Recently in News roundups Category

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

• The Emerging Risks of 2012
• The supersizing of America: retooling for the obesity crisis
• Some Downsides of Social Media for Doctors
• Report: U.S. may never get back its investment in AIG
• OSHA Pocket Guide - Protecting Yourself from Noise in Construction (PDF)
• Why inspectors might hesitate to shut down a mine
• Untreatable Tuberculosis Baffles Doctors
• 5 Ways Employers Can Reduce Worker Stress

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, ePrognosis.org, 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!

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

• Inspections of Dairy Farms to Begin
• Tackling Muscle and Joint Pain (PDF) - a useful tool courtesy of kendallburton
• Emory Researchers Use iPhone 4 for Remote Assessment of Stroke
• Interactive safety: What's wrong with this photo?
• Worker fails to prove necessity for inground pool
• Bob's Top 10 Predictions for 2012
• The Ten Most Annoying Management Terms Of 2011

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

To usher in the new year, we're posting recaps of 2011 and prognostications for 2012 that we've gathered from some of our regular sources around the web.

PropertyCasualty360
Top 10 Stories of 2011
Catastrophes 2011: The Top 10 -- Revisited
2011's Headlines Set 2012's Course

Risk & Insurance
OSHA announces top workplace violations for FY 2011
POINT: 2012: A Bang-Up Year for Risk Managers
COUNTERPOINT: 2012: Another Challenging Year for Risk Managers

Business Insurance (registration may be required)
The Year in (Insurance) Cartoons
Business Insurance's top stories of 2011

Risk Management Magazine
Year in Risk

Joe Paduda
Predictions for 2011 - how'd I do?

Jon Gelman
(Gelman's) Top 10 Workers' Compensation Blog Posts for 2011

LexisNexis
Larson's Spotlight: Top 10 Cases for 2011 That You Should Know About
The Year in Review: Top 10 Workers' Comp Fraud News Stories

Workers Comp Zone
Top 10 Developments in California Workers' Comp in 2011

OSHA Law Update
Top 5 OSHA Developments to Look Out For In 2012

SafetyNewsAlert.com
Top 10 safety stories of 2011 - reader's choice

Tech Decisions
Top Tech Feature Articles of 2011

HR Daily Advisor
Year in Review

Human Resource Executive
A Look Back: At Employment-Law Issues
A Look Back: At the Workplace

Gary Schwitzer makes his hosting debut with Unwrapping early presents, wrapping up '11 Health Wonk Review series. Gary is the publisher of the excellent HealthNewsReview.org 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 "ny.gov" domain naming convention - the new web address is www.wcb.ny.gov. WorkersCompensation.com 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!

• Risk Managers Find Santa Exposed, Urge $1 Billion Coverage Plan
• Straight No Chaser: The 12 Days of Christmas
• I Got a Feeling, Hanukkah style
• Portable North Pole - Create a personalized video from Santa Claus for your children, friends, family members or colleagues
• Make a Flake
• Singing Christmas Hedgehogs - a cute interactive feature which shows that the holiday season is hard on hedgehogs!
• Tesla Christmas Tree - impressive, but don't try this at home!
• Gallery of Unfortunate Christmas Cards
• Don't Sue Me Santa Clause

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.

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.

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 Brainline.org.
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

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

• DOT Bans Hand-Held Cell Phone Use by Drivers of Buses and Large Trucks
• Save a Life: Recognize the signs of a stroke - STR
• Scent Free Workplaces - resources from the Canadian Centre for Occupational Health and Safety
• Skeletons and plague pits are grisly and surprisingly frequent finds in major construction projects - interesting item from Lloyds
• Georgia Factory Worker Sues After Being Fired for Refusal to Wear '666'
• Master the New Gmail with These Tips, Shortcuts, and Add-Ons
• Extreme holiday decorating & electrical safety

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.

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.

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

• Scent-Free Policy for the Workplace
• Workplace Bullying: Make it stop
• Cancer Victim Allowed to Sue for Retaliation
• Want to quit smoking? There's an app for that.
• Investigators: Better security needed at oil storage tanks to stop deaths
• Next Frontier in Credit Scores: Predicting Personal Behavior

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

• World Series Throws Risk Managers a Curve
• The Employer's Bill of Rights
• Simple Solutions for Office Hazards
• Oct. 16-22 Is National Teen Driver Safety Week
• OSHA gathering info on hearing loss prevention
• A Year Out of the Dark in Chile, but Still Trapped - followup on Chilean miners
• 10 Tips for Encouraging PPE Compliance

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

• Tracking Prescriptions with Technology
• What You Need to Know About the Workers' Comp and FMLA, ADA, and HIPAA
• Disaster Planning for Any Business
• Driver survey shows heavy cellphone use
• Texting While Driving Game - gauge your distraction
• 5 Reasons You Must get the Employee's Explanation
• Macaroni insurance?

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...

• America's Deadliest Jobs


• OSHA record keeping: what's the difference between medical treatment and first aid?


• The $6.9 Billion Smoking Gun E-Mail


• October 6: National Depression Screening Day


• DiabetesIQ Is a New Interactive App to Better Manage Diabetes

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.

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.

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.

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

workerscompensation.com: 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

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.

Reminder: 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.

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 BusinessInsurance.com

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?

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."

Related:

• Roberto Ceniceros of CompTime: S&P's credit downgrade & the cost of collateral for large deductible programs
• Phil Gusman, PropertyCasualty360: Indirect Impact of S&P Downgrade May Be More Meaningful for Insurers
• Mark Hoffmann at Business Insurance: U.S. debt downgrade will not affect insurer investment: Experts
• Bob Graham, Insurance & Financial Advisor: Investments of insurers 'unaffected' by S&P's U.S. ratings downgrade

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.

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 www.facebook.com/ohiobwcfraud

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

• Major League Baseball injuries increasing
• NCCI: 2010 was good for workers' comp residual market administration
• WCRI Study: Workers' Comp Drug Costs Higher in Texas, Louisiana
• The Preventable Annual Tradition Of High School Football Deaths
  
• Occupational Asthma in the U.S. Workplace

Cavalcade of Risk, the biweekly roundup of risk-related posts is posted at My Personal Finance - check out Issue # 136 - Riskiest Sports Edition.

Given 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.

Stateside
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.

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!

Mark 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.

Briefs

* 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

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 phishing scams.)

Data risks are here to stay. At DePaolo's Work Comp World , the topic is the convenience and risk of electronic records. He notes that the real real issue is the ease by which sensitive information may be obtained in large quantities, then analyzed and/or utilized for malicious purposes, and underscores the above point that employees rather than hackers likely constitute the biggest risk.

Healthcare related matters
How did one hospital address the increasing risk that nursing home patients will be transferred to a hospital for their end of life care? Jason Shafrin of The Healthcare Economist explores the issue in his post about maximizing utility for end-of-life care.

David Williams of Health Business Blog demonstrates the risk of being an early adapter of online services in his post about the disappearance of Google Health. He also offers a case study in physician risk in a post dissecting a medical malpractice defense related to a paraesophageal hiatal hernia repair and Nissen Fundoplication procedures.

Does providing user-friendly, patient-centric, clear, concise and objective information about the risks, benefits and alternatives of various treatment options enable consumers to choose wisely and forgo risky, dubious and expensive options. Jaan Sidorov posts about Health Advocacy Groups, Evidence-Based Medicine & Shared Decision Making at Disease Management Care Blog .

Safe retirement planning
Variable annuities are often promoted as a risk-free way to receive consistent retirement income. Kevin Mulligan of Retirement Planning Blog looks at the truth of the matter in his post on the risk of variable annuities.

If you plan to retire before Medicare kicks in, what are your healthcare coverage options? Free Money Finance looks at various ways to get retiree health insurance before the age of 65.

Assorted terrifying perils
For our final entry, Consumer Insurance Blog poses the most important question of the day: Are you ready for the Zombie Apocalypse? Find out before it's too late.

That concludes this week's edition - thanks to all submitters!

The next issue of Cavalcade of Risk is scheduled for July 13 at the Notwithstanding Blog - see you there!

Tinker Ready posts Health Wonk Review: Hockey, hoodlums and hot rod angels at Boston Health News

There's a lot of good reading in this issue - check it out!

Health Wonkery on Twitter
If you just can't wait a few weeks to get the next update of HWR, here are links to some of the HWR bloggers who are active on Twitter:

• Tinker Ready: @tinkerrr
• David Williams: @HealthBizBlog
• Health Affairs: @Health_Affairs
• New Health Dialogue: @NewHealthDialog
• Jaan Sidorov: @DisMgtCareBlog
• Glenn Laffel: @pizaazz
• Incidental Economist: @IncidentalEcon
• Avik Roy: @aviksaroy
• Gary Schwitzer: @garyschwitzer
• Richard Elmore: @richelmore
• Lucidicus Project: @Lucidicus
• Interdisciplinary Nursing Quality Research Initiative: @INQRIProgram
• Brady Augustine: @bradyafl
• Lynch Ryan: @workcompinsider

Cavalcade of Risk - for the biweekly smorgasbord of risk-related news from the blogosphere, check out the new edition of Cavalcade of Risk hosted at Political Calculations.

The $17 million fraud - not chump change - Most employers and insurers get very heated on the topic of work comp fraud - as well they should. But while keeping an eye on the front door for shoplifting, some thieves are loading up the company safe from the back door. This week, four members of a California doctor mill were indicted in a $17 million workers' comp fraud. This stunning scheme bilked the city of Los Angeles and 19 insurance companies. Joe Wheeler talks more about the fraud and how it exposes a weakness in the system. He rightly notes, "That this relatively small fraud provider ring offering obscure medical procedures could make off with millions of dollars before being caught should make anyone involved in workers' comp benefits take a breath." Note to employers: it's not enough to think your insurer will manage everything - you need to take an active interest in managing and questioning claims, too.

In the line of duty - Louisiana flags are flying at half mast this week for two insurance investigators who were shot to death by an agent last week while investigating fraud. According to Insurance Times, investigators Kim Sledge and Rhett Jeansonne "...had gone to the Ville Platte office of suspended insurance agent John Melvin Lavergne to collect records. Lavergne shot the investigators and then killed himself." Louisiana is now looking into whether fraud investigators should be able to carry guns.

Is the soft market finally hardening? - Joe Paduda talks about recent reports from Towers Perrin and Fitch Ratings pointing to firming work comp premiums. No, really!

Dollars for doctors - ProPublica has been featuring an ongoing series that investigates the financial ties between the medical community and the drug and device industry. You can follow the entire series from the above link. In addition to several feature stories, there were frequent updates in made in May, several of which discuss drug industry ties to medical societies. In October, ProPublica also rolled out a searchable database of physicians who have received drug money, gleaned from public disclosures of seven large pharma companies. For a sampling, here is Massachusetts.

Ferreting out the more obscure news... - Among all the informative and useful information he posts over at Comp Time, Roberto Ceniceros also manages to ferret out some of the quirkier workers comp stories. This week, he posted about Palin's emails and the workers comp connection and last week, it was porn industry hazmat suits.

Confined space videos - WorkSafeBC produces a lot of great safety resources. Recently, a three-part video series on confined space came to our attention - worth checking them out. Part 1: Safe Yesterday, Deadly Today; Part 2: Test to Live; and Part 3: Rescue: Just Calling 911 Doesn't Cut It.

Health Wonk Review - John Irvine & Matthew Holt host a hefty edition of Health Wonk Review over at The Health Care Blog - lots of good health wonkery there!

Illinois work comp reform - After all the sturm und drang in the Illinois reform process, we've had a breakthrough ... a reform bill finally passed on the last day of the legislative session. In a Tale of Persuasion, AP's Zachary Colman takes you step by step through the painful process. And at Managed Care Matters, Joe Paduda offers an excellent rundown of some of the key provisions in the Illinois work comp reform bill.

In other Illinois news, the matter of $10 million in repetitive stress claims filed by Menard County prison guards has taken some new twists. The Illinois house recently passed a bill requiring the release of the related workers' comp test records in compliance with the Freedom of Information Act. A report obtained through the FOIA shows that locking and unlocking prison cells didn't injure the guards.

Missouri's second injury fund woes - Injured workers in Missouri are being left in the lurch, according to a story in stltoday.com. about the state's troubled Second Injury Fund Roberto Ceniceros posts more about Missouri's financially-ill second injury fund.

Mobile risks - Andrew Simpson writes about the increased workers comp exposure as more workers go mobile in Insurane Journal. In the past, the workplace was a clearly defined place and the hours of operation were also clearly defined, but as more and more workers go mobile, things are much less clearly defined - the lines between professional and personal life are blurring. Plus, employers are often supplying the mobile devices to workers, increasing their exposure to claims that occur when off site or off the clock. "Insurance claims professionals say claims made by workers injured while doing things where the relation to their employment is unclear are on the rise and the increasing use of mobile devices is challenging traditional notions of work-related injuries."

Workplace violence factors - The Workplace Violence Blog posts about the prevalence of workplace violence as evidenced by a Society of Human Resource Management survey, and states that "Approximately $55 billion a year is lost to litigation awards, property damage and lost productivity from workplace violence. It is estimated that productivity can drop as much as 50% in the six to eight weeks following a workplace violence incident." The post includes seven common organizational factors that contribute tow workplace violence.

