Recently in Research Category

August 26, 2014

 

benefits.JPG

Workers' compensation benefits rose by 1.3 percent to $61.9 billion in 2012, while employer costs rose by 6.9 percent to $83.2 billion, according to a report released today by the National Academy of Social Insurance. The Academy notes that this reflects the continued economic recovery as employment and earnings rise, and that despite the uptick, program spending as a share of covered payroll remains below historical levels. Employers' costs as a share of covered wages increased by $0.03 in 2012, to $1.32 per $100 of covered wages; benefits paid to injured workers decreased by $0.03, to $0.98 per $100 of covered wages.

You can view and download the full report from the Academy site for state-by-state detail -- REPORT: Workers' Compensation: Benefits, Coverage, and Costs, 2012 -- along with a press release and an infographic, from which we've illustrated this post. The Academy notes these highlights from the state-by-state results, which show that between 2010 and 2012:


  • The number of covered workers and amount of covered wages increased in all jurisdictions

  • Benefits per $100 of covered payroll decreased in 39 jurisdictions.

  • Employers' costs per $100 of covered payroll increased in 42 jurisdictions.

  • In 2012, medical benefits exceeded cash benefits in 33 jurisdictions.

nasi.JPG

| Permalink | No Comments

August 13, 2014

 

Summer reading! Here's a roundup of links to a variety of recent studies and reports that we find noteworthy - some that haven't received wide circulation.

Mathematica: Risk Factors Associated with Disability Following Work-Related Injuries (PDF)
Nan L. Maxwell and Nathan Wozny of Mathematica Policy Research have issued a study on work-related disability using a previously untapped database -- administrative data on claims filed under the Federal Employees' Compensation Act (FECA) -- to show how risk factors underlying disability following a work-related injury differ across groups defined by demographics, employment characteristics, and injury type (that is, injury or illness). Differences exist in three areas: the probability of incurring an injury, the probability of incurring a disability once an injury has occurred, and the size of the association between a risk factor and the probability of incurring a disability. This heterogeneity was previously undetected in narrower data sources and highlights the importance of tailoring efforts to identify and support individuals at - risk of disability to the population of interest.

NASI: State Policies on Provider Market Power (PDF)
The National Academy of Social Insurance (NASI) and Catalyst for Payment Reform (CPR) issued a comprehensive evaluation of state laws addressing the power of health care providers to negotiate higher prices, cataloging the laws and regulations state governments are using to maintain or increase competition in health care markets, which the recent wave of mergers among hospitals and other consolidation among providers has significantly reduced. See the press release for a summary.

Health Affairs: Price Transparency For MRIs Increased Use Of Less Costly Providers And Triggered Provider Competition
Covered by Sarah Kliff in Vox, When health care prices stop being hidden, and start getting real
"That lack of transparency in health prices partially explains why there is huge variation in what doctors charge for the exact same service. An appendectomy can cost anywhere between $15,000 and $186,000. Doctors don't usually feel the need to make their prices competitive when shoppers can't see them.
Over the past two years the Blue Cross and Blue Shield health plans have been running a quiet experiment, to see what would happen if prices became available in some cities but not others. And they found that just the act of making prices available can have a really dramatic impact on what they had to spend to get patients a very basic procedure."

AECOM: Alcohol Use Disorders Linked to Decreased 'Work Trajectory'
Workers with alcohol use disorders (AUDs) are more likely to have a flat or declining "work trajectory," reports a study in the July Journal of Occupational and Environmental Medicine, official publication of the American College of Occupational and Environmental Medicine (ACOEM).

The Influences of Obesity and Age on Functional Performance During Intermittent Upper Extremity Tasks
Journal of Occupational and Environmental Hygiene, Lora A. Cavuotoa* & Maury A. Nussbaumb. In this study, the main and interactive effects of obesity and age on functional performance were assessed during intermittent exertions involving the upper extremity.

Multiple jobholding in states in 2013
Monthly Labor Review presents data on the multiple-jobholding rate, or the percentage of individuals who hold more than one job, by state and region.

And two not-to-be missed reports we've previously noted:

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

WCRI: 8 revealing state studies on workers compensation
WCRI has issued eight new state-specific studies identified new predictors of worker outcomes that can help public officials, payors, and health care providers improve the treatment and communication and injured worker receives after and injury - leading to better outcomes.
Bill Coffin looks at data and results of Phase 1, covering Indiana, Massachusetts, MIchigan, Minnesota, North Carolina, Pennsylvania, Virginia and Wisconsin.

| Permalink | No Comments

April 30, 2014

 

In October, 2013, the Food and Drug Administration (FDA) allowed the opiate Zohydro ER to come on the market despite its own Advisory Panel voting 11-2 against it because it was not tamper resistant. Twenty-nine state Attorneys General petitioned the FDA to reverse its decision, but the FDA declined to do so, saying that the drug is safe and effective if used as directed.

We chronicled Massachusetts Governor Deval Patrick's Quixote to the Windmill charge as he attempted to ban the sale of the drug in the state. The windmill won when US District Judge Rya W. Zobel overturned the state's ban. Shortly thereafter, just days before his ban was due to expire, Governor Patrick remounted Rocinante and made a less Quixotic charge: he followed the lead of governors in other states by imposing sweeping restrictions on how Massachusetts doctors prescribe the powerful pain killer, the first pure opiate.

The restrictions, which Zohydro ER's maker, Zogenix, calls "draconian" and "unjstified," require that doctors:

  • Evaluate a patient's substance abuse history and other current medications;
  • Provide a "letter of medical necessity" to the pharmacy;
  • Enter a "pain management treatment agreement" with the patient; and,
  • Use the state's online Prescription Monitoring Program, which tracks prescriptions of controlled substances, before prescribing drugs like Zohydro that are extended-release medications containing only hydrocodone and do not come in an "abuse-deterrent form."

Zogenix is fighting back. On Monday, the San Diego-based company filed a federal lawsuit arguing that the Massachusetts new restrictions impose "draconian" mandates on doctors and "amount to an effective ban of the drug" that is unconstitutional.

The Suit asks that the Court vacate any restrictions imposed on the sale of Zohydro ER.

Governor Patrick says that his problem with Zohydro ER is that it does not come with "abuse deterrent" packaging. Zogenix responds with three assertions:

  • The active ingredient in Zohydro ER, hydrocodone bitartrate, is no more potent than most other opioids;
  • There are more than 30 extended-release opioids on the market, and only one has an FDA-approved label indicating it has abuse deterrent properties; and,
  • No product on the market today addresses the most prevalent form of abuse, taking an excessive number of tablets or capsules.

Yesterday, things got even hotter in the Bay State when drug abuse prevention groups, state lawmakers and organized labor leaders rallied outside the statehouse on Beacon Hill demanding even more restrictions.

The rally drew more than 150 demonstrators who, in addition to the call for greater restrictions, urged Congress and federal officials to reverse the FDA's approval of Zohydro ER.

Those who attended the WCRI's annual conference in Boston in April will recall the stemwinding luncheon speech of Steve Tolman, former Massachusetts state Senator and now President of the Massachusetts AFL-CIO. Tolman, who ardently and passionately does all he can to combat drug abuse in the Commonwealth, was in rare form at yesterday's rally.

"We don't need any more opiates! We don't need any more addiction," he shouted to the crowd. "Yes, we know that people need pain medication, but they need the right type of medication. And it needs to be monitored."

Massachusetts Senate President Therese Murray promised the demonstrators that the legislature will take action and is now working on a comprehensive bill dealing with all aspects of addiction, from education to prevention to treatment.

But, with the exception of theft, the only way people get opioids is by doctors prescribing them, and, right now, doctors are cautious and, in some ways, befuddled. They know there's a big opioid problem, which has prompted Governor Patrick to declare a state of emergency, but they don't want government invading their patient examination rooms. Nonetheless, shortly after the Governor announced his restrictions, the Massachusetts Board of Registration passed emergency regulations adopting them.

Moreover, in this week's New England Journal of Medicine, Doctors Yngvild Olsen and Joshua M. Sharfstein present a thoughtful op-ed focused on Zohydro ER and the greater issue of the intersection of chronic pain and pain management medication. They write:

Chronic pain, which affects tens of millions of people in the United States, is associated with functional loss and disability, reduced quality of life, high health care costs, and premature death. U.S. physicians are now more likely to recognize and treat chronic pain than they have been historically, with the number of prescriptions written for opioids having increased 10-fold since 1990.
Over the same period, however, the rate of overdose deaths in the United States has more than tripled. This is not a coincidence. Many doctors have prescribed opioids for chronic pain without following best practices, understanding the risk for the development of substance-use disorders, or recognizing the red flags that can emerge in clinical practice. There is now evidence from states including our own, Maryland, that some individuals whose path to addiction may have started with a prescription for pain are progressing to heroin.

It is becoming crystal clear that re-educating doctors regarding opioid usage is central to any attempt to fix this problem.

It is also clear that this crisis is not about Zohydro ER, although the drug may prove a catalyst for change. Rather, we are witnessing a growing countrywide realization that we are slipping into a public health crisis unlike anything we have ever seen.

In the workers comp field, there is a glimmer of hope. Progressive Medical and PMSI yesterday reported a slight drop in the number of opioid prescriptions written, as well as the costs of those prescriptions in 2013. Other PBMs are reporting similar moderate declines. But that is workers comp, the tiny caboose on the great big health-care train.

This issue demands more than the piecemeal approach it now is getting. Lives, careers and families are being destroyed, while too many constituencies operate alone, unable to achieve any kind of a cohesive and comprehensive solution. It is time for the FDA, the AMA, the US Congress and Big Phama to come together in serious purpose to address this public health emergency, which is rapidly spiraling out of control.

If not, more of America's humanity will just continue to wither and die. We are better than that.

| Permalink | No Comments

December 13, 2012

 

Unlike any other US state, Texas has never required its employers to buy or provide statutory workers' compensation. Texas employers who opt-out of this traditional form of injury benefit system are called non-subscribers. In 1993, 44% of Texas employers were non-subscribers, and they employed 20% of the employees in the state. By 2008, employer non-subscribers had shrunk to 33%, but their percentage of the state's total workers had grown to 25%. No one knows for sure, but estimates are that as many as 114,000 Texas employers have opted-out.

Until now, with the exception of two academic studies, one in 1996 examining lost injury days, the other, a 2010 survey of large, multi-state non-subscribers, no one has ever fully examined the Texas opt-out phenomenon. But, with the release today of the 87-page "Workers' Compensation Opt-Out: Can Privatization Work? The Texas Experience and the Oklahoma Proposal," that has changed.

Funded by the big TPA, Sedgwick CMS, published by the New Street Group and written by Primary Researcher Peter Rousmaniere and former Risk & Insurance editor and New Street Group founder Jack Roberts, this thorough, well-researched and entirely lucid analysis is certain to propel the opt-out debate now and in the foreseeable future.

In Texas, It's 1910 All Over Again
To get a grasp of the back-to-the-future Texas opt-out, think 1910, the year before states began enacting workers' compensation laws, the grand bargain in which employers promised to replace lost wages and cover medical costs due to injury and workers agreed not to sue employers when the workers were injured on the job.

Lots of employers buy workers' comp in Texas, but for those who don't it's 1910 all over again with virtually no state oversight. Let me be clear about that: In Texas, there is no requirement for non-subscribers to pay for work injuries in any way. There is one important difference, however. The Texas legislature has statutorily removed the three major defenses used by employers prior to workers' comp statutes being enacted to defend themselves against worker suits: contributory negligence, assumption of risk and the negligence of fellow employees. Also, without workers' comp, there can be no "exclusive remedy," and for non-subscribers there isn't. Large non-subscribers, such as Costco, have been very creative in dealing with that.

Rousmaniere and Roberts discovered that Texas opt-out was a bit of a carnival sideshow until ten to fifteen years ago when large employers like Costco, whose program they analyze in depth, cottoned on to the idea that they could provide a sleek, fast-moving, common-sensible injury benefit management system if they wove it into their ERISA plans. ERISA, the Employee Retirement Income Security Act, is a federal program which allows employers to design their own benefit systems, and substantially more than a cottage industry has evolved in Texas to help them do that for worker injuries. The operable phrase in that last sentence is "design their own."

Designing Their Own
Suppose someone, your boss for example, said to you, "There's no more workers' comp. Design me a plan that will provide our workers who get injured immediate medical care and wage replacement. Make worker participation mandatory. Keep the administration to nothing more than what is absolutely needed for it to run smoothly, and, before I forget, keep all the lawyers out of it."

What would you do? Well, large employers in Texas have had about fifteen years to think about that, and at least one of them, Costco, has created the ideal program I would design myself if I had a magic wand. I say "at least one," because Costco is the only employer Rousmaniere and Roberts point to, although they do report on interviews with many professionals involved in Texas opt-out. They also suggest that Costco is fairly typical of the large employer opt-out experience.

After much research and planning, Costco became a non-subscriber in 2007. At that time, the company operated 15 large warehouses throughout Texas, carried a payroll of $87 million and employed about 4,000 workers. Its loss costs had grown to around $150 per employee, or 97 cents per hundred dollars of payroll. In the four years following non-subscription, losses fell to 46 cents per hundred dollars of payroll, a decline of 52%, with high employee satisfaction for the system.

Here are the main points of Costco's worker injury benefit program, and remember, Costco was able to start with a blank piece of paper:

  • Work must be the "sole cause" of injury, not just a "contributory factor." More about this below.
  • Injuries "must" be reported by end of shift, but in no case later than 24 hours after happening. Failure to do this will negate any benefits. Workers who don't report in time are on their own; most use group health to cover medical costs, but, as one can imagine, a worker is more likely to win the Powerball than to not report within 24 hours.
  • Employees receive a taxable 80% of pre-injury wages with no waiting period. They're paid from day one.
  • Upon hiring, workers are required to accept binding arbitration for disputed claims, and Costco picks the arbitrators. If unsatisfied with the arbitrator's ruling, employees do have the option of bringing suit for employer negligence in civil court, but since 2007 only three such suits have been brought; two were settled modestly, and the third is pending
  • Chiropractic care is not allowed (Costco's analysis of its losses concluded that excessive chiropractic care was a major driver of loss costs and unnecessary for employee recovery)
  • There are no permanent partial disability awards
  • Wage and medical benefits end after 156 weeks, but, in rare cases, future medicals can be settled (Rousmaniere and Roberts don't address this, but I'm wondering about the degree to which CMS plans on extending its long, bony Medicare fingers into this pie)
  • Costco carefully picked an emergency care and specialist medical provider network comprised of highly reputable physicians, with as many as possible being board-certified occupational medical physicians. Costco routinely pays its providers full invoiced charges
  • If employees fail to follow through on medical recommendations or miss appointments for no good reason, benefits are terminated
  • For the rare event when injuries extend beyond 156 weeks, Costco has purchased insurance to cover the tail
  • Because any disputes go quickly to arbitration, attorney involvement is nearly non-existent

With loss costs reduced by 52% and employee satisfaction high, Costco obviously has a winning program. Costco has seamlessly woven injury benefits into its ERISA plan, blending them with its group health and short and long-term disability programs.

One thing that Costco wrestles with is co-morbidity. Imagine a Type-1 diabetic warehouse worker without safety shoes who drops some heavy object on his or her foot. Because of the diabetes, the foot is much more susceptible to infection, which actually happens. Then, because diabetes seriously inhibits healing, the infection worsens, and the foot is amputated. In statutory workers' comp, this would be covered, but what about at Costco. I asked Peter Rousmaniere about this. He wrote back:

"You are right, this would be excluded... With Obamacare assuring universal health coverage, the opt-out employer's message will be something like, "Don't expect indemnity payments for a work injury if there is a good chance that your personal health condition will contribute to it."

Rousmaniere admits that this "sounds draconian," but he believes that this issue, as well as what to do about degenerative conditions, such as what to do about the 55-year old wall board hanger whose rotator cuff finally gives out, will gradually self correct with help from the ADA as well as the Affordable Care Act. The jury on this is decidedly out. But, just for a moment, imagine that he's right. What we could be moving toward, after decades of failed experiments, is the first manageable and potentially successful version of 24-hour care.

The Other Side of the Coin
One thing is clear from the Rousmaniere and Roberts study: Costco and other large employers like Target and Safeway, two other non-subscribers, have the resources and core values necessary to provide compassionate care for injured workers while bringing them back to work as fast as medically possible in a businesslike way. But what about Kenny's CITGO, down the street on the corner with five employees, all of whom, including Kenny, live paycheck to paycheck? And Kenny is just as free to non-subscribe as Costco.

