, the March Madness Edition. He has filtered this to a nice trim edition of what he calls the "elite 8." We're pleased that he thought our post made the grade!

| Permalink

March 15, 2012


Guinness is good for you - That's the news from Tinker Ready, who is hosting the Health Wonk Review: Wearing the Green for the St. Patrick's Day Edition at her blog Boston Health News. We think it's pretty fitting to have a Boston blog hosting this particular edition!

From the bizarre file - Thomas A. Robinson ofRisk Management Magazine offers a list of the 10 most bizarre workers compensation cases during 2011. Robinson rightly notes that, "Despite their unusual nature, however, one must always be respectful of the fact that while a case might be bizarre in an academic sense, it was intensely real, affecting real lives and real families." So true. We hope he'll follow with a collection of the 10 most bizarre employer acts - we've seen a few in our day.

OSHA whistleblowers - Just a reminder: Don't fire someone for reporting safety hazard. A Florida charter school is learning this lesson the hard way. OSHA is suing Manatee School for the Arts in Palmetto, Fla seeking reinstatement of the former employee with full benefits; payment of back wages, punitive damages, and compensatory damages, among other things.

New York's Reg. 194 - There's a big brouhaha in New York over N.Y. Reg. 194, with risk manager groups and agent groups coming down on opposite sides of the fence. N.Y. Reg, 194 is a broker-disclosure rule that requires agents to advise clients that they receive commissions from insurers. The ruling was proposed by the Division of Insurance in the aftermath of the Spitzer investigations against several large brokerage firms. Last week, a NY Appellate Court upheld the rule.

Exploding pig farms - We posted a link to this issue before - but the mysterious hog farm explosions continue to stump scientists. A strange, potentially explosive foam is surfacing near manure pits in about 1 ou tof every 4 hog farms, and has caused six explosions since 2009. According to the article: "This has all started in the last four or five years here. We don't have any idea where it came from or how it got started," said agricultural engineer Charles Clanton of the University of Minnesota. "Whatever has happened is new." The National Hog Farmer has more background: Foaming swine manure poses explosive risks.

Wellness focus - Of cancers affecting both men and women, colorectal cancer (cancer of the colon and rectum) is the second leading cancer killer in the United States, and the number one cancer killer in non-smokers. Why not issue a reminder to your employees: Colorectal cancer screening saves lives.

Market conditions - Roberto Ceniceros notes that captives are thriving as the work comp market hardens. Rising prices for traditional insurance vehicles always means that alternative insurance programs see growth.

| Permalink | 1 Comment

March 8, 2012


Risk Roundup - Emily Holbrook hosts Cavalcade of Risk #152 at Risk Management Monitor

Florida's pill war - Timothy Martin and Arian-Campo Flores of the Wall St Journal take in the Florida landscape after the pill mill crackdown in New Front Opens in the Florida Pill War. They note that, "One former hot spot in Broward's Oakland Park now has just two pain clinics, compared with 26 a few years ago, said Lt. Pisanti. "It changed almost overnight," he said."
However, the addicts haven't gone away. The authors note that, " ... drug users and dealers adapt to the changing landscape and pill demand shifts to retail pharmacies and other establishments that appear to have been set up to skirt the new restrictions." The article talks about the pressure pharmacists are facing and an increase in forged prescriptions.

Pill pushing docs, take note - My colleague recently posted about the prosecution of Ohio's Dr. Paul Volkman, the single most prolific prescriber of Oxycodone and related opioids in the entire country. (Four life sentences) Individual states and the feds are starting to get tough about cracking down on this stuff. Joe Paduda talks about the prosecution of drug-dealing docs in CA, FL, CO and other states. Also see Roberto Ceniceros' blog post on the race to stop opioid abuse.

"Odd Lot" Doctrine - Dave DePaolo talks about the psychology of disability and the inter-relatedness of disability and mental health as illustrated by a case of a injured Wyoming worker. After his claim wended its way through the courts, the worker was granted permanent total disability benefits under the "odd lot" doctrine.

Is obesity getting a bum rap? - Maggie Mahar challenges assumptions about obesity in her post Obesity: Fact vs. Fiction at Reforming Health blog. As with everything Maggie writes, it's worth a read!

ADA and Veterans - The Equal Employment Opportunity Commission recently released a new Guide for Employers on Veterans and the Americans with Disabilities Act (ADA). EEOC says that, "The revised guides ... make it easier for veterans with a wide range of impairments - including those that are often not well understood -- such as traumatic brain injuries (TBI) and post-traumatic stress disorder (PTSD), to get needed reasonable accommodations that will enable them to work successfully." Related:
Guide for Wounded Veterans, which answers questions disabled vets may have about the protections and rights when returning to their former job or looking for civilian jobs.

Market Pulse - Clair Wilkinson of Terms + Conditions posts about more evidence of a slowly turning market citing new reports and studies.

Quick takes

| Permalink

March 1, 2012


Our colleague Joe Paduda has posted the latest and greatest edition of Health Wonk Review at Managed Care Matters, and it's a good one. If you haven't checked it out lately, you should - there are some really high quality participants and regulars - including a few newcomers like Wing of Zock, a blog with a name that makes us feel like our blog name is pretty pedestrian.

Joe featured a link to our post about the criminal probe related to the Upper Big Branch Mine Disaster and he added an editorial update via link to a new story posted today: UBB disaster: Ex-mine security chief gets 3 years in prison.

You can see more on this conviction and the judge's reasoning about sentencing over at our go-to blog on all mining-related matters - Ken Ward's Coal Tattoo.

| Permalink

February 22, 2012


Insurance Regulatory Law is this week's host for Cavalcade of Risk #151 - and it's a challenging one!

| Permalink

February 16, 2012


Health Wonk Review - Jason Shafrin has posted the Health Wonk Review: More than Birth Control Pills edition at Healthcare Economist. And there is indeed much more than birth control in this issue: politics, health care reform, the Affordable Care Act, and a grab bag of other timely topics. Check it out!

CDC calls prescription drug problem "epidemic" - The CDC weighs in on the prescription drug abuse problem, calling it "epidemic" and "the fastest growing drug problem in the United States." Risk & Insurance offers a concise summary. And on the same theme is a story about how New Jersey has implemented a Prescription Drug Monitoring Program. "In unveiling the program last month, state officials related that one patient obtained more than 2,500 doses of oxycodone and methadone in a four-week period. The patient presented what are now believed to be forged prescriptions to three pharmacies on 14 separate occasions, spread out his visits among the pharmacies, and paid sometimes with cash and sometimes by insurance."

Affordable Care Act: What if... - What if the Supreme Court overturns the mandate? At Managed Care Matters, Joe Paduda looks at what the repeal of the mandate would mean for workers comp.

Marijuana & impairment Roberto Ceniceros recently discussed the issue of marijuana use and impairment. He cites a recent Louisiana appeals-court ruling that upheld benefits for an injured worker who showed positive in a post-injury test for consumption of marijuana and a prescription drug.

Emerging Risks: Exploding Hog Farms - Hog farmers take note: the Minnesota Daily covers reports of a mysterious foam that has caused Midwest swine barns to unexpectedly explode. The foam can build up to heights of four feet on manure pits. "The foam traps gases like methane and when a spark ignites it causes an explosion. About a half dozen barns in the Midwest have exploded since the foam was discovered in 2009. / In mid-September 2011, a barn in Iowa was added to the growing number of barns taken down by the foam. In the explosion, 1,500 pigs were lost, and one worker was injured."

Contractors in conflict zones - At Risk Management Monitor, Jared Wade discusses contractor deaths in Afghanistan as reported in a recent New York Times article. He notes that, "In 2011, for the first time, there were more civilian contractors working for U.S. companies that died in Afghanistan than there were U.S. soldiers." He follows up with excerpts and links to a prior Risk Management story on working in the world's most dangerous locations

Economy & Insurance - Global financial woes will not derail the economy, according to Robert Hartwig, President and Economist at the Insurance Information Institute, who has been a reliable forecaster and source of information on both the overall economy and the impact on the insurance industry. He sees opportunities for insurers beyond waiting for rate increases. Read more in Chad Hemenway's story at Propertycasualty360: Hartwig: U.S. Insurers Should Look at 'New Trajectory of Growth'

Aging & Construction Work - The Center for Construction Research and Training analyzed 100,000 workers comp construction industry claims for the
state of Colorado to understand the relationship between the claimant
age and costs by the causes and natures of injuries and illnesses. Consistent with other aging studies, the report says "Older construction workers filed a small percentage of the total workers' compensation claims; however, when they did file a claim the associated costs were greater." Review the key findings: The Role of Age on the Cause, Type, Nature and Cost of Construction Injuries (PDF)

News briefs

| Permalink

February 2, 2012


Louise Norris jumps into the political fray with this week's Health Wonk Review - Campaign 2012 Edition at Colorado Health Insurance Insider. It's a great edition with some solid submissions, and we are smitten by the great historic voting photos that Louise used to punctuate the posts. Check it out.

Other noteworthy news

Follow the money - In the continuing saga of Florida's physician-dispensed workers comp drugs and the associated costly price tag for employers, Joe Paduda looks at the behind-the-scenes opposition muscle aimed at any legislative attempts to put limits on this practice. He cites a recent research report, which tracked more than $3 million in political donations to "one Mirimar address, dozens of companies." The Florida Independent news story goes on to say, "In suburban Tampa, a single-story building at 610 South Blvd. is home to countless political committees in Florida and all over the country, and is known as a veritable political action committee mill. A similar story lies in Miramar, where two doctors -- Paul Zimmerman and Gerald Glass -- run dozens of companies that, altogether, have funneled more than $3 million into state political campaigns and committees in recent years." Joe notes, "$3.2 million total shows clearly just how important Florida is to dispensing companies and their affiliates."

Violence in the Workplace - "Workplace homicides 'Are not crimes of passion committed by disgruntled coworkers and spouses, but rather result from robberies.' And the majority of workplace assaults are committed by healthcare patients." These are a few top line findings in the NCCI research report on Violence in the Workplace. Although homicides are trending down, they comprise 11% of workplace fatalities. You can download a copy of the complete report, which is part of NCCI's ongoing research into the topic of work violence.