Industry growth - Insurance is one industry that is poised for growth. According to a recent research report issued by IBISWorld, employment in TPAs and and claims adjusting is set to grow 5.7% annually between now and 2016. "Other industries in the IBISWorld top 10 fastest-growing for the next few years include sustainable building material manufacturers, multi-family home builders, used car dealers, remediation and environmental cleanup services."

MRSA facts from the CDC - From the CDC, MRSA and the workplace, including a list of frequently asked questions. Staph infections, including antibiotic resistant MRSA, MRSA skin infections can occur anywhere. However, the CDC notes that some settings have factors that make it easier for MRSA to be transmitted. These factors, referred to as the 5 C's, are as follows: Crowding, frequent skin-to-skin Contact, Compromised skin (i.e., cuts or abrasions), Contaminated items and surfaces, and lack of Cleanliness. Locations where the 5 C's are common include schools, dormitories, military barracks, households, correctional facilities, and daycare centers.

Happy birthday, Cavalcade of Risk! - Russell Chatswood hosts the Fifth Anniversary Edition of Cavalcade of Risk - check it out. Russell is a New Zealander and among the Cavalcade's posts is an update on the Christchurch earthquake claims from a report issued by New Zealand's Investment Savings and Insurance Association (ISI).

New to our blogroll - DePaolo's Work Comp Blog - by industry veteran Dave DePaolo, founder and CEO of WorkCompCentral.

When the bears win - In a post at Comp Time today, Roberto Ceniceros reports on a Utah appeals court ruling that upheld benefits for a light-duty employee who was fired for sending porno to colleagues via email. In citing the ruling, Ceniceros quotes The Stranger in the The Big Lebowski who said, "Sometimes you eat the bear, and sometimes, well, he eats you." That is our nomination for our motto of the week.

Zombie style at the CDC - Have trouble getting your message heard by employers and employees? Maybe you need a new, attention-getting spin. Consumer Insurance Blog posts about how the CDC highlighted the importance of disaster and emergency planning by repackaging it as Preparedness 101: Zombie Apocalypse. With this packaging, they went from a few thousand page views for normal posts to more than 1.2 million over the course a few days.

Cell phones & brain cancer - In reaction to the recent World Health Organization warnings about cancer and cell phones, Merril Goozner posts about the role that conflicted science plays. Also see Gary Schwitzer's post: News release precedes release of evidence on new cell phone/brain cancer warning.

ADA Amendments Act - The final regulations issued by the EEOC to implement the ADA Amendments Act of 2008 became effective on May 24. The new regulations feature 9 "Rules of Construction" to help employers determine whether an impairment substantially limits a major life activity. HR Daily Advisor offers a pair of posts to help employers plan for the changes: ADAAA Effective Tomorrow--Ready for Its 9 Rules of Construction? and ADAAA Effective Today--Steps Employers Should Take.

Cool tool - Objects falling from a height are a serious safety hazard - that's why anyone working at a height should secure their tools. Tethers are a good way to do this. Hammerhead Industries offers a one page reference sheet: Tool Tether Guide (PDF)

Bus safety - At Risk Management Monitor, Jared Wade brings the news of another fatal bus crash which claimed the lives of 4 and injured more than 50. Driver fatigue is cited as the cause of the crash. Wade cites this as another instance highlighting the industry's lack of oversight, and posts about other recent coverage on bus safety. He notes that there have been two stalled-in-Congress bills that have attempted to impose greater regulations: the Motor Coach Enhanced Safety Act and the Bus Uniform Standards and Enhanced Safety (BUSES) Act.

OSHA fines - from The Safety Blog, the Top 10 fines for construction companies. "In total in the 2010 fiscal year OSHA inspected 16,473 small construction companies and handed out 50,630 citations. These citations cost employers more than $46 million or an average of about $900 a citation."

Chris Fleming hosts a substantive Memorial Day issue of Health Wonk Review at Health Affairs Blog - there are a lot of good submissions on a variety of topics, from Medicare and the Affordable Care Act to quality and healthcare IT.

If you have an interest in health care - and with medical costs comprising a bigger and bigger portion of the claims dollar every year, you probably do - Health Affairs Blog is a good candidate for your regular reading list. The Blog is an offshoot of the publication of the same name, a peer-reviewed health policy journal that has held a premier place in the health policy arena for the last 30 years. The blog is a welcome adjunct to the journal. According to their "About" page: "The Blog features posts from noted health policy experts on both sides of the political aisle as well as regular Health Affairs contributors and staff. Recent bloggers have included Former Bush HHS Secretary Tommy Thompson, economists Uwe Reinhardt and Gail Wilensky, California HealthCare Foundation President and CEO Mark Smith, and Congressman James Cooper (D-TN)."

Cavalcade of Risk - Emily Holbrook is hosting the 131st edition of Cavalcade of Risk at one of our favorite risk-related blogs, Risk Management Monitor. Check it out!

Compensability issues - In disputes as to whether an employee's injury or illness is eligible for benefits, courts look at the issues of whether the injury arose in the course and scope of employment. Roberto Ceniceros posts that while course and scope have generally been regarded as a single doctrine, that may be changing with the challenges posed by an increasingly mobile work force. See his blog post: "Course and scope" separated.

Safety for the solitary worker - Speaking of a mobile work force, do you have workers who work alone? Solitary work poses unique safety challenges. See Safety Daily Advisor's tips for keeping solo workers safe.

Claims IT systems webinar - Health Strategy Associates has an upcoming webinar that may be of interest to some of our readers: the results of HSA's First Annual Survey of Workers Comp Claims IT Systems. If the sponsoring organization's name isn't familiar to you, it's our fellow blogger and friend Joe Paduda's firm - he's sponsoring the seminar in conjunction with colleague Sandy Blunt. If this interests you, act now - the webinar is scheduled for tomorrow!

Mining safety, one year later - On last week's anniversary of the West Virginia Big Branch mine disaster that claimed 29 lives, the latimes.com looks at progress - or lack of progress - in enhancing miner safety: Families of dead miners feel let down by Washington. The story reports that in the past year, a safety bill has failed and the backlog of safety cases has grown.

Top HR issues - Workforce covers the top 10 HR concerns as reported by the Employers Resource Association. These issues are compiled from the more than 8,000 hotline calls made by the organization's membership of 1,300 companies in Ohio, Kentucky and Indiana.

Mousing elbow - As we incorporate more and more devices in our work-world, technology-related maladies seem to multiply. Greg LaRochelle of the MEMIC Safety Blog talks about Mousing Elbow and how to prevent it. See also Blackberry Thumb, Cell Phone Elbow, IPod Ear. Also, see our ergo tips for setting up a workstation.

Medical costs - Can making physicians aware of the costs for procedures help to curtail costs? Katherine Hobson of WSJ's Health Blog reports on an interesting research project that showed a decrease in expenditures for routine lab tests when physicians were made aware of the overall costs for such procedures: "Cosimi tells the Health Blog the study represents "a good first step, just to show that there's a problem, and a potential solution." The goal would be to establish guidelines for proper testing. And he says it's not just blood work that could benefit from this kind of approach. At his own transplant unit, he noticed changes in prescribing behavior simply by posting the very different costs of two similar antibiotics."

Hidden costs - We all know the health risks of smoking and that smoking can contribute to comorbidities that hinder worker recovery. But there are lesser known risks that can contribute to claim costs, In PropertyCasualty360, Zack Craft of Total Medical Solutions talks about how smoking can damage sensitive medical equipment too, and a factor that adjusters should consider.

Wage & hour violations? There's an app for that - If you feel like your employees are tracking you, they may well be. Employment attorney Michael Fox posts about the Department of Labor's new timesheet i-phone app, which is intended to help employees track the hours they work and the wages they are owed. The DOL says that, "This information could prove invaluable during a Wage and Hour Division investigation when an employer has failed to maintain accurate employment records."

Did you miss your biweekly dose of heath wonkery last week? Grab a cup of Monday morning coffee and catch up now with news from the best of the health blog pundits - Hank Stern hosted a concise compendium in his Health Wonk Review Spring Renewal edition at InsureBlog. Thanks, Hank!

The latest edition of Cavalcade of Risk is up, hosted by David Williams of MedPharma Partners LLC. If you have any interest in liability for dog bites, insuring exotic animals (kangaroo, anyone?) or the percentage of drivers who admit to driving without insurance (about 10% - yikes!) - among other interesting items - check it out. It's brief and very much on point.

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

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

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

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

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

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

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

News briefs

• Weekly Toll: Death in the American Workplace
• Kansas Governor Signs Workers' Comp Reform Bill
• Here's a Scary Fact: 75% of Substance Abusers Are Employed
• Prescription drug abuse: are you complicit?
• ACOEM Comments on Update of NIOSH Nanotechnology Strategic Plan for Research and Guidance
• 11 iPad Apps for meetings and presentations
• 200 largest companies CEO compensation report.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Briefs from the Blogosphere

• Feds investigate Illinois state agencies for fraud
• Drug cost inflation - it's getting bad
• Top 25 Property/Casualty Insurance Writers
• 5 recent work comp cases you should know about
• How much time do you have to produce OSHA Logs for an OSHA inspector
• Health Risk Appraisals: Are you maximizing their potential?
• Insurance issues for the rich and famous

We are now a week and a half into the Japanese disaster, which encompassed a terrible trio of catastrophic events: an earthquake, a tsunami, and a near-nuclear meltdown that looked to be vying for a top spot in the record books. The death toll tops 9,000, with another 13,000 still missing. And today at the Fukushima Nuclear Plant, although a large scale meltdown looks to have been narrowly averted, the extent of the radiation leaks and the related damage are still yet to be fully assessed.

The heroes of the past week, those credited with keeping events at the nuclear plant from spiraling irretrievably out of control, are being hailed as "the Fukushima 50." In actual numbers, they are more like 200 courageous souls, taking turns in 50-person shifts while the world watched from outside the 20 kilometer evacuation zone.

When the full extent of the crisis at the Fukushima plant became apparent in the wee hours of March 15, TEPCO wanted to remove all staff. Prime Minister Kan summoned TEPCO President Masataka Shimizu to his Office and told him that leaving was was not an option. "This is not a matter of TEPCO going under; it's about what will become of Japan," he said.

ABC news sheds a bit more light on the team who struggled to restore order to the crippled plant. The crews are though to be hands-on workers, technicians, rather than managers.

"The crews are not necessarily made up of strong young men. Emergency nuclear scenarios suggest asking older retirees to volunteer, not because they're more expendable, or even because they're more skilled, but because even if they're exposed to massive amounts of radiation, history has shown they would die of old age before they die of radiation induced cancers, which can take decades to develop."

"While radiation-induced cancers are a serious worry for those exposed to high doses of radiation, they usually take at least a few years to set in.

"You may see an incidence of cancer 30 years down the road. Cataracts can set in in 30 to 40 years," said Jenkins. "Leukemia showed up within a few years in the atomic bomb survivors, but solid cancers did not appear until 10 years and continue [to show up] to this day," said Hall."

Wikipedia's page on the Fukushima 50 offers more detail about the radiation exposure these workers faced in comparison to that of other nuclear workers.

"The international limit for radiation exposure for nuclear workers is 20 millisievert (20 mSv) per year, averaged over five years, with a limit of 50 mSv in any one year, however for workers performing emergency services EPA guidance on dose limits is 100 mSv when "protecting valuable property" and 250 mSv when the activity is "life saving or protection of large populations."

Prior to the accident, the maximum permissible dose for Japanese nuclear workers was 100 mSv in any one year, but on 15 March 2011, the Japanese Health and Labor Ministry enforced the permitted 250 mSv limit, in light of the situation at the Fukushima Nuclear Power Plant."

Between 1986 and 1992, it is thought between 600,000 and one million people participated in works around Chernobyl and their health was endangered due to radiation. Because of the dissolution of the USSR in the 1990s, evaluations about liquidators' health are difficult, since they come from various countries (mostly Ukraine, Belarus and Russia, but also other former Soviet republics). Furthermore, the government of Russia has never been keen on giving the true figures for the disaster, or even on making serious estimates. However, according to a study by Belarusian physicians, rate of cancers among this population is about four times greater than the rest of the population. (Wikipedia notes that "All the figures quoted by various agencies are controversial.")

Insurance issues related to Japan's disaster
According to the Insurance Information Institute, Japan's earthquake could cost $15 billion to $35 billion, one of the costliest ever. This would be a tough enough kick in the shins for the insurance industry, but III notes that, "... four of the five costliest earthquakes and tsunamis in the past 30 years have occurred within the past 13 months."

See more from III at their excellent resource page on the Japan earthquake and Pacific Tsunamis

Here are some other insurance-related articles that shed light on one or another aspect of this mammoth event.

We aren't up our international compensation law, but our Googling turned up this overview of Workers Accident Compensation in Japan.

Joanne Wojcik tackled the nuclear topic in Business Insurance in her article Coverage restrictions expected to limit nuclear claims (subscription required). We offer this excerpt:

Under Japan's 1961 Law on Compensation for Nuclear Damage, which was amended in 2010, power plant operators' liability for accidents such as those after the earthquake and tsunami is limited to 120 billion yen (about $1.5 billion), with the Japanese government assuming responsibility for any third-party damage or bodily injury claims beyond that amount.