Kenny and others like him are the Third World of non-subscription. Operating with no regulatory or legal oversight by the state, he can do what he pleases or what he perceives he can afford, which is probably not much. If one of his workers is injured, and Kenny decides to offer nothing in the way of injury benefits, the worker is on his own. He can certainly sue Kenny for employer negligence, and Kenny won't have those three pre-workers' comp era defenses to rely on. However, no attorney is going to take the employee's case because Kenny won't have the resources to pay if he loses, which he probably would. But, to quote Rousmaniere and Roberts, "That is a hollow victory, indeed."

And on a grander scale, what about the large employer with significant resources, but who also may have more than a bit of malevolence in its DNA and wants to play schoolyard bully (see Massey Energy)? In an environment without one scintilla of regulation will the bully treat workers fairly?

The Oklahoma Proposal
After studying the lay of the land for the Texas opt-out and seeing where the Punji Pits are (see Kenny's CITGO and Massey Energy), Oklahoma legislators crafted a remarkable piece of opt-out legislation that narrowly lost 42 to 50 in the Oklahoma House of Representatives in late April, 2012.

The Oklahoma proposed legislation would have corrected many of the perceived flaws in the Texas opt-out system. For example, Oklahoma would require any employer choosing to opt-out to provide similar, in some cases better, benefits than the statutory system. Also, injury benefits would be required to be part of an ERISA-approved plan, although there is significant uncertainty if this provision would withstand a constitutionality challenge. Further, employers applying to opt-out would have to pay a fee of $1,500 annually to do so. This would more than likely eliminate the Kennys of the world, employers who just don't have the resources to "pay to play."

Rousmaniere and Roberts expect Oklahoma legislators to do some tinkering and re-file during 2013. They think there is a good chance that this time the legislation will pass. Whether Governor Mary Fallin, who campaigned on a platform of workers' comp reforms, will sign it is another matter.

Summary
This 87-page report is a Herculean effort, and, in my view, the worker's compensation insurance industry owes Rousmaniere and Roberts a huge debt for spending close to a year to produce it. Sedgwick should be commended for funding it. Perhaps we can forgive Rousmaniere for a bit of acquired bias, but he's seen, up close, what a conscientious, fair-minded employer can do if given the chance. I come away from his report finding myself agreeing with him as he wrote me the other day: "Every state should offer and every medium and large sized employer should consider opt -out." But to this I add, "With a healthy dose of regulatory and state oversight. Not everyone is Costco."

| Permalink | 2 Comments

November 28, 2012

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Other noteworthy items


| Permalink | No Comments

October 3, 2012

 

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

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

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

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

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

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

News Briefs

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

shackleton-medical-kit.JPG

| Permalink | No Comments

August 22, 2012

 

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

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

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

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

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

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

Other news of note

| Permalink | No Comments

August 15, 2012

 

When it comes to on-the-job assaults, healthcare workers are on the front lines. Earlier this year, NCCI issued a report on Violence in the Workplace, which showed that homicides and assaults are trending down. Good news, overall, but let's take a closer look at assaults:

"The decline in the rate of workplace assaults has lagged the steady decline in the rate for all lost work-time injuries and illnesses. This reflects a notable change in the composition of the US workforce and, in particular, the ongoing increase in the share of healthcare workers, who experience remarkably high rates of injuries due to assaults by patients. This is especially common in nursing homes and other long-term care facilities. In fact, 61% of all workplace assaults are committed by healthcare patients. For assaults, coworkers make up just 7%, and someone other than a healthcare patient or coworker comprises 23%. The remainder is unspecified."

Now, a new research report from Maine offers a close-up snapshot of the issue of workplace violence as it relates to caregivers. The Research and Statistics Unit of the Maine Department of Labor compiled data from First Reports of Injury for 2011 and issued a report on 2011 Violence Against Caregivers in Maine.

The report encompassed about 100,000 workers in healthcare and affiliated professions. Of the nearly 10,000 thousand injuries reported by those workers, 13.4% were related to violent and aggressive acts by patients and care recipients.

Key report findings include:

  • Where incidents occurred - Mental health care settings and other residential care facilities accounted for 52% of all violent/aggressive incidents in 2011. These were followed by nursing care facilities for the elderly and people with disabilities, 18.9%, and general medical and surgical hospitals and services, 16.8%.

  • What types of jobs were involved - Nurses at all levels (including nursing assistants) were involved in 21.27% of the cases; education technicians were involved in 18.6% cases; direct support professionals (personal care, hygiene, life skills, etc) were involved in 9.4% cases; Other occupations with significant numbers of cases included psychiatric technicians, behavioral health technicians and analysts, mental health and social workers and child care and senior child care workers.

  • What types of assaults occurred - The most prevalent type of assault - being hit - accounted for 21.3% of all incidents. Bites were the second highest reports, at 16.6%, of the incidents. Other identifiable assault categories included kicks, 9.45%, and being grabbed, 9.4%.

Due to the high number of bite incidents, a specific section of the report focuses on bite injuries and references information from the Federal Bureau of Prisons' 2009 Clinical Guidelines regarding viral and bacterial exposures and the potential for infections if the skin is broken. The report also cites NIOSH publications and reports, including common risk factors for violence and a list of potential prevention strategies.

The full report is available in PDF: Maine's Caregivers, Social Assistance and Disability Rehabilitation Workers Injured by Violence and Aggression in the Workplace in 2011.

(Hat tip to WorkersCompensation.com for pointing us to this news item.)

| Permalink | No Comments

August 13, 2012

 

Last month, there was a story about a South Carolina sheriff who was denied workers comp benefits for mental distress that he suffered after fatally shooting a suspect. In Brandon Bentley v. Spartanburg County, and S.C. Association of Counties SIF, the South Carolina Supreme Court upheld a lower court denial saying that "...the use of deadly force is an expected and standard part of being a sheriff and is "not an unusual or extraordinary employment condition" that might qualify for workers' compensation under the state's restricted coverage for purely mental injuries. In citing statistics, the Sheriff had unsuccessfully tried to demonstrate that such a shooting was indeed an extraordinary event in Spartanburg County. "

The Court noted that it made its decision according to the law as it is written but "... the court did say the state law related to mental injuries should be updated. If South Carolina lawmakers revised state law, it would join a handful of others, wrote the court. Hawaii, Michigan, New Jersey, New York and Oregon already do not require that the conditions of employment be unusual and extraordinary in order for someone to collect compensation." (Source: Court brings new focus on mental health of law enforcement.)

Hopefully, his community or his police force sees the wisdom of extending some counseling to this officer, despite the denial of full benefits. Re-examining this issue makes good sense. While risks may well be part of the job, people are not automatons that can shut out the emotional residue of terrible events, regardless of training. PTSD is very real, and we must get better at dealing with it. This story was brought to mind again after watching the hard-working police Chief of Aurora Colorado reporting on the gruesome task that his staff faced in responding to the tragedy. In one of his daily updates, his voice broke when he spoke of the stress and toll this took on first responders.

Left untreated, the effects of PTSD on law enforcement can be terrible. In 2012 so far, more police have died by their own hand than by gunfire. According to Badge of Life, a police suicide prevention program, there have been 73 police suicides this year vs. 19 officers killed by gunfire. Badge of Life is conducting A Study of Police Suicides. The first full study of police suicides in all 50 states was published in 2009 in the International Journal of Emergency Mental Health. At that time, the suicide rate for police officers was 17/100,000, compared to the rate for the general public of 11/100,000 and 20/100,000 for the Army.

Badge of Life points us to a documentary that is in progress on the topic, Code 9 Officer Needs Assistance. It's being co-produced by the wife of a retired state trooper suffering with PTSD, exploring the darker side of law enforcement as it tells the stories of police officers and their families who are now suffering the mental anguish of the careers they chose, which has led some to suicide. Click the above link or the image below to see a powerful excerpt from the documentary. You can get more information on the Code 9 Facebook page.

officer-down.JPG

Related Resources
Law Enforcement Use of Deadly Force Incidents: Helping Reduce the "Second Injury"

Remember to save yourself: The importance of managing critical incident stress (PDF)

Law Enforcement Traumatic Stress: Clinical Syndromes and Intervention Strategies

Suicide Prevention Resource Center

| Permalink | No Comments

May 3, 2012

 

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

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

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

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

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

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

  • Robert P. Hartwig looks at the labor market recovery and the impact on insurers
  • Harry Shuford talks about the economy and what it will take to get us moving again
  • Peter Burton offers a legislative outlook, in which he recaps some of the major changes in 2011 and looks ahead to 2012
  • Joe Paduda looks at some key issues driving medical costs, opioid overprescribing and physician dispensing
  • Nancy Grover offers an overview of the state of insurance technologies
  • Tanya Restrepo and Harry Shuford write about the aging workforce and its effect on comp
  • Jim Davis and Yair Bar-Chaim examine the first rise in injury claims frequency in more than a decade
  • Dennis Mealy and Karen Ayres discuss the history of ratemaking in workers compensation
  • Charles Tenser examines four of the most discussed legal challenges involving workers comp
| Permalink | No Comments

April 19, 2012

 

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

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

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

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

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

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

Safety Culture is the way safety is perceived, valued and prioritised in an organisation. It reflects the real commitment to safety at all levels in the organisation. It has also been described as "how an organisation behaves when no one is watching". (Source: Skybrary).
The enduring value and priority placed on worker and public safety by everyone in every group at every level of an organization. It refers to the extent to which individuals and groups will commit to personal responsibility for safety; act to preserve, enhance and communicate safety concerns; strive to actively learn, adapt and modify (both individual and organizational) behavior based on lessons learned from mistakes; and be rewarded in a manner consistent with these values. (Source: Safety Culture: A Concept in Chaos).

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

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

  • Does health & safety commitment start at the top? Here's one quick check: Is health & safety included in your organization's mission statement? Does the President/CEO articulate the health & safety vision? Everyone knows that what the head honcho wants done is what gets done. If it isn't on his or her radar as a top-tier priority, it won't be on the radar for managers either. "Captain Sully" Sullenbeger speaks about how values start at the top and require "authentic action."
  • Are sufficient resources allocated? Management must back the corporate commitment with dedicated budgets, staff, and resources commensurate with the goals. This includes maintaining equipment and facilities and allocating training resources.
  • Are there written policies and procedures? Are essential functions and physical demands of each job documented? Management should also capture the company's commitment to safety in a written policy that is distributed to all employees and regularly reinforced.
  • Are health & safety goals on the "managerial dashboard"? The old adage about "what gets measured gets done" has more than just a grain of truth to it. Is health & safety included in annual business plans and goals? Are health & safety goals addressed and progress measured in concrete metrics? Does health & safety get reported on in business reviews the way any other critical business process would be addressed?
  • Is there accountability? You won't be able to take a bite out of losses without teeth in your program. Health & safety goals should be a part of every job description and every performance review at every level of the organization.
  • Are comprehensive inspections for hazards and behaviors conducted regularly? Do senior managers participate in walk-throughs and inspections? Does the CEO?
  • Do managers and supervisors "walk the walk"? In all-too-many many organizations, safety is just something expected of the line staff. Do managers and supervisors keep the rules themselves? Are visitors and vendors indoctrinated to safety rules at the onset of any visits?
  • Is health & safety addressed in a meaningful way in employee orientation? Studies show that new hires are at greater risk of injury than experienced workers. Is job safety training the first thing addressed in any new hire training? Does the worker have hands-on training in not just how to do the job, but how to do it safely? Is particular care taken with workers who pose risk challenges, such as young workers and workers who don't have strong command of the English language? Peer-to-peer buddy systems that monitor new employees for safety can be particularly effective.
  • Is safety training and communication ongoing process? In good organizations, training is not a "once and done" affair and safety value communication isn't relegated to an annual speech. Employees are retrained, processes are re-evaluated, and expertise is shared on a continual basis via team meetings, newsletters, company intranets, formal training sessions, and more. Remember to offer training when employees change jobs or get assigned new responsibilities. And don't forget to "train up": Many middle and senior managers don't know the real day-to-day hazards inherent in their own business or appreciate the role they play in fostering - or perhaps sabotaging - a safe work environment.

  • Is there strong employee involvement? At minimum, employees should be involved in in safety committees, inspections, and shaping corrective measures for eliminating hazards. Good organizations help to imbue a sense of ownership in employees at all organizational levels and encourage workers to share ideas that eliminate unsafe acts and working conditions for themselves and others. Employers need to create a climate that allows frank and open feedback from employees and must work to overcome the perception that giving safety-related feedback creates interpersonal conflict.
  • Is there a process for analyzing all accidents and near misses? We favor the term "analysis" over "investigation" to emphasize that the exercise is not about assigning blame but getting to the root cause of the breakdown, to understand where things broke down to learn from errors, incidents, and accidents. Immediate remedial actions should be taken.
  • Is progress recognized and acknowledged? - Mark safety milestones and progress to goals. Recognition can be simple - congratulating a work team in a meeting, free donuts in the morning or a pizza lunch to show employees that their efforts are valued. Employees sincerely appreciate recognition, which in turn increases motivation and commitment to work safely.

Additional Resources
OSHA: Safety & Health Management Systems eTool

OSHA: Creating a Safety Culture

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

| Permalink | No Comments

April 2, 2012

 

In the 2010 Oregon rankings for the cost of comp insurance, New York comes in 13th, with an average rate of $2.34 per $100 of payroll. That does not sound too bad, until you factor in the extraordinary 20.2 percent assessment that is tacked onto premiums. ** This assessment is double that of the nearest state (Minnesota at 8.9 percent) and nearly five times the average among states. When you combine the already high rates for coverage with the assessment, New York ends up near top of high cost states.

Quoting research from the Workers Comp Policy Institute (WCPI), Risk & Insurance Magazine identifies three major components in the assessment:
- the Second Injury Fund, accounting for half the total
- the Reopened Case Fund that covers claims reopened after more than 7 years
- the Workers Compensation Board, which oversees comp in NY

Recent reforms may eventually reduce the impact of the first two cost drivers, but there is no end in sight for the third. New York operates a huge - and largely redundant - bureaucracy to administer comp claims. Where other states empower insurance companies to make decisions on individual claims, with the state involved only in disputes, New York is involved in every step of every claim. The Board has over 300,000 hearings per year, overseen by 97 judges. The system generates 31 million forms annually, all of which are scanned and saved! Stenographers document every proceeding: a well-intentioned effort to pilot the cost-saving use of video recording devices met with ferocious opposition in the state legislature. The Board employs over 1,300 people; as a point of reference, the Massachusetts DIA, in a state with one third the number of workers, has only 167 employees.

The high cost of insurance might be more tolerable if injured workers were the primary beneficiaries, but this is not the case. The maximum weekly benefit in New York is only $740, which might support a frugal worker in upstate New York, but it will not buy much in the five boroughs. By comparison, Illinois - ranked number 3 for cost - has a maximum wage benefit of $1,288, while MA, ranked 46th, pays up to $1,136.00.

New York is stuck in an archaic system that is fiercely defended by the stakeholders who benefit from its inefficiencies. If only this same energy and commitment were devoted to the protection of disabled workers in the Empire State. Surely, that would be a system worth emulating.

**We heard from our friends involved with the Oregon ranking study, who provided the following clarification:

The Oregon WC Rate Ranking study does include state assessment rates in our index rate computation. We ask our state respondents to provide the rates that are assessed as a percentage of premiums. The NY rating bureau provided us that information in 2010, and there was a 14.2% factor included in the study index rate for NY. Apparently the rate has increased since that time, and the 2012 index rates would incorporate that information in our next study, due out this fall.

Unfortunately assessments are an area that does not lend itself to straightforward comparison. States use different terminology (assessment , surcharge, tax, etc), have different bases for assessment, and fund different functions through this mechanism. So there is plenty of room for different interpretations when looking at the data, depending on where the lines are drawn for inclusion or exclusion.



| Permalink | No Comments

March 27, 2012

 

Here's a quick summary. In a 50 state overview, there were no "A" students.

The State Integrity Investigation is a $1.5 million public collaborative project designed to expose practices that undermine trust in state capitols -- and spotlight the states that are doing things right. It describes itself as "an unprecedented, data-driven analysis of each state's laws and practices that deter corruption and promote accountability and openness. Experienced journalists graded each state government on its corruption risk using 330 specific measures. The Investigation ranked every state from one to 50. Each state received a report card with letter grades in 14 categories, including campaign finance, ethics laws, lobbying regulations, and management of state pension funds."

Click on the U.S. map to see your state's corruption risk report card. No states scored an "A." New Jersey, Connecticut, Washington, California, and Nebraska scored in the "B" range. Eight states flunked, scoring 60% or less: Michigan, North Dakota, South Carolina, Maine, Virginia, Wyoming, South Dakota, and Georgia. All the remaining states were "C" and "D" students, with our home state of Massachusetts scoring a lackluster 74%, coming in at 10th "best" overall.

How did the insurance departments score?
As citizens, both corporate and private, we find the whole report fairly intriguing, but for the purposes of this blog, we were particularly interested in the ratings for State Insurance Commissions. PropertyCasualty360's Mark Ruquet did a good analysis of this in his article 16 State Insurance Commissions Fail Integrity Evaluation.