New blog of note - The folks at PRIUM, a workers' compensation utilization management company, have recently launched Evidence Based, a blog that will focus on our favorite topic - workers comp - with particular emphasis on the over-utilization of prescription drugs in the treatment of injured workers. Recent posts have dealt with state efforts to control narcotics. See recent posts on Arizona: The Simple Path to Controlling Narcotics in Non-Monopolistic States and Ohio's New Rules: A Good Start (with a Potential Gap).

Getting social - Pro tip for social media users: If you are going to file a workers' comp claim, you should think twice about posting party pics on Facebook - judges may take them into consideration when evaluating the merit of your claim.

The Feds & Fraud - In Government Executive, Kellie Lunney explores the reasons why the federal workers' comp program remains vulnerable to fraud. According to a study by the Government Accountability Office, limited access to data is a key culprit. "Specifically, we found that limited access to necessary data is potentially reducing agencies' ability to effectively monitor claims and wage-loss information," the report stated. In addition, agencies' overreliance on self-reported data from claimants, the frequent use of physicians not employed or selected by the government, and the expense involved in conducting investigations and prosecutions have stymied efforts to stamp out fraud. GAO noted that investigations are the "most costly and least effective" way to reduce fraud, but the ability to prosecute those who cheat the system is a valuable deterrent.

OSHA Posting Compliance - Employers, did you remember to post OSHA Injury & Illness Reports on Feb 1? If not, make sure that you do. Rules require that employers post "...the official summary of all injuries and illnesses occurring in the previous year. The information must be compiled on the OSHA Form 300A or an equivalent and posted in a conspicuous place or places where notices to employees are customarily posted. The information must remain up through April 30, 2012." For more information and to learn if this requirement applies to your organization, check out OSHA's Recordkeeping page.

Quick takes

| Permalink

January 19, 2012


We're delighted to be hosting Health Wonk Review this month. In looking for a potential theme, we turned to "the Googles" to see if January was noteworthy for any special commemorations beyond Martin Luther King day. Well buckle down because it looks like we will all be very busy. January is apparently train-your-dog month, radon awareness month, "get organized" month, crime-stoppers month, budget month, cervical health awareness month, closet organization month, mentor month, beer month, pet registration month, anti-human trafficking month, tuna month, pork month, and more - we're sure we've missed some and we're exhausted already.

We've decided to go with beer month (as we wrote this last night) and a turn to the classics: January is named after Janus, the ancient Roman god of the doorway. Janus is generally depicted as a two faced god, with one face looking to the past and one to the future. Here on Health Wonk Review, our last issue included some recaps of the prior year, so in this issue, we are looking to the future and what the coming year might hold for healthcare.

Reading the tea leaves
Since our last issue, several of our intrepid wonks have proffered prognostications for the coming year. First up is Joe Paduda at Managed Care Matters who offers his workers' comp predictions, which are expansive enough to encompass not one post, nor two, but but three - and if he is right, it looks like it will be a busy year in the occupational medicine arena.

At The New Health Dialogue Blog, Joe Colucci notes that the countdown to the SCOTUS ruling on the Affordable Care Act has begun, and weighs in with prognostications about how the constitutionality challenges are likely to fare.

At InsureBlog, Bob Vineyard looks ahead at the future of healthcare, finding some things you won't get on the 6 o'clock news.

The devil-some details
While some of our posters are looking at the broad trends, others are looking under the hood. As the saying goes, the devil is in the details.

At Health Affairs Blog, Timothy Jost examines the first set of Supreme Court briefs filed in the challenge to the ACA, including the U.S. government brief defending the constitutionality of the minimum coverage requirement, aka individual mandate.

At Health Care Renewal, Dr. Roy Poses takes a bipartisan look at the presidential candidates and their financial relationships with large health care organizations, wondering whether any of them would be inclined to advocate for health reform measures that might threaten the interests of these organizations. He notes that some of these relationships appear significant enough to be called conflicts of interest in arenas other than the political one, yet none of the candidates has made a point of disclosing these relationships as potential conflicts.

Louise Norris of Colorado Health Insurance Insider examines some of the potential reasons why claims expenses in Colorado's new high risk pool are double the national average. She points out that, "pre-existing condition exclusion riders have all but disappeared in the individual health insurance market in Colorado. Nearly all carriers now use underwriting rate increases instead."

On the eponymously named John Goodman's Health Policy Blog, John examines barriers that physicians face in pricing and packaging their services in a post entitled How Doctors are Trapped.

David Williams of Health Business Blog looks at Medicaid expansion and questions if we will we get our money's worth. He notes that as more diabetics are added to the rolls, their out of pocket costs will fall. But overall costs will rise steeply and it's unclear whether outcomes will improve.

Healthcare Economist Jason Shafrin investigates how Medicare's physician value-based purchasing scheme will work. He notes some of the challenges involved in evaluating physicians for quality and cost.

Brad Wright is looking sharp at his newly designed blog, Wright on Health, where he offers an overview of the Independent Payment Advisory Board, the mechanism created by the Affordable Care Act to deal with growing Medicare spending. He looks at how it works, as well as what it can and cannot do.

Gary Schwitzer looks at senior health care policies from another perspective. He earns his Health News Watchdog blog name as he digs up the truth about a dishonest health care hoax intended to scare seniors which has recently been making the rounds, including airtime on a national radio call-in show.

And for another angle on senior care, at Health AGEnda, Marcus Escobedo looks at the issue of life expectancy and whether it should affect treatment. His post discusses a new evidence-based website for predicting life expectancy among older patients,, and the debate surrounding its use.

On the technology front...
Primary care physician Jaan Sidorov believes the digitization of health care information will commoditize primary care. At Disease Management Care Blog, he examines the transport of information and the likelihood that, when it comes to routine medical problems, patients won't need to be seen by a physician in a traditional face-to-face visit.

Also on the healthcare technology front, Dr. Michael Koriwchak has a post a Healthcare Talent Transformation where he takes a closer look at the "enthusiasm gap" between Health IT startup companies and physicians and opines about some of the reasons for barriers to adoption.

Closing thoughts...
At Corporate Wellness Insights, Kat Haselkorn reminds us that wellness can be a good investment with a good ROI, and that ignoring workplace wellness is as risky as gambling because no employee is immune to illness or injury.

Here at Workers Comp Insider, we point you to our piece on How Doctors Die, recounting a thoughtful article by a physician who notes that, "What's unusual about them is not how much treatment they get compared to most Americans, but how little."

Next up: Our next edition of Health Wonk Review will be hosted by Louise Norris at Colorado Long Term Care Insider on February 2!

| Permalink

January 11, 2012


Risk Roundup - Political Calculations blog hosts this week's Cavalcade of Risk, replete with a post rating system. Check it out.

Florida repackaged drugs issue redux - Dave DePaolo posts about a new effort to put a price cap on Florida's repackaged drugs. He posits that changing economic and regulatory conditions might create a more favorable climate for passage. He also talks about how "capping the price of drugs has been hotly contested by the Florida Medical Association (FMA) and a company called Automated Healthcare Solutions (AHCS)." AHCS is a firm whose executives have contributed heavily to politicians to prevent such legislation. A Tampa Bay news report talks about how the state's pill mill crackdown was held up by proponents of doc dispensing, including AHCS principals: "The two Miramar workers' compensation doctors have helped pump about $3 million into the political system through a dozen companies in the past year." A story in the Florida Independent covers an earnings report for top lobbyists, noting that, "Among the companies to have spent the most on lobbying is Automated HealthCare Solutions, a group whose co-chairmen have become fixtures on the political scene. According to the Current, Automated HealthCare has posted minimum lobbying expenditures greater than $300,000." For more on why repackaging controls are needed, see Joe Paduda's posts: Drug Dispensing by Docs and Repackagers and the myth of AWP.

The big five - Roberto Ceniceros reports that Top 5 workplace injury causes make up 72% of direct workers comp costs, according to a research report by Liberty Mutual Group. "Overexertion--or injuries caused by lifting, pushing, pulling, holding and carrying--costs businesses $12.5 billion in direct annual expenses and accounts for more than 25% of the national burden." This was followed by falls on the same level, falls to a lower level, bodily reaction, and struck by object.

Violence in Nursing - In When it hurts to help, Victoria Ison reports on workplace violence in nursing. Many might assume most violence is perpetrated by patients or intruders but not so: "Assistant nursing professor Cindy Thomas said the most common form of violence currently seen in health care occurs between nurses. She said violence between physicians and nurses is second, and violence between patients and nurses is actually third most common."

Strange suits - Top 10 Bizarre Workers' Comp Cases for 2011. From an eye-related injury after hitting a bowling ball with a sledge hammer to a fall from a helicopter while attempting to capture a deer with a net - read Thomas Robinson's picks for workers comp lawsuits with strange circumstances. Robinson reminds us that, "one must always be respectful of the fact that while a case might be bizarre in an academic sense, it was intensely real, affecting real lives and real families."

Brief takes

| Permalink

January 6, 2012


Healthcare policy - Kick off the new year with a bit of health policy wonkery. Jared Rhoads hosts 2012's first edition of Health Wonk Review at The Center for Objective Health Policy. We'll be hosting the next issue here on this blog later in the month.

OSHA fines double for serious violations - OSHA Law Update has a good overview of statistics recently released by OSHA. While the number of inspections have dropped in 2011, fines for serious violations or workplace safety doubled. The average OSHA penalty per serious violation in 2011 increased to $2,132, more than doubling from 2010's average of $1,053. OSHA head David Michaels points out that this is still too low, "We have to maximize the impact of our penalties because we're trying to not just focus on the employer where we found the [violation], but the whole industry." OSHA conducted 40,648 inspections, down from 40,993 in 2010. The drop was attributed to a change in inspection priorities, with a higher mix of health inspections and recordkeeping compliance, which take longer.

Wyoming - "Wyoming's overall workplace death rate was more than three and a half times the national average in 2010 and has ranked worst in the nation five of the past 10 years." A yearlong study and report to the Governor by epidemiologist Dr. Timothy Ryan points to a lack of workplace safety culture and finds that employers consistently fail to enforce safety rules. (Thanks to Joanne Wojcik for the pointer.