To meet the requirements of the law, Japanese nuclear power plant operators buy property and liability insurance from the Japan Atomic Energy Insurance Pool. JAEIP provides nuclear property, nuclear liability, general liability and terrorism coverage to nuclear power plant operators. However, JAEIP does not sell the utilities coverage for earthquake damage, tsunami damage or business interruption, leaving the Japanese government responsible for those costs.

If a nuclear incident similar to that occurring in Japan were to happen in the United States, the U.S. Price-Anderson Act limits liability for nuclear power plant operators to $12.6 billion.

At Risk Management Monitor, Emily Holbrooke looks at the issue of business interruption and its effects on global corporations. Many think the real story is one of good engineering saving thousands of lives - Jared Wade discusses this in his posting about how Japan's bulding codes prevented casualties.

Also in Business Insurance, Judy Greenwwald looks at the complicated claims process ahead:

Corporate policyholders that do business with companies in Japan face a complicated process when they attempt to tap their contingent business interruption coverage because of the intertwining nature of the disasters that have struck the nation, observers say.

"This is going to be one of the most complicated catastrophes that I've seen," said William Okelson, Chicago-based director of property claims for Lockton Cos. L.L.C. There are "so many variables," including the original quake, the tsunami, resulting fires, nuclear power plant dangers and the government rationing of electricity.

At LexisNexis, Julius Young examines a "what if " scenario: What If? Workers' Comp and Earthquakes. Jon Gelman puts the events in some historical context relative to other large-scale disasters and nuclear events: A Nuclear Workers' Compensation Disaster.

Health Wonk Review - What do baseball and healthcare have in common? Find out - Glenn Laffel of Pizaazz hosts a fresh helping of the best of the health policy blogosphere: Health Wonk Review: Spring Training Edition

Does an anti-immigrant climate affect workers comp costs? - At Comp Time, Roberto Ceniceros discusses a recent news story in which Tom Hensley, president of Fieldale Farms Corp, testifies before the Georgia General Assembly about the detrimental impact that anti-immigration measures are having on his business. The impact included higher turnover and higher workers comp costs. Roberto is interested in hearing if anybody else has witnessed a similar trend of Latinos fleeing a state because of anti-immigrant sentiment and then claims trending upward - drop him anot if you have something to add.

Can you hear me now? Musicians and other workers who are exposed to loud music in their workplace are typically given short shrift in the occupational safety and health literature. Recent studies at nightclubs show that all employees (waiters, bartenders, DJs, etc,) were exposed to noise levels above internationally recommended limits and were at a higher risk of early hearing loss and tinnitus. The NIOSH Science Blog discusses music-induced hearing loss.

Giffords covered by work comp - Stephanie Innes of the Arizona Daily Star reports that federal workers' comp is footing the recovery bill for Gabrielle Giffords and two of her employees who were shot in January. Because they were working, it's an on-the-job injury. The federal law has no cap on medical payments, which is fortunate since the story reports that, "The Brain Injury Association of America says inpatient rehabilitation costs can range from $600 to $8,000 a day depending on services, and outpatient rehabilitation can cost $600 to $1,000 a day."

Shrinking employer appetite for RTW? - Joe Paduda looks at how the economy may impact workers comp in 2012. Is higher severity in the offing? Joe talks about why that might be the case.

What makes a good claims organization? - At PropertyCasualty360, Carl Van, president and CEO of the International Insurance Institute, Inc., has posted the first in a three-part series on The Five Standards of Great Claims Organizations. See how your organization or your vendor stacks up.

Complex care - the folks at TMS continue to demonstrate that in complex care cases, the devil is in the details - and those details may be impeding an injured worker's recovery and costing you money. See Pressure mapping: The underwear case for another example of how a small problem can become a big one.

Cool tool - Calculate your injury and illness incidence rates for your organization and compare them with national, state-specific, or industry-specific averages: Incidence rate calculator and comparison tool

Jobs of yesteryear - Ptak Science Books features a series of photos of Pennsylvania Coal Boys on the job in 1895 excerpted from an issue of Scientific American.

Japan - HR Web Cafe has posted various resources, including options for donations. The interactive before and after satellite images are very dramatic, giving some sense of scope.

Jay and Louis Norris have posted the 126th edition of Cavalcade of Risk at Colorado Life Insurance Insider - and it's a good one. We post blog news roundups regularly - and we are always delighted when our friends from Colorado host - they do a great job summarizing, presenting and commenting on submissions. Check it out!

Jared Rhoads of The Lucidicus Project hosts this week's Health Wonk Review, and he dishes up a heaping helping of the blogosphere's best heath policy posts from the last two weeks. Check it out!

Happy Birthday - to David Williams at Health Business Blog for 6 years of quality healthcare blogging. David is one f the regular Health Wonkers. See his Best of the Blog post for a fine sampling of his work.

More sports-related head trauma tragedy - Earlier this week, my colleague posted about football-related chronic traumatic encephalopathy (CTE). Yesterday, the New York Times featured a story about how hockey brawler Bob Probert also suffered from CTE: "But the legacy of [Bob] Probert, who died last July of heart failure at 45, could soon be rooted as much in his head as his hands.After examining Probert's brain tissue, researchers at Boston University said this week that they found the same degenerative disease, chronic traumatic encephalopathy, whose presence in more than 20 deceased professional football players has prompted the National Football League to change some rules and policies in an effort to limit dangerous head impacts."

Bill review - Are you getting what you pay for with medical bill review? At Managed Care Matters, Joe Paduda takes some of the mystery out of the equation in his discussion about what your savings should be from your work comp medical bill review program.

Criminal indictment for Massey mine official - Hughie Elbert Stover, the chief of security for Massey Energy's Upper Big Branch Mine has been charged with two felonies related to the April 2010 explosion that killed 29 coal miners. He is accused of lying to investigators and destroying records. On his blog, reporter Ken Ward asks if this is just the beginning of indictments.

Don't mess with Texas - If you ever use the words "workers compensation" and "Texas" in the same sentence, you better think twice. TX law blogger John Gibson has been issued a "cease and desist" order and threatened with further legal action for his TX Workers Comp Law Blog for having the temerity to use the words "workers compensation" and "Texas" in his blog. We can't get Gibson's take because his blog appears to be down (www.texasworkerscomplaw.com), but Julius Young posts the scoop on the Texas workers comp language imbroglio at his Oakland Workers Comp Blog. If you don't see his post - or ours - please blame Texas. Just to be on the safe side, from here on out we may begin referring to Texas as "Exas-Tay."

Sedgwick acquires SRS - In a major move in the world of third party administrators, Sedgwick completed the purchased of Specialty Risk Services for $278 million. SRS was the claims TPA arm of The Hartford. In his bog on the Hartford Courant, Matthew Sturdevant reports that: "The deal makes Sedgwick CMS the largest independent North American provider of claims administration services. The combined companies will have annualized revenue of about $1 billion as well as almost 8,500 employees."

Devil's in the details - Yvonne Guilbert of Complex Care Blog posts two concrete incidents that show how one small detail missed in home care could easily end up costing $50,000 or more.

Safe hiring practices - As the economy ramps up, new hires will increase an employer's potential for workplace injuries. At MEMIC Safety Blog, Greg LaRochelle says that a new employee is 5x more likely to have a lost-time injury than a more experienced worker, and that 40% of all workers injured on the job have been on the job for less than a year. He posts about hiring practices to help mitigate risk.

Hiring Vets - HR Daily Advisor offers a good roundup of tips and advice for hiring returning veterans. The post includes questions to ask and to avoid during the interview.

Short Takes
AIG results and workers comp
Four steps to evaluate absence policies
Insurance Fraud Hall of Shame 2010
Smiling makes the world go round
7 wellness benefits employees want most

When is healthcare like a box of chocolates? Find out over at Colorado Long Term Care Insider, where Louise & Jay Norris host an excellent Valentine's Week Edition of Health Wonk Review.

Other news of note:
Tasers & cop claims - Roberto Ceniceros of Comp Time has an interesting post on how taser use by police is reducing injury rates and comp claims because it provides a low-impact way to subdue suspects. But tasers are also used on cops-in-training, sometimes resulting in serious injuries.

The straight dope - Joe Paduda has a do-not-miss post on narcotic opioids in workers comp and Cephalon's role, in which he discusses how drugs like Fentora & Actiq, which are FDA approved only for cancer patients, are being promoted to workers comp patients. (One court ruling stated, "data suggested that more than 80% of patients using Actiq did not have cancer," and "oncologists accounted for only 1% of Actiq prescriptions filled at retail pharmacies in the U.S.") Cost is a huge issue, but Joe points out that it is not all about the money: Actiq has been linked to dozens of deaths from overdose.

Medical marijuana - Last week, Michigan court rulings dealt a double blow to medical marijuana. One of the Michigan rulings upheld the firing of a Walmart employee who had been proscribed the drug to control symptoms of his brain cancer, a case we posted about last year: Walmart: Shopping for Souls in Aisle Three. (Also see our recent post: Medical Marijuana in the Workplace: Dude, Lock Me Out!.)

Insurer market share - Cyril Tuohy of Risk & Insurance offers a short journey through the latest insurance industry statistics, including some great stats about market share: This Just in: Known and Lesser Known Facts About the Industry

Not something you see every day - CompNewsNetwork informs us that the Ohio Bureau of Workers' Compensation has recently snagged a record $830,000 in restitution from a prior fraud conviction. The case was truly egregious - an anesthesiologist who bilked the system for $60 million in fraudulent claims - while contributing to at least two deaths in the process. Dr. Jorge Martinez was sentenced to life in prison for "the first known conviction involving a criminal charge of health care fraud resulting in death after the overdose of two patients seeking treatment for work related injuries."

Illegal immigrant update - Peter Rousmaniere's Working Immigrants blog is your in-the-know source for tracking the latest issues and stats on the topic. Via the Pew Hispanic Center, he informs us that the 2010 illegal population in 2010 remains about the same as in 2009: about 11.2 million, of which 8 million are in the workforce, and 58% of which are Mexicans. See more detail: Estimate of illegal immigrant population in 2010.

Good WC bookmark - We are adding WorkCompWire as a bookmark in our sidebar and you should keep it handy too. It's a good source of news and opinion - check it out!

Savings on complex care - Yvonne Guilbert points out that overlooking simple facts can add significant costs to a claim very quickly. She asks carriers what they are missing on complex claims that might be costing them money.

Market pulse - At PropertyCasualty360, Caroline McDonald talks about why buyers shouldn't get to comfortable with low workers comp rates. One of the primary sources for the article is our friend Mark Walls of Safety National - who is also well know as the founder of LinkedIn's Work Comp Analysis Group.

Diversity - Jared wade posts that 18 insurance firms are among the best companies for LGBT employees to work for - "scoring a perfect 100% as a Best Place to Work for their 'support equality for lesbian, gay, bisexual and transgender employees,' according to HRC."

Distracted driving in NY - A sign of things to come? In New York, drivers will get two points for talking on hand-held cell phones. A two-point penalty has already been in place for texting while driving. At that rate, auto insurance sure could get expensive quickly for compulsive phone-o-philes.

Mental health - CCOHS, the Canadian counterpart of OSHA, makes the case for why employers should care about mental health at work.

Feeling risky? Catch up on your reading - Jaan Sidorov of The Disease Management Care Blog hosts this week's risky roundup: The 124th Cavalcade of Risk

Work Comp history
Yesterday, we posted a feature on window washers as a dangerous profession, which included some vintage photos of workers pre-OSHA. Later, via Complex Care Blog, we were alerted to Peter Rousmaniere's excellent article in Risk & Insurance, Into the Work Killing Ground, which turned the clock back even further. Peter offers a fascinating and chilling glimpse into what the working world was like at the start of the last century, before workers compensation laws had been enacted. He notes that, "The fatality rate at the time, if transposed to today's population, would exceed 300,000 deaths a year. Our rate was twice as high as England's." He talks about one young attorney, Crystal Eastman, who began documenting injuries and fatalities just in the Pittsburgh area alone. Her report became a catalyst for the ensuing law. If, like me, you didn't know about her contribution to workers' comp, you can learn more about Crystal Eastman at Wikipedia.

This dramatic satellite shot from NOAA captures the scope of the blizzard that swept across the country in the last few days. Being snowbound offered our contributing bloggers lots of time to think about all things healthcare, and in that arena, the climate is almost as stormy as the weather. The Florida judge's ruling against the Health Care Act was much on the mind of several of our bloggers, as was the State of the Union address -- both of which occurred since our last compilation. We have a lot of good submissions this week - grab a cup of cocoa to take the chill off and dig in.

Managed Care Matters - Hosting has its privileges, so we kick off this issue with a nod to the blogger who did the heavy lifting last issue, Joe Paduda. One thing we love about Joe is that he is never one to mince words, as evident in this week's submission, Paul Ryan's blatant hypocrisy - and the abject failure of mainstream media. Joe takes the Wisconsin representative to task, along with most of his colleagues in the GOP and the mainstream media. He finds today's hand-wringing over healthcare related debt insincere from the same players who ignored yesterday's elephant in the room. Also see his related post: If health reform is overturned.