The state Insurance Commissions were evaluated on these questions:

  • Is the state insurance commission protected from political and special interest influence?
  • Does the state insurance commission have sufficient capacity to carry out its mandate?
  • Are there conflicts of interest regulations covering members of the board and senior staff of the state insurance commission?
  • Are the conflicts of interest regulations covering members of the board and senior staff of the state insurance commission effective?
  • Can citizens access the asset disclosure records of the state insurance commission?
  • Does the state insurance commission publicly disclose documents filed by insurance companies?

One of the things we like about the map and the site is that you can keep drilling down. Click your state, then click a specific category - such as "State Insurance Commissions," "Ethics Enforcement Agencies" or "Public Access to Information" and then click again to see the specific areas that were evaluated. Click any one of those criteria to see how the score was derived, and click again for further detail. You can also read or submit comments. On each individual state page, there is also a narrative story behind the score and a running list of related news articles.

We'll be spending some time exploring the site further, but our first reaction is positive and we applaud the effort: we love sunlight when it comes to the public good and think it benefits everyone. We'd love to hear reactions about how accurate or inaccurate readers think reports are relative to their own state scores.


| Permalink

January 30, 2012

 

The Rand Corporation has published a study of California OSHA's prevention programs, which are mandated by state law. Despite enough caveats to sink a battleship, the study does illuminate, if only for brief glimpses, a path for establishing truly effective safety and prevention programs.

History and Ideology
First, a little background on California OSHA. In the 1970s, the state as big as a country implemented its own OSHA inspection program. In 1987 a Republican governor trimmed the budget by eliminating CAL/OSHA, leaving the feds to take over the program. Gee, guess how that worked out...Two years later, CA took back the program. Over the next few years, the legislation evolved, resulting eventually in a requirement that all CA employers implement an Injury and Illness Prevention Program (IIPP) with the following key elements:
- Identification of hazards and risks
- Training programs for employees in managing those risks
- Periodic hazard surveys to determine effectiveness of hazard mitigation
- Documentation of training and hazard surveys

IIPP being a state-sponsored program, state government had to train and disperse field inspectors to determine whether employers were in compliance. That raises two very big problems: first, the scale of the effort: with 700,000 employers in the state, inspectors can only perform about 8,000 inspections per year. Equally important, with limited time on site, inspectors lack the tools, training and time to measure the actual effectiveness of an employer's IIPP.

Elements in Good Safety Programs
IIPPs mandate that employers implement the key elements of good safety programs:
- Workers know the employer's point person for safety
- Workers know how to report hazards
- Workers with good safety records are rewarded
- workers with poor safety records are disciplined
- hazards and risks are analyzed on an ongoing basis
- identified hazards are mitigated in a timely manner
- training is ongoing

As any astute reader can surmise, there is a huge gap between developing a written program with the above elements and actually implementing it. A nice cottage industry arose in California, where employers could buy an IIPP program off the shelf - and promptly store the binder, unopened, on a shelf. A written program does not a safety program make.

Does the CAL/OSHA Program Work?
So what did the Rand researchers find? Does the CAL/OSHA program prevent injuries? Is it effective?

Well, sort of, kind of, not really, we're not sure...

By the time you sort through the caveats - the impact of an unstable economy, the under-reporting of injuries by small employers, the lack of specificity in inspection visits, etc - you have very little conclusive evidence one way or the other. When visiting employers for the first time, inspectors consistently found that they were out of compliance, lacking written plans and evidence of an effective safety program. When making a second visit, especially after an injury, the results improved; there is nothing better than a serious injury to revitalize a safety program. Alas, two years after an inspection, there is no measurable lasting benefit to the program. [It is important to note, however, that unionized workforces had a more sustained and effective focus on safety than non-union environments - fodder for the ideologues, for sure.]

The Role of Government in Safety
The Rand study raises a number of compelling issues and is well worth the reading. In the final analysis, the study points out the limits of any state intervention. To be sure, inspectors could spend more time on site; they could do more qualitative analysis of the written documentation and interview a good sample of the workers. But these steps would still likely result only in incremental and relatively minor improvements.

We would all probably agree that a commitment by a company's senior management is essential: safety must be a priority in all operations. We would also agree that the above key elements belong in any effective safety program. Finally, we all recognize that safety consciousness must be embedded into a company's standard operating procedures.But that's the ideal: what happens in the real world?

Where inspections reveal ineffective safety programs, where employers exploit workers and put them at risk, systematic fines and penalties are certainly in order. Such penalties are an effective means of getting an employer's attention. Once you have that attention, it is at least feasible that employers will see the benefits of making safety a priority and eliminating workplace hazards. Government cannot make it happen, but without government, far too many employers would lack the motivation to maintain a safe workplace.

In the long run, effective safety programs are cheaper and more efficient - more profitable! - than a workplace fraught with unnecessary and unacceptable risks. At least, that's the theory and a core belief of this blog. In practice these days, with predatory employment practices on the rise, one begins to wonder...


| Permalink

December 19, 2011

 

From time to time, we like to take a look at the wizardry that is under development in rehabilitative and assistive technologies. What used to be on the order of Flash Gordon type fantasy is now reality within reach. In out first clip, Toyota Unveils Quartet of Healthcare Robots. MedGadget says these four robots are expected to be production ready in 2013. Three are walking assist and balance training robots that would help in patient rehab. The fourth is a patient transfer assist - something we see as very valuable in helping to prevent health care worker injuries.

And while on the topic of lifting aids, we'd be remiss if we didn't include RIBA, a versatile if somewhat surreal patient care robot.

Finally, we have a Robotic Man's Best Friend to Guide the Blind. Yes, it may cost a bit more, but think of the savings in dog food. All joking aside, it's exciting to see these technological advances moving closer to the practical reality of helping people to overcome injuries and disabilities.


| Permalink

December 7, 2011

 

"Every time Massey sent miners into the UBB Mine, Massey put those miners' lives at risk"
Joe Main, assistant labor secretary for mine safety and health and chief of MSHA

A scathing report issued by the U.S. Mine Safety and Health Administration yesterday put the blame for the coal mining disaster that claimed 29 lives on "a workplace culture that valued production over safety." The report characterized the coal mining disaster as "entirely preventable", one that could have been avoided if long-standing and well-known safety standards had been followed. The report documents flagrant safety violations, routine coverups of violations, and intimidation of workers to keep them from reporting safety hazards and violations.

Ken Ward, who has covered the Upper Big Branch Mine Disaster with painstaking detail in The Charleston Gazette, reports:

"Outlining flagrant safety violations and a practice of trying to cover up major hazards, the U.S. Mine Safety and Health Administration officials cited mine operator Performance Coal Co. with 369 violations -- including 12 that directly contributed to the disaster -- and levied more than $10.8 million in fines.
Both the fines and the settlement are by far the largest ever in a case over worker safety in the mining industry."

In addition, federal prosecutors announced a $200 million settlement with Alpha Natural Resources, the firm that bought Massey Energy. The settlement calls for $80 million to be directed to enhanced safety at all the company's underground mines, as well as a dedicated training center and a $48 million trust to fund mine safety research at academic institutions. The settlement also includes $46.5 million in restitution for the families of the disaster victims.

Ward states:

Key to the deal, though, is that -- unlike a previous deal with Massey following the Aracoma Mine fire -- the Justice Department is not agreeing to never bring charges against any individual executives, officers or employees of Massey or Performance. Goodwin said resolution of issues with Alpha allows prosecutors to focus their resources on potential cases against such individuals.

In addition to his newspaper reports, Ward covers related events at his Coal Tattoo blog. Of particular note is a post in which he talks more about the settlement and how U.S. Attorney's criminal probe will continue. He quotes one US attorney as saying, "If anything, certain aspects of our investigation are going into high gear."

All eyes will be on Alpha going forward. Their buyout occurred last June despite intense opposition, questions about events, and allegations of secret deals revolving around the $8.5 billion sale. Shortly after this deal, Alpha joined industry opposition to tougher safety rules.

The report was issued on the 104th anniversary of the worst mining disaster in U.S. history - the coal mining explosions at Monongah W.V. that claimed 362 lives. While mining safety has improved in the decades since, yesterday's report demonstrates there are many more improvements that could and must occur to protect workers.

Related prior posts
Massey Energy Mine Disaster: The Soul of a Bean Counter
Mining safety: not just for China
Cold comfort: Crandall Canyon survivors and workers comp
A bad way to make a living
The sad, quiet death of Bud Morris - father, husband, motorcycle aficionado
The feds and Phantom Miners
Sago mining disaster and workers comp: newly formed insurer to pay benefits
Sago mining deaths: a sorry way to begin the new year

| Permalink

October 26, 2011

 

How bad is the obesity epidemic? Bad enough that car makers are increasing the size of cars to accommodate our collective expansion - typical family cars have gained about a foot of width over than half a century ago. And in a Plump My Ride research initiative, at least one luxury automaker is researching how obesity affects mobility while driving.

A recent study by Gallup says that obesity and related conditions total $153 billion in annual productivity losses. U.S. workers who are overweight or obese and have other chronic health conditions miss an estimated 450 million additional days of work each year compared with healthy workers. The study also notes:

"The $153 billion in annual lost productivity costs linked to unhealthy workers in the United States is more than four times the cost found in the United Kingdom. The striking difference is the result of fewer unhealthy workers in the U.K. About 14% of full-time U.S. workers are of a normal weight and have no chronic illness, compared with 20% in the U.K."
Julie Liedman discusses obesity and its effects on the workplace in a recent article in Risk & Insurance. She cites a new report by Lockton Inc. that documents other costs related to obesity:
  • Some 74 percent of the adult U.S. population, aged 20 years and older, is either overweight or obese
  • Medical costs associated with obesity are estimated at $168.4 billion per year
  • The increase in obesity prevalence accounts for 12 percent of the growth in health care spending

Liedman notes that this report suggests traditional wellness programs aren't enough to tackle the issue of morbid obesity and employers should consider offering benefits that cover more dramatic interventions, such as bariatric surgery.

"A person with a BMI of 25 to 29.9 is considered overweight; a person with BMI of 30 to 39.9 is considered obese and a person with BMI of 40 or more, or a BMI of 35 or more with an obesity-related disease such as diabetes, heart disease or sleep apnea is considered morbidly obese. People with BMI of 40 or more, or 35 or more with an obesity-related disease, are considered candidates for surgery."

We've previously discussed obesity costs as they relate to workers comp based on an NCCI study. While some might think that the suggestion for employers to consider benefits to cover bariatric surgery to be a radical response, it may be a Hobson's choice of "pay for it now" or "pay for it (more) later." We've pointed to several cases that determined employers must pay for weight reduction surgery as part of recovery from a work-related injury. See Compensable weight loss surgery? A new wrinkle in obesity and New York Weighs in on Obesity.

By the way...
Do you know your own BMI? Use this BMI calculator to check your own weight or to use in your wellness communications.

Related past posts
Tip Toeing Around Obesity
The Cost of Getting Better
Injuries at the gym: compensability, incentives, and wellness
Morbid Obesity and the Essential Job Functions of a Cop
Weighty matters: the high cost of obesity in the workplace
Obesity in Workers Comp: Duke Sounds the Alarm

| Permalink

March 30, 2011

 

A few years ago, an important NIOSH study on nursing home lifting equipment demonstrated that the benefits outweigh the costs. In addition to recapping the equipment investment in less than three years, NIOSH found a 61% reduction in resident-handling workers' compensation injury rates; a 66% drop in lost workday rates; and a 38% decline in restricted workdays. Plus, the rate of post-intervention assaults during resident transfers dropped by 72%. That's pretty impressive.

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

NCCI summarizes the study results:

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

One of the interesting aspects of the study is the safe lift index, referenced above, which was developed by researchers to aggregate answers from the survey questions into a single number. Researchers looked at several variables pertaining to policies and procedures. These included the training of certified nursing assistants in proper use of mechanized lifts, preferences of the Director of Nursing for powered mechanical lift use, potential barriers to the use of powered mechanical lifts, and enforcement of the lift policies. The report discusses these factors in greater detail, and demonstrate that there are many variables beyond just the equipment that affect overall program efficacy.

Many states have safe patient handling laws

In recent years, a number of states have enacted legislation mandating safe patient lifting - and that no doubt has contributed to the rapid adoption rate noted by NCCI researchers. According to the American Nursing Association, a strong advocate for such legislation, 9 states have implemented safe patient handling laws. These include Illinois, Maryland, Minnesota, New Jersey, New York, Ohio, Rhode Island, Texas, and Washington, with a resolution from Hawaii. In addition, they are tracking states with pending legislation in 2001, currently 6 states: California, Illinois, Maine, Massachusetts, Missouri and Vermont. You can also track this legislation via a map and you can access additional resources and information at ANA's excellent Safe Patient Handling website.

Prior posts on safe lifting
Texas enacts safe lifting guidelines for a hazardous industry
Washington passes "Safe Patient Handling" legislation
NIOSH study on nursing home lifting equipment: benefits outweigh costs
Safe Lifting and Movement of Nursing Home Residents

| Permalink

February 21, 2011

 

Dr. Trang Nguyen has some serious doubts about the effectiveness of spinal fusions, especially in workers comp. In his study of 1,450 cases of chronic lower back pain in the Ohio comp system, Dr. Nguyen focused on an outcome near and dear to the hearts of all comp practitioners: the number of injured workers returning to the workplace after surgery. The results of his compelling (if less than purely scientific) study, published in Spine Magazine, are cause for alarm.

Dr. Nugyen looked at cases involving chronic back pain that were at least two years old, divided equally among workers who had spinal fusions and those who did not. Among those with fusions, only 25% returned to work, compared to 66% among those who received conservative (non-invasive) treatment such as physical therapy.

That is a huge differential. In addition, 27% of the fused workers had to undergo a second surgery, and as any claims adjuster can tell you, doubling up on spinal surgery places workers on a downward slope toward failed back syndrome: permanent total disability. Among the fused workers, 11% were permanently disabled, compared to only 2% among those who avoided surgery. Finally, most of the workers who underwent fusions were still on strong opiates two years after the treatment. In other words, they still suffered from the pain that led them to treatment in the first place.

While this is not a definitive study, the findings surely offer a cautionary tale not only for workers who suffer from back pain, but for their families and employers as well. It is no great mystery why fusions have become the treatment of preference for so many medical specialists. One doctor used the analogy of giving out hammers: people with hammers - surgeons who can do fusions - look for nails (people who might need the treatment).

Something for the Pain
We are an impatient culture. When in pain, we want immediate relief. Given time, appropriate medications and the skilled hands of physical therapists and chiropractors, the pain usually goes away, or at least reaches more tolerable levels. To be sure, there are severe injuries when fusion is the necessary option; however, pain alone is not an indicator of such severity. The problem with fusion is that it creates rigidity in a part of the body that is designed for flexibility. A rigid spine is an open invitation to lifelong pain and despair.

From the comp perspective, we should remain aggressively sceptical of most proposed spinal fusions. Claims adjusters should routinely require a disciplined utilization review, an objective second opinion and an independent medical exam. Place a strong burden of proof on any doctor proposing fusion for an injured worker. Fusion should be the treatment of last resort.

These are not merely delaying tactics. Rather, they are essential strategies for buying precious time, time for the natural healing process to take place and time to avoid what often becomes a path to oblivion. If, as this study shows, the odds for return to work are more than double for workers receiving conservative treatment, then it is in everyone's best interest to avoid fusion surgery. Refuse to Fuse. That's a motto worth posting over the desk of every comp adjuster in America.


| Permalink

November 15, 2010

 

Last week, our nation honored its veterans for service rendered to the country. Although belatedly, we join in offering thanks. One could make the case that our nation's gratitude should be a 365-day-a-year tribute rather than largely confined to a single celebratory day. On returning home, many veterans face an enormous hurdle, the day-in-day-out battle of finding employment, a formidable challenge for any vet but made even more difficult in the current economy. Beyond an expression of appreciation, there are many good reasons why employers should hire vets. The U.S. Department of Labor has collaborated with Office of Disability Employment Policy (ODEP), the Veterans' Employment and Training Service (VETS), and other federal agencies to offer a Step-by-Step Employer Toolkit for Hiring Veterans.

In addition to their military service, there is another debt that we owe to our vets, particularly those who have been wounded physically or psychologically. It is one of life's great ironies that war, which is responsible for so much death and destruction, is also a catalyst for the advance of medicine and medical technologies.