Hello, hard market - By year's end, it looks as though insurers finally had something to toast. Joe Paduda posts that the soft workers comp market is over. He cites a MarketScout report, which indicated rates were up 3% in December, the highest increase among all P&C lines.

Claims adjuster workload norms - At Comp Time, Roberto Ceniceros asks if 12 to 18 minutes per claim file is adequate. He's looking for feedback on "how much time should be devoted per file in order for adjusters to do a really great job."

Michigan, Maryland - WCRI recently issued two new cost-per-claim reports on Maryland and Michigan. Both studies include observations about the impact of recessionary pressures on claim costs. The picture may change going forward in Michigan, where reform legislation was just signed, the state's first overhaul in more than twenty years.

Brief takes

We close with this compelling video, which might provide some inspiration for your new year. It's a great video to share with your work force. (Hat tip to the Renaissance Alliance Consumer Insurance Blog

| Permalink

January 3, 2012

| Permalink

December 22, 2011


Gary Schwitzer makes his hosting debut with Unwrapping early presents, wrapping up '11 Health Wonk Review series. Gary is the publisher of the excellent and its associated Health News Watchdog blog - take a look around while you are there.

Absence Management - The Disability Management Employers Coalition and Liberty Mutual recently released a set of best practice for absence management and easing the transition back to work after a disability leave. Download a whitepaper on Best Practices in Return to Work or view Taming the Intermittent Beast, a one-hour webinar on managing intermittent leave.

Support a good guy - Joe Paduda explains why you should join the Friends of Sandy Blunt on LinkedIn.

Desperate Housewives - Reality just got a little harsher for a would-be reality TV star caught in a huge California workers comp scam, She and her husband were charged with $30 million in premium fraud. "The couple gained notoriety in 2010 after fraud investigators raided several properties they owned and found luxury cars including a Bentley, two Ferraris, $500,000 in jewelry and $51,000 in cash. They also found an application for Kile to appear on the television show."

Going and coming - Injuries that occur while traveling to and from work generally are not compensable. There are several common exceptions to this "going and coming" rule - if an employer provides transportation, if traveling is part of the normal course and scope of an employee's job (such as a salesperson), or if the employee is on a "special mission" for the employer. Risk and Insurance reports on a recent benefit denial by the New Jersey Superior Court, Appellate Division in a case where a company president was invoking the "special mission" exception for an injury that occurred during an early trip to work for a special meeting. In denying the appeal, the court reasoned that the exception did not apply because the president was not required to be away from the restaurant's usual place of business and he did not have "identifiable time and space limits on his employment."

Up in smoke - Roberto Ceniceros posts about a denied claim involving a landscaper injured after a fall from a tree. Ceniceros notes that, "A urine sample taken at the hospital the day after the Tennessee man fell showed he had an intoxicant level 50 times beyond the threshold for a positive result, leading a doctor to describe him as a chronic pot user." The court concluded that while the employee was not guilty of willful misconduct, his intoxication was a proximate cause of the injuries.

Hope for PTSD relief? - Wired has an interesting article on a how the Navy is testing neck injections to relieve PTSD. The unorthodox procedure, which is called stellate-ganglion block (SGB), has secured immediate relief for some PTSD sufferers.

NYWCB Web change - Effective December 20, the New York State Workers' Compensation Board (WCB) updated its website to use the standard "" domain naming convention - the new web address is has more detail about related email changes.

On the lighter side: Holiday roundup
In honor of the holiday season, we've put together a grab bag of some fun holiday links. We wish all our friends the best for the season!

| Permalink

December 14, 2011


Our favorite "down under" blogger Russell Chatswood has posted the latest and greatest issue of Cavalcade of Risk at his Chatswood moneyblog. Now despite the mild weather we are enjoying right now in the northeastern U.S., we are envious of Russell's blooming garden, as evidenced by the photos in the post. And beyond the flora and fauna, there is your garden variety biweekly grab bag of risk-related posts from around the blogosphere. Check it out.

| Permalink

December 13, 2011


Ironically, when we first learned about potential trouble with a three-decker fire in Worcester last week, we were in the process of gathering links about a recent NFPA report showing that firefighter injuries are down eight percent from 2009; in addition, we had come upon another Arizona study that showed that more firefighters are injured while engaged in training and exercise than in fighting fires. We were tracking NFPA stats on injuries by type of duty and by nature of injury.

But then we heard about the new tragedy in Worcester where 17-year veteran firefighter John Davies lost his life in a three alarm fire. He and his partner were searching the tenement's third floor for possible trapped people when a wall collapsed on Davies. His partner Brian Carroll fell through to the basement, and was subsequently rescued, surviving his injuries.

Subsequent news reports of the fire say that no body has been found in the rubble. The resident that was reported missing is still missing, and authorities are searching for that person as a witness. Unsurprisingly, the home that burnt had 30 code violations and the owner is facing charges.

A firefighter death is a difficult and tragic event whenever and where ever they occur. About 100 firefighters die in the line of duty each year. FEMA notes that "Although the number of firefighter fatalities has steadily decreased over the past 20 years, the incidence of firefighter fatalities per 100,000 incidents has actually risen. Despite a downward dip in the early 1990's, the level of firefighter fatalities is back up to the same levels experienced in the 1980's." In 2011 to date, 83 firefighters have died in the line of duty.

The death of firefighter Davies is a particularly difficult loss. He was to be married on New Year's Eve. He was the father of three sons, one of whom is returning from an Afghanistan deployment to attend his Dad's funeral. But occurring as it did in December, a few short days after the 12-year anniversary of the Worcester Cold Storage building fire that killed six firefighters, this is a particularly painful loss for the Worcester firefighting community. This grievous loss is still fresh in the minds of many locals. Both Davies and his partner were among the firefighters that responded to that fire. Both Davies and his partner were stationed at Franklin Street Station, a new station and memorial which was built at the site of the former Cold Storage warehouse.

Funeral ceremonies for John Davies are scheduled for this Thursday. It is being reported that as many as 12,000 firefighters from across the country are expected.

Firefighting may indeed be getting safer overall, but this week, statistics pale in the face of gritty reality. As long as people are trapped in burning buildings, firefighters like John Davies will be losing their lives. And as insignificant a response as it is, we thank them.

| Permalink

December 8, 2011


After a Thanksgiving hiatus, Health Wonk Review is back with your biweekly view of what the healthcare policy wonk's have been blogging about. Brad Wright hosts Health Wonk Review: Holiday Shopping Guide at Wright on Health.

Workers Comp Networks - At Managed Care Matters, Joe Paduda has been front and center covering the matter of Aetna's exit from workers comp and his post today, Aetna part 2. Also related, his post about Where work comp networks are headed.

UBB Report followup - In followup to yesterday's post, here is a link to the MSHA Upper Big Branch Investigation Report - it's a detailed account, including transcripts of interviews.

Bloodborne Pathogens - According to the CDC, about 385,000 sharps-related injuries occur annually among health care workers in hospitals, and the average risk of bloodborne infection following one of these injuries is approximately 1.8%. The NIOSH Science Blog posts about needlestick punctures and bloodborne pathogens, highlighting the film Puncture which is about the personal injury case of Vinessa Shaw, a nurse who contracts AIDS after an accidental stick. The post calls attention to the NIOSH injury prevention initiative, The Stop Sticks Campaign. which is aimed at clinical and nonclinical health care workers and health care administrators in hospitals, doctor's offices, nursing homes, and home health care agencies.

Pole Dancing: - A Georgia Court recently ruled that Pole Dancers are not independent contractors. "The Judge found the club exercised control over the dancers because the amounts charged by the dancers for certain types of dances were set by the club. The club also established what amounts had to be paid by the dancers to the DJ and to other employees of the club each day at the conclusion of their shift. The club could also fine or fire the dancer for not coming to work or being late. The Judge also noted that every other FLSA case brought by exotic dancers from Alaska to Florida had concluded they were 'employees', and not 'independent contractors'." Note: This is not the first pole dancing issue we've covered. My colleague posted about another claim with a pole dancing angle last May. This should lead to some interesting search results in our logs - not to mention some disappointed searchers.

Brain Trauma - the New York Times has a 3-part series on 28-year old professional hockey player Derek Boogard's death due to repeated head trauma, chronic pain and a deadly drug addiction. Read part 1 A Boy learns to Brawl, Part 2 Blood on the Ice and Part 3 A Brain 'Going Bad'. There is also a related video: An Enforcer's Story. For a good resource on preventing, treating and living with traumatic brain injury, we point you to
Related - In doing our rounds, we note that Dave DePaolo has an excellent post on Professional Sports and the Relevancy of Comp.

In the I-guess-it-doesn't-go-without-saying department - Slightly off track here, but Bob Wilson has a rather unusual warning that we are passing along as a public service: Beware the Door to Door Breast Examiner.

News Briefs

  • Workplace Health Missing From Public Health Rankings
  • NICB Reports 7% Uptick in Q3 Suspicious Claims - workers comp was up 12%
  • Early Impact of the 2007 Reforms in New York - from WCRI
  • Preventing Worker Deaths and Injuries from Contacting Overhead Power Lines with Metal Ladders - home holiday decorators also take note!
  • 10 eye injury pitfalls to watch for at work
  • Irregular Night-Shift Work Associated With Higher Diabetes Risk
  • Limit Your Employer Liability for Holiday Parties
  • | Permalink

    November 30, 2011


    David Williams of Health Business Blog hosts the biweekly roundup of posts in the Insurance Fest Edition of Cavalcade of Risk. Check it out! Plus, poke around David's blog - lots of good information, such as his recent posts on What does an Explanation of Benefits (EOB) actually explain and part 2.

    The elephant in the room - Last week, my colleague reported on several issues and trends under discussion at the WCRI Conference. One of the key issues that has attracted some media attention is Richard Victor's conference summary about the elephant in the room - employment. Insurance Journal's Andrew Simpson has more on the tough challenges that face the workers' comp system in the coming years as we cope with the "unprecedented disruption of the labor market."

    Ghosts of crises past... - Peter Rousmaniere recalls the workers comp crisis of 1991 private sector markets in some states came close to collapsing. He discusses ensuing legislative reforms and changes in employer and claims payer practices, which are are still making their impact known in today's market.