The Apothecary (posted at Forbes) - Avik Roy's post Florida v. HHS: Why Vinson's Ruling Might Stand offers a detailed discussion of the four components of Judge Vinson's Monday ruling, with an emphasis on why the lack of a severability clause might be the key factor in overturning the entire law.

California Healthline - With talk of rolling back the Patient Protection and Affordable Care Act dominating the news, Dan Diamond reminds us that this isn't the first time that Congress has considered overturning a major health law. He wonders if the battle over the 1988 Medicare Catastrophic Coverage Act and its repeal 17 months later mightn't hold some lessons for today.

Colorado Health Insurance Insider - Louise Norris suggests that any debate on healthcare should be based first and foremost on facts rather than rumors. She puts on her detective hat in considering whether a Colorado Representative's vote was swayed by debunked info from an E-mail forward. She thinks the public debate should be informed by a higher standard and offers some clues for spotting suspect chain-mail claims

Disease Management Care Blog - Jaan Sidorov considers Atul Gawande's recent essay The Hot Spotters and asks if targeted care management is something new? Jann says that while The New Yorker article might garner the glitteratis' attention, the practice of identifying and reaching out to patients at risk is a standard MO in many commercial insurance plans. "What's next, Dr. Gawande," he asks, "discovering that there are machines that use electromagnetic radiation to take pictures of people's insides?"

Health Affairs Blog -Tim Jost offers an analysis of Judge Vinson's decision invalidating the Affordable Care Act, while his co-bloggers opine about the implications of the Sate of the Union speech and its aftermath: Kavita Patel on health care and the State Of The Union; Len Nichols who suggests being honest for a change, and Joe Antos with a taste of budgets to come.

Health AGEnda - In his post on the the John A. Hartford Foundation's blog, Chris Langston poses a good question: Why are Medicare's innovations more secret than the Joint Strike Fighter?. He champions the idea that we should be more nimble, transparent and collaborative in sharing innovations and improvements in care, particularly in terms of knowledge that we as taxpayers have already purchased.

Health Beat Blog - Maggie Mahar suggests that when it comes to electronic health records, perhaps we should walk before we run. She likens the mad stampede of EHR implementation to a market bubble with too many sellers, too many buyers, and too little information. In light of this, she tackles the question of whether Congress should defund the conversion to EHRs as some are proposing.

Health Business Blog - What makes you sad? For David Williams, it comes down to three words: US biogenerics policy. David makes the case that the debate on biogenerics misses the point: There are better, safer, faster ways to bring down the cost of biotech drugs while preserving incentives for innovation.

Health Care Renewal - Roy Poses makes a strong contribution to this week's roundup with his post Big Door Keeps On Turning. He lists examples of health care leaders going from government to industry and then back to government again. He asks if this revolving door, with its constant interchange among corporate and government health care leaders, is a sign of how corporatist health care has become and if we can we really expect a cozy corporate leadership class with no fixed loyalty to any organization to put the care of individuals and populations ahead of their personal interests and relationships?

Health News Review Blog - Gary Schwitzer enlists the help of Harry Demonaco, director of the Mass. General Hospital's Innovation Support Center in turning a critical eye on health screening advice issued by Prevention magazine, which advised readers, "If you haven't had these cutting-edge screenings, put this magazine down and call your doctor. Now." This is cited as another bad example of screening madness in US health care journalism, which promotes and fosters screening outside the boundaries of the best evidence.

Healthcare Economist - Jason Shafrin informs us that home health services are among the fastest growing services that Medicare provides. In thinking of reform to control this rise in spending, he turns to MedPAC's 2011 Home Health R eform Recommendations.

Healthcare Technology News - Rich Elmore and Paul Tuten discuss the launch of pilot projects enabling secure direct messages among healthcare stakeholders in their post about Direct Project implementations taking flight. They offer project details and note that this is a very big deal, as reflected in the related briefing by David Blumenthal (National Coordinator for Health IT), Aneesh Chopra (US CTO) and Glen Tullman (CEO Allscripts) among other federal and industry participants.

healthyimagination - In December, scientists and healthcare professionals shared groundbreaking research an NIH symposium focused on health disparities. Lisa Cappelloni shares some of the novel approaches aimed at eliminating health inequities in her post Advancing Minority Health: New Minds, New Methods.

The Hospitalist Leader - Bradley Flansbaum offers A Hospitalist's Lament, a thoughtful essay on the issue of end of life care and advance directives. In the light of controversies like death panels and care rationing, he states that our country may be at least a decade or two away from having a sophisticated discussion on this subject. He illustrates the complexity of the surrounding issues through an intriguing exercise conducted with his colleagues.

Improving Population Health - David Kindig is another contributor who listened closely to the State of the Union address, and asks if one could find any mention of population health, public health, or prevention in the speech. While he didn't hear those phrases directly, he was heartened by the speech addressing two major drivers of health -- education and jobs.

The Incidental Economist - Austin Frakt says that cost shifting is not well understood and has become a political football. He sheds light on the topic in the first of a series of posts: Hospital cost shifting: Brief history and possible future.

Insure Blog - As the oft-quoted Andy Warhol line goes, we will all have our 15 minutes of fame. But in the world of insurance, fame may be measured in cents rather than minutes, if Hank Stern's post about Ceridian's 2-cent Moment is any measure. In this case, the company made headlines when a cancer patient was denied coverage over a 2 cent shortchange. Or was there more to this story than the headlines? Hank digs a little deeper and offers his two cents on the matter. (Oh, and kudos to Hank & crew for Insure Blog's 6 year blogiversary - quite the landmark!)

John Goodman's Health Policy Blog - In his post The Case For Health Insurance, John states that everyone should have access to health insurance, and notes that real insurance involves a pooling of risks. "The insurer must make sure each new entrant to the pool pays a premium that reflects the expected costs that entrant brings to the pool. Otherwise, the insurer won't be able to pay claims. The business of insurance is the business of pricing and managing risk."

The Notwithstanding Blog - Genomic medicine, end-of-life care, and rationing are three "hot" areas of medicine and health policy in which much stock is given to the opinion of bioethicists. Our blogger at the Notwithstanding Blog (written by a first-year medical student) says that he has a bad feeling in observing the near-uniformity with which the bioethics establishment has opposed medical advancement and patient empowerment, and uses the lens of public-choice analysis to argue that the deference shown to their prescriptions is at least partially misplaced.

Pizaazz - In his post about how early career physicians use Facebook, Glenn Laffel reviews a study that should give some comfort to those who worry that physicians will misuse the social networking site by failing to protect patients' protected health information.

Workers Comp Insider - In the niche area of occupational illnesses and injuries, Jon Coppelman demonstrates that some villains contributing to skyrocketing health care costs might lie entirely outside the delivery system. He examines the curious spike in carpal tunnel injuries reported by guards at an Illinois correctional facility in his post John T. Dibble's Sympathetic Ear.

That wraps up this issue! Next up to bat: Louise Norris at Colorado Long Term Care Insider on February 16!

Get your biweekly fix of risk: Cavalcade of Risk #123: High-Yield Edition is now posted at The Notwithstanding Blog. There's an eclectic roundup of posts and you might take the time to visit the host blog too - our blogger is a Canadian med student studying here in the U.S., and posts "tales from medical school, health policy analysis, critiques of the academic medical zeitgeist, and the occasional bonus Canadiana."

Misclassification in Maine - analysts in the Maine Labor Department estimate that tax losses to the state resulting from misclassification could be as high as $36 million a year. As in many other states, lawmakers had been looking at establishing guidelines and rules for independent contractors. Newly elected Governor Paul LePage abolished the state's misclassification task force that had been working on this initiative, stating that he would be introducing legislation based on the federal definition.

Union Demographics - Jeffrey Hirsch of Workplace Prof Blog gives us the latest report on union density for 2010: "Overall union density went down from 12.3% to 11.9%; in the private sector, union density went down from 7.2% to 6.9%, and in the public sector, it went from 37.4% to 36.2%." See more detail at his post.

Vote for Workers' Comp Notable People - Lexis Nexis announced the finalists in its Workers' Comp Notable People 2010 - check it out and vote for your favorites. Voters can select two individuals from each of the three categories. The voting period runs from January 23, 2011 through February 4, 2011. Click here to join and vote in the LinkedIn Work Comp Analysis Group.

Food industry - WorkersCompensation.com features an in-depth federal report on Injuries, Illnesses, And Fatalities In Food Manufacturing In 2008, which notes that "Workers in food manufacturing are more likely to be fatally injured and experience nonfatal injuries and illnesses than workers in private industry as a whole. Food manufacturing workers are also much more likely to suffer an injury requiring job transfer or restriction than one that requires days away from work."

Underwriters - After reading an article on disappearing jobs, Jared Wade of Risk Management Monitor considers whether insurance underwriters are an endangered species now that technology can crunch the numbers.

Sign of changing times? - Roberto Ceniceros discusses how some of the large carriers are letting business walk rather than price it too low. With the combined ratio moving up, many industry analysts have stated that underwriting will make the difference between profit and loss and it appears that some insurers are taking heed.

Technology - Some workers comp insurers are adopting self-reporting options for payroll reporting for employers.

Quick takes

• Mining Deaths Up in 2010
• Can You Demand FMLA Fitness-for Duty-Cert? Sure, BUT ...
• Workers comp benefits for injured illegal workers: where are we?
• Retaliation Topped EEOC Filings for 2010
• Supreme Court Rules Background Checks Appropriate for NASA Lab Workers
• Whistleblowing & Compliance Law Blog

It's deja vu all over again at Managed Care Matters, where Joe Paduda hosts commentary on the rematch of the healthcare reform debate in this week's Health Wonk Review: Repeal, replace, renew, revise, revisit - what the bloggers say. It's a great issue with good contributions and diverse opinions on the matter. Check it out!

The skinny on fat - As a follow-on to my colleague's post on the not-so-hidden-cost of obesity earlier in the week, we offer this visualization - the obesity map from the CDC, which shows the dramatic rise in obesity rates from 1985 through 2009. You can also see a state-by-state breakdown of obesity rates.

Underwriting front and center - Dan Reynolds of Risk & Insurance does a great job of outlining just how much of an underwriter's nightmare workers comp has become and looking at how much worse it could get - and why. Chad Hemenway of PropertyCasualty360 (formerly known as National Underwriter) reports on a recent presentation by Insurance Information Institute's Bob Hartwig who says that the industry is at a tipping point, and underwriting will be the driving force in profit or loss for 2011.

Horseplay ruling At Business Insurance, Roberto Ceniceros reports on a recent Virginia high court ruling which allocated benefits to a worker injured during horseplay. The injured employee was a victim, not the perpetrator, of the horseplay. "The state high court also relied on a theory of recovery, which has found that joking actions of co-workers are a risk of employment because humans are playful and from time to time engage in pranks, which can be dangerous."

Aging & Workers Comp - Working Safer or Just Working Longer? - new study by California's Commission on Health and Safety and Workers' Compensation. The report contains a lot of interesting information and notes that "Interestingly, despite the large increases in the fraction of workers 55+, the impact of the aging workforce on expected workers' compensation costs is modest. Frequency and duration effects partially offset each other and older workers still represent a minority of all workers. The aging workforce will increase workers' compensation costs only about 2% as of 2030 above the cost if the distribution of workers by age had remained the same as 2000."

And about those seniors... - Jon Gelman posts about a push to put a cap on workers comp for federal workers based on age. According to Senator Susan Collins, "At the U.S. Postal Service, for example, 1,000 employees currently receiving federal workers' compensation benefits are 80 years or older. Incredibly, 132 of these individuals are 90 and older and there are three who are 98." Gelman's post includes links to states and counties who are also looking at this issue.

OSHA - OSHA's Top 10 Safety Violations for 2010 - In 2010 OSHA issued over 94,000 safety-related citations for violations. OSHA stated that nearly half of the total violations were accounted for by the top 10 safety violations.

It's Cavalcade of Risk week and issue #122 is hosted by our friend David Williams at Health Business Blog - check it out!

Industry pulse - Good news. Robert Hartwig of the Insurance Information Institute takes the pulse of the property casualty industry and sees signs of life: Insurance Industry On The Mend. "Mr. Hartwig said in comparison to all of 2009, the industry's 2010 third-quarter results are close to all of the prior years. While the industry is not back to where it was prior to the economic downturn in 2007 when it reported property and casualty net income of $62.5 billion, it is performing significantly better than the worst of the downturn in 2008 when p&c income came in at slightly more than $3 billion."

That's good news, but it's not time to break out the champagne yet. A.M. Best forecasts downward rating pressure for the commercial market and two new reports indicate that reinsurance prices should remain soft in 2011.

Physician dispensed drugs - If you are an employer or an insurer and this topic isn't yet on your radar, it needs to be. Joe Paduda posts about recent NCCI report on physician-dispensed drugs in workers comp, a significant growth area that NCCI says is putting upward pressure on WC costs. California took steps to regulate the practice a few years ago after learning that repackaged costs were two to twelve times higher than the fee schedule.

Labor - The New York Times reports that cash-strapped states are looking to curb labor unions. Expect a flurry of legislative initiatives to limit the power of labor unions representing government employees. While both parties are wrestling with ways to keep state budgets in line, the article notes:

"But in some cases -- mostly in states with Republican governors and Republican statehouse majorities -- officials are seeking more far-reaching, structural changes that would weaken the bargaining power and political influence of unions, including private sector ones."