Just as weapons become more sophisticated, so too do the medical technologies designed treat the wounds that these weapons exact. From wars in ancient times to the present, civilian medicine has been advanced by battlefield medicine, first practiced on wounded warriors.

advanced-prosthetics.jpg

Wired Magazine has been one of the ongoing sources we turn to get our fix about battlefield advances in medical technology. A recent article - Military's Freakiest Medical Projects - is a fascinating case in point, highlighting advances in prosthetic limbs, skin grafts, burn repair, bone cement, suspended animation, and more. The article's intro explains that "Some of the Pentagon's extreme medical innovations have already debuted in the war zone. And with myriad applications outside of combat, these advances in military medicine mean that revolutionary changes for civilian care aren't far behind."

Another recent article - Exoskeletons, Robo Rats and Synthetic Skin: The Pentagon's Cyborg Army - focuses on technologies that foster recovery, such as neurally controlled prosthetics, or that enhance performance, such as wearable exoskeletons that amplify amplify troop strength and endurance.

As exciting as these developments are, not all effective treatments rely on advanced technology - some are reassuringly "old-school." A case in point is this heartwarming story about vets with PTSD who train service dogs as companions for vets in wheelchairs. The dogs do double duty, serving as therapy dogs for those with PTSD while they are being trained, and later as helper dogs for those confined in wheelchairs. You can learn more about this most excellent program at Paws for Purple Hearts.

And if you doubt the healing and restorative power of dogs, we leave you with this evidence: an incredible compilation of clips of dogs welcoming home soldiers. One warning: have a box of tissues nearby!

| Permalink | 2 Comments

October 21, 2010

 

We have just one item to share today - an important and useful tool from the folks at Oregon's Department of Consumer & Business Services: 2010 Oregon Workers' Compensation Premium Rate Ranking, which ranks all 50 states plus the District of Columbia for rates that were in effect in January 2010.

oregon.jpg

We've taken the liberty of excepting a graphic to give you a sampling of the information, but you really want to save a copy of the report for future reference - the data is updated every two years. The chart offers a bird's eye comparative view of state rankings; and accompanying chart breaks data down by state. As might be expected, there is more detail for Oregon.

Montana and Alaska continue to be among the two most costly states but shifted order since 2008. In 2008, Ohio ranked third highest costs, but has dropped to #17, while Illinois moves up to the #3 spot, a dubious distinction. North Dakota, Indiana, And Arkansas are the three least costly states in 2010. Massachusetts had previously been #49, rising in the ranks to #44 in a list where higher means less costly. For comparison, see the 2008 report.

For commentary on this report and other related matters, see our past posts:

| Permalink

January 19, 2010

 

NCCI has issued its latest report (PDF) on the status of older workers in the comp system, with a particular focus on workers 65 and up. If nothing else, the study reinforces the notion that older workers are safety conscious and a relative bargain. For employers worried about workers comp costs, older workers are not a significant problem.

In 1988 eleven percent of workers 65+ participated in the workforce; now 17 percent of these older workers are still working. That percentage will likely increase as the long-term effects of the financial collapse continue to resonate through the damaged economy. Some people continue working because they want to; many more continue because they have no choice.

Injury Prone?
The frequency rate for older workers varies by occupation: in construction, older workers appear to be safer than younger workers - they are injured at a 4 percent rate, compared to 12 percent for their younger colleagues. The results are flipped in retail/sales: older workers are injured at a 23 percent rate, compared to 15 percent for all others.

As you might expect, the leading cause of injuries for 65+ workers are slips, falls and trips - 47 percent of all injuries for this cohort. (Younger workers suffer these injuries at a 24 percent rate). For strains and sprains - the overall leading cost-driver for workers comp - the results are reversed: the frequency for older workers is 23 percent, compared to a whopping 38 percent for all others.

It does take longer for older workers to recover from injuries: they have a median days-away-from-work rate of 16, compared to 12 days for workers in the 55 to 64 group and 10 days for workers 45-54. Despite this higher rate, overall indemnity costs are lower. Why? Because older workers make substantially less on average than younger ones. Wages peak in the mid-50s and then fall off dramatically after age 65, down to the same level as the entry level 20 to 24 group. So much for the notion of paying for experience!

The only red flags in the study involve the retail trade and service/hospitality industries, where older workers are showing higher-than-average costs for comp. These jobs probably offer ample opportunity for slips, trips and falls, the number one cause of injuries for these workers, .

It will be fascinating to watch NCCI's study evolve over the next decade. The percentage of workforce participation for the 65+ group is going to increase steadily. With this growth, the risks will be enhanced. There is likely to be an upward trend in both frequency and severity, but perhaps not as much as feared. Certainly, the NCCI study reinforces the argument that older workers are safe, reliable and motivated. There is no reason to discriminate against them. If anything, you could make a good case for preferring an older worker to a younger one. Fodder for further thought, indeed.

NOTE: Special thanks to reader Soon Yong Choi for spotting an error in an earlier version of this post (see comments). Given my checkered track record with numbers, I can only hope that Choi and similarly adept readers continue to cast a critical eye on any of my postings where statistics are involved.

| Permalink | 2 Comments

January 15, 2010

 

In the interests of keeping Insider readers mentally alert for as long as possible, we present the results of a study that appeared in the Journal of Alzheimer's Disease (and is summarized in the Wall Street Journal). The study found that long-term cell phone use appears to protect against and even reverse Alzheimer's-like symptoms in mice. Here is the Journal's description of the study:

Mice genetically engineered to develop brain impairments similar to Alzheimer's in humans were divided into two groups. One group was exposed twice daily to hour-long electromagnetic fields akin to those created during cellphone use. Mice in the other group were not exposed to the radiation. After seven months, young mice in the first group fared significantly better on cognitive tests than their unexposed littermates. Older mice, which had already developed symptoms of Alzheimer's, exposed to the radiation for eight months in a subsequent experiment also performed better than older nonexposed mice. Mice, younger and older, not engineered to develop Alzheimer's also appeared to benefit from the radiation. Biopsies suggested such exposure might fight Alzheimer's by inhibiting the buildup of certain protein plaques in the brain, the researchers said.

Given that exposure to radiation is considered a plus here, head set devices cannot be used. If your goal is Alzheimer's prevention, you have to keep that cell phone clamped against your ear.

Before you start dialing up everyone on your call list, you might want to take note of a few caveats: first, what is true for mice is not necessarily true for humans. Further studies involving larger numbers of mice would be needed, and even then there would be no definitive correlation with humans.

There are also a couple of potential safety issues connected with cell phones: use of cell phones while driving is a widely-recognized hazard. In some states, use of cell phones without a head set is illegal. After being pulled over, you could try the line: "but officer, I cannot use a headset because I'm trying to avoid Alzheimer's." You'll get a chuckle...and a ticket.

Beyond the safe driving issue, there are some inconclusive but alarming indications that heavy use of cell phones might result in brain tumors.

So there you have it: talking on your cell phone might help prevent Alzheimers, but it might also cause a motor vehicle accident or even a brain tumor. Personal risk management at its ambiguous best. It's all so confusing, I'm going to take a coffee break. Caffeine, they say, is really good for you. Except when it isn't.

| Permalink | 3 Comments

January 6, 2010

 

It's been some time since we've made a foray into one of our favorite topics: emerging health technology, particularly in the area of rehabilitative and assistive technologies. We've compiled a few stories that we found fascinating and promising. If you enjoy them and and would like to read more, we point you to the following excellent sources: Always: Medgadget and MassDevice. Sometimes: Wired and Gizmodo.

Throw out those crutches
Crutches are an awkward and uncomfortable so we are delighted to learn about the Freedom-Leg, an "off-loading prosthetic," which allows users greater mobility. The device allows a user to avoid putting any weight on the injured foot, ankle or knee, but keeps the strength in the upper muscles of the injured leg.

Bionic fingers
If you are advancing in years as I am, you will remember TV's popular Six-Million Dollar Man and The Bionic Woman. Yesterday's fantasy is today's reality, giving powerful new potential to amputees. Prodigits is a prostehetic device for partial-hand amputees who are missing one or more fingers. Bionic or self-contained fingers that are individually powered allow users to bend, touch, grasp, and point.

Gastric "condom" for obesity, diabetes treatment
A recurring topic here on the blog is the debilitating impact of comorbidities such as obesity and diabetes on the recovery process. Obesity is frequently also a contributing factor to a work-related injury. Recently, we've seen some controversial court decisions mandating that employers foot the bill for gastric by-pass surgery for workers who are recovering from work-related injuries.

A new temporary device, the EndoBarrier Gastric Bypass, holds promise for helping with weight loss. The device is implanted endoscopically via the mouth, creating a chamber in the stomach which limits the amount of food a patient can digest. A prior story showed the device had positive results in clinical trials.

enn2344.jpg

| Permalink

September 8, 2009

 

According to the Department of Labor's site on the history of Labor Day, the holiday is a yearly national tribute to the contributions workers have made to the strength, prosperity, and well-being of our country. But for low wage workers, there isn't much to celebrate this holiday. A 2008 study of 4,387 workers in low wage jobs in Chicago, Los Angeles and New York - Broken Laws, Unprotected Workers (pdf) - revealed widespread violations of basic wage and labor laws. These violations affected all worker, regardless of legal status, race, or gender. The study found numerous violations of minimum wage and overtime laws; workers who log hours without being paid for their time; workers who are denied earned breaks and meal time; charges illegally deducted from worker pay; retaliation by employers for complaints; and denial of workers' compensation benefits, including encouraging employees to commit fraud.

Nearly two-thirds of all workers surveyed had experienced a wage violation in the week prior to being interviewed. About one in four had been paid less than the minimum wage the week before being surveyed; about one in seven had worked off the clock; about three in four who had worked overtime were not paid the proper amount.

Stating that the workers' comp system is not functioning in the low-wage labor market, the report's executive summary noted the following:

    Of the workers in our sample who experienced a serious injury on the job, only 8 percent filed a workers' compensation claim.
  • When workers told their employer about the injury, 50 percent experienced an illegal employer reaction -- including firing the worker, calling immigration authorities, or instructing the worker not to file for workers' compensation.
  • About half of workers injured on the job had to pay their bills out-of-pocket (33 percent) or use their health insurance to cover the expenses (22 percent). Workers' compensation insurance paid medical expenses for only 6 percent of the injured workers in our sample.

The economic toll
Study authors call these violations wage theft and paint a grim picture of the economic toll that these violations impose on the workers and on the communities at large. The average worker lost $51 from an average weekly earnings of $339, or about 15%. Assuming a full-time, full-year work schedule, we estimate that these workers lost an average of $2,634 annually due to workplace violations, out of total earnings of $17,616.

Survey authors estimated that approximately 1,114,074 workers in the three cities combined experience least one pay-based violation per week. Extrapolating from this figure, front-line workers in low-wage industries in Chicago, Los Angeles and New York City lose more than $56.4 million per week as a result of employment and labor law violations.

When impacted workers and their families struggle in poverty and constant economic insecurity, the strength and resiliency of local communities suffer. When unscrupulous employers violate the law, responsible employers are forced into unfair competition, setting off a race to the bottom that threatens to bring down standards throughout the labor market. And when significant numbers of workers are underpaid, tax revenues are lost.
The report recommends three principles that should drive the development of a new policy agenda to protect the rights of workers:
  • Strengthen government enforcement of employment and labor laws
  • Update legal standards for the 21st century labor market
  • Establish equal status for immigrants in the workplace

| Permalink | 3 Comments

May 27, 2009

 

Take 78 million Baby Boomers and their retirement plans, mix with a woebegone social security system and the global economic meltdown of 2008/2009. Add in rising health care costs and the insurance industry's natural propensity to avoid troubling issues, and you have a recipe for a looming catastrophe of the first order. That's the premise that Lynch Ryan CEO Tom Lynch puts forth in his article in the current issue of the IAIABC Journal, Aging America: The Iceberg Dead Ahead, which IAIABC has given us permission to make available to our readers.

Tom describes the massive problems that the aging workforce presents to workers compensation systems - problems that are compounded by funding problems with other social insurance programs. He makes the case that neither states, the federal government, or insurers are prepared for the claims and cost problems that will develop over the next decade, and offers recommendations to address these problems, including the creation of a special federal commission.

Admittedly, we are partial to the author, but we think the article is worth a read.

In addition to putting in a plug for the article, we'd like to call your attention to the publication that it appears in. The IAIABC Journal is published two times per year by the International Association of Industrial Accident Boards and Commissions (IAIABC), an association of government agencies that administer and regulate their jurisdiction's workers' compensation acts. It's a peer-reviewed Journal, and one of a few remaining venues that publishes original research papers and in-depth treatment of workers compensation issues and opinions. Issues are substantial - the current issue weighs in at 158 pages. It is edited by Robert Aurbach. For a sampling of content, we've taken the liberty of printing this issue's article abstracts to give you a flavor - click to continue.

| Permalink | 1 Comment

March 10, 2009

 

Historically, the tendency has been for employers to segment potential employee health and disability issues into two discrete silos: occupational safety, prevention, and other issues related to workers comp are most often managed by risk managers and safety staff. General employee health issues are usually tucked under an organization's benefits and human resources department as part of group health - or under a wellness program, if one exists. But increasingly, data shows that the two are often inextricably linked and it makes good sense to address health issues with a more holistic approach. This seems an area rife for attention given the recent multi-year trend of decreased claim frequency and increased claim severity in workers comp. It's also a critical issue given the aging work force. Employers need to recognize the effect that co-morbid conditions such as obesity, diabetes, and high blood pressure can have on disability recovery and medical costs - and to get more upfront about preventing and addressing these health conditions.

Roberto Cencineros, writing for Business Insurance notes that NCCI has released preliminary findings on an upcoming report on obesity which shows that workers comp medical claims open for one year cost three times as much when the injured employee is obese, and claims that are open for five years are five times more costly when involving an obese claimant. For smaller claims, the study will show that the cost differential can be even greater.

This should not be eye-opening news - there have been numerous other studies linking obesity to high medical costs and longer duration of lost time. One 2007 study documenting the cost link between obesity and workers comp by researchers at Duke University found that obese workers filed twice the number of workers' compensation claims, had seven times higher medical costs from those claims and lost 13 times more days of work from work injury or work illness than non-obese workers.

Ceniceros notes that the workers comp industry has focused on treating specific injured body parts while overlooking so-called co-morbidity factors, such as obesity, that increase claims duration and costs. Comorbidities not only can lengthen the recovery period, they may also be a precipitating factor in claims. According to the article, "...some employers even have begun collecting obesity data to help fend off future claims that may not be work-related, particularly those involving police and firefighters who must take pre-employment physicals and whose heart attacks and other ailments often are presumed to be work-related, said Glenn Backus, senior vice president for Alternative Service Concepts L.L.C., a Reno, Nev.- based claims administrator."

For more on the dawning awareness that workers comp programs should not be divorced from overall employee health issues, see the Bill Thorness article in the 2008 NCCI Issues Report, Wellness Comp, (PDF) where he addresses the issue of whether there is a place for health promotion programs in workers comp. "The bottom line is that workers compensation specialists should at least be at the table for discussions on how to make the workforce healthier. Health and productivity shifts the basic value proposition, according to AON, into the question of "How can [healthcare] plans be modified to incent employees to adopt healthy behaviors, moderate cost increases, and minimize absenteeism and presenteeism?"

| Permalink | 1 Comment

November 4, 2008

 

If you are an employer with operations in multiple states or if you are just plain curious about how your state's workers' comp costs stack up to other states, we have just the tool for you. The Oregon Department of Consumer and Business Services has just released its biennial report on state rankings for workers' compensation premium rates (PDF). The report ranks all 50 states plus the District of Columbia for rates that were in effect in January 2008. Alaska, Montana, and Ohio take the win, place, and show awards for the three highest rates - not a race you want to win. Quick on their heels are three of our New England neighbors - Vermont, New Hampshire, and Maine - coming in at third through sixth respectively. On the opposite end of the spectrum, the three states with the least expensive rates were North Dakota, Indiana, and Massachusetts. The home state of the survey's authors didn't fare too badly, ranking at #39.

See Table 2 to find a listing of states. The costliest states appear at the top of the list. The table shows an Index Rate which the study authors define as "the payroll weighted average premium for $100 of payroll based upon the 50 occupations in Oregon with the greatest losses." The table also shows current ranking against the ranking in 2006 so you can determine if a state's costs have negative or positive momentum. A shift up or down by a few points may not have much significance but a sharp increase up or down is a good indication that something is going on in the state that deserves another look.

For more reports of this nature, see Tom Lynch's post about this report in 2006. He offered some good commentary, as well as links to other state ranking reports. He comments that all three reports have value, but the Oregon report is notable for being free and accessible while the other reports must be purchased.

Related:
Oregon's press release on the report
Your Government at Work - Worker injury research you can actually use
Eight steps to controlling workers' comp costs in your company Part 2, Part 3

| Permalink

March 31, 2008

 

This series is meant to paint a realistic, well-sourced and objective portrait of American health care early in the 21st century as compared with that of our 29 partners in the Organization for Economic Cooperation and Development (OECD, all of us comprising the most developed democracies in the world), and to examine how workers' compensation fits into that mix. We've done a lot of the former and some of the latter. Now it's time to finish the job.