    Meanwhile, in England... - Jon Gelman notes that Britain's Department of Work and Pensions has concluded that the principle of "no fault" should be eliminated from the workers' comp system. "In a review published next week there are calls for a 'rebalancing' of safety laws and a dramatic reduction in the number of rules in the workplace." Jon notes that our US system was modeled after Britain's.

    California Network Utilization Study - If California proves to be the national pacesetter that it so often is, look for network utilization to increase. According to a recent study by the California Workers' Compensation Institute (CWCI), the use of Physician Networks in California workers' comp is at a record high. Network physicians now provide more than 75% of all first year physician-based treatment, and receive two thirds of the dollars paid for physician-based services rendered in the first year. You can download the full report (and other reports too) from the CCWI Research page.

    Dental claims - If you think it's difficult to find a physician who understands workers comp issues, how about a dentist? At Risk Management Magazine, Laura McClain explores some of the complexities involved in dental claims, such as the fact that the average dental claim requires 17 dental provider visits. She notes that risk managers generally rely on their PPOs to manage dental injuries, but suggests that because these claims require a more specialized approach, risk managers need to give them special attention.

    Essential Functions - We couldn't find a better example of why it's important to document the essential functions of a job that the recent case that Jon Hyman Of Ohio Employers Law Blog discusses in his post, "SAY IT! SAY IT!" Yelling as an essential function. Hyman's take away for employers: "Just because the ADA (as amended by the ADAAA) renders virtually every medical condition a protected disability does not render employers defenseless. Essential functions come in all shapes and sizes. When handling an accommodation request from a disabled employee, do not omit consideration of all facets of the job."

    US Road Casualties Mapped - Transportation related accidents are not only one of the leading causes of work-related fatalities in the US, they are one of the leading causes of death, period. Between 2001 and 2009, 369,629 people died on US roads. Now, courtesy of the Guardian's Data Blog, you can see US traffic fatalities - every one mapped across America for those years on an interactive map. You can zoom in to search by your location. (Thanks to Liz Borowski at the always excellent Pump Handle for the pointer).

    Cool Tool - NIOSH offers a Noise Meter shows how long it takes before a particular sound level becomes dangerous to the human ear. You can listen to the sounds and sound intensities of everyday objects. It's an interesting little toy to share with workers to call attention to prevention efforts. Also see the other NIOSH resources on noise and hearing loss prevention.

    Still an important health issue... - omorrow is World HIV-AIDS Day. The CDC has a good workplace resource: Business and Labor Responds to AIDS, which includes info on policy development, supervisory training materials, and educational materials.

    News of Note

    | Permalink

    November 16, 2011


    Insurance Writer Nancy Germond hosts this week's edition of Cavalcade of Risk and she has a seasonal theme: The Turkey Edition. Check it out.

    Reminder - Tomorrow is Great American Smokeout day. More than 46 million Americans still smoke and if some of them are your employees, it is likely that smoking is taking a financial toll on your organization. It's not too late to remind your employees: here are some printable tools, or you can just email a reminder about 1-800-QUIT-NOW, a free smoker's quit line.

    Wellness - Speaking of smoking or any other so-called lifestyle issue that is related to employee health, Roberto Ceniceros recently tackled the topic of wellness programs being adapted for workers comp in an article in Business Insurance, as well as at his blog. He notes a trend toward integrating wellness benefits into workers comp programs, which "...requires employers to transcend traditional corporate silos that typically separate risk management and workers compensation departments from those administering health benefits and nonoccupational disability plans."

    Sandy Blunt update - Joe Paduda recently featured a post on progress in clearing Sandy Blunt's name. North Dakota Supreme Court's disciplinary board has recommended that Cynthia M. Feland, the prosecutor in the Blunt case and now a judge, should have her attorney's license suspended for 60-days and be required to pay court costs related to her failure to "... disclose to Michael Hoffman, defense attorney for Charles Blunt, the Wahl memo, and other documents which were evidence or information known to the prosecutor that tended to negate the guilt of the accused..." Next step, new trial? (For more background, see A Good Man Wronged). We had a chance to catch up with Sandy at the Las Vegas Work Comp Expo at the Medata reception. Sandy is serving as Vice President of Insurance Services with Cy King and crew. (Side note: if you are ever invited to a Medata reception, say yes. Three words: "nice people" and "yum.")

    Other notes from last week's Las Vegas Workers' Comp Expo - Kudos to Peter Rousmaniere, who collaborated with Sedgwick to produce a great video on the history of workers comp - we'll bring it to you as soon as it's available online.

    Our fellow blogger Joe Paduda kicked off the show with an informative opening general session, part of which was a Point/Counterpoint style sparring between Joe and David North of Sedgwick and Davidson Pattiz of Zenith about pricing and billing transparency. You can see Joe's reports from Vegas here and here.

    Evan Falchuk was part of a panel on expert physicians. Falchuk is President and Chief Strategy Officer of Best Doctors, an organization that has been making quite a splash on the healthcare side. (Check out Falchuk's blog, See First). While not as widely known as their general healthcare services, Best Doctors also offers services in the workers comp arena, which include help for legacy claims, complex care claims, and cases involving chronic pain, among other services.

    Chris Brigham of Impairment Resources made an impassioned presentation on how we can and should be making a commitment to prevent the needless disabling of injured workers. He and his team were also exhibiting, side by side with their partner firm and our neighbor, Insurance Recovery Group, who were touting their subrogation services.

    Other sightings: Colleague Jim Paugh was representing his new predictive analytics endeavor, WorkersComp Analytics; Mark Walls was the man of the hour, moderating sessions and hosting a reception for members of his popular linkedIn Work Comp Analysis Group; We also spotted Bob Wilson, another online pioneer, and were fortunate to spend time with Helen Knight of King Knight Communications, arguably the best PR person in workers comp; and a shoutout to Frank Pennachio (erstwhile guest poster) and Susan Toussaint of Work Comp Advisory Group, who we finally met in person. Finally, congrats to Nancy Grover, program chair, along with all the advisors and staff of LRP and Risk & Insurance for putting on a good conference.

    | Permalink

    November 10, 2011


    Hank Stern of InsureBlog is hosting an entertaining edition of the Health Wonk Review. Take a few moments and you will learn some interesting things: The dangers of obesity - a well-known hazard for adults - is also a danger for pets. There is an alarmingly high rate of pregnancy among U. S. teens - 10 percent of all pregnancies; in a directly related issue, the ideologically-driven attempt to mitigate these pregnancies through "abstinence pledges " has proven remarkably ineffective: one study shows that 88 percent of abstinence pledgers go ahead and have sex anyway.

    Speaking of failed programs, we will resist, at least for the moment, the temptation to pontificate on the appalling situation at Penn State University. Suffice it to say that power comes with responsibility, especially toward the powerless. Protecting the brand is a sorry excuse for failing to protect the innocent.

    | Permalink

    November 2, 2011


    Welcome to Cavalcade of Risk #143. In searching to see if the number 143 had any particular significance, we stumbled on an interesting bit of trivia about the late lamented children's hero, Mr. Rogers. For the last 30 years of his life, he maintained his weight at exactly 143 pounds. According to writer Tom Junod, Rogers found beauty in the number because, "the number 143 means 'I love you.' It takes one letter to say 'I' and four letters to say 'love' and three letters to say 'you.' One hundred and forty-three." There are a lot of interesting facts associated with Mr. Rogers. Did you know that every one of his famous sweaters was knitted by his Mom? Learn more in 15 reasons Mr. Rogers was best neighbor ever. The world would probably be a lot less risky a place if we all took Mr. Rogers' message of respect to heart.

    Moving on to our entries this week, we begin with some good news that we can all revel in. In his post Remember: I'll Drink to That!, Henry Stern of InsureBlog tells us that moderate tippling may reduce our risk of Dementia. We're not sure Mr. Rogers would approve, but pass the Bloody Mary, please.

    At Risk Management Monitor, Emily Holbrook notes that Thailand's worst flooding in five decades has affected companies in every industry, from automotive to technology to pharmaceuticals and beyond. She demonstrates Thailand importance in global supply chains in her post about the 5 companies hit hardest by the Thailand floods.

    If Doctors were aware of the actual costs of healthcare being incurred when they provide treatment, would that help in controlling costs? Louise Norris of Colorado Health Insurance Insider examines a physician's cost control suggestion in her post about real time tracking of healthcare costs.

    Russell Hutchinson covers the insurance equivalent of the last mile: actually ensuring that coverage will work for you by covering the proper handling of the policy and how the proceeds will feed into your estate management plans. See Insurance and the Filing Cabinet at Chatswood Consulting Moneyblog.

    Despite the fact that millions of children are uninsured, many of these children are eligible for Medicaid/CHIP. Jason Shafrin, The Healthcare Economist, examines trends in participation in these public insurance programs in his post about state governments providing health insurance to more children.

    David Williams offers his thoughts on the risk-reward tradeoff related to prostate-specific antigen testing in his post a few observations on the PSA testing debate at Health Business Blog.

    Are on-line video doctor visits are a cost effective way to increase access to health care? In his post about virtual medical office visits, Dr. Jaan Sidorov points out that this form of telemedicine has the additional advantage of offering a lower cost alternative for insured beneficiaries who already enjoy high access.

    In which industry are you most at risk of suffering an on-the-job injury: construction, manufacturing, mining, or nursing homes? Find out in our Pop Quiz here on Workers Comp Insider

    Eric Turkewitz of New York Personal Injury Law Blog presents a real-world case of an insurer playing the odds and losing in his post about a insurer being slammed for bad faith as the Judge cites "A Few Good Men".

    Jacob looks at five common life insurance mistake and how to void them at My Personal Finance Journey.

    FMF says there are standards that every policy should uphold as well as additional, more personal considerations to take into account when buying long-term care insurance. He offers guidance for the basics in buying long-term care insurance at Free Money Finance.

    Should the Federal Insurance Office release insurers' statutory financial data to the public in a manner similar to that used by the SEC with its EDGAR tool? R.J. Lehmann tackles this topic in FIO, FOIA and a free market in insurance data posted at Out of the Storm News.

    Super Saver makes the case that while the short term downside risk of the stock market is high, the long term downside risk is still low in his post Is it Different this Time? at My Wealth Builder.

    | Permalink

    October 28, 2011


    Joe Paduda hosts The Superhero Edition of Health Wonk Review, in which he attributes superpowers to our regular health wonk contributors and cites them for doing battle with tough issues. My question is when are we going to get the costumes, Joe?