Prevention works - A concerted campaign to reduce textile service worker injuries is working, according to the recently released annual TRSA Textile Services Industry Safety Report. Recordable injuries and illnesses dropped by 17 percent from 2008 to the 2009, and have dropped by 50% since 2005. Sandy Smith reports on SafeTRSA, an industry-wide safety initiative to improve worker safety through awareness, education and training.

Breast cancer & comp - At Comp Time, Roberto Ceniceros discusses City of Las Vegas v. Lawson. The Nevada Supreme Court ruled that a firefighter is entitled to a presumption that her breast cancer arose from her on-the-job exposure to benzene. His post also discusses male breast cancer.

Dramatic Australia flood footage - Office workers catch footage of a modest creek turning into a raging torrent sweeping cars away. More news and dramatic videos of the cataclysmic Australian flooding is available on MSNBC. At least 16 people are reported dead and more than 90 missing in what has been likened to an inland tsunami. Brisbane is under siege. You can follow breaking news on Twitter at #Brisbane.

Here's a compilation of top news stories in 2010, encompassing workers comp, insurance, risk, general business, and more:

• OSHA lists its 10 Most Frequently Cited Standards in Fiscal Year 2010
• Risk Management Magazine offers its 2010 Stories that Defined the Year in Risk
• Joe Paduda of Managed Care Matters weighs in with his picks for the Top Work Comp Stories of 2010
• Insurance Journal names the 2010 Top Insurance Stories in the West
• National Underwriter's picks for the Top-10 Insurance Stories of 2010
• Robert Hartwig of Insurance Information Institute looks at 2010 - First Nine Months Results and Workers Compensation, updated December 2010
• Mealey's Litigation Report offers Endurance Coverage 2010: The Year's Ten Most Significant Insurance Decisions Reaches the Decade Mark (Thanks to Claire Wilkinson of Terms + Conditions for the pointer)
• Jared Wade of Risk Management Monitor offers a list of the Top 10 Books of 2010 for Risk Managers
• Oakland Workers Comp Blog posts about the Top 10 California Workers' Comp Events in 2010
• SafetyNewsAlert's Top 10 Deadliest Workplace Tragedies for 2010.
• ManufacturingWeekly's Readers' Picks for the Top 10 Manufacturing Stories of 2010
• Medgadget: 10 Best New Medical Technologies and Devices of 2010
• The New Yorker's Top 10 Business Stories of 2010

• Dana Reynolds of Risk & Insurance offers A 2011 Wish List for Risk Managers and Cyril Tuohy offers his 2011 "Wish-Not" List for risk and insurance managers.
• Joe Paduda looks in the crystal ball: What's Up for 2011 - Predictions for Work Comp in the Next Year and assesses his 2010 prognostication performance.
• The Atlantic offers its pick of the 10 Business Stories That will Dominate 2011
• Research & Markets: 2011 Trends to Watch: Insurance & Technology.
• PwC: Behind the Numbers: Medical Cost Trends 2011
• Risk & Insurance: 2011 Outlook for the Property/Casualty Insurance Industry
• Small Business Trends: Outlook for 2011 and 2011 Trends Driving Rural Small Business

When it comes to blog surfing, what's your tolerance for risk?

Jason Shafrin of Healthcare Economist puts that to the test in his Pick Your Poison Edition of Cavalcade of Risk. Jason offers two ways to access this week's selections: risk lovers can pick "blindly" by topic; or, for the risk averse, Jason includes a post description and ranking.

Brad Wright has an excellent holiday edition of Health Wonk Review posted at his blog, Wright on Health - check it out! It's the last issue until 2011 so fill up on your health wonkery now!

And in other news briefs....
Nix on the Mine Safety Bill - Ken Ward of Coal Tattoo reports that an attempt to resurrect a major mine safety reform bill was defeated in the House of Representatives, but that the House did approve more funding for mine safety.

The Most Influential People in Workers Comp for 2010 - as designated by Workers' Comp Executive - hat tip to Roberto at Comp Time for the pointer.

Healthcare reform and workers comp - Joe Paduda or Managed Care Matters offers his analysis of the SwissRe analysis of health reform and workers comp.

Health Care and the Uninsured - HealthLawProfBlog offers helpful links to important parts of the updated Kaiser Family Foundation's Commission on Medicaid and the Uninsured.

The Bunkhouse Rule - Do you know what this is? If not, Judge Tom offers a good example.

Overview of Wal-Mart Stores Inc. v. Dukes - atty. Gerald Maatman presents a backgrounder and overview of the class action gender discrimination suit against Wal-Mart which is being heard by the Supreme Court.

Eight tips for meeting with a potentially violent employee - tips from attorney Robert Bettac's recent presentation at BLR's National Employment Law Update are posted at HR Daily Advisor.

Worried about scanner-related radiation? - Check out this line of radiation shielding and privacy undergarments. Not sure if they work, but they are a hoot.

A few new-found resources

• Actuary Info Blog - we've linked to this smart blog before - it bills itself as a "brain teaser Blog with non-conventional, witty, remarkable and serendipitous financial and actuarial related news." There are some fun and thoughtful entries.
• The OSHA Updater - a safety blog by Chad Marshman of the EasySafetySchool.com
• DocuBase - a hand-picked selection of resources, reports and publications from government agencies, NGOs, think thanks and other public interest organizations
• Safe Lifting Portal focuses on patient safety and caregiver injury prevention, sponsored by Liko, a designer and manufacturer of lifts, slings and patient transfer accessories.
• Crowd Management Safety Guidelines for Retailers - an OSHA Fact Sheet

Check out this week's Cavalcade of Risk, which is hosted by Nina Kallen, a Massachusetts attorney who runs the blog Insurance Coverage Law in Massachusetts. These carnivals are a good way to discover new blogs and we are happy to discover this one, right in our own backyard.

Flammable Ice Cream - an interesting Loss Prevention case study from Liberty Mutual that addresses the issue of flammable liquid hazards in unexpected place.

America's Best Hospitals Ranked - Complex Care Blog offers links to the recent rankings, as well as an interesting video on thinking differently about health care from the Mayo Clinic.

Beneath the Bell Jar: Companies Confront a Rise in Workplace Suicides - Emily Holbrook looks at this tough issue in the November issue of Risk Management.

Employee whistleblower protections in food new safety law - at Today's Workplace, attorney Jason Zuckerman discusses the robust whistleblower protections included in the FDA Food Safety Modernization Act (FSMA), which are included to ensure that workers can disclose food safety concerns without fear of reprisal. He offers a detailed overview of the provisions.

Update on OSHA's worker safety in construction efforts - OSHA Deputy Assistant Secretary Jordan Barab's keynote speech, which was delivered at the Building Trades Employers' Association of New York 2010 Safety Conference.

TSA Brings Problems on Itself - we discussed TSA employee stress earlier in the week. Workplace human behavior consultant and author Aubrey Daniels suggests that better attention to service and training might go a long way to reducing traveler tension - and would also, no doubt, make things easier for the screeners themselves.

Fatal occupational injuries at road construction sites, 2003-07 (PDF) - a report recently issued by the Monthly Labor Review, which analyzes trends and circumstances around the fatalities.

Remote Workers Need More Than Cookie-Cutter Safety Strategies - from Risk and Insurance, a discussion on telecommuting workers and an approach to keep them safe.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

"Consistently at the top of the heap when it comes to workers' comp blogs, the Workers' Comp Insider is a rare combination of breadth and depth. Now in its eighth year, the Insider covers comp issues, risk management, business insurance, and workplace health and safety from Anchorage to Miami. It provides in-depth analysis concerning workplace legislation, occupational medicine, and best practices from Maine to Hawaii. It should be in the "favorites" folder of every comp attorney's web browser."

The pre-election season used to be dubbed the silly season, but this year it might better be termed the scary season - things are getting pretty acrimonious. Following up on the scary theme, Meredith Hughes, Allison Levy, and Sam Wainwright of New Health Dialogue Blog team up to bring you Health Wonk Review: All Hallows Eve Edition. It's an entertaining and substantive issue, and the last issue before the election.

And in other news of note:
Joe Paduda of Managed Care Matters tackles the issue of physician dispensed drugs in work comp and explains how repackaged drugs can add to costs by an alarming magnitude. In 2007, California closed this loophole that allowed repackaged drugs to go "off the grid" in terms of existing pricing controls, and other states are now looking at this issue. Joe's post compiles research and explains why this is an issue you should know and care about.

Roberto Ceniceros of Comp Time looks at the NFL's recent focus on helmet-to-helmet hits. He links to a press release from the NFL Players Association, which makes the point that player safety extends beyond the field, calling on the league to "call on the league to end "nasty litigation against nearly 300 players' workers compensation cases and stop saying 'no' to the disability benefits of NFL legends."

Yvonne Guibert of Complex Care Blog discusses obesity and comorbidities and the impact on claims costs. She offers research and resources to help employers grapple with this issue. The current issue of Human Resource Executive also carries a good article on how obesity adds to healthcare costs, along with some approaches that employers are taking to mitigate the problem.

For all practical purposes, Texas is the only state in the union that allows employers to opt out of mandatory workers comp coverage. Peter Rousmaniere takes a look at how the opt-out option has affected employers in the current issue of Risk and Insurance. And on the topic of opting out, see Good News for Texas Non-subscribers, Bad News for Excess Carrier, a post by Michael Fox of Jottings By An Employer's Lawyer.

Advanced Safety and Health News Blog discusses and links to federal OSHA's recently issued special evaluation of state-run OSHA programs. "The reports provide detailed findings and recommendations on the operations of state-run OSHA programs in 25 states and territories. The review was initiated after a 2009 special OSHA report on Nevada's program, identified serious operational deficiencies in that state."

Judge Tom of the eponymous blog schools us on Oklahoma's law on recreational injuries and workers comp. In 2005, the law was tightened to exclude any injuries that stem from recreational and social activities, even those occurring on the employer's premises. He notes: "The larger, unanswered question is whether employers no longer have tort immunity for injuries sustained at recreational and social functions such as Christmas parties, company sponsored sports leagues, the Orcutt basketball pick-up game, attendance at charitable events to name a few."

Short takes
Weekly Toll: Death in the American Workplace
High Unemployment Rate a Drag on Workers' Compensation Insurers
Health care group spends $4 million on safety, saves $14 million
Specialist and primary care pay per hour
FedEx to Pay $2.3 Million Over Independent Contractors

We are pleased to be hosting the biweekly Cavalcade of Risk. We thought we'd kick things off on a light note with these amusing ads from Bangkok Insurance that cleverly illustrate the concept of probability.

Insurance is based on weighing and measuring the odds, and protecting ourselves against those odds. You can consult this handy chart on the lifetime odds of death for selected causes to assess your risk. (And to cheer you, you can also check dead at your age to see which famous people you've already outlived.) But even when you know the odds, life can throw curve balls ... clever insurers know this and use the unexpected to remind us to keep our policies up to date ...

When real life outperforms the commercials...
As we delve into this week's submissions, we see a few real-life examples of what can happen when people don't pay-to-play in hedging against risks. Khaleef Crumbley at KNS Financial talks about whether pay-to-spray fees are good idea or not in his post about the recent TN case where firefighters stood by as a home - and the pets within - burned to the ground because the owner forgot to pay his annual $75 protection fee. This case was notable because it involved a public service, but Tred R. Eyerly of Insurance Law Hawaii posts another cautionary tale about paying fees on time - this one involving an insurance company. He discusses a legal case in which the court denied an insured's claims against its flood insurer.

If you aren't happy with your insurance coverage, Jeff Rose of goodfinancialcents offers 6 factors that make switching insurance companies and firing your agent all worth it. But if you are considering a switch in insurers, Nancy Germond of AllBusiness.com suggests that you not be too hasty and you don't do it for the wrong reasons because cut-rate insurance may cost you much more.

And when considering insurance coverage, Silicon Valley Blogger reminds us about coverage to which we are often entitled but frequently overlook: Extra insurance coverage through credit cards: use those perks.

Miscellaneous perils
Henry Stern of InsureBlog notes that if you think those big old Bel Airs of your parents' day were safer than today's econoboxes, think again. He offers compelling video evidence in his post Retro Risk Reduction. And while on the topic of transportation risks, we point to our own post on a rather unsettling mater: the sorry state of medical certification of commercial drivers and other public transportation regulatory issues.

Ironman at Political Calculations cautions that you not let technological advances leave you in the dust. He offers a cool tool to help you assess whether you are keeping up: When will you become obsolete?. But while technology advances offer opportunities, they are not without their own risks. Emily Holbrook of Risk Management Monitor posts that if we find ourselves in a courtroom, social media has increased our risk for an unfair trial.

Sometimes our risk comes from quarters where we least expect it. We've all been alerted to the dangers of identity theft - but usually we expect the danger to be from strangers. Wenchypoo of Wisdom from Wenchypoo says that the danger is sometimes all in the family. She posts on the strange phenomena of parents stealing their kids' identities.

Risk management & health care
David Williams of Health Business Blog tells us that reducing the use of head CT scans for certain kids can reduce cancer risk, improve customer service and maintain quality. The only new risk is to reimbursement: Fewer scans often mean less revenue for the provider organization.