First, a bullet-point recap. In Parts One through Four we saw that:

  • American per capita health care spending is two and a half times the average in the OECD and 25% higher than our closest competitor, Switzerland.
  • American per capita health care spending on pharmaceuticals is double that of the average in the OECD.
  • We perform more sophisticated testing and surgeries than any other country.
  • Our physicians earn double the compensation of their OECD counterparts.
  • Our hospital stays are 25% shorter and our doctor visits 42% fewer than other OECD citizens.
  • Despite all the spending, we don't live longer and are no healthier than the average among OECD countries.
  • There has been explosive growth in the incidence of Type 2 Diabetes, much of it caused by an epidemic of obesity, and 27% of the per capita increase in our spending on health care since 1987 is attributable to obesity.
  • At nearly 31%, the percentage of obese adults in the US is the highest in the OECD and 25% higher than Mexico, the country that wins obesity's OECD silver medal, yet we been unable either to halt or reverse the growth of obesity in America.
  • Thirty-one percent of our total health care expenditures go toward insurance administrative costs, far more than any other OECD country.
Meanwhile, over on the workers' comp side of things...
It is indisputable that health care costs in America far exceed those for any other OECD country and have been sharply and steadily rising over the last 20 years. Bleak as that portrait is, the situation with health care costs in workers compensation is even more dire:
  • Since 1996, worker' compensation medical treatment costs, representing only 3% - 4% of total US spending on health care, have been rising at twice the rate of those sharply and steadily rising group health costs.
  • We spend significantly more to treat worker injuries than similar injuries in group health, principally because of over-utilization of medical services.
  • Pharmaceutical costs, representing 18% of total incurred losses at the fifth service year, are a large chunk of the ice beneath the water line, the costs that are often hidden and unknowable (When have you ever seen prescription drugs itemized on a loss run?). If you are an employer, ask yourself these questions: Do you have any idea of the prescription drugs your injured workers are taking? Do you have any idea of the extent to which your injured workers are being prescribed narcotics, such as OxyContin, Actiq, Fentora, Duragesic, even Vicodin? If not, you need to have an immediate talk with your insurer and your Pharmacy Benefit Manager. It's that important.
None of us can do much about the ridiculous costs of health care in America today. To quote Hercule Poirot, the problem is "a many-headed Hydra." But employers and insurers can do something about the ridiculous costs of health care in workers' compensation. What, you say?

At the end of this five-part series, here is a conclusion and a modest proposal, which to many will seem trite, even pedestrian, but 24 years working with more than 4,000 clients guarantees it works:

Conclusion: medical costs grow as indemnity costs grow, because injured workers stay out of work longer than is medically necessary.

The modest proposal: A caring, aggressive, systemic, performance-oriented and measured program that focuses on a) preventing injuries from occurring in the first place and b) if injuries do occur despite your best efforts, bringing injured employees back to work in some medically approved capacity of temporary modified duty as quickly as possible. This early return to work will keep injured workers connected to the workplace and the ingrained routine of getting up, getting dressed and going to work every day. Absent that, the injured worker will stay at home where he or she will create a new routine of staying out of work and making up his or her own, stay-at-home modified duty program. If I were injured and could not go to work because my employer had nothing for me to do, that's what I would do, and so would you. And that does not have to happen.

It's a lot of work, but it's as simple as that.

I've enjoyed writing this series. I hope it's given you something to think about.

| Permalink | 1 Comment

March 19, 2008

 

We have seen that America spends more on health care than other developed democracies around the world for outcomes that, on the whole, are no better than those achieved by the average OECD country. Our health care "system" perpetuates ever-increasing spending without delivering results to justify the expense. Moreover, because of our country's isolation, both geographically and culturally, few Americans actually know about or appreciate this disparity. In the words of that eminent philosopher, Pogo, "We have met the enemy, and he is us."

But not all the news is gloom and doom. We lead the world in medical technological innovation, and we have chosen to target this expensive technology at some very thorny problems. Further, statistics don't always tell the whole or true story. Sometimes, one needs to lift up the rug and check what's lying underneath.

Take infant mortality, for example.

The best place to find infant mortality data is (drum roll): the US Central Intelligence Agency, which tracks the rate of infant deaths in 241 countries around the world in its World Facts Book.

Currently, the CIA shows Angola, with 184 deaths per 1,000 births, as having the highest infant mortality rate (IMR) in the world, 241st out of 241. That is, more than 18% of Angola’s infants die shortly after birth. In fact, with the exception of Afghanistan, the 24 countries with the world's highest infant mortality rates are all in Africa. It has long been known that IMR directly correlates with a nation's per capita GDP.

At the other end of the scale, Singapore, a high-GDP country, ranks first, with the world's lowest infant mortality rate – 2.3 deaths per 1,000 births, followed by Sweden, Japan, Hong Kong, Iceland and France.

And where in this mix is the United States you may ask. Well, with a rate of 6.37, we rank number 41 in the world.

Or do we? It all depends on how one treats the numbers, because not everyone defines infant mortality the same way. The most common definition is: the number of deaths of infants, one year or younger, per 1,000 live births. The question is – what is a live birth? The World Health Organization (WHO) defines a live birth as "any born human being who demonstrates independent signs of life, including breathing, voluntary muscle movement, or heartbeat." However, the United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths. And the US is far more aggressive and advanced in attacking and treating significant neonatal complications. Visit any major teaching hospital's neonatal ICU and you’ll see what I mean. The inference is that the US’s actual comparative infant mortality rate may actually be lower, perhaps much lower, than is statistically reported.

But those neonatal ICUs cost a lot of money. It’s an investment the US has chosen to make, unlike most other countries, and it is symptomatic of why we spend so much more than the rest of the world on health care.

Of course, if you spend a few minutes talking with a mother and father who have just brought a young child home, healthy and smiling, after six months, of so, in one of those expensive, neonatal ICUs, you might be excused for thinking, as they surely do, that the cost is worth every penny.

Prior entries in this series:
Part Three: What Do We Get for the Money?
Part Two - What does it cost?
Part One: The best Health Care Plan in America

| Permalink | 3 Comments

March 17, 2008

 

In Part One of this series, we began looking at some of the many cost disparities between group health and workers' compensation.

In Part Two, we compared US health care costs with costs in the other 29 member-countries of the Organization for Economic Cooperation and Development (OECD). OECD countries, all democracies, are considered the most economically advanced in the world. We saw that health care spending in the US is a breathtaking 250% greater than the average for all of these developed democracies. Moreover, as measured by Gross Domestic Product (GDP), health care made up 15.3% of the US economy in 2004 - up from 5.1% in 1960 - nearly double the rest of the OECD.

Today, it's time to examine what we're getting for all that money. It seems fair to ask a few questions relative to the other OECD countries:

1. Do we live longer?
2. Are we healthier?
3. What other factors could affect how the health of US citizens compares with OECD citizens?

Do we live longer than people in other OECD countries?
Simply put, we spend a lot more on healthcare than all other OECD countries, but don’t live any longer for the money. In fact, we live shorter lives than most.

As of 2004, average life expectancy at birth in the US was 77.5 years, which ranks 22nd out of the 30 OECD countries. While this is slightly below the OECD average, it is four and a half years less than top-ranked Japan. Also, it may surprise readers to learn that life expectancy is two and a half years longer among the people of our neighbor to the north, Canada. And, despite all the editorial bashing of the UK's National Health System, its citizens outlast us by a full year, while people in Spain, France, and Italy live, on average, more than two years longer than we do.

Are we healthier?
For all the money we spend on healthcare one would think we enjoy Olympian health, but this does not appear to be the case. Although it pains me to write this, I can find no peer-reviewed studies that conclude that we are a healthier people than our OECD neighbors.

The OECD provides specific disease incidence data in two areas: cancer (malignant neoplasms) and acquired immunodeficiency syndrome (AIDS). In both cases, the US has the highest rates in the OECD. The incidence of cancer in the United States is 34% higher than the average within the OECD (358 cases per 100,000 people versus 266). With respect to AIDS, the US incidence is an astonishing 675% higher than the rest of the OECD (147 cases per 100,000 people versus 19 in the OECD). Our mortality rate due to AIDS ranks second in the OECD (4.2 deaths per 100,000 people, well behind the staggering rate of 8.6 in Portugal). Yet our mortality rate for cancer ranks only 14th among OECD countries.

What about obesity, reputed by many to be epidemic in the US? With the exception of the UK and the US, which get their obesity statistics by actually measuring people, OECD countries get their results from surveys, so the only fair comparison is the US versus the UK. In 2004, while the UK's overweight population was 14% higher than that in the US, our obese population was 39% greater.

On the other hand, the US rate of alcohol consumption and incidence of daily smoking were both lower than the average for OECD countries (daily smoking in the US is the third lowest (17%) of all OECD members).

Unfortunately, obesity has been shown to be a greater driver of health care and health care spending than alcohol consumption or smoking – "the effects of obesity are similar to 20 years of aging (PDF)." According to Thorpe, et al, (The Impact of Obesity on Rising Medical Spending (PDF), Health Affairs, 20 October 2004), 27% of the per capita increase in US health care spending between 1987 and 2001 was attributable to obesity. There is a direct correlation between obesity and Type 2 diabetes and obesity and hypertension. Is it any wonder that in the last thirty years Type 2 diabetes and hypertension have seen explosive growth in the US?

What other factors could affect how the health of US citizens compares with OECD citizens?
There are many other factors that have been identified as influencing how the health of Americans compares with the rest of the OECD. Some of these are:

1. The age of our population – While this will be a concern in the immediate future as baby boomers grow older, currently 12% of the US population is older than 65, which is below the OECD average of 14%.

2. Income and insurance – The US is unique in the OECD, because it does not have a national insurance program. About 60% of us are covered by some form of employer-provided insurance. Another 26% are covered by Medicare or Medicaid. That leaves 14% who are uninsured in any way. Among this group, most of whom are poor and many of whom are sick, healthcare often goes a-begging, with harmful results. For example, hypertension is less controlled in this group, “sufficiently so that the annual likelihood of death in that group rose approximately 10%." (Newhouse et al, Free for All? Lessons from the RAND Health Insurance Experiment, Harvard University Press, 1993).

Twenty-two OECD countries provide more than 98% of their citizens with public health insurance covering at least hospital and in-patient care. Despite this, Americans spend less out-of-pocket than the people of most other OECD countries – 13.2%. The OECD average is nearly 20%. Studies have shown that when a people pay less out-of-pocket for healthcare, total spending rises.

3. Sophisticated medical procedures – In the movie Pat and Mike, Spencer Tracy famously said of Katherine Hepburn, "There's not much meat on her, but what there is is choice." The same can be said for hospitalizations in the US. Although hospital stays are fewer and shorter, a lot of high-powered activity goes on.

For example, the US ranks in the top five OECD countries for the rate of caesarean section childbirths as well as all forms of organ transplants with the exception of lung transplants. Moreover, we're in the top five for all four of the heart procedures on which the OECD collects data. We perform coronary bypass surgery and angioplasties at more than double the rate of the OECD average. Finally, we perform far more coronary revascularization procedures than any other OECD country. Despite performing substantially more invasive heart procedures than all other OECD countries, death rates for heart disease in the US are the 17th worst in the entire group.

4. Advertising – Between 1996 and 2003, pharmaceutical advertising quadrupled. Turn on the nightly news and count the ads for prescription drugs. Only two countries in the world allow this, the US and New Zealand. I find it amazing that more than 75% of the brands advertised had ROIs of more than 50%. Clearly, Americans respond to direct-to- consumer drug advertising, which is one reason why we spend double the OECD average on prescription drugs.

How does this all relate to workers’ compensation?
We've seen that, despite spending more on healthcare than any other country in the world, Americans don’t live longer or enjoy better health than citizens of any other OECD country. But every day, medicine practiced within workers' compensation depends entirely on the US healthcare "system," if we want to go so far as to call it that. It's certainly systemic, but perhaps systemic in a lot of the wrong ways.

Prior entries in this series:
Part Two - What does it cost?
Part One: The best Health Care Plan in America

| Permalink | 1 Comment

March 14, 2008

 

The RTW Knowledge Base Website is a free service from Australia providing research based information and links to external resources on work disability prevention. We received a notice about this site from Mary Wyatt, an Occupational Physician based in Melbourne Australia. She offered a good overview of the site's features, so we will take the liberty of using her description of the site:

The Return to Work Knowledge Base was developed by ResWorks (a small Australian nonprofit) with the support of the WorkSafe Victoria RTW Fund. The site has been endorsed by the Australasian Faculty of Occupational & Environmental Medicine.

The website is designed to help with return to work. The site includes:

  • Research papers translated into plain language. The articles can be browsed in interest group collections - employee, employer etc. Alternatively all articles can be seen via the 'View all Articles' tab. On the summary pages the article title is the link to the full text. A search facility is available on all pages.
  • Resources - links to useful information on work disability such as patient handouts, work disability reports, treatment guidelines. The link to the Resources Page for each group is at the top of the left navigation menu on the summary pages. Most links are to patient handouts, guidelines, or reports on the topic. Other links are to webcasts or videos relevant to the field.

Research is often difficult to access and for most people research is hard to read. The site translates individual research papers into a format that can be understood and houses the information in a readily accessible format. Topics include consequences of being off work in the long term, medical issues, workplace factors, system factors, and people issues.

There are two broad ways the site can help:
1. Increasing peoples' knowledge and understanding of the area through reading the information provided on the site.

2. Influencing others. Many working in this area practice best evidence care. However it can be difficult to influence others with a less enlightened approach. The site is designed for sharing of information with the ability to send links to colleagues or print articles (eg for patients, HR managers, supervisors).

| Permalink

March 11, 2008

 

In 1986, US workers' compensation medical costs were 44% of total incurred loss dollars. Ten years later, the percentage had grown to 48%. By 2006, medical costs amounted to 58% of total loss costs. And today, nearly a third of the way through 2008, they hover around 60%. The annual workers' comp medical cost rate of growth is nearly double the painfully steep rate of growth in the Group Health arena, and it has been so since 1996 (Source: NCCI and Insurance Information Institute).

And why not? Workers' compensation health care is the best health care plan in America, maybe even the world. Injured employees pay no premiums, co-pays, or deductibles. Prescription drugs are free, and tax-free indemnity payments cover most lost wages. No wonder acute and traumatic injuries cost nearly 50% more than similar injuries in the group health world, according to an NCCI Research Brief (Workers Compensation vs. Group Health: A Comparison of Utilization.)

No wonder chronic, soft tissue, musculoskeletal injuries cost more than double similar injuries in the group health world. And the disparity is probably even more than that, because NCCI could only examine and compare cost data for the first three months following injuries. Why? Because workers' compensation tracks injuries by claim numbers, but group health does not. Therefore, in group health, the further one gets from the date of injury, the harder it is to tie rendered medical services to a particular injury.

It's no secret that over-utilization is the biggest reason that workers' comp medical costs are so much higher than costs in group health. True, on the whole and with some notable exceptions, workers' comp medical fee schedules have caused prices for individual medical services to be only slightly higher than individual services in group health, but in nearly every part of the country workers' comp utilization dwarfs that of group health. Makes you wonder what the workers' comp case management and utilization review companies are actually doing, doesn't it?

The difference here is stark. The group health plans put systemic fences around utilization. Workers' comp does not. If you twist your knee mowing the lawn out in the back forty on a Saturday morning and require arthroscopic knee surgery, your health plan will approve a certain number of visits to a rehab facility after surgery, normally six or seven. After that, you'll need approval for any more. Of course, you can always choose to self-pay. But in the world of workers' compensation, that's one decision you don't have to make.

Because health care utilization and costs have become such large issues in workers' compensation, as well as group health, and because in this frenzied Presidential election season that seems to never end health care has become quite the political football, over the coming days I'm going to examine specific parts of it further. Next up - a bit of analysis of the current mantra all current presidential candidates seem to agree on (some might call it a "lie," but I couldn't possibly go that far), namely, that here in America "we have the best health care in the world."

If only that were true.

| Permalink | 4 Comments

November 19, 2007

 

A cornerstone of Lynch Ryan's work for more than twenty years, a long-held mantra, has been that employees who work for good employers -- employers who care for their workers and show it by the way they treat them -- report all work injuries when they happen, get expeditious treatment and return to work faster. Moreover, their injuries cost significantly less than those of employees who work for less caring employers. A major driver for low workers' compensation costs is the quality of the relationship between employer and employee.

We've seen this in our consulting work time and again, but it's nice to have independent research confirm the mantra.