    By the way, while you are at Joe's blog, don't overlook his smoking gun post Physican dispensing - boy do we have a deal for you!

    Good news - DOL reports that private industry workplace injuries and illnesses declined in 2010. They fell to a rate of 3.5 cases per 100 equivalent full-time workers, down from 3.6 cases in 2009. But the more serious cases are holding constant: More than one-half of the 3.1 million private industry injury and illness cases reported nationally in 2010 were of a more serious nature that involved days away from work, job transfer, or restriction--commonly referred to as DART cases.

    Wellness - Ezra Klein covers Cleveland Clinic's wellness program in Health Care's Brave New World of Compulsory Wellness. The program is not without some controversy, but it appears to be working: "Not only has the clinic cut its health-care costs, but its employees are also getting healthier in measurable ways. Workers have lost a collective 250,000 pounds since 2005. Their blood pressure is lower than it was three years ago. Smoking has declined from 15.4 percent of employees to 6.8 percent."

    See you there? - we're getting close to two important industry events, and we'll be at both. From November 9 to 10, we'll be at the National Workers Compensation & Disability Conference in Las Vegas. If you are attending, why not meet up at Mark Walls' Link UP reception at 5 pm on Wednesday? We'll also be at the WCRI's 28th Annual Issues & Research Conference in Boston on November 16 and 17. We're looking forward to both. Drop us a line if you will be attending too.

    Sneak peek - Business Insurance has had a redesign and is offering an "open house" through the 31st of the month. Here's the workers' comp section - if you read Workers Comp Insider regularly, you know we are a Roberto Ceniceros fan. The whole publication is worth a glance, BI has an excellent staff of reporters many of whom have been with the publication for years.

    Get your fright on - In honor of Halloween weekend, we thought this feature on 8 Terrifying Robots Now Stalking Your Local Hospital was appropriate - but be warned, the feature appears on an irreverent site and if you are at work, it might trigger your company's net nanny filter. Also on a scary theme, we noted this recent study on Psychopathic bosses.

    News Briefs

    | Permalink

    October 20, 2011


    Van R. Mayhall of Insurance Regulatory Law makes his debut as host of Cavalcade of Risk with his "Meet the Experts" edition. Mayhall is an expert himself - an attorney who practices in the areas of Business & Corporate Law and Insurance Regulatory Law. We welcome his participation!

    Workers Comp Conference - Nancy Grover offers a sneak peek at highlights of the National Workers' Compensation and Disability Conference & Expo which is on the docket for November 9 and 10 in Las Vegas. You can follow more about upcoming conference events on LinkedIn's National Workers' Compensation and Disability Conference & Expo Group.

    Maximizing wellness program ROI - According to a post by Preston Diamond in Risk Management Monitor, "On average, employers can see a 30% reduction in Workers' Compensation and disability claim costs, according to a review of 42 published studies involving the economic returns of wellness programs. Moreover, wellness programs will reduce the costs of absences that, according to the 2010 Kronos/Mercer Survey on the Total Financial Impact of Employee Absences, add up to 8.7% of payroll costs, more than half the cost of health care." But experts caution that all wellness programs are not equal so employers need to implement with care. See 5 Steps Companies Should Take Before Launching a Wellness Program.

    Performance Standards & Disabilities - Employment law attorney Daniel Schwartz posts an FAQ on Applying Performance Standards to Employees with Disabilities. He notes that although the ADA affirms an employer's right to define jobs and to evaluate employees according to consistently applied standards governing performance and conduct, it's a case where the devil is in the details. But he links to some lesser-known EEOC guidance on the matter that helps to address some common questions.

    High costs of excessive alcohol consumption - According to a new study on the costs of excessive drinking by the Centers for Disease Control and Prevention, the cost of excessive alcohol consumption in the United States in 2006 reached $223.5 billion, which translates into about $1.90 per drink or $746 per person. Researchers also pointed out that 72% or the total costs could be attributed to losses in workplace productivity.

    Is Ohio drinking the tea? - Looking at some ballot issues in Ohio, Roberto Ceniceros asks if a tea party initiative could end workers' comp. He cites a Toledo Blade editorial which argues that although the intent of the measure is to thwart the health-care reform law, it may open the door to some unintended consequences.

    A picture is worth a thousand words - The Geography of a Recession is an animated view of U.S. unemployment from 2007 to 2011. Hat tip to Workplace Prof Blog for the pointer.

    Lift Gates - Tony Jones of the MEMIC Safety Blog offers a good overview on safety considerations related to lift gates, including equipment considerations, pre-operations, operations, and special considerations.

    News briefs

    | Permalink

    October 13, 2011


    Health Wonkery - Christopher Fleming hosts Health Wonk Review Unadorned at the Health Affairs Blog. Check out the latest from the best of the health policy bloggers. And if healthcare is of concern to you, Health Affairs should be a regular read!

    Bad behavior - When it comes to bad behavior, we are equal opportunity finger pointers. We've seen fraudulent employees. We've seen terrible bosses. We've seen bad brokers, bad insurers, and quack docs. Fraud is a game everyone can play and no one has a corner on the stupidity market. Among the recent crop of losers, we start with a post from HR Web Cafe about a mean-spirited employer who got a smackdown from a labor judge for a rather unusual contest he used to "motivate" his workers to better performance. And also on the employer side of the house, we have a classic case of premium fraud by a California tree trimming business that failed to pay workers comp premiums, under-reported payroll by more than $2 million, and failed to pay taxes. On the employee side, Roberto Ceniceros tells the story of nightmare employees who let rage over a small thing turn into a tragic event.

    Spying on Employees - Employment law attorney Heather Bussing offers some useful guidelines on employee privacy and what employers can monitor. This is a really good overview. We encourage reading the entire article. Here's some of her take-aways: "If the employer owns the system, hardware or both, the employer can monitor employees' use of it, including personal files and communications.
    If the employee owns the system and hardware, the employer's ability to view and obtain personal files depends on the whether the employee is using it at work, whether the employer has a legitimate interest in viewing the communication, what the state's laws and employer's policies are, and what the employee's objective expectations of privacy are."

    Repackaged Drugs - Joe Paduda has been in the forefront of a crusade against the practice of repackaged drugs, which has been promoted as a convenience for patients, but in practice is a costly work around for fee schedules. This is one of those under-the-radar issues that many employers may not see, but in states where the practice is allowed, it is costing big bucks. Joe first talked about the practice in 2006, and has been regularly posting updates. He brings you the latest from the eye of the storm: Is Florida finally going to fix its (repackaged) drug problem?

    OSHA - OSHA has recently issued Nail Gun Safety - A Guide for Construction Contactors. OSHA says that nail gun injuries are responsible for approximately 37,000 emergency room visits annually. "These injuries occur as a result of unintended nail discharge; nails that bounce off a hard surface or miss the work piece and become airborne; and disabling the gun's safety features, among other causes. Injury prevention is possible if contractors take steps such as using full sequential trigger nail guns; establishing nail gun work procedures; and providing workers with personal protective equipment."

    Child Workers - Celest Monforton gets the bureaucratic runaround when she tries to find out why child labor regulations were delayed by the White House's Office of Management and Budget. A Labor Department update to the 40-year old regulations were stalled for 9 months - meanwhile, two teens lost legs in a grain auger accident, precisely the type of event that made such an update to regulations imperative.

    Excess Loss Development - NCCI had released a new research report on Workers Compensation Excess Loss Development. They note that, "Large loss and excess development is relevant to calculating excess loss factors used in retrospective rating."

    News Briefs

    | Permalink

    October 5, 2011


    Risk roundup - Jay and Louise Norris of Colorado Health Insurance Insider host this week's Cavalcade of Risk - it's the Colorado nature edition. Congrats to the Norrises on their 5 year blogging anniversary and 10th issue hosting the Cavalcade.

    Check the facts - At Comp Time, Roberto Ceniceros tells the story of an insurer relying on a newspaper's crime report as the basis for denying a claimant's workers comp benefits. While this situation might seem like one that wouldn't surface all that often, we'd make the case that it is a cautionary tale for anyone who is using social media as an investigative tool.

    Culture of Caring - Dave DePaolo has an interesting post on how the culture of caring relates to a workplace where the turnover rates are high, like fast food joints. Is high-touch communication and an early return-to-work model as effective when turnover is 120%? We'd note that high turnover is not only an impediment to return to work, it's no doubt also a factor in the number of injuries that occur. New, untrained workers have more injuries. The Bureau of Labor Statistics data shows that more than 40% of work-related injury claims are filed by workers who have been on the job for 12 months or less, and a NIOSH study found that employees 24 years old or younger are two times more likely to suffer a nonfatal injury than their older co-workers.

    Medical Costs - In our last news roundup, we linked to the Kaiser Family Foundation's recent report that average family benefits premiums are up 9%. Joe Paduda of Managed Care Matters offers his thoughts on why premiums are up so much when medical costs are flat.

    Workplace Violence - Michael Fox of Jottings by an Employer's Lawyer posts about OSHA's new directive on procedures for investigating workplace violence complaints. He notes that two industry groups get singled out for particular focus: Healthcare and Social Service Settings and Late-Night Retail Settings.

    Anniversary of Patel Memo - At Lexis-Nexis, Robin E. Kobayashi commemorates the 10 year anniversary of the Patel Memo. Bonus points to you if you know what the Patel memo is. Here is a clue: it launched an entire workers comp-related industry.

    Case to watch - The EEOC is suing Texas-based BAE Systems for violating the ADA by firing a man who weighed 680 pounds. The man had worked at his job for 16 years and had logged good performance evaluations. The intersection of obesity and the ADA is one to watch.

    When light duty runs off the rails Safety News Alert discusses a case of a worker who returned to work on light duty. While on light duty, he received partial disability benefits because the job didn't pay as much as his previous position. But the employee had trouble getting along with his supervisor and asked to be laid off - which the employer granted. The employee then applied for full work comp benefits. Check out the court's decision.