Speaking of kids, Louise of Colorado Health Insurance Insider suggests a real-world compromise for child-only policies, which would offset the increased risk that insurers take on in guaranteed-issue, open enrollment periods for child-only policies.

If you haven't heard about accountable care organizations(ACOs) yet, click on over to Healthcare Economist. Jason Shafrin talks about why providers love ACOs. Hint: it may be less about improving patient outcomes and more about market power.

Jaan Sidorov of Disease Management Care Blog offers 10 reasons why health insurers that offer fully insured products are unlikely to offer work-site wellness programs anytime soon - despite their cost saving potential.

Click on over to Healthcare Economist, where Jason Shafrin has posted Health Wonk Review to the "Rescue", a most excellent edition of health policy wonkery, proving that our regular participants have as many trenchant opinions and observations about healthcare post-reform as they did pre-reform.

And in some other news...
Elation - There aren't all that many good news stories when you hear about a mine collapse but the world has just witnessed one of the rare exceptions in real time. Reuters put global TV viewership at more than a billion - everyone united to see a different kind of reality TV. The Boston Globe offers a powerful portfolio of rescue photos from the Big Picture, and you can also see an in-depth portfolio from the Chilean Government's Flickr photostream. Newsweek offered a simple but powerful infographic about the ordeal: What if everything you needed to survive had to fit through this space? and The Telegraph offers excellent diagrams of the mine shaft and the rescue. If you haven't had a chance to read Wright Thompson's excellent article in Sports Illustrated, Above and Beyond, make it a point to do so. It's a well-written article that explores the human story from the perspective of one of the miners, a former soccer star, and it also gives a glimpse into the miners' ordeal and the engineering challenge of the rescue. Also noteworthy: Ken Ward's thoughts posted at Coal Tattoo. Ward reports on West Virginia mining matters for the Charleston Gazette and has covered far too many mining stories that did not have happy endings. He writes about what we can learn from the Chilean mine rescue.

More on medical marijuana - "Would a request to pay for marijuana be subject to utilization review? What standards would utilization review use to review it?" These and other issues are considered in a recent article on medical marijuana in Risk & Insurance. In all, 14 states and 27 cities have legalized medial marijuana, which means that employers need to familiarize themselves with the laws governing their work force. Substance abuse expert William J. Judge says that employers should treat medical marijuana just as they would any other drug, such as opiates and amphetamines. He notes that the latter are a class of drugs that are illegal until prescribed.

Lifestyle issues and comp - My colleague Jon has been posting about obesity issues as they play out in real-world scenarios. Meanwhile, a new obesity report by the CDC explains the reason for concern, In 2000, there were no states with an obesity prevalence of 30% or more; now there are 9 states. Also, there is no state with an obesity prevalence of less than 15%. In addition to increased legal challenges around obesity issues, there is the additional factor that obesity hinders recovery. And it is not the only so-called "lifestyle issue" that puts a drag on recovery. The folks at Work Comp Complex Care blog look at smoking and how it impacts complex care recovery.

Social media - managing the risk - Check out More Media, More Opportunity, More Risk: The Upside and Downside of Social Media in this month's issue of Risk Management Magazine. It's a series of six articles that cover the benefits and the risks involved in social media, allowing with tips for how to manage the risk.

Free online WC conference - Over at Comp Time, Roberto Ceniceros notes that he will be moderating a free online workers comp conference which will address safety, cost control strategies, alternative risk financing, and comp claim medical costs, among other topics. It's schedule for December 9, and will run for 5.5 hours.

Check out Cavalcade of Risk #115 - your biweekly compendium of risk posts - this time, the "open enrollment" edition.

Check out the latest Health Wonk Review posted by Peggy Salvatore at Healthcare Talent Transformation - it's chock full of good posts and entertaining to boot: Health Wonk Review: Take Me To Your Leader - Egads!

And in a few other news items ...
Can you offer unpaid internships? - Is your organization eligible to offer unpaid internships? If you are a profit-making entity, the answer is probably not. As part of its enhanced focus on employee misclassification, internships are one of the areas that the Department of Labor is examining. If your organization offers internships, you need to ensure you are in compliance with the Fair Labor Standards Act. DOL's Wage and Hour Division has issued guidance: Fact Sheet # 71: Internship Programs Under The Fair Labor Standards Act. If your organization's internship qualifies as a "training program" you may be an exception to the rule. The linked Fact Sheet lists 6 criteria which organizations can use to determine eligibility for training programs that would be allowed as unpaid internships.

While on the topic of compliance with wage & hour laws, here's a list of other Fact Sheets, which looks like a good page to bookmark for reference.

Work comp trends - Work Comp Complex Care Blog recently featured series on "Big 3 Trends in Workers Compensation" as noted by the Total Medical Solutions vice president of clinical services, Kevin Glennon. There's some good information, if you haven't seen them: Part One: Obesity; Part Two Aging Workforce; and Part Three: Antibiotic-Resistant Infections

Lost tax revenue - The IRS estimates that across the country, $345 billion of tax revenue is lost each year to the underground economy. Check out Roberto Ceniceros' post at Comp Time fro more on the topic: Notes on the underground economy

Safety is top labor issue - A new study by the National Opinion Research Center at the University of Chicago found that more than eight in 10 workers ranked workplace safety as their most important labor issue. Family and maternity leave was ranked as the second most important issue, followed by minimum wage, paid-sick days and time-and-a-half overtime pay. David Shadovitz offers more on the study at Human Resources Executive: Putting Workplace Safety First.

Healthcare costs - A recent survey of 466 large and midsize employers conducted by Towers Watson projects that employers' health care costs will rise by 8.2% in 2011. According to the Employee Benefit News coverage of the survey, "Among survey respondents, 59% plan to implement significant or moderate health care plan design changes in 2011, and 67% plan to do so in 2012."

Russell Chatwood hosts this week's edition of Cavalcade of Risk. Our host from "down under" brings the latest and greatest from the world of risk, with a heavy skewing to healthcare. Think that's on everyone's mind, at least here in the pre-election U.S.? Go check it out!

Louise Norris of Colorado Health Insurance Insider hosts the Politics, Money and Health edition of Health Wonk Review. There's a particularly good crop of posts and Louise does a great job offering summaries, so be sure to check it out!

Follow up to tower safety - In posting yesterday's dramatic tower-climbing video, we appealed to any safety to experts to add comments. We were fortunate to have commentary from Wally Reardon who points us to the Facebook Tower Climber Protection project. Of the video, he notes: "If free-climbing is allowed by OSHA; why is the other climbers face blurred? He would not want to be identified or have his company ID'd either (that's why). OSHA does not allow free-climbing EVER on towers. Special PPE has been designed to eliminate the need to free-climb. We have double lanyards with fall arrest to "crab walk" up the tower for example. Free-climbing has been banned since 1994."

Facebook as a fraud detector - New York's State Insurance Department brought workers comp fraud charges against a woman based a Facebook posting. The woman was boasting about her salary at a job while collecting benefits from an injury that occurred at a previous employer. Attorney Jon Gelman's blog has a good post on how how Facebook is turning up in workers compensation courts.

Industry innovators - Congratulations to all those named as winners in Risk & Insurance's 2010 Innovator Awards, with special kudos to our friend Gary Anderberg, Practice Leaders for Analytics and Outcomes at
Broadspire Services. (Read a few of his guest posts here at Workers Comp Insider). For a dose of inspiration and to find out where the industry leaders are headed, check out all the innovator profiles.

Employer WC costs decrease - a report by the National Academy of Social Insurance (NASI) points to good news/bad news for employers. The good news: "Employer costs--defined as benefits paid and administrative costs for self-insured employers, and premiums and deductibles paid for those who buy insurance--fell 6.7 percent in 2008 to $78.9 billion." But don't get too excited because the bad news is that medical payments and cash benefits to injured workers saw the largest percentage increase since 2001: "workers' compensation benefits paid increased 4.4 percent to $57.6 billion in 2008--the most recent year for which data was available. NASI said an 8.8 percent increase in payments for medical care drove medical spending to $29.1 billion in 2008, while wage replacement benefits paid directly to injured workers rose by 0.3 percent to $28.6 billion."

Retaliation is a no-no - It's never a good idea to harass a worker who has been injured on the job. Amtrak learned that the hard way after being ordered to pay a Seattle cleaning worker more than $160,000 after it was determined that supervisors had retaliated against her after she reported an on-the-job injury. She was discouraged from filing a report, and then fired, and then her firing was rescinded and reduced to a suspension.

When animals attack - It seems like there has been an increase in workers being attacked by wild animals lately, but it is probably just that these stories are more widely available due to the web. Here's a scary clip of a lion attacking his trainer at MGM Las Vegas. Apparently, the worker needed stitches, but wildlife experts say if the lion had been serious, things could have been dire. Meanwhile, in an attack that ended less benignly, an exclusive remedy challenge is looming for SeaWorld Orlando related to the trainer who was killed by a whale. (Hat to tip Comp Time, where we found the lion clip.)

Our friend David Williams is hosting Cavalcade of Risk #113 over at Health Business Blog. Also of note on his blog, his post on a recent Kaiser study on healthcare, which includes some interesting statistics about practices related to healthcare quality monitoring.

Here at Workers Comp Insider, we are in "back to school" mode - catching up after a long Labor Day weekend, having tucked in a few final summer vacation days. So we have only one item today that fits in with the theme of risk ... a remarkable video clip of security camera footage from a harrowing 2008 cruise that just recently made its way to the web. How would you like to have been one of the employees or a guest on this particular cruise? Or the risk manager?

I don't know which segment is scarier - the passengers and crew sliding around in the cafeteria in the first half or the forklifts and heavy equipment careening around in the second half. Yikes.

The Sydney Morning Herald offers more information about what happened on the cruise. The article doesn't report on any injuries among the 671 crew, but says that, "Forty-two passengers were injured in the storm. The worst injuries were a fractured pelvis and fractured wrist, with most of the injured suffering cuts and bruises." After the event, the company offered passengers a 25% discount on future cruises. Also, "...recommendations made after an investigation into the event, including the securing of furnishings and providing bridge staff with night-vision binoculars, had been implemented by the company."

Grab a coffee and head on over to Hank Stern's InsureBlog, where he's posted Health Wonk Review: In the Here and Now. He describes it as a "minimalist" style, which means more meat, less potatoes!

And in other noteworthy news this week:
Twittering insurers - Terry Golesworthy features an interesting post about how insurers are using Twitter, along with lists of insurance leaders by number of followers, by growth and by activity. He observes, "Twitter continues to be used by most insurers to provide soft marketing messages about promotions, sponsorships and customer endorsements. Other activities include financial quizzes, insurance related education materials, warnings regarding impended natural disasters and Facebook announcements. Some insurers do respond publically to customer questions but, largely, this is not the significant activity." In the comments on his list, insurance agent Ryan Hanley (@AlbanyInsurance) notes that agencies are actually driving the social media movement, and that is based on their using the channel for relationships rather than as a broadcast tool.

Safety is #1 - At The Pump Handle, Celeste Monforton posts that "just in time for the Labor Day holiday," a new study has been released by the University of Chicago's National Opinion Research Center, indicating 85 percent of workers rank safety on the job as their top labor standard.

Misclassification - State efforts focusing on employer misclassification continue to be strong and there appears to be a deep vein to mine.

• In California, Country Builders Inc is paying a whopping $3.9 million in back pay, fines, and payment to the work comp fund as a settlement with a suit filed by the Attorney General for various labor law infractions, including misclassification to avoid workers comp payments. In addition, the company is barred from working on government-funded public works for three years.
• The New York construction industry should go on notice. Governor Patterson has just signed the Construction Industry Fair Play Act, "...which creates a clear litmus test to distinguish the difference between a worker and an independent contractor. It also provides a method to clearly define which business on a construction project is responsible for which workers. Finally, for the first time in State history, it imposes monetary and criminal penalties specifically for the act of employee misclassification on construction projects."
• A new Wisconsin law strengthens enforcement tools for targeting construction misclassification. The law will take effect on January 1.
• While the construction industry has been a major area of focus, other industries such as the trucking industry have also been targets of probes. And then there is the continuing FedEx driver saga, which my colleague has posted on frequently.

September is National Preparedness Month - FEMA has designated September as and offers emergency preparation resources for employers. At the Risk Management Monitor blog, commercial risk management expert Brian Smith replies to Emily Holbrook's questions about disaster preparation and business insurance.

The Notwithstanding Blog puts a medical spin on things in hosting Cavalcade of Risk #112: Medical School Edition. This is an excellent showing for a new host and a relatively new blogger, self described as an "economics-trained fledgling first-year medical student." After you've perused this week's edition, why not poke around his blog a bit to kick the tires?

Workplace fatalities drop dramatically - In 2009, 4,340 workers died on the job, according to the preliminary Census of Fatal Occupational Injuries 2009, which was recently issued by the Bureau of Labor Statistics (BLS). This is the lowest number on record since data began being collected in 1992, and represents a dramatic drop from the 5,214 deaths in 2008. In terms of 100,000 full-time equivalent workers (FTEs), it is a drop from 3.7% to 3.3%. Transportation-related injuries accounted for the highest number of fatalities (39%), followed by assaults and violent acts (18%), contact with objects (17%), falls (14%), exposure to harmful substances/environments(9%), and fires/explosions (3%).