In the mid-1960s, the Department of Labor's Employment and Training Administration (at that time called the Office of Manpower, Automation, and Training ) wanted to understand specific issues pertaining to the U.S. labor market, such as retirement, the return of housewives to the labor force, and the school-to-work transition. To do that it began conducting longitudinal studies, studies that look at a random group of like people to see how they develop over time. The Office began four such studies following groups of young men, older men, young women and, no, not "older" women, but rather "mature" women. The studies were originally targeted for five years, but, because they were yielding a mountain of data, they were extended until 1983, allowing other agencies to piggy-back along to glean even more information about how these first baby-boomers and World War II veterans were maturing in post-war America.

Because of the success of these studies, the Bureau of Labor Statistics decided to conduct an even more ambitious project, and in 1979 it launched the "National Longitudinal Survey of Youth 1979," (NLSY79)

NLSY79 randomly selected and interviewed a cohort of 12,686 young Americans, 14 to 22 years old, all born between January 1,1957 and December 31, 1965, and it has been interviewing them regularly ever since, for nearly three decades now. As of 2004, there were 7661 people still in the survey group. These people have provided profound and relevant data about the aging of the last of the eighty million American baby-boomers.

What does this have to do with workers' compensation? Actually, quite a lot.

Until I read Joe Paduda's recent blog post, I was unaware that any researchers had ever mined the NLSY79 data for workers' compensation insights. Thanks to Joe I have been enlightened. Thank you, Joseph.

In 2005, Darius Lakdawalla, Robert Reville and Seth Seabury of the Rand Institute for Civil Justice published "How Does Health Insurance Affect Workers' Compensation Filing" (this is a Working Paper, meaning it has not been formally peer-reviewed). Using NLSY79 data, they confirmed Biddle and Roberts 2003 Michigan study (purchase required), which found that only about 55% of workers sustaining lost time injuries ever file claims for benefits, as well as an Oregon state-sponsored study of the 2002 Oregon Population Survey suggesting that 54% of workers reporting workplace injuries filed claims. They also found that unionized workers were more likely to file claims following work injuries.

Moreover, the Rand researchers found that workers without health insurance are about 15% less likely to file a claim than injured workers with health coverage.

A still more surprising finding may be that workers at companies that merely offer health insurance benefits are 50% more likely to file a claim after suffering a work injury than workers at companies that do not offer health insurance benefits.

However - and here is the major finding for me - lost time, as well as the cost of lost time for these workers who file more claims is about 20% less than for the workers who are not offered health insurance.

Finally, other types of fringe benefits - like paid vacation days - also seem to be associated with higher filing rates. For example, when both health insurance offers and paid vacations are present in the same employer, both variables are significant (at the 95% confidence level) and both have coefficients around .10 for claim filing.

What does this tell us? Well, for me it reinforces our mantra. These employees may report more injuries, but, as the NLSY79 data show, they return to work faster and their injuries cost significantly less than do the injuries of employees who work for employers who do not provide these benefits. Quod est demonstrandum.

The Rand study is compelling and instructive, but you do have to know a few things about statistical research to get the most out of it. Nonetheless, it should provide fuel for further workers' compensation research using the NLSY79 treasure chest of demographic data. This stuff is too good to sit on a shelf gathering dust.

| Permalink | 2 Comments

November 6, 2006

 

Here’s a question for you: If you were to ask any employer in America how his or her workers’ compensation costs compare to similar employers in other states, what do you think the answer would be? Well, I’ve been doing that with employers I meet for a long time, and I have yet to meet one who thinks his or her costs are lower than those of employers in other states.

Moreover, if you expand the question to inquire about employee benefits, most employers will venture that indemnity benefits paid in other states are most likely lower than what’s doled out in theirs.

It’s the old, “The grass is always greener” thing. But is it really, and how would you know? And here’s one last question: Suppose those employers really wanted to know the comparative cost and benefit data for their state and decided to ask a room full of insurance professionals about it. What do you think the insurance professionals would say?

For many years, we at Lynch Ryan have tracked research reports from three highly credible organizations that produce state rankings of workers’ compensation costs and benefits, one a private actuarial firm, another an Oregonian governmental entity and the third a non-profit, Washington, DC, foundation.

Actuarial & Technical Solutions, Inc, an actuarial consulting firm located in Ronkonkoma, NY, has been publishing state cost and benefit data annually since 1992. Its 2006 report, Workers’ Compensation State Rankings – Manufacturing Industry Costs and Statutory Benefit Provisions, has been released within the last month.

The Oregon Department of Consumer & Business Services publishes comparative cost data every two even-numbered years. Oregon’s 2006 Workers’ Compensation Premium Rate Ranking Summary Report was released this past Friday, 4 November 2006 (the complete report won’t be published for another two to three months).

And the National Foundation for Unemployment Compensation and Workers’ Compensation (UWC), headquartered in Washington, DC, has, since 1984, published annual, and class specific, comparative state data in a report titled, Fiscal Data for State Workers’ Compensation Systems. In this report. you’ll find annual data and total indemnity and medical benefit payments over the last 12 years.

The UWC has also published a Research Bulletin called, State Workers’ Compensation Legislation and Related Changes Adopted in 2005. Perusing that somewhat eye-glazing, 77 page report offers up such tidbits as Maryland’s House Bill 461, which “Applies workers’ compensation occupational disease presumptions to Montgomery County correctional officers who suffer from heart disease or hypertension (my italics) resulting in partial or total disability or death,” effective 1 October 2005. Wow!

The Oregon reports are free; Actuarial & Technical Solutions charges $105 for a single report, and the UWC reports costs $25 for those who are not members of the Foundation ($20 for those who are).

The first thing you need to know about the three comparative cost reports is that, while they use different methodologies, they all pretty much arrive at the same place. For the most part their rankings are in general agreement. One state may be ranked #5 in one report and #7 in another. Personally, that’s close enough for me.

All three reports contain some rankings that appear predictable, but there are surprises and paradoxes, too. For example, notwithstanding changes to its law, most workers’ compensation professionals would expect California to be at or near the top of the cost rankings, and they’d be right. But who knew that my home state, Massachusetts, which so many of my conservative friends continue to call Taxachusetts, would rank way down at the bottom, either 43rd or 47th, depending on whose report you read? That’s a surprise, and here’s a paradox: Despite ranking as the least costly of the major industrial states in which to buy workers’ compensation, Massachusetts provides higher benefits than any other state except Nevada, which ranks in the middle of the pack in terms of cost.

We have found the data mined from these reports, as well as others, invaluable as we consult to employers and insurers around America. Searching out and understanding this research, and doing our own, as well, allows us to put costs and benefits in perspective and is very helpful in designing reasonable and achievable cost reduction targets for our clients.

I urge the workers’ compensation professionals among our readers to get and read the reports. It’s time well spent. If you’d rather not do that, but have some questions about them, you can email us at communicationsATworkerscompinsiderDOTcom (insert the @ and "." where indicated - we avoid spelling it out to foil the spam bots). Or, if you’d prefer, call anyone at Lynch Ryan (my direct line is 781-431-0458, Ext 1). We’d love to hear from you.

By the way, if you do get in touch, let us know what you think of the Insider and if there’s anything you‘d like to see us do to make it even better.

| Permalink

June 29, 2006

 

Let's say someone offers to pay you to do some research about their product. You set up a non-profit research entity and deposit their hefty check. What would your goal be: to prove the product ineffective? to discourage people from using it? Not likely. But how would you determine the extent to which the source of your funds contaminates the research? Would it help clarify matters if the donor gave you some stock in the company and paid you to educate other doctors about their product?

If you like murky waters, you'll love big pharma's contributions to the charitable trusts set up by docs around the country. In a fascinating article by New York Times reporter Reed Abelson (registration required), we read that charities established by doctors are the recipients of money to fund research: not research in the abstract, but research pertaining to the use of products manufactured by the donors themselves. This arrangement, while not inherently illegal, is loaded with potential conflicts of interest. Call it business as usual in the world of medicine.

When Charity and Profits Intersect
Abelson writes about Dr. Maria Rosa Costanzo, who made a presentation to cardiologists at a conference in March. She touted a $14,000 blood filtering device, which her research demonstrated was more effective (albeit more expensive) than intravenous diuretic drugs at removing excess fluid from patients with heart failure.

Although outside researchers raised questions about the study's conclusions, the doctor was convinced. "We believe these results challenge current medical practice and recommendations." She predicted many patients might benefit. Dr. Costanzo did disclose to the audience that she was a paid consultant with stock in the device's maker, a Minnesota company called CHF Solutions. But she omitted another potentially important detail: CHF Solutions was also one of the largest donors to the nonprofit research foundation that had overseen the study. The company contributed about $180,000 in 2004.

In addition, Dr. Costanzo did not bother informing her listeners that the nonprofit entity conducting the research, the Midwest Heart Foundation, was in turn an arm of the for-profit medical group outside of Chicago where Dr. Costanzo and more than 50 of her fellow doctors treat heart patients -- in many cases using products and drugs made by CHF Solutions and other big donors to their charity. Although the CHF Solutions filter has not yet won wide acceptance across the country, for physicians at Dr. Costanzo's medical group, it is the device of choice.

If you check out the foundation's website, you'll see that they promote their ability to "offer our patients access to the most progressive cardiovascular treatments and preventative strategies, giving them the same opportunities as patients at university hospitals." In other words, patients can access the latest technologies, even before they have been formally approved by the FDA. As good as this sounds, I would be surprised if the doctors disclose their financial interests to their patients. These patients might have second thoughts if they knew that the research is potentially biased from the outset.

Contaminated Thinking?
The more the Insider probes the decision-making process in medicine, the more questions we have. Why do doctors prescribe some drugs more than others? Why has oxycontin proved so popular among doctors treating workplace injuries? Why do drug companies hire ex-cheerleaders (with no background in science) to sell drugs to doctors? Do doctors think about the potential conflict between their own financial interests and the products they recommend to their patients? The ultimate question, of course, is whether patients are getting the best possible treatment, with the most effective medications, or whether the interests of the patients are subordinated to the financial interests of the doctors.

There are no easy answers. We like to think of charity and good medicine as matters of the heart. But in the world of American medical care, when you scan the doctor's chest, you just might see something that looks less like a heart and more like a wallet.

| Permalink

June 27, 2006

 

How does your organization's hourly wage and benefit expenditure stack up to the national average? You can find out by comparing your costs to the most recent Employer Costs for Employee Compensation report (March 2006) from the U.S. Department of Labor’s Bureau of Labor Statistics, the hourly compensation cost per civilian nonfarm worker averaged $26.86, with salaries accounting for just over 70 percent of the total, and benefits accounting for just under 30 percent. Workers compensation represented 1.8 percent of the hourly expenditure, a rate that has held steady since at least 1998. Health benefits have increased significantly. According to the report, "the average cost for health benefits was $1.72 per hour worked in private industry (6.9 percent of total compensation) in March 2006. In March 2001, employer costs for health benefits averaged $1.16, or 5.6 percent of total compensation."

The following breaks down the hourly cost for a civilian worker by the dollar amount and percent of each specific cost component.

Component ... Cost ... Percent
Total compensation ... 26.86 ... 100.0
Wages and salaries ... 18.82 ... 70.1
Total benefits ... 8.04 ... 29.9

Paid leave ... 1.88 ... 7.0
- Vacation ... 0.88 ... 3.3
- Holiday ... 0.62 ... 2.3
- Sick ... 0.29 ... 1.1
- Other ... 0.10 ... 0.4

Supplemental pay ... 0.67 ... 2.5
- Overtime and premium ... 0.24 ... 0.9
- Shift differentials ... 0.06 ... 0.2
- Nonproduction bonuses ... 0.37 ... 1.4

Insurance ... 2.18 ... 8.1
- Life ... 0.05 ... 0.2
- Health ... 2.05 ... 7.6
- Short-term disability ... 0.05 ... 0.2
- Long-term disability ... 0.04 ... 0.1

Retirement and savings ... 1.15 ... 4.3
- Defined benefit ... 0.72 ... 2.7
- Defined contribution ... 0.44 ... 1.6

Legally required benefits ... 2.16 ... 8.0
- Social Security and Medicare ... 1.51 ... 5.6
- Federal unemployment insurance ... 0.03 ... 0.1
- State unemployment insurance ...0.15 ... 0.5
- Workers’ compensation ... 0.47 ... 1.8

The report includes detailed breakdowns for specific industry segments. Other related reports and custom reports are available at National Compensation Survey - Compensation Cost Trends.

| Permalink

January 3, 2006

 

What's in store for the coming year? Here are the Herman Group's 2006 Workforce Trends, courtesy of Anita Campbell's Small Business Trends. They strike us as right on the money:

1. Intensifying competition for qualified workers.
2. Gradually increasing attention to employee retention.
3. Increasing investment in older workers.
4. Shift in retirement plans to lifetime lifestyle funding.
5. Continued off-shoring of some work, coupled with return of other work.
6. Larger investment in corporate training.
7. Growth in telecommuting.
8. Expansion of staffing industry.
9. Heightened flexibility in work arrangements.
10. Employer dissatisfaction with product of schools.

Some other trends and predictions that we found interesting:

| Permalink

December 16, 2005

 

Our friend Joe Paduda sent us a link to a new report issued by Harvard Medical School stating that carpal tunnel syndrome is not caused by computer use. The report disputes the conventional wisdom that carpal tunnel syndrome is a repetitive stress injury, stating that it is often incorrectly described as one. Rather, it is a compression of the median nerve in the wrist that affects about 2 to 3 percent of the population.

This reinforces a Danish study on keyboards and carpal tunnel syndrome that Ergonomics Today reported on in 2003. In that study, researchers stated that keyboards are not an "occupational risk for developing carpal tunnel syndrome." But note:

"While the researchers indicated that keyboard usage probably is not linked to CTS, they did find an association between using a mouse for more than 20 hours each week and a slightly elevated risk of developing CTS. They also noted that evidence existed that linked 'forceful industrial work' to the development of CTS."

For more information, see the Mayo Clinic's pages on carpal tunnel syndrome. Among the occupational risk factors they list: "Power tools - such as chippers, grinders, chain saws or jackhammers - and heavy assembly line work, such as occurs in a meatpacking plant. Although repetitive computer use is commonly assumed to cause carpal tunnel syndrome, the scientific evidence for this association is weak."

That�s not to say that there are not other muscular maladies that may be associated with heavy computer use and poor workstation design, or that CTS isn't aggravated by heavy computer use. But it would seem to indicate that computer use is not a precipitating factor, and that much of what is commonly thought to be CTS may be mislabled.

Related posts:
Ergo tips - workstation ergonomic design
Laptop ergonomic woes

| Permalink | 1 Comment

October 10, 2005

 

Want to have an impact on the future of occupational medicine? Do you purchase (or influence the purchase) of occupational medicine services for your organization? Do you manage relationships with medical service providers for your company? If so, the American College of Occupational & Environmental Medicine (ACOEM) invites your opinion via an online survey. Click here to take the survey.

The purpose of the survey is to assist the American College of Occupational and Environmental medicine (ACOEM) in learning more about the current practices, priorities, and point of view of those who pay for and use occupational medical services. In particular, ACOEM wants to learn how company managers and executives in organizations are currently viewing a few major issues in organizational and occupational health. ACOEM also wants to hear what companies look for when choosing physicians to provide either hands-on or consulting medical services for their workers compensation and disability programs.

The survey is being conducted by Crescendo Consulting Group, a national research and consulting firm based in Portland, ME. Results will go directly to Crescendo Consulting Group to preserve anonymity.

The survey should take less than 15 minutes of your time, and individual responses will be confidential. In exchange for participation, ACOEM will provide an executive summary of results to any participants who supply contact information.

| Permalink

October 7, 2005

 

Thanks to all those of you who have taken our reader survey - the survey is still active if you'd like to take it, but we thought we would report on results to date.

So far, we've learned that 63% of the survey respondants visit daily or several times a week; 84% rated the blog as excellent or good; 61% work in the insurance industry; 27% of respondants are clients or friends of Lynch Ryan while 73% have no connection; respondants come from 20 states, as well as Canada, Australia, and Egypt.

Areas of interest:
-Claims management 80%
-Legal issues 80%
-Medical issues 65%
-Online tools, links, resources 61%
-Safety & prevention 59%
-Employer loss reduction tips 55%
-Injured worker info 51%
-Human resource issues 47%

How respondants self identified:
-Employer/manager 22%
-Insurer or TPA 10%
-Regulator 10%
-Law 10%
-Agent/broker 8%
-Health & Safety practioner 8%
-Educator/librarian/trainer 5%
-Consultant 5%
-Employee/injured worker 4%
-Case manager 4%
-Media 4%
-Risk manager 4%
-Financial industry 4%
-Union 2%

| Permalink | 2 Comments

August 26, 2005

 

Earlier this week, the Trust for American's Health issued a new report on obesity in Anmerica with the disturbing news that about 25% of American adults are obese. Health Daily News Central has more information on the details of this report. We've also previously blogged about obesity and workers comp.