    New blog Well, new to us. TexasM Mutual Insurance Company's blog has been up and running for about 15 months now, but we just discovered it via our Twitter feed. There are some good posts, particularly some good safety information. Texas Mutual Insurance Company is the state's leading provider of workers' compensation insurance, with approximately 32 percent of the market. (And remember, Texas is a state where private employers can choose whether or not to carry workers' compensation insurance coverage.)

    Also of interest...

    | Permalink

    September 29, 2011


    Best of the healthcare blogosphere - Looking for your biweekly fix of health wonkery? Check out Health Wonk Review: Muppets Edition! - posted by Joe Colucci at The New Health Dialogue blog.

    Health Care Costs - The Kaiser Family Foundation's 2011 Employer Health Benefits Survey revealed that average annual premiums for family health benefits are up 9%, topping $15,000. According to the report, "Premiums increased significantly faster than workers' wages (2.1 percent) and general inflation (3.2 percent). Since 2001, family premiums have increased 113 percent, compared with 34 percent for workers' wages and 27 percent for inflation." It's pretty jolting, and even more so when you check the graphic depiction of rising costs. You can find additional report documents here.

    Drug deaths - Los Angeles Times reports that drug deaths now outnumber traffic fatalities in U.S.. Apparently, we've been so busy fighting "the drug war" that we've overlooked the creeping and insidious threat of the prescription pain and anxiety drug problem. Deaths related to these drugs now outpace deaths from heroin and cocaine combined.
    Mark Walls pointed this article out and he has a discussion going on the LinkedIn Work Comp Analysis Group. He also links to several related resources - here's a sampling: ACOEM - Comments to State WC Officials on Prescription Opioid Abuse in the U.S.; Joe Paduda - Understanding Opioid Abuse; and Mark Walls - It Starts with the Regulators

    Safety tools - The Federal Highway Administration has a portal for Work Zone Safety. It includes some good highway safety tools and resources for you safety program.

    Time Capsule - What was work life like in 1943? Check out The Ropes at Disney's, an employee handbook from 1943. Pop quiz: How many current labor law violations can you spot?

    And in another look back at days of yore, Oregon's Willamette River Bridge Project posts an historic construction photo of the Willamette Bridge, inviting readers to spot the safety hazards. The answers are already posted, so if you want to play along, don't peek at the comments.

    | Permalink

    September 21, 2011


    Cavalcade of Risk - The Terrorism, CyberWar, Floods, Bad Mortgages, Robberies, Investment Losses and Disease Edition of Cavalcade of Risk is hot off the press and posted by Jaan Sidorov at Disease Management Care Blog. Check it out!

    Tribute to Workers - A few weeks ago, we made a 9/11 memorial post, which focused heavily on the event, the aftermath, and the losses. More recently, we came upon an excellent New York Times feature that focuses on portraits and stories of workers who are rebuilding the World Trade Center, the largest construction project in the United States. It's a positive testament to the future, to resilience, and to some great American workers. The rebuilding effort has employed 3,200 workers. NYT features more about the WTC rebuilding project.

    Student Athletes? - Jared Wade posts about how the NCAA Has Used the Term "Student-Athlete" to Avoid Paying Workers Comp Liabilities - part of a longer article that The Atlantic featured on college sports. Wade notes that, "For our purposes, however, the most interesting excerpt chronicles the how and the why of the NCAA's creation and widespread promotion of the term "student-athlete." According to Branch, the main reason that former NCAA head Walter Byers, in his own words, "crafted the term student-athlete" and soon made sure it was "embedded in all NCAA rules and interpretations" was because it was an excellent defense against being held liable for workers compensation benefits that those injured in athletic competition could seek."

    Prescription Drugs - NCCI has issued Workers Compensation Prescription Drug Study: 2011 UPDATE (PDF), a 31 page report. The key findings:
    *The indicated Rx share of total medical is 19%; this is slightly higher than the estimate given in our 2010 update
    *OxyContin climbs from the number 3 WC drug in Service Year 2008 to number 1 in Service Year 2009
    *Hydrocodone-Acetaminophen drops from the top WC drug in Service Year 2008 to number 3 in Service Year 2009
    *Recent overall cost increases are driven more by utilization increases than by price increases
    *Physician dispensing continues to increase in Service Year 2009 in almost every state
    *Increased physician dispensing is associated with increased drug costs per claim *Per-claim Rx costs vary significantly by state

    At Managed Care Matters, Joe Paduda offers his educated observations on the pharmacy study.

    Agricultural worker protections - Laura Walter of EHS Today writes about A Disposable Work Force: Farm Worker Advocates Push for Agricultural Worker Protections. Her article focuses on a new report published by the advocacy organization Farmworker Justice which criticizes the H-2A temporary guest work visa program. The report claims that it makes agricultural workers vulnerable to poor working conditions. Farm worker advocates argue that to improve these conditions, foreign agricultural workers should be able to seek legal immigration status.

    Battle of the giants - In catching up on a backlog of blog reading, we find a post from Roberto Ceniceros' Comp Time of great interest. It focuses on the battle of the giants chronicling the ongoing dispute between two workers' comp behemoths, AIG and Liberty Mutual. The dispute is being fought in court, and now in the court of public opinion via dueling websites.

    Hunt for misclassification is getting muscle - The Department of Labor and the IRS will be teaming up with other federal agencies and the labor departments of 11 states to share information that will help to track down employers that misclassify workers. For more on this, see Jon Gelman's post, US Dept of Labor Moves Aggressively on Misclassification of Employees and Dave DePaolo's post One Way to ID Scofflaw Employers: IRS Co Op

    Social Media - The more we use Twitter, the more we like it - we've certainly come across some great users and learned about some great pointers and links to breaking news. One Twitter user we've found particularly helpful is Kyle Thill posting for @ToyotaEquipment, a forklift dealership from Minneapolis. With 15,000+ followers, he must be doing something right! Safety is one of the ongoing themes of his posts, so if that's of interest to you, he's a good Twitter user to follow. He also issues The #Safety Daily Update, which is a curated "newspaper" of web-related safety matters. It's worth checking out.

    Signs of life for the elusive hard market - At Terms + Conditions, Claire Wilkinson talks about an uptick in commercial insurance prices as reported by Tower Watson's latest commercial lines pricing survey.

    Administrative note - We've shut down comments due to an unbelievable flood of comment spam. We're sorry about that - but we don't have the time to deal with it. If we come up with any new magical solutions to curtail it (we've tried many) we may reinstate comments at a later time.

    | Permalink

    September 15, 2011


    David Williams has posted the In Their Own Words edition of Health Wonk Review over at Health Business Blog - healthcare costs and healthcare reform continue to be vitally important issues to workers' comp. Whither goes the 98% of the health care market, the workers' comp 2% has little choice but to follow. This biweekly digest by professionals, pundits, and practitioners is a good way to keep up on things.

    | Permalink

    September 12, 2011


    First responders and oral histories
    We are mindful that the 9-11 story was one that largely affected ordinary people who were going about their workdays. When the planes hit, thousands of first responders jumped into action and their courage and quick actions helped to save untold thousands. Among the many remembrances and stories in the10-year commemorative events, we found the 60 Minutes story on the experiences of first responders to be particularly powerful. It focused on 911 Responders Remember, an oral history project initiated by Dr. Benjamin Luft, director of the Long Island World Trade Center Program (the SUNY-Stony Brook arm of the WTC Medical Monitoring and Treatment Program consortium). This Center of Excellence provides service and monitoring to approximately 5,000 WTC responders across Long Island. These men and women are law enforcement officers, construction workers, electricians, emergency medical personnel, firefighters, iron workers, plumbers, dog handlers, doctors, and many others.

    In addition to cancer, respiratory and pulmonary disorders and other physical problems, many workers still suffer from varying levels of emotional or psychological distress, including PTSD. This project is a national historical record, a public health document, and for many participants, a therapeutic exercise which allows them to open up to tell about events or things that they witnessed that they may not previously been able to talked about.

    See more testimonies.

    Related: A decade later, the list of Sept. 11 victims continues to grow
    Related: Fight Over Compensation for 9/11 Responders Shifts to Cancer Victims.

    Hitting close to home
    September 11 took an extremely heavy toll on the insurance industry. The terrible events claimed the lives of 295 employees of Marsh & McLennan and 176 employees at Aon Corporation. Dave Lenckus of Business Insurance offers recollections from insurance executives who were connected with or escaped from the WTC in his article Terror of September 11 lives in memory. Also see the company tribute pages: Remember: September 11, 2001 - a site to remember and celebrate the lives of those Aon employees lost on September 11, 2001, and Marsh & McLennan 9/11 Memorial - both a website and a physical memorial.

    Tribute song & Firefighter Foundation
    After 9/11, our own Tom Lynch recorded a 9/11 Tribute Song with Peter Clemente at Mechanics Hall in Worcester, MA. Actor and comedian Denis Leary used the song to raise money for the New York fallen firefighters. Leary is very devoted to firefighters and runs the Leary Firefighters Foundation. The Foundation was established in 2000 in response to a tragic fire in Worcester, Massachusetts that claimed the lives of Leary's cousin, a childhood friend, and four other firefighters. The Leary Firefighters Foundation's mission is to provide funding and resources for Fire Departments to obtain the best available equipment, technology and training. Inadequate equipment - particularly faulty tracking and radio equipment - contributed to deaths in both events.

    Insurance media coverage
    PropertyCasualty360: 9/11: 10 Years Later, Execs & Risk Managers Weigh In on How Industry Has Changed

    Insurance Journal: 9/11 and Terrorism Risk 10 Years Later and Why 9-11 Changed Everything

    Risk & Insurance: Selling Carriers on Rebuilding Ground Zero

    Risk Management Monitor: Ten Years After

    Occupational Health & Safety: NFPA Cites Safety Improvements Rising from 9/11

    CNNTech: How 9/11 inspired a new era of robotics 9/11 Tribute

    Other resources
    Understanding 9-11: A Television News Archive - a library of news coverage of the events of 9/11/2001 and their aftermath as presented by U.S. and international broadcasters. A resource for scholars, journalists, and the public, it presents one week of news broadcasts for study, research and analysis.