In explaining the decrease, BLS points to economic factors. In 2009, total hours worked dropped by 6%, following a 1% drop in 2008. The drop was particularly pronounced in dangerous professions, such as the construction industry, which historically account for a large percentage of fatalities. Plus, officials say that 2009 numbers are preliminary, and that some data may be delayed by the fiscal constraints experienced by reporting agencies.

Ohio's workers comp system - Insurance Information Institute's Bob Hartwig told a gathering of Ohio state officials that the state should privatize it's workers compensation system. He made the case that moving Ohio from a monopolistic state fund to a competitive market would afford more choice to employers. Ohio is the largest of the four states in which the state is the exclusive provider of workers compensation coverage. The other three states are Washington, North Dakota, Wyoming. West Virginia is the most recent state to make the transition from a monopolistic system to a competitive market.

OSHA cites SeaWorld - Last February, Tilikum, a 12,000-pound orca, attacked and dragged whale trainer Dawn Brancheau to her death. After investigating the circumstances surrounding the death, OSHA cited SeaWorld for three violations. "OSHA's investigation revealed that this animal was one of three killer whales involved in the death of an animal trainer in 1991 at Sea Land of the Pacific in Vancouver, British Columbia, Canada. SeaWorld had forbidden trainers from swimming with this whale because of his dangerous past behavior, but allowed trainers to interact with the whale, including touching him, while lying on the pool edge in shallow water." SeaWorld's former health-and-safety director turned whistleblower is also speaking up, calling her former employer's practices questionable and dangerous. Linda Simons was fired by SeaWorld, allegedly for speaking up during the investigations.

Disability - The 2010 Survey of Americans with Disabilities, conducted by the Kessler Foundation in conjunction with the National Organization on Disability, reports on the gaps between people with and without disabilities. The survey found that employment represents the largest gap: "Of all working-age people with disabilities, only 21% say that they are employed, compared to 59% of people without disabilities - a gap of 38 percentage points. People with disabilities are still much more likely to be living in poverty." Indicators are tracked over time, and this is the sixth time the survey has been conducted in 24 years.

Obesity and Disability - Obesity is linked to higher health care costs than smoking or drinking, and plays a major role in disability at all ages, according to Rand Corporation researchers, who have been conducting a series of studies analyzing obesity trends and estimating their effects on future health care costs. "More than one in five U.S. adults are now classified as obese based on self-reported weight, and almost one in three based on objectively measured weight." Researchers also found that the fastest-growing group of obese Americans consists of people who are at least 100 pounds overweight.

Quick takes
Caveat emptor - Joe Paduda at Managed Care Matters offers a buyer checklist of issues when evaluating work comp savings on medical bill review.

Fraud fighting - at Comp Time, Roberto Ceniceros relates the story of some creative investigation tactics used to prove workers comp fraud on the part of a Florida mail carrier.

RIMS - check out the RIMS website, which has just been overhauled. In addition to improved navigation, it includes more accessible news feeds on the front page.

Legal brief - When is a deviation not a deviation? The Arkansas Court of Appeals ruled in favor of truck driver whose injury occurred off-route.

Joe Paduda is the man of the moment. His Managed Care Matters blog is worth a regular perusal for the informed commentary he offers about the medical side of workers comp. Today, there's twice as much reason to visit because he's the host of this week's Health Wonk Review, in which the focus is on implementing health care reform. Check out this biweekly best of the health policy blogosphere!

Violence on the job - This week, The Hartford Courant posts that the total work comp payout for the shooting at Hartford Distributors could set a record. The company's workers' compensation insurer is The Hanover Insurance Group. Reporter Matthew Sturdevant notes that families of deceased and injured workers have one year from the Aug. 3 shooting to file workers' compensation claims and discusses state benefit levels. (See our related posting from last week about the aftermath of the shooting in Connecticut. )

In another corner of the world, other workers were homicide victims. The New York Times offers a tribute to 10 medical workers who were killed while on a mission to provide aid to remote Afghanistan villages that generally don't have access to medical care. Workers included 6 U.S. medical personnel and humanitarian workers, one German, one Briton and two Afghans.

Volunteer firefighter case - The Chicago Tribune reports on a recent Iowa court finding in a dispute between two insurers which ruled that a volunteer firefighter must be officially summoned to duty to be covered by workers' comp. Justin Fauer died while trying to rescue his boss from a manure pit. In addition to being a farm worker at the farm where he died, Fauer was also a volunteer firefighter. According to the report, "The farm's insurance company, Grinnell Mutual Reinsurance Company, paid the claim but sought for it to be shared by the fire department's company, Traveler's Insurance Company, claiming Fauer also responded as a firefighter." The Iowa Supreme Court upheld a district court decision that "...a volunteer firefighter cannot be summoned to duty by circumstances, but can only be summoned by the fire department or some other official channel."

Deadline reminder to 9-11 recovery workers - Ground Zero workers must register by September 13 of this year to be eligible for future worker's compensation benefits if they are sick or should become sick as a result of 9/11 exposure. Less than half the estimated 100,000 volunteers and workers who are eligible to register have done so. Authorities urge workers to register as a precaution. Joel Shufro of the New York Committee for Occupational Safety and Health says that ""You don't have to experience symptoms to file for this ...You may never use it. We are seeing so many workers now developing symptoms and some are getting worse. So this is a very protective measure, safety net, so people who do get sick in the future will have protection."

Popcorn Lung - Richard Bales of Workplace Prof Blog posts that an Illinois jury has awarded $30.4 million to a plant worker suffering severe lung disease from diacetyl. See more from on the popcorn lung case from the Joplin Globe.

BP agrees to pay for safety violations at Texas City refinery -
Liz Borowski of The Pump Handle reminds us that before BP became synonymous with the Gulf oil disaster, it's prior "claim to fame" was the 2005 Texas City refinery disaster that killed 15 workers. When OSHA conducted a 2009 follow-up investigation, it issued $50.6 million in failure-to-abate citations, plus $30.7 million for 439 new willful violations it identified. BP had disputed these violations, but last week, agreed to pay the entire $50.6 million.

Nancy Germond hosts this week's Cavalcade of Risk #111. Make sure you click her "just for fun" video for a display of unusual talent! Of course, her links to more serious risk-related posts are fun too, although in a slightly more nerdy way ;-)

Here are a few other links to news items that hit our radar:

• Kleen Energy explosion: OSHA issues third-largest fine ever


• Employee wellness the L.L. Bean way


• The Book of Odds: the odds of everyday life


• Misuse and abuse of prescription drugs in the workplace


• Insurers' top underwriting priorities


• Top 20 ADA cases: Large jury verdicts and perhaps some litigaphobia


• Workers' comp meets the ADA: A rock and a hard place


• Disaster planning for small businesses


• The Ultimate Glossary: 101 social media marketing terms explained


• It's official: WHO says swine flu pandemic is over


• Top 40 red flags which might indicate fraud


• Safety-driven software aims to block texting while driving

Jaan Sidorov has an air travel themed Health Wonk Review posted over at Disease Management Care Blog, which he calls "frequent flyer miles for your brain." There's a roundup of assorted news on the health care policy front ranging from a post on the growth of MinuteClinics to a look at hospital quality surveys. Get your dose of the news from some of the brightest braniacs in the health policy blogosphere.

Here are a few other health-care related news items we noted in our travels: Katharine Van Tassel of HealthLawProfBlog posts the disturbing news revealed via a survey that 36% of responding physicians don't believe in reporting impaired colleagues. And at Managed Care Matters, Joe Paduda talks about the results of a Kaiser Health Tracking Poll that demonstrates the power of mis-information: "Half of seniors (50%) say the [heathcare reform] law will cut benefits that were previously provided to all people on Medicare, and more than a third (36%) incorrectly believe the law will "allow a government panel to make decisions about end-of-life care for people on Medicare."

The Weekly Toll - If you haven't visited in awhile, stop by The Weekly Toll to read about US workers who died on the job this past week. Many seasonal hazards are represented with a high toll of tractor and farming-related fatalities and construction-related deaths in this week's grim list. And the list does not include the 8 employees of Hartford Distributors who were killed by a coworker.

Whistleblowers - Michael Fox of Jottings By An Employer's Lawyer tell us that the difference between cloth and leather gloves is just over $1 million in his post about a Maine court's ruling in favor of a whistleblower who was terminated after making complaints about safety and working conditions. Maine courts aren't the only ones who are taking a dim view of retaliation against employees who report safety problems: at Today's Workplace, Mike Hall posts that OSHA takes whistleblowers seriously and has established a website to offer a Whistleblower Protection Program.

Teen workers - Elizabeth Cooney writes about young employees who face injury or even death on the job in an article in the Boston Globe. Teens often are employed in some of the most dangerous jobs and have little in the way of training, as evidenced by the fact that the nonfatal injury rate for 15- to 17-year-olds in the United States was 5.2 per 100 full-time equivalent workers per year, double the rate for adults 25 and older. She discusses research from the state's Teens at Work initiative, which revealed that of "208 teens under age 18 who had been injured at work from 2003 through 2007, about half said they had no safety training. About 15 percent said there was no supervisor on site when they were hurt. Almost a quarter said they had no work permit."

Remarkable story - Chrissy gets a new face from Work Comp Complex Care: "...her story of recovery is incredible on several levels - for the medical technology involved; for the reminder that dedicated health care professionals have the power to make a huge difference in a patient's quality of life; and for the grace and attitude of the woman who suffered a devastating, life-changing injury and did not let it defeat her."

Protecting football players - In Hitless or Witless?, Skip Rozin of WSJ.com discusses new NFL safeguards to protect football players from serious head injuries. Long overdue, and more is needed. The biggest hurdle will be overcoming the culture. As Rozin puts it "One of the biggest obstacles here is the athletes' code of playing hurt."

Nursing shifts - A new study from the University of Maryland-Baltimore reveals that long shifts pose health hazards for nurses - and may increase the risk to patients, as well. Study authors said that "the most common problems with an overemphasis on 12-hour shifts are needle-stick injuries, musculoskeletal disorders, drowsy driving, and other health breakdowns related to sleep deprivation."

Legal briefs - In South Carolina, the court ruled that free living quarters offered as inducement for employment are considered wages. In a case involving horseplay, an Iowa court ruled in favor of a butt-shaking employee on appeal. A Washington court found that a fitness for duty test did not violate the ADA.

OSHA - Dwayne Towles of Advanced Safety Health News Blog warns employers that OSHA is scrutinizing safety incentive programs and may be asking for any written policies or details of any contests or promotions. They are looking for programs that might discourage employees from reporting injuries. Towles offers his thoughts for how to handle matters should OSHA come calling. And while on the topic of OSHA visits, SafetyNewsAlert offers additional suggestions in prepping for an inspection: top 10 dos and don'ts for OSHA inspections from 2 OSHA inspectors.

Check out the Rocky Mountain High Edition of Cavalcade of Risk. Louise of Colorado Health Insurance Insider produces a great compendium of recent "best of the web" risk posts on a variety of topics ranging from the ubiquitous health care debates to investing and long term insurance. It's a great way to get a sampling of several blogs. Plus, Louise and Jay's blog always offers a refreshing street-level view of issues related to health care. They offer a wise take on the big issues but also offer good advice on everyday health issues: If you ever get a rock stuck in your nose...".

A good man wronged - Joe Paduda has been fighting the good fight for Sandy Blunt, former North Dakota state work comp fund CEO. Blunt had a recent setback when the Supreme Court affirmed his felony conviction, but more recently we learn that the prosecutor is under investigation for prosecutorial misconduct in the case. One of the charges against her is allegedly withholding exculpatory evidence from Blunt's attorney. (If you aren't familiar with the Blunt case, see Peter Rousmaniere's article Blunting Political Vindictiveness or plug "Blunt" into Joe's search feature and catch up.) We had the good fortune to meet Blunt at an industry symposium prior to all these events - he was on fire with his commitment to overhaul the ND agency, to inspire employees and employers alike, and to ensure the best possible care for injured workers. Innovative, energetic, creative - by all accounts, he was making a significant positive impact. Then came a series of surprising charges resulting in his ouster. As we've noted before, most of these charges were minor, trumped up administrative issues, such as spending a few hundred dollars on lunches and gift certificates to motivate staff - practices that were not uncommon in other state departments. Other more serious charges were dismissed or shown to be erroneous - and now we have potential prosecutorial misconduct being investigated.

ADA at 20 years - It's been 20 years since the Americans with Disabilities Act was signed into law, a groundbreaking initiative which afforded unprecedented public access and workplace protections to the disabled. All those parking spots, wheelchair ramps, wider doorways, and sloped curbs? They didn't exist a few decades ago. For a commemorative featuring recent news stories, commentary and employer resources, see HR Web Cafe: The ADA at 20 Years.

Calling Uncle Sam - Is the workers comp system broken for occupational diseases such as the ones that are likely to result from the BP oil spill cleanup? Peter Rousmaniere thinks so - the feds have had to bail the system out in two prior catastrophes within the past decade. He makes the case for federalizing occupational disease in his column at Risk and Insurance.