About the same time this report was released, the news broke that Dr. Tony Bennett is being investigated by New Hampshire's Attorney General and the New Hampshire Board of Medicine for offending one of his patients by telling her she was obese and needed to lose weight. He refuses to apologize for his remarks and faces possible disciplinary action ranging from a reprimand to revocation of his license.

We don't know exactly what the doctor said or the manner in which he said it, but we have to wonder if this woman isn't taking the state's motto of "live free or die" a little too much to heart. Should a doctor only tell patients the health information that they want to hear? We don't think so, and would be interested in hearing your thoughts on the matter.

Reactions from the blogosphere
Obesity is a well defined condition. It responds to weight loss. How can this possibly have caused a stir? -- DB's Medical Rants

He was "reported" for telling a patient the truth. If we cannot tell patients that they are obese - and that they should do something about it - then can we tell patients to stop smoking, or stop drinking - or what about crack cocaine? -- DB's Medical Rants

When did rudeness become a matter for attorneys general? -- Medpundit

The NH Medical Board either a) has information about this that's way more serious than that alreayd announced, or b) is filled with utter morons without enough do.
Time will tell. --
GruntDoc

... But if the reporting is accurate, it would seem to be another piece of evidence that contradicts the frequent excuse of tort-reform opponents that aggressive medical malpractice lawsuits are needed to compensate for under-vigilant medical boards. -- Overlawyered.

Kevin, M.D. has posted more reactions from the blogosphere

| Permalink | 4 Comments

June 21, 2005

 

The aging of the American workforce is a dynamic that we have been tracking closely. I can personally swear that as one ages the body begins to wear down. Oh, that this truth were not so.

In my father's day, it was common for people (mostly men) to work until age 65 and then retire on the proverbial company pension augmented by social security benefits. That changed dramatically toward the end of the twentieth century.

In the mid to late 90s, the goal became to retire early; age 55 would be nice. The dot-com bubble suckered us all into thinking it could be done. In 1998, a Gallup survey, conducted for USB Financial Services, found that only 36% of respondents planned to wait to retire until age 62 (pdf). But the horror of 9/11, the war on terror, the stock market collapse of 2001 that substantially reduced portfolios and the myriad Enron-type scandals that blew away entire pension funds all hit older workers smack dab in the middle of their futures. And when Gallup conducted the same survey in 2002, the percentage of workers who planned to put off retirement until after age 62 had grown to 47%. In 2004, the number had ballooned to 57%.

So, now we've returned to my father's time, except without the pensions and with significantly delayed and threatened social security. Older workers will continue to get older on the shop floor.

Do you think that the workers' compensation system is prepared for this? Age isn't considered in workers' comp manual rating. (Neither is education, but we'll leave that for another time.)

Rotator cuff sprains and aging
Here's something to think about. The rotator cuff sprain (something I know a great deal about) ranks 28th in terms of injury frequency for all workers, but 3rd for workers age 65 and above. In fact, 3 of the top 4 injuries to older workers are of the soft tissue variety to the shoulder, neck and lower back. To see a dramatic example of how bodies really do break down over time consider the following NCCI chart, which depicts the frequency of rotator cuff sprains by different age groups.

When valued at 18 months, the rotator cuff sprain of an older worker costs about a third more than for any other age group, $28,360 versus $21,910 for all other age groups. Moreover, every one of the top ten injuries to older workers costs substantially more than the same injuries among younger workers. And this situation will get worse as more and more older workers are literally forced by financial circumstances to stay on the job.

We believe that this phenomenon is so serious an issue that it may ultimately impact the way manual rates are calculated.

The impact on employers
As if running an American company weren't hard enough already, what does this mean for employers?

It's a problem. On the one hand, older workers have been doing their jobs for a long time; they're good at them, and they have experience that just can't be found in their younger colleagues. On the other hand, although younger workers have more injuries, those injuries are substantially less costly than their older mentors.

A knee-jerk, and very discriminatory, response might be for employers to try to "weed out" the older population and replace it with its younger version. We can only hope no employer starts the long walk down this painful and litigious road.

We'll continue to think about this issue and report on it in subsequent blog postings. As always, we invite your comments. But for now, we advise employers with aging blue collar workforces to re-double their safety and ergonomic efforts in order to provide as much protection as possible for these very skilled and experienced, but potentially brittle workers.

| Permalink | 2 Comments

June 15, 2005

 

A couple of new studies reinforce a number of concerns that we continue to raise concerning the aging of the American workforce. NCCI has released a study (PDFs) that specifically addresses the potential impact of an older workforce on workers compensation costs. Not surprisingly, they find that older workers get injured less often than younger ones, but when they do get hurt, their recovery times are slower and the cost of the claims is higher. The NCCI study focuses on the specific injuries that generate the most dollar losses among older workers: rotator cuff strains, lumbar disc problems and carpal tunnel syndrome. (We alerted readers in a prior blog that workers over 50 should be very careful when performing jobs above the shoulder level.)

The specific risks associated with older workers need to be examined in the context of changes in the overall workforce. The Workers Compensation Research Institute (WCRI) has published an interesting study on Return-to-Work Outcomes in four key states: California, Massachusetts, Pennsylvania, and Texas. WCRI found that workers over the age of 55 who are injured are 12 to 35 percent less likely to return to work when compared to workers between the ages of 25 and 39. In addition, these older workers are out of work 62 to 276 percent longer. (I would like to quote from the study at length, but the information is proprietary and protected by copyright, so I am limited to quoting from their press release.)

One Side of the Story
WCRIs study included data from approximately 750 injured workers in each of the four states. The data is based on workers with more than seven days of lost time who reported having a substantial return to work (they returned for at least a month) or who reported having no substantial return to work during this time. I think it is worth noting that the data is based solely upon worker interviews, which took place three and one half years after the injury. At some point I would hope that WCRI would expand their study to include interviews with the former employers of the injured workers. I would really like to know whether the employer tried to get the injured employee back to work; whether there were modified duty opportunities available to the worker; and whether the employer maintained any contact with the employee during the disability. In a word, how hard did the employer try to get these people back to work?

By 2012 there will be over 10 million more workers older than 55 than there are in the current workforce. As the baby boom generation continues to age -- and as it is confronted with the financial realities of retirement -- the number of workers age 55 and older is projected to grow by 49 percent. This is four times the growth rate projected for the overall U.S. labor force. Turmoil in the economy may actually increase these numbers: failed pension plans, inflation, instability in an eroding middle class all increase pressure on older people to keep on working.

Education Levels and Duration of Disability
Here is the real bombshell in the WCRI study: a workers education level is a key factor in the likelihood of return to work and the duration of the out of work spell. Workers with a high school education returned to work 10 to 60 weeks faster than those with less education. In other words, one of the stongest predictors of no return-to-work is a lack of education: for workers with grade school education only, the duration of disability is significantly increased.

We are seeing a convergence of factors that may indeed become a "witches brew" for trouble in workers comp. We have an aging workforce. People are under pressure to work deeper into what used to be retirement years. Many older workers lack formal education, so they are less likely to have readily transferable skills. When their aging bodies fail, what are they going to be able to do? The pressure to keep on working might be fine for those of us doing white collar work, but what does that bode for the millions who must depend upon their physical strength and flexibility to perform the work? What would you do if you were in your 60s, after a lifetime of hard work, confronted with chronic problems in your knees and shoulders, with no pension and little saved for retirement? What exactly are your options?

In a future posting, we will share some thoughts on the steps employers can take to minimize the risks in employing older workers.


| Permalink

May 31, 2005

 

We continue to track the national crisis in health care coverage. we've blogged it before and we'll blog it again. As of 2003 about 45 million Americans lacked health insurance. Of these, there are about 20 million American workers without health coverage, which comprises a seismic undercurrent in workers compensation. Health care coverage tends to follow income: the lower your income, the more likely you cannot afford health insurance. The Kaiser study, which we cited back on April 6, notes that 40% of the workers without health insurance have less than a high school diploma. Twenty two percent of the uninsured report their health as "fair or poor." In addition, about one third of uninsured workers rely on physical labor for their living. These three overlapping groups are at especially high risk for prolonged disability under workers comp. It's probably no coincidence that Texas, the state with the highest incidence (27%) of non-covered workers is also the state where workers with a low education are most likely to receive permanent disability payments.

A recent article in the Boston Globe (registration required) by Theo Emery of the AP notes that Massachusetts has joined the ranks of the states singling out large employers who fail to offer coverage to all their employees. The state pays more than $52 million a year to cover workers in a broad range of jobs, from universities and hospitals to the U.S. Postal service. Four employers -- Dunkin Donuts, Stop & Shop, Walmart and McDonald's - have more than 1,000 employees each who received public health benefits. Now there is talk of surcharging these and similarly situated employers. Any such surcharge would provide political fireworks indeed!

Coalition of the Stymied
So I was pleased to read Robert Pear's article in in the New York Times (registration required) that a group of 24 leaders representing health care, business and workers has been meeting quietly to hash out a concensus for providing coverage to the uninsured. The participants range from the liberal Families USA to the conservative Heritage Foundation, the U.S. Chamber of Commerce and the National Association of Manufacturers (NAM). The group also includes the AARP, the A.F.L.-C.I.O. and the American Medical Association. I am encouraged that, first, they agreed that there is a major problem; second, that they can meet in a room together and just talk and listen to each other; and third, that despite their ideological differences, they might be able to agree on some solutions.

So far they are focusing on proposals to expand coverage to as many people as possible, as quickly as possible. They recognize that there are many reasons for people being uninsured, so rather than trying to come up with a "one size fits all" solution, they are exploring more flexible models.

Neil Trautwein, assistant VP for NAM, compares the talks to medieval alchemy, bringing together disparate and volatile ingredients: "It could produce some wondrous proposal, or could blow sky-high."

Thus far, here are some of the options they are exploring:
Tax credits to help parents provide insurance for children.
Deduction programs for employees whose employers do not offer health insurance; the employee contributions would be matched by other sources to provide coverage.
Tax credits to small businesses to help pay for insurance.
Expansion of Medicaid.
Federal grants to states to help them establish insurance purchasing pools.

Aggressive Timetable
The working group hopes to have a specific proposal by the end of the year. They have no illusions about the scale of this effort. As Stuart Butler of the Heritage Foundation says, "it's a coalition built of frustration. True believers on the left and the right have been stymied on this issue." Here's wishing them the best of luck in this essential endeavor. We'll keep you posted.

| Permalink

March 1, 2005

 

The Conference Board, a New York-based business research group, recently issued the findings of a job satisfaction survey of American workers. The findings were picked up in newspapers around the country, including the Boston Globe. The results should be of interest -- and concern -- to workers compensation and disability carriers alike.

The survey of 5,000 households found that only half of all workers are really happy with their jobs, down from nearly 59 percent in 1995. Of those who are happy, about 14 percent say they are very satisfied, on par with the group's last survey in 2003 and down from 18.4 percent in 1995.

The long-term drop in job satisfaction has been driven by rapid changes in technology, employers' push for productivity, and shifting expectations among workers, said Lynn Franco, director of the group's Consumer Research Center.

''As large numbers of baby boomers prepare to leave the workforce, they will be increasingly replaced by younger workers, who tend to be as dissatisfied with their jobs but have different attitudes and expectations about the role of work in their lives," Franco said. ''This transition will present a new challenge for employers." And, I would add, insurers.

To be sure, the drop in job satisfaction varies by age and income. The biggest decline in on-the-job happiness was among workers earning $25,000 to $35,000 and among workers between the ages of 35 to 44. It's not surprising that job dissatisfaction follows low wages and skimpy benefits.

Implications for Insurers
One line in the press release really hit me: "This information reveals that approximately one-quarter of the American workforce is simply showing up to collect a paycheck." I can't help but reflect on this whopping 25% of workers who apparently hate their jobs. What would happen if they were injured on the job and started collecting indemnity payments -- in other words, they start being paid for not working. At the same time, even though they lack health benefits in their low paying jobs, workers compensation now covers all of their work-related treatments, with no co-pays and no deductibles. Assuming the employer is educated enough to want these low wage earners back, how would they get them back to productive employment? If I truly hate my job, I'd probably prefer getting paid for not doing it!

As consultants to employers and insurers, LynchRyan emphasizes the need to build a positive work culture. Unhappy workers are less productive, less motivated and at higher risk for prolonged disability. The quality of their performance suffers along with their attitudes. A positive work culture recognizes individual contribution and makes it worthwhile for the individual employee to show up and perform the job. When workers are reduced to just showing up for the paycheck, the magnitude of the risks for employers and insurers can hardly be overstated.

| Permalink

December 17, 2004

 

A Saint Louis University study that appears in the December issue of Pain reports that black Americans who suffer work-related back injuries are compensated less for their injuries than white people in similar situations.

"The implications of these differences are sobering. Even though patients have equal access to health care through the worker's compensation system, there are substantial differences in the treatment costs that they incur," principal investigator Raymond C. Tait, a professor of psychiatry, said in a prepared statement.

He and his colleagues studied 1,472 lower back injury worker's compensation cases in Missouri. They found that money spent on medical care for blacks was about a third (an average of $4,000 less) of that spent on whites and that total disability settlements for blacks were about half ($3,000 lower) than the amounts given to whites."

The study also cites prior research by the Institute of Medicine on racial and ethnic disparities in health care. Congress requested this study in 1999, and the final report which was issued in 2002 found that:

" ... a consistent body of research demonstrates significant variation in the rates of medical procedures by race, even when insurance status, income, age, and severity of conditions are comparable. This research indicates that U.S. racial and ethnic minorities are less likely to receive even routine medical procedures and experience a lower quality of health services.

The report says a large body of research underscores the existence of disparities. For example, minorities are less likely to be given appropriate cardiac medications or to undergo bypass surgery, and are less likely to receive kidney dialysis or transplants. By contrast, they are more likely to receive certain less-desirable procedures, such as lower limb amputations for diabetes and other conditions."

This is quite disturbing stuff indeed. The report suggest the need for more evidence-based medical guidelines to help providers and health plans make sound decisions and to ensure equity of care. It also points to the need for more minority providers.

Thanks to Jordan Barab at Confined Space for pointing us to the recent St. Louis study.

| Permalink | 2 Comments

November 29, 2004

 

The Department of Labor's Monthly Labor Review features an 18-page report about work-related multiple-fatality incidents (pdf). While 9 out of every 10 work-related accidents that result in death involve a single fatality, between the study years of 1995 and 1999, 10 percent of the fatal events involved multiple deaths.

There were 1,109 incidents resulting in 2.949 deaths during the study years. Almost three quarters of these incidents involved two fatalities per event, but the nine worst catastrophes claimed a total of 266 workers lives. Nearly two-fifths of these multiple-fatality accidents involved transportation; homicides accounted for another one fifth of all such events.

The article presents side-by-side comparisons of by-exposure and by-industry data for multiple fatality events and all fatal events. This first-time study is an interesting way of viewing the data on fatalities because the data do not always track with the results for single-fatality events.

The data is not always what "conventional wisdom" might assume. Some workers that have a high proportion of overall fatalities, such as fishers and loggers, do not have a similarly high proportion of multiple-fatality events; other professions that might be expected to have a have a high proportion of multiple-fatality events, such as construction workers and miners, do not. While these occupations represent a high proportion of single-fatality incidents, they have a smaller proportion of multiple-fatality incidents. Yet while other occupations may have a low fatality rate overall, such as managerial and professional occupations, they have a significant proportion of multiple-fatality events when compared to overall fatalities for those professions. For example, the study reports:

"While managerial and professional specialty occupations account for one-ninth of overall occupational fatalities, they make up one-fifth of multiple-fatality transportation incidents and one-third of multiple-fatality homicides and suicides. For example, the legal profession, with a fatality rate a mere fraction of the overall rate, is very safe. Nevertheless, 14 multiple-fatality incidents involving 20 fatalities account for more than a quarter of the 74 work-related fatal injuries to lawyers, mainly air crashes in which workers in other occupations also died."

The report presents a snapshot of data from a different vantage, and as such, may be valuable to risk management and prevention efforts. The report concludes:

"First, multiple-fatality incidents occur in varying degrees in almost all event or exposure categories, but in some they make up larger or smaller shares of the categorys overall fatalities. Second, except in the case of murder-suicides, very rarely does the fatal event or exposure differ among the individual victims of the same multiple-fatality incident. Third, most multiple-fatality incidents involve workers in the same or similar industries and occupations. Finally, multiple-fatality incidents are a unique phenomenon: in most major respects, the fatal events or exposures underlying the circumstances under which they occur and the kinds of jobs in which they are most prevalent often do not reflect the fatal injury experience as a whole."

| Permalink

November 18, 2004

 

Does heavy computer use increase the risk for glaucoma? Yes, according to a study by the University of Japan at Toho. The study was conducted with 10,000 office workers who are heavy computer users:

the researchers found that those who were short-sighted and sat in front of computer screens for long hours were at significantly higher risk of developing/having glaucoma - their chances of developing glaucoma were double (compared to non-computer screen watching people).