    The Encyclopedia of 9/11 - from New York Magazine

    The September 11 Digital Archive

    | Permalink

    September 7, 2011


    Cavalcade of Risk - Emily Holbrook hosts this week's Cavalcade of Risk at Risk Management Monitor - go check it out. If you are interested in risk and insurance - and presumably so if you are reading this blog -- then RMM should be on your must-read blog list. If you aren't familiar with it yet, take a few minutes to poke around the archives Emily and Jared consistently do a terrific job on an array of risk related matters. It covers everything from bedbugs to earthquake hotspots.

    Substance abuse & WC - Roberto Ceniceros posts about a controversy over stats citing the prevalence of drug and alcohol use in workers comp accidents and claims. Merchants Information Solutions says they are a factor in 65% of all accidents and 50% of all claims. Peter Rousmaniere disputes this and puts his money where his mouth is. "And here is why Rousmaniere thinks potentially exaggerated claims about the prevalence of alcohol and drugs in workers comp claims is dangerous: he says it "perpetuates an unhealthy tendency to shift attention away from safe worksite policies and towards blaming the worker."

    Prescription drugs - Joe Paduda talks about the recent WCRI benchmark report on prescription drugs in Washington and explains why what works in Washington likely won't work elsewhere.

    Spinal Cord Injuries - Kelly Scott posts about spinal cord injuries, noting that September is spinal cord injury awareness month.

    Changing workforce - Lots of good reading in The Atlantic recently. Well, more than recently, but a few caught our eye over Labor Day. Sara Horowitz makes the case that the freelance surge is the industrial revolution of our time, with a follow-on article about a jobs plan for the post-cubicle economy. And, also of note, a slide show on 7 Jobs that are making thousands of workers sick

    Illinois - Ameet Sachdev of The Chicago Tribune charts changes to the workers compensation law.

    Cool Tool - We just discovered OSHA's $afety Pays Cost Estimator, an interactive expert system to assist employers in estimating the costs of occupational injuries and illnesses and the impact on a company's profitability. Hat tip to the post at Safety Daily Advisor, which talks more about the tool.

    bi-conference.JPGReminder: September 22 - If you haven't signed up yet, head on over to Business Insurance and register for Virtual Advantage 2011 - Workers Comp Trends & Cost Control Strategies. We're very pleased that our own Tom Lynch will be participating on a blogger panel with three other blog luminaries: Roberto Ceniceros, Joe Paduda, and Mark Walls. There will also be a keynote by NCCI's Harry Shuford, an expert panel on pharmaceutical cost controls for worker's comp - and more. It's a one-day virtual conference - and best of all - there is no charge to attend.

    | Permalink

    September 1, 2011


    Health Wonk Review is launching its back to school season with The Hurricane Irene Edition posted by Avik Roy at the Apothecary. If you've been missing your biweekly dose of health wonkery during the abbreviated summer schedule, now is your chance to catch up!

    | Permalink

    August 24, 2011


    Nina Kallen hosts this week's Cavalcade of Risk at Insurance Coverage Law in Massachusetts - check it out.

    Other noteworthy new briefs:
    Business Insurance has had a complete online overhaul - here's a guide to the new

    HealthLawProf Blog covers the intersection of pharmaceuticals and online media in a pair of recent posts worth checking out: Social Media and Drug Promotion and Do No Evil: Googling Canadian Drug Imports.

    Roberto Ceniceros: Top 20 largest workers comp insurers

    Dave DePaolo: The 5 Stages of Work Comp Death

    Jon Gelman: What to Do During an Earthquake

    Joe Paduda: Work comp claim reserves - not good, but not too bad either

    Claims Journal: "Fraud Dog" to Bring Insurance Fraud Cases to Reality TV

    MEMIC Safety Blog: The Bite Stuff: Dogs not always a worker's best friend

    Safety Daily Advisor: Are Your Exit Routes OSHA Compliant?

    New York Times, Room for Debate: Could Farms Survive Without Illegal Labor?

    | Permalink

    August 10, 2011


    Jason Shafrin, our favorite Healthcare Economist, is hosting this week's digest of risk-related posts Cavalcade of Risk #137: Risk Grabs the Headlines. Check it out!

    S&P Downgrade Robert Hartwig of the Insurance Information Institute weighs in: Understanding the U.S. Debt Downgrade: No Significant Impact on Insurers: "The nation's property/casualty insurers have very limited direct exposure to the U.S. government bond market and have collectively set aside hundreds of billions of dollars to pay unanticipated claims," said Dr. Robert Hartwig, president of the I.I.I. and an economist. "Both of these factors will enable the industry to operate effectively despite the recent downgrade of long-term U.S. bonds." Consequently, Hartwig added, "Existing policyholders, people and businesses filing claims and those seeking to purchase insurance will not experience any difficulties arising from the downgrade."


    Lingering effects - 10 Years and a Diagnosis Later, 9/11 Demons Haunt Thousands - "One measure of the psychological impact of 9/11 is this: At least 10,000 firefighters, police officers and civilians exposed to the terrorist attack on the World Trade Center have been found to have post-traumatic stress disorder, and in a kind of mass grieving, many of them have yet to recover, according to figures compiled by New York City's three 9/11 health programs."

    One year ago... - Last week marked the anniversary of the shooting Hartford Distributors in Manchester, Connecticut. Here is a link to our post about the event, in which we discussed some of the comp-related aspects of the case and whether employer's can take measures to inoculate against such events.

    Not-so-friendly reminders department - Employers should be aware that workers' comp related retaliation can get expensive. But that is chicken scratch next to the penalties that might be imposed for things like failure to carry work comp insurance, misclassifying employees, and violating stop work orders.

    OSHA tool - Planning Ahead for Hot Weather: Employer Checklist.

    | Permalink

    August 4, 2011


    Joe Paduda has posted a steamy Health Policy Heat Wave edition of Health Wonk Review over at Managed Care Matters. He notes that "Far from the summer doldrums, activity related to the debt limit, IPAB, Medicare reform and Health Exchanges is at a late-September pace." Get in on the action, Joe always hosts a lively and informed edition.

    Coming & Going - Roberto Ceniceros discusses the compensability case of a NC public school principal who was shot while driving to work. This is an interesting case because the principal was conducting phone business on a school-issued phone while commuting and he was also paid for travel expenses. He was awarded benefits, but the case is headed for appeals court. Ceniceros notes that injuries that occur during a commute generally are not compensable. He also notes that this might be some of the earliest case law on this issue. And with the brave new world of ubiquitous work enabled by mobile devices, it surely won't be the last.

    Radical change - Peter Rousmaniere talks about the recent Illinois workers' comp reform and the radical change that the reform signified for workers' comp, change that he notes has largely gone unnoticed. He discusses two significant issues that surfaced in the reform: the "nuclear option," which Rousmaniere noted "freaked out almost everyone" - yet despite the dramatic language, an opt-out or non-subscribe program has long existed in Texas. The second issue that he notes is "an easy-to-overlook provision" that allows for union carve outs, which he discusses in greater detail. Peter's take on all things workers' comp is always well worth reading.

    FL CFO tackles check-cashing fraud - WorkCompWire reports that the Florida CFO will be reviewing check cashing services for collusion in workers' comp fraud, which is said to be diverting more than a billion dollars from Florida's economy. According to CFO Jeff Atwater, this latest workers' compensation premium scheme is highly organized and orchestrated by individuals who know the construction and subcontracting industry and are intent on evading payment of workers' compensation premiums.

    MA AG recoups millions in drug overcharges - In the latest of a series of settlements, Rite-Aid will pay $2.1 Million to resolve allegations of prescription drug overcharges. The settlement is the 5th in a series of similar settlements, the result of an investigation by Attorney General Coakley's office into prescription drug overcharges by pharmacies to public entities under the workers compensation insurance system. Settlements now total $7.9 million. Walgreens recently settled for for $2.8 million. Other pharmacies with settlements include CVS, Shaws Supermarkets, and Stop & Shop. Recouped money will be returned to cities and towns.

    OH BWC publishes Facebook fraud page - If you commit workers comp fraud in Ohio, you may find your photo on Facebook. Yesterday, we posted about workers' comp and social media, so we were interested to see that the Ohio Bureau of Workers Comp has launched a special investigations Facebook page. It will include news on recent investigatory action, a most-wanted section and a link to report fraud. The page can be found at

    World's scariest job? - If not the scariest, it certainly is a contender: Chinese Road Workers. For other scary jobs, see our post on the workers on the cruise from Hell and the untethered tower workers. I'll stick with blogging, thanks.

    Quick takes

    | Permalink

    July 27, 2011


    Cavalcade of Risk, the biweekly roundup of risk-related posts is posted at My Personal Finance - check out Issue # 136 - Riskiest Sports Edition.

    | Permalink

    July 21, 2011


    fan.jpgGiven the time of the year and the weather, you wouldn't blame our health wonks if there were all lazing around at the beach, but judging by this week's submission, they are all braving the heat and hard at work. And it is hot. It's sizzling outside and on fire in DC as the budget battle heats up and the debt ceiling deadline looms ever closer.

    Our wonks are hot too. We kick off this week's edition with Health Wonk Review founder Joe Paduda jumping into the fray. In who passed Part D and why you should care posted at Managed Care Matters, Joe holds some feet to the fire for the deficit.

    And before the budget cutting cuts too close to the bone, DC policy makers might consider posts from two of our wonks: At California Healthline, Dan Diamond reports on the recently released Oregon Health Study on Medicaid which some have called the "Most Important Study in Decades" and asks about its potential effect on health reform/health policy discussion. And in the first of a two-part series posted at The John A. Hartford Foundation blog's Health AGEnda, Chris Langston posts his concerns that in the current budget-cutting environment, we may be throwing out the baby with the bathwater with the recent focus on Medicare hospice costs.

    While we're dealing with heated issues related to reform, next stop is Health Beat for a post in Maggie Mahar's series on myths surrounding medical malpractice. She deconstructs 7 "myths" which are used to support caps on malpractice awards and looks at the political underpinnings for the push for malpractice reform. She makes the case for meaningful reform under the Affordable Care Act that will achieve a balance of financial carrots and sticks designed to enhance patient safety.

    The devil is in the details
    As we move deeper into the implementation of the Affordable Care Act, many of our wonks have opinions on its progress. As would be expected on a complex initiative that continues to draw heat, not everyone would characterize the changes as progress.