Walking the walk when it comes to obesity - Employees at Total Medical Solutions are taking their role as health care providers to heart and taking a leadership stance when it comes to doing something about obesity. In the last three months, 25 employees have shed a total of more than 400 pounds, and achieved good local press for their accomplishments. We were reminded of seeing this story when we read Roberto Cenicero's post on the biggest loser, corporate edition, which talks about a competitive challenge several of Minnesota's largest corporations have embarked on. His post also links to a recent study from Integrated Benefits Institute on "health and productivity management" practices at 450 U.S. companies.

Quick lesson in how to save $550,000 - Discouraging employees from filing a workers compensation claim for an on-the-job injury is a no-no. Just ask Rawley's of California how they fared in a recent criminal investigation, which revealed that some managers were routinely telling injured employees to use their own insurance rather than report injuries to the state.

In the "what else is new" department... - Mark Hoffmann of Business Insurance reports on news from the most recent RIMS Benchmark Survey: The soft market is still going strong. "The survey, based on information provided by risk managers, found that workers compensation experienced the greatest decline in the second quarter, at 3.8%, while property and D&O dropped by 3.5%."

Like much of the country, we've had a sizzling summer here in the northeast, and we are just entering the dog days of summer. In Ancient Rome, the Dog Days extended from July 24 through August 24 and were popularly believed to be an evil time "when the seas boiled, wine turned sour, dogs grew mad, and all creatures became languid, causing to man burning fevers, hysterics, and phrensies."

That sounds like a pretty accurate description of the climate as we head on into election season. If you thought all the excitement over health care reform had died down and you could slack off for your summer reading, think again. Things are still pretty heated and we expect much in the way of sea boiling, wine souring, madness, phrensies and hysteria right through the November election. To help you make sense of things, our esteemed contributors offer up an assortment of hot issues related to healthcare - from costs and reform to technology and ethics.

In A Reply to the Cato Insitute Report, Part 1 Maggie Mahar of Health Beat takes on Michael Tannner's 52-page thesis Bad Medicine, which asserts that the Patient Protection and Affordable Care Act is both unaffordable and unfair. Bad Medicine is meant to serve as a playbook for those who hope to kill reform, a theme that Tanner says will serve as the "centerpiece of Republican campaigns this fall."

In his post Controlling health care costs: Who's responsible?, Joe Paduda of Managed Care Matters wonders why those who believe health reform is socialism don't have faith in the free market's ability to control costs and deliver quality.

Uwe Reinhardt of Health Affairs Blog contemplates the difference between widgets and health care as he examines the issue of whether more insurers will better control health care costs.

In Standardizing Payments for Childbirth, Louise of Colorado Health Insurance Insider offers a quick and dirty summary of her idea to lower the c-section rate, which would be one piece of the 'costs' puzzle that is overwhelming our healthcare system.

David Williams of Health Business Blog expresses doubt about the sincerity of Republican objections to sending extra money to the states for Medicaid, but just in case, he offers a suggestion for how the deficit hawks can satisfy their concerns about Medicaid spending.

We have a pair of posts from the bloggers at Health Access WeBlog. First, Anthony Wright notes that the rate hikes by Anthem Blue Cross of California that helped jump-start health reform have had a second, third, and fourth act. He thinks that their recent rate filing demonstrates that public scrutiny matters. Next, Beth Capell reminds us that reform isn't just about expanding coverage - it's also about saying adios to the junkiest of junk health insurance.

A final rule for the "Meaningful Use" Regulation for Electronic Health Records has recently been issued, and two of our regular contributors shed light on the topic. Rich Elmore at Healthcare Technology News delivers a compendium of resources and analysis related to the final rules for Health Information Technology - Meaningful Use and Standards/Certification. David Harlow of HealthBlawg explains how this rule, along with the EHR certification rule and the HIPAA rule amendments (also recently released) will govern the future development of health IT in this country, and discusses details and implications of the meaningful use rule.

In his posting The Medicare 'doc fix': How to make political lemonade, Austin Frakt of The Incidental Economist, says that the Sustainable Growth Rate system was flawed from the start and should have been fixed years ago, but now we have an opportunity to make necessary systemic changes.

Jaan Sidorov of Disease Management Care Blog says that although the risk may appear to be low, Congress should consider the risk of a physician boycott of Medicare. He suggests that good business practice -- Enterprise Risk Management (ERM) -- requires it.

In Whose costs? Our costs, The Notwithstanding Blog suggests that patient convenience as a benefit of medical care delivery is largely ignored, and he makes the case for why it is a factor that should be weighed in any honest evaluation of competing reform proposals.

Peggy Salvatore of Healthcare Talent Transformation advocates for E-learning as the most cost effective and best way to educate healthcare workers on the use of IT in her post Technology for Healthcare Education: Build it and They Will Come, and Keep Coming!

Jared Rhoads of the The Lucidicus Project has been tweeting about the highlights and lowlights of the healthcare chapter of Mitt Romney's book, "No Apology: The Case For American Greatness." He's compiled his tweets in his blog post: Twead #3: Mitt Romney. (Here's a Twitterspeak Guide for all you non-tweeters)

Media Matters
In Everybody outta the pool!, Henry Stern of InsureBlog reports on a new high risk health pool and suggests that an agenda-driven press has mangled the message.

At Healthcare Economist, Jason Shafrin observes that when Congress enacted the Medicare and Social Security programs, the media coverage was intense. He notes, however, that Medicaid's beginnings were more humble.

Ethics and marketing
Roy Poses of Health Care Renewal posts that the Avandia spin cycle continues even after the FDA safety hearings, noting that the case offers a good lesson in the need for skepticism about data and claims proffered to support commercial health care products. He finds it particularly disappointing that formerly prestigious medical societies and disease activity groups are increasingly funded by industry, and increasingly act like industry marketers.

Tinker Ready looks at the ethics of advertising, questioning whether hospitals should be promoting drugs used in clinical trials as "treatment" in her post MGH: Research as Marketing? at Nature Network Boston. We usually see Tinker at Boston Health News but this post appears the forum/blog/calendar/jobs site for local scientists.

Extended reading
In a series of posts (#1; #2; #3; #4; and #5), Brad Wright takes a closer look at health reform by elaborating on quotes drawn from Brown University political science professor Jim Morone's Health Affairs article Presidents and Health Reform: From Franklin D. Roosevelt to Barack Obama."

Over a series of posts at The Apothecary, Avik Roy discusses a Medicaid study from the University of Virginia which suggests that Medicaid patients fare worse than the uninsured (and far worse than those with private insurance) when undergoing a broad range of surgical procedures. Roy also points to posts by Incidental Economist Austin Frank, who has a different take on the studies.

Jaan Sidorov dishes up a summer smorgasbord of risk at the 109th Cavalcade of Risk Picnic edition over at Disease Care Management Blog.

Speaking of risk, yesterday Business Insurance twittered: Among the accomplishments of the legendary George Steinbrenner: making George Constanza learn about risk management. Risk management isn't a topic that surfaces in TV sitcoms too often, so we thank them for the reminder - check out a You Tube clip of Seinfeld's classic segment on risk management.

As long as we're having a bit of fun with risk management, let's up the ante a bit by throwing in some actuaries and accountants. A newly discovered blog that we are happy to recommend - Actuary Info - features many interesting and deliciously nerdy posts. For today's purposes, we call your attention to these two:

Actuarial Risk Management Humor: During the pause of a Risk Management conference, a professional risk manager, an accountant and an actuary were in the gents room standing at the urinals ...

Actuarial Risk Management Puzzle Joke: Three actuaries and three accountants are traveling by train to visit a 'Risk Management Conference'. At the station, the three accountants each buy tickets and watch as the three actuaries buy only a single ticket...

Happy post holiday weekend. This is a big vacation week, but if you are one of the many who is on the job today, here's a serving of a few news items that caught our attention.

Complex Care - here at Lynch Ryan, we focus on helping injured workers to recover and get back to normal life activities, including work, as soon as possible. But the reality is that some workers have serious injuries that require long-term recovery or permanent care. The Work Comp Complex Care Blog focuses on issues related to injured workers who require ongoing care. A few notable recent posts on things that can have a positive impact on outcome over the long term: Success Story: Simple Change Makes A Big Difference For Injured Worker and Standing Improves Mobility and Wellness in Patients Confined to Wheelchair.

West Virginia - We've been seeing a spate of stories about state workers comp programs moving from BrickStreet to private carriers. BrickStreet has been the sole provider of such insurance for government agencies, but that changed as of today, July 1. BrickStreet says this is to be expected, the same thing happened when competition went into effect for private sector clients two years ago.

Vermont is cracking down - Vermont employers who don't carry workers comp beware: your business may be shuttered. Previously, when an employer was found to be without workers comp coverage, there was a five-day grace period to obtain coverage before business closure, along with a fine of $150 a day. The Vermont legislature recently increased penalties for noncompliance - employers found without workers comp coverage must now be closed immediately and fines have been increased to $250 per day. In addition, as of September, the Labor Department will add four limited service positions to step up enforcement.

OSHA challenge - CalOSHA is convening a panel on how to better protect workers in the adult film industry. OSHA's existing state blood-borne pathogens regulations already cover condom use in productions filmed in the state, but many in the industry oppose mandatory condom use. It's a serious issue -- Los Angeles health officials have linked eight of as many as 22 possible HIV infections identified between 2004 and 2008 as tied to the industry.

Economic indicators - Roberto Ceniceros offers a roundup of recent economic news. In another post, he cites a recent news report noting that five Ohio pension funds and the state's Bureau of Workers' Compensation owned 30 million shares of BP stock, and wonders whether other state comp funds might be similarly affected.

Catastrophic risk scenarios - Jared Wade of Risk Management Monitor tells us about 7 potential disasters worse than the BP spill.

Obesity - At Booster Shots, the LA Times health blog, Tami Dennis notes that the obesity rate now tops 25% in two-thirds of the states, with Colorado being the only state coming in under 20%. The data is from a recent report F as in Fat: How obesity threatens America's future (pdf), which was issued by the Trust for America's Health and the Robert Wood Johnson Foundation.

DC court says no to PTSD - the D.C. Court of Appeals denied benefits to a former Pepco employer who sought benefits for a work-related case of post-traumatic stress disorder. Benjamin Ramey claimed that he suffered fear and embarrassment that resulted in PTSD after being tested for being drunk on the job. After the drug testing, Ramey was placed on suspension and enrolled in a rehabilitation program, but fired when he was ejected from treatment due to continued drinking.

Note to fraudsters - If you are out on workers' comp disability benefits, you may want to think twice about accepting a part in a Hollywood film.

A fresh new Cavalcade of Risk is awaiting your perusal at Wenchy's place - check it out!

Five years ago almost to the day we blogged the saga of Dr. Jayant Patel, a surgeon of staggering incompetence who wreaked havoc on the citizens of Bundaberg, Australia. After 14 weeks of testimony, more than 75 witnesses and nearly 50 hours of deliberations over six days, a jury convicted Patel of manslaughter in the deaths of four patients and causing "grievous bodily harm" to a fifth. These charges involve just a small number of the cases where Patel's doctoring skills have been called into question. There may be further trials ahead.

The most appalling aspect of this case involves institutional denial: despite Patel's obvious incompetence - nurses actually hid patients from him - and despite explicit and alarming descriptions of his shortcomings as a doctor, administrators continued to support Patel, even naming him "employee of the month" following an egregious operating error that led to the death of a patient. Only when an enterprising reporter Googled his name did his prior problems as a surgeon in America pop up, at which point his employment was finally terminated.

The maximum penalty for manslaughter in Australia is life in prison. Dr. Death, in other words, is facing life. (He is filing an appeal.) In a just world, the administrators who hired, coddled and facilitated Patel would also be held accountable. But in case you haven't noticed, this is not exactly a just world. The wheels of justice, slow though they may be, have finally put an end to Patel's bizarre career, which transformed the medical premise of "do no harm" into its opposite. We can only say that he will do no further harm - a small consolation to his victims and a savage indictment of his profession.

Brad Wright of Wright on Health has an excellent edition of Health Wonk Review, which shines a spotlight on research. Brad notes that, going forward, research will be incredibly important as health reform is implemented and evaluated. He offers a fine research roundup from leading healthcare bloggers - check it out!

Healthcare - According to a Commonwealth Fund report on healthcare, which assessed and compared data from patient and physician surveys in seven countries in 2007, 2008 and 2009, the U.S. scored sixth out of seven countries on quality issues, yet we spent more than double per person than any other surveyed country. See the full report How the Performance of the U.S. Health Care System Compares Internationally, 2010 Update, which includes both a snapshot chart and an interactive comparison tool. Related: Results from the National Scorecard on U.S. Health System Performance, 2008

The importance of timely reporting - In Manucy v. Joe Manucy Racing, The Louisiana Court of Appeal recently ruled that an employee who was injured during horse training was ineligible for benefits because although the injury was immediately apparent, the worker did not file for benefits until about a year and a half after the injury occurred. Louisiana law stipulates a one-year from date of injury filing deadline for injuries that are immediately evident, and two years for injuries that do not develop immediately. In this case, the injury was immediately apparent, requiring ambulance transport and surgery within two months. State law varies on statues of limitations for benefit eligibility, most commonly falling between one and three years from date of injury. Many states