    To start, it can be helpful to look at the way the debate has been framed. Joseph White looks The Mixed (De)Merits Of 'Bending The Cost Curve' at Health Affairs Blog, tracing the development of the phrase. He argues the risks of this now ubiquitous metaphor outweigh its benefits - particularly in how it reflects the dominance of the debate by budgetary perspectives, favoring the interests that benefit from high costs now by devaluing approaches that would reduce costs more quickly.

    And in another post at Health Affairs Blog, Tim Jost tackles the proposed regulations for Health Insurance Exchanges in the first of a three part-series of posts. Part 1 introduces the regulation and deals with the exchanges themselves; Upcoming posts will analyze the provisions of the regulations addressing qualified health plans (QHPs) and health insurance issuers (part 2) and the reinsurance, risk corridor and reinsurance regulations issued the same day (part 3).

    At The Apothecary, Roy Avik offers a play-by-play replete with video clips of a recent congressional hearing on Independent Payment Advisory Boards (IPAB). Avik's take: "I thought that we had a fairly productive discussion about the ins and outs of Medicare's problems, and IPAB's role in addressing them."

    At InsureBlog, Bob Vineyard looks at the numbers for the Pre-existing Condition Insurance Plan (PCIP) and finds them lacking.

    Jaan Sidorov of The Disease Management Care Blog suggests that there is one question any hospital board should ask management about participating as an Accountable Care Organization (ACO), which are risk-bearing arrangements.

    The Affordable Care Act contains requirements and deadlines for the implementation of electronic medical records, collectively known as Meaningful Use (MU). At Healthcare Talent Transformation, David Scher breaks down the truths and common fallacies associated with Meaningful Use of Electronic Medical Records: A Practical Overview.

    At John Goodman's Health Policy Blog, John takes a look at the difference that RomneyCare has made. He says that most conservative critics of Massachusetts health reform have focused on any piece of bad news about the program they can find. The thinking has been that if this is the model for the federal legislation everyone calls "ObamaCare" it's got to have a lot of defects, right? But he notes that "The real story coming out of Massachusetts is that the whole thing is a yawner."

    Anthony Wright of Health Access Blog says that the real work of health reform is in setting up the Exchanges, and he reports on progress and milestones in the California Health Benefits Exchange.

    At Colorado Health Insurance Insider, Louise Norris tell us that in Colorado, the rules are changing for employer funding of individual health insurance. The Division of Insurance's stance regarding the use of Health Reimbursement Account (HRA) funds has changed again, with rules appearing to to have has both relaxed and tightened.

    Docs and dollars
    Many of our wonks have been looking at the issue of how physicians get paid.

    At Health Care Renewal, Roy Poses observes that having the former CEO of a health care corporation that paid more than $1 billion to settle fraud charges as Governor of Florida seems to have led to some interesting investigative reporting. In his post Would You Like Fries With That? - The Fast Food Model for the Corporate Physician he cites a story about the health care corporation with which Rick Scott was most recently associated as an example of what happens when the distinction between physicians and hamburger flippers is blurred.

    Do physicians make more money when they treat more complex patients? Jason Shafrin, The Healthcare Economist, examines a recent study in Denmark to see whether this has proven true.

    At Health Business Blog, David Williams helps us to understand the economics of health care credit cards for elective procedures: Why do doctors offer credit cards? It helps them avoid discounting

    Over at the e-CareManagement blog Vince Kuraitis teams up with Jaan Sidorov to discuss the 100 year shift, in which they see the potential for "a tectonic realignment among physicians, hospitals and payers." In the first of a seven part series, they offer an overview of trends - noting that physicians' economic interests are increasingly aligning WITH payers and AWAY FROM hospitals. Will this result in doctors and payers eventually sitting on the same side of the negotiating table?

    Consumer care
    At The New Health Dialogue, director Shannon Brownlee makes the case that less is more when it comes to angiograms, the imaging test that precedes an angioplasty or stent. She discusses a report by Grace Lin and Rita Redberg, cardiologists at the University of California, on three focus groups with groups of cardiologists who talked about three hypothetical patients. If your cardiologist recommends you undergo an angiogram, this paper will likely give you a reason to question that recommendation closely.

    At HealthNewsReview Blog, Gary Schwitzer has a pair of posts that raise questions about the proliferation of robotic surgery despite questions about evidence for benefits, harms - and costs. One talks about how Wisconsin hospitals with robots double prostate removals within 3 months and a second on the dearth of studies on the effectiveness of robotic surgery - a case of enthusiasm which has not been matched by comparative studies.

    At Pizaazz Glenn Laffel makes the case that EMRs can help reduce racial disparities in health care. He discusses why and how Electronic Medical Records can help narrow the digital divide, and calls attention to some vendors who are offering tools to help providers enhance care for medically underserved communities.

    At the Improving Population Health blog, David Kindig talks about environmental issues as a factor in public heath in the post Population Health and the Physical Environment: Beyond Air and Water.

    Tinker Ready reports and interesting case study of ADA accessibility adaptations that go well beyond Braille and ramps in her post Universal design: The science of access at the Museum of Science at Nature Network Boston - a refreshing story of progress.

    Occupational health
    Here at Workers' Comp Insider, our focus is generally on the occupational health arena, and we recently looked at whether OSHA's Voluntary Protection Program (VPP) is broken. A recent study points out that several program participants have had multiple fatalities - should they retain their status that allows exemption from programmed OSHA inspections?

    That concludes this issue of Health Wonk Review. Our next issue - and final issue of the summer season -- will be hosted at Joe Paduda's Managed Care Matters on August 4.

    | Permalink | 1 Comment

    July 14, 2011


    Risk roundup - This week's edition of Cavalcade of Risk - edition #135 - is being hosted by The Notwithstanding Blog. In that several countries celebrate their independence in the month of July, our host has a suitably related theme that may test the breadth of your geographic trivia. Oh, and there are some good posts this week, too!

    bi-conference.JPGMark September 22 on your calendar now - Better yet, head on over to Business Insurance and register for Virtual Advantage 2011 - Workers Comp Trends & Cost Control Strategies. We're very pleased that our own Tom Lynch will be participating on a blogger panel with three other blog luminaries: Roberto Ceniceros, Joe Paduda, and Mark Walls. There will also be a keynote by NCCI's Harry Shuford, an expert panel on pharmaceutical cost controls for worker's comp - and more. It's a one-day virtual conference - and best of all - there is no charge to attend.

    Presumption - And speaking of Mark Walls, congrats to him on his first column in Risk & Insurance. If you don't know Mark by name, suffice it to say he is the powerhouse behind LinkedIn's popular Work Comp Analysis Group. In Not all claims are created equal he talks about the thorny issue of presumption and how presumption laws fiddle with a basic tenet of the workers compensation pact: that the burden to prove an injury or illness "arose out of employment" falls to the employee.

    Self Insurance - If the workers comp market continues to harden, as many are predicting, many employers might be looking to alternatives to the traditional insurance options. In Risk Management Magazine, Richard C. Frese, a consulting actuary from Milliman, tackles the topic in his article Does Your Self-Insured Program Need a Tune-Up?. It's a good overview of what you need to know if you are considering the move.

    Employment law - Attorney Phillip Miles posts a handy SCOTUS Employment Law Year in Review 2011 - a summary of cases with links for more information.

    New blog discovery - check out Texas Mutual's Blog. We particularly liked the recent post on The ABCs of new employee safety. This is an important issue - in their own claim analysis, they found that roughly 27% of job-related fatalities involve employees who have been on a new job for less than 90 days. They also cite the OSHA stat that 40% of all injured employees have been on the job for less than a year. They also note that "new employee" may not just be a new hire: "New employees include people who transfer to a new position, return to work after an extended absence, operate a new piece of equipment or implement a new procedure." Check out the post for tips on this topic.

    Wow of the week - a little off topic, but check out this amazing video of the massive haboob (dust storm) that hit Phoenix on July 5.


    * Opioids, deaths, and workers comp

    * LAPD prescription drug abuse tied to disabilities

    * Consumer Reports: Can you read this drug label?

    * The 10 worst states for P&C insurers

    * Safety tip sheet: Livestock handling

    * Safety on the loading dock

    | Permalink | 1 Comment

    June 29, 2011


    We're pleased to be hosting issue #134 of the Cavalcade of Risk. We kick off this issue with an excellent TED presentation by Bruce Schneier on The Security Mirage which talks about how the feeling of security and the reality of security don't always match. He looks at why we spend billions addressing dramatic but rare risks that make headlines while neglecting more probable risks -- and how we can break this pattern.

    Schneier is a renowned security technologist and author with an excellent blog. Recently, Morgan Housel of The Motley Fool related the five cognitive biases that Scheir spoke about to lessons for investors.

    Our regular roundup
    This week, our blogger participants have submitted a tasty smorgasbod of entries on a variety of risk-related topics.

    We start with a pair of posts by our fearless leader, Hank Stern, from InsureBlog. Have you heard about the growing practice of personal car sharing? Hank looks at the consumer risks associated with the newly expanding "peer to peer" car sharing services industry in his post Stupid Client Tricks: P & C Edition. It's a great and informative post, but we would be remiss in leaving his blog without directing you to another post entitled Bark, Screech, Yowl. You'll have to click through to see the topic but here's an inducement to click: this post includes a video of a cat driving a car.

    While on the topic of insurance, we have a pair of posts that look at other aspects of your personal coverage. For your auto coverage, Philip Taylor asks what's the catch when it comes to Safe Driver Discounts in a post that examines the fine print of safe driver discounts. And do you know your financial exposure if your home should be destroyed in a disaster? At Canadian Finance Blog, Tom Drake asks if you have enough insurance on your home.

    Speaking of disasters, we know that catastrophic weather events are expensive, but rain? At Risk Management Monitor, Jared Wade looks at the the high economic costs of routine weather events. And on the topic of everyday-weather-related risks, we point you to our recent post here at Workers Comp Insider on lightning and lightning strike survivors in what we call "the one in a million club you don't want to join."

    Businesses & cyber exposure
    At Terms + Conditions, Claire Wilkinson posts about the recent spate of cyber attacks, highlighting the exposure that many businesses face. (And we would note that you don't have to be a bank or financial institution to have exposure. Note this recent item on how employers are vulnerable to a security breach by their own employees' ignorance of p