In the study, out of 500 short-sighted people who spent long hours in front of the computer screen, 350 either had glaucoma or showed symptoms for the onset of glaucoma.

Glaucoma is a disease of the optic nerve that can cause blindness. It can progress rapidly before any symptoms are evident. People who have risk factors for developing glaucoma should be tested regularly. Are risk managers paying enough attention to eyestrain and eye safety when it comes to office workers? Does your firm have an "eye ergonomics" program? Here are some online resources to get you strated.

Vision Health Management: Visual Ergonomics in the Workplace
10 tips for avoiding eyestrain
A dozen things you should know about eyestrain
CCOHS: Eye discomfort in the workplace
NIH: Eye exercises and stretches
BBC: Eye problems
OSHA: computer monitors

| Permalink | 1 Comment

October 5, 2004

 

Are you a researcher with an interest in workers compensation? If so, you may want to submit an application to the John Jones Scholar in Workers Compensation Research by February 1, 2005 for a $10,000 research grant. This award was created by the Workers' Compensation Research Institutes (WCRI) Board of Directors to recognize the many contributions of John Jones, one of the founders of WCRI. The objective of the grant is to stimulate interest in workers compensation research and facilitate creation of important, new, publishable research. Topic areas of interest for potential research include medical treatment guidelines, return to work, benefit adequacy and equity, reducing litigation, and evaluating the design of PPD systems. For more information, contact: Linda Carrubba at 617-661-9274, ext. 245 or lcarrubba@wcrinet.org

| Permalink

September 30, 2004

 

Workplace fatalities rose in 2003 to a total of 5,559 deaths, according to the Department of Labor. Here's a breakdown from the DOL report about the industry segments with the most deaths.
The construction industry had the most deaths - 1,126, followed by 805 deaths in the transportation and warehousing sector.

When the number of workers in each industry was considered, the highest death rate was in the sector of agriculture, forestry, fishing and hunting, with 31.2 deaths per 100,000 workers. Mining was next, with a rate of 26.9 per 100,000 workers. Construction's rate was 11.7, and transportation and warehousing's was 17.5.

The most frequent work-related deaths were on highways - 1,350 last year, compared with 1,373 in 2002.

Texas had 491 job-related deaths last year, earning the dubious distinction of being the state with the highest rate of increase for work-related fatalities. Texas increased by 17.7 percent in 2003, while the national number of fatalities increased by less than one percent compared to 2002.

One of the other trends that the Department of Labor data indicates is that Hispanic workers died on the job more frequently than others, with a rate of 4.5 deaths per 100,000 compared to a rate of 4.0 for whites and 3.7 for blacks.

We've posted about the high death rate for Mexican workers before. A recent disturbing report by the News & Observer of Raleigh depicts illegal practices in camps for migrant farm workers in North Carolina. When you read about the shocking and flagrant practices - it's almost unbelievable to think such abuses occur in the United States - it's not hard to understand why the death rate is so high.

North Carolina farmers have a legal pipeline to foreign workers, known as the federal H-2A program. But the number of H-2A workers has fallen 15 percent since 2002, from about 10,000 to 8,500 this year. Growers say the rising costs associated with the program have contributed to the decline.

H-2A workers in North Carolina are entitled to a wage of $8.06 an hour, workers compensation and round-trip travel reimbursement. In July, the Ohio-based Farm Labor Organizing Committee began a campaign to unionize H-2A workers.

Instead, farms increasingly find workers through labor contractors.

Whatever the industry, whatever the state, whatever the demographic group, it's distressing to see work-related fatalities increase. It's hard not to see a parallel with the "kinder, gentler" OSHA of recent years. As an industry, this is a trend we have to stop in its tracks.

| Permalink | 4 Comments

September 8, 2004

 

A Towers Perrin report entitled Is It Time to Take the SPIN Out of Employee Communication? (pdf) reveals that in a survey of 1,000 working Americans, only 51 percent believe that their company generally tells the truth in its communications to employees, and one in five employees believes that their employer generally does not tell the truth.

Among the other survey findings:

  • Company communications about the business are viewed as credible by less than half of employees and appear dishonest to roughly a quarter of the workforce.
  • Senior leadership is viewed as less credible than front-line managers and supervisors.
  • Employees generally believe their companies are more honest with shareholders and customers than they are with employees.
  • Longer-service and older employees tend to be more skeptical about company communications than newer recruits.
  • 55% of those surveyed believe their company tries too hard to put a positive spin on issues in its communication with employees.

The Towers Perrin study notes that this break in trust follows both a recessionary period and a relatively recent spate of corporate scandals. We think that the survey also reflects an ongoing attenuation of the good faith between employers and employers that characterizes an increasingly transient work force. Layoffs, outsourcing, and benefit cuts all take their toll, and perhaps the more so if communication about these events is viewed as inauthentic.

The survey authors make the point that credibility is essential for work force retention; we would state that maintaining the credibility of management and your corporate communications programs should be part of your overall risk management program. Employers who are perceived as dishonest will not command loyalty. It can be all too easy for employees to justify dishonesty or entitlement in response to perceived deceit on the part of the employer, perhaps by taking a few extra sick days, or magnifying a slight back ache into a full blown disability claim.

We are always surprised by how many employers are reluctant to provide basic communication about workers compensation to their employees -- almost as though by mentioning the very words, claims will follow. Yet we believe that the advantages of open, honest, and proactive communications far outweigh any potential disadvantages. Far better for an employer to explain the rights, benefits, and protections afforded by workers compensation before an injury occurs than to leave it to a neighbor, relative, or attorney to provide potentially inaccurate or biased information after an injury has occurred. We would encourage employers to discuss the rights and responsibilities of all parties in advance - to thoroughly explain what workers compensation is and how it works, coupled with a message about the organization's commitment to maintaining a safe working environment and expectations for working safely and adhering to safety policies.

The Towers Perrin survey offers some good suggestions for improving communications. These include:

  • Recognize that communication must start at the top.
  • Understand your audience - use surveys and other feedback mechanisms to ensure that you understand your audience.
  • Audit your communication channels and match the message to the channel
  • Train leaders and managers in how to communicate effectively.
  • Tell the whole story - provide not just the facts but the context and the business rationale.
  • Ensure a two-way dialogue.

| Permalink

August 4, 2004

 

Good news for workplace safety advocates. In response to a Freedom of Information Act request by the New York Times, OSHA has been ordered to release company names and the worker injury and illness rates of the American workplaces with the worst safety records. This will allow reporters and the general public to identify the riskiest employers and will also provide the data to evaluate OSHA's efficacy. Read more on this story at Confined Space.

In a recent report, The Center for Studying Health System Change finds that the proportion of Americans under age 65 covered by employer-sponsored insurance fell dramatically from 67 percent to 63 percent between 2001 and 2003. According to Ross at The Bloviator, this change affects 9 million people, many in the 18-39 age range.

Thanks to Tom at Inter Alia, we learn that The Joint Commission on Accreditation of Healthcare Information has launched a new version of Quality Check, a tool to compare the quality of medical care at more than 16,000 facilities nationwide. Tom points out that you can compare up to 6 organizations at the same time.

According to a recent survey of 450 large employers conducted by Hewitt Associates, most employers don't track the costs of employee absence. The study notes that almost one-third of the company's polled had implemented absence management programs.

| Permalink

July 7, 2004

 

This year's NCCI Issues Report contains a report by Richard Victor of the Workers Compensation Research Institute (WCRI) of Cambridge, MA on WCRI's ongoing study of injured worker outcomes in California, Massachusetts, Pennsylvania, and Texas. The objective of the research is to measure key outcomes that are frequently at the heart of public policy decision making:

  • recovery of health
  • successful return to work
  • injured worker access to healthcare
  • injured worker satisfaction with healthcare

Most interestingly, the highest per-claim medical expenditures and the highest frequency of visits do not necessarily yield the highest satisfaction by workers or the best outcomes.

"For example, workers in Massachusetts and Pennsylvania report better outcomes after their injuries, on average, than do workers in California and Texas. This includes better perceived recovery of physical health and functioning; more frequent, faster, and more sustainable returns to work; greater access to desired providers and services; and higher levels of satisfaction with their healthcare.

Better outcomes occur in Massachusetts and Pennsylvania even though workers in California and Texas receive more medical services, on average, that generate more medical expenses for employers compared with workers in the other states. Further, this occurs despite the fact that workers from each of the four states report, on average, similar perceived severity of injuries."

One of the specific examples that the report cites is that Massachusetts, a state with some of the best outcomes, also has the lowest medical prices of the four states at $4,937; in contrast, Texas has one of the poorest worker outcomes, yet it has one of the highest medical prices of the four states at $11,617.

It's a report worth your time to read. This is one of the first major studies to measure injured worker satisfaction and outcomes, and to measure them against a multi-state backdrop so that system variables can be compared and contrasted.

The annual Issues Report available at NCCI is always worth checking out. Also, we keep a link to WCRI in the sidebar - it's a good practice to periodically visit the WCRI - What's New page to keep abreast of their current research and reports.

| Permalink

May 13, 2004

 

Thanks to Ross at The Bloviator for informing us that we are midway into the Cover the Uninsured Week, and that more than 20 million workers lack health insurance.

Ross provides a link to a 57-page state-by-state analysis of Americans without health insurance (PDF) commissioned by The Robert Wood Johnson Foundation (RWJF) and conducted by the State Health Access Data Assistance Center located at the University of Minnesota School of Public Health. It uses data from the CDC's 2002 Behavioral Risk Factor Surveillance System. Pages 23 through 36 provide state-by-state tables on uninsured rates for adults, comparisons of the uninsured by ethnicity, rates of both insured and uninsured who do not have a personal doctor or health care provider, and other important data. Texas has the dubious distinction of leading the nation with 27% uninsured working adults.

In conjunction with the week's activities, the Kaiser Family Foundation issued a study that examines the cost of medical care for the uninsured and how much care they receive compared to fully insured people. The study reports:

"Uninsured Americans could incur nearly $41 billion in uncompensated health care treatment in 2004, with federal, state and local governments paying as much as 85 percent of the care, according to a new Kaiser Commission on Medicaid and the Uninsured (KCMU) study. Even with uncompensated care, the study shows that people uninsured for the entire year can expect to receive about half as much care as people fully insured.

"Another major finding of the study, authored by Urban Institute researchers Jack Hadley and John Holahan, is that if the country provided coverage to all the uninsured, the cost of additional medical care provided to the newly insured would be $48 billion - an increase of 0.4 percent in health spendings share of the gross domestic product.

"Leaving 44 million Americans uninsured exacts a substantial price on society as well as individuals, while covering the uninsured would improve their health care without generating large increases in overall health spending," said Diane Rowland, executive director of the Kaiser Commission on Medicaid and the Uninsured."

| Permalink

March 9, 2004

 

Human Resource Executive's Workindex reports that the ranks of uninsured workers at large firms - companies with 500+ workers - have been growing at a rapid rate. According to a recent report - The Growing Share of Uninsured Workers Employed by Large Firms (PDF file) - issued by the Commonwealth Fund, the proportion of uninsured workers at large firms increased from 25 percent to 32 percent in recent years, while the proportion of uninsured workers in small and mid-sized firms declined.

The study calls the rising rate of uninsured workers in large firms an "unreported phenomenon." While there is widespread awareness that smaller firms have high numbers of uninsured workers, the report states that:

" ... features other than size also affect whether an employer offers coverage; in fact, recent research suggests that workers' income is a better predictor of lack of health benefits than firm size ... In addition, the likelihood of an establishment offering health coverage is 20 percent higher in manufacturing than in service jobs, and 60 percent higher if some workers are union members, according to the National Center for Health Statistics (1997)."

The report elaborates on the relation of income to insurance:

"Indeed, the problem of uninsurance in large firms is concentrated among low income workers. While 46 percent of low-income workers in large firms are uninsured for some time during the year, only 14 percent of middle- and 8 percent of high-income workers in large firms are uninsured at any point during the year."

Meanwhile, as the ranks of the uninsured swell, Maine is experimenting with universal access to affordable healthcare in a program called Dirigo. "The goal is to insure 31,000 people this summer and cover the state's remaining 130,000 uninsured by 2009." It's a laudable effort that bears watching, although other state initiatives such as "pay or play" programs have met with limited success.

The issue of uninsured workers should be of great interest to risk managers and human resource practitioners, particularly in relation to workers comp. While there are few studies documenting the practice, conventional wisdom holds that medical cost shifting often occurs when workers lack insurance - the so-called "Monday morning" claims. The Workindex article suggests:

"Low employee morale and absenteeism could become issues ... as well as false workers' comp claims resulting from injuries an uninsured employee actually sustained outside the workplace, but didn't have the health-care insurance to cover it."

The healthcare situation is likely to get worse before it gets better. Recent reports indicate that healthcare costs continue to grow, but at a slower rate.

"Healthcare spending in the United States is projected to grow 7.8 percent in 2003, down from the 9.3 percent growth experienced in 2002, according to a report issued by the Centers for Medicare & Medicaid Services (CMS). A slowdown in health care spending growth in 2003 would follow six consecutive years of acceleration. As a percentage of Gross Domestic Product (GDP), healthcare spending is expected to continue to grow, reaching 15.3 percent in 2003, up from 14.9 percent in 2002, according to the report."

| Permalink

January 29, 2004

 

A recent study on lower back pain and return to work was conducted by a Dutch research team, and the findings were unsurprising to those of us who espouse the idea of an active rather than a passive recovery whenever possible. In the study, workers with nonspecific low back pain who engaged in a graded activity program returned to regular activities - including work - sooner than those who got "normal care." On average, the active recovery path cut one month off a three-month recovery period, and follow-up studies showed no difference in the reinjury rate.

This study bolsters the case for employers to have a safe, progressive return to work program that eases injured workers back to their normal jobs. The study author comments:

"Athletes and other professionals are highly motivated, have high self-esteem, are not depressed, and have a strong motivation to keep doing what they always do," he suggests. "Can we imbue the injured worker with some of the ideals and motivation of the injured athlete?" Based on the van Mechelen team's study, the answer appears to be "yes." Their program changes how disabled workers see -- and cope with -- their lower back pain."

Dr. Jennifer Christian is an occupational physician who has worked in settings ranging from an insurer's office to right on the shop floor. She often uses "the grocery store test" as a barometer of fitness for work. It goes something like this: If you worked in your family grocery store, would you be back at work, or would the injury or illness preclude that? Of course, it goes without saying that any worker's return to work after an injury of illness must be planned carefully within physician restrictions.

The hidden key in both this study and the grocery store test may well center on that all-important word, motivation. If you are an employer, ask yourself this: would your employees be motivated to come back to your workplace?

By the way, if you ever have the chance to hear Dr. Christian speak at a national meeting or forum, do be sure to sign up...she is quite a forward thinker on workers compensation and disabilty issues.

And thanks to Judge Robert Vonada and his always excellent PAWC weblog for pointing us to this study.

| Permalink | 1 Comment

January 28, 2004

 

Peter Rousmaniere has a column entitled A Voice of the Worker in Risk & Insurance that is well worth reading. He reports on the Workers Compensation Research Institute's (WCRI) study, Outcomes for Injured Workers. The research encompassed 3,000 claimants in California, Massachusetts, Pennsylvania, and Texas. It's one of the first studies from the worker perspective, assessing recovery, return to work, and access to and satisfaction with health care.

There is much in the study that provides a springboard for further study - why are workers more satisfied and why are outcomes better in MA and PA than in CA and TX? Satisfaction and recovery, it appears, do not align with the highest expenditures, for example.

Rousmaniere discusses one disturbing aspect of the study that points to a worker population that is being marginalized:

"Many injured workers never succeed in returning to the wage levels they had achieved before their accidents. The data suggest that the vast majority with less than an eighth grade education do not get close to where they were pre-injury. They account for much of the injured workforce in states like California and Texas, maybe due to the large Hispanic workforces there."

He suggests that, given these circumstances, the most attractive option for these workers might be joining the cash sub-economy or to seeking some form of permanent disability awards.

Rousmaniere suggests that " ... the workers' comp system can respond only so much on behalf of this worker group. The California system's tableau of generous legal and medical benefits for claimants is a mirage. The concept of voc rehab has largely failed as a major solution. What may help are better incentives for the employer to retain the worker from day one of the injury and through, if and when a permanent award is made."

We must ask ourselves if, in these instances, we are fostering a permanently disabled class. Clearly, the most successful outcomes occur when incentives are aligned - worker and employer. Both must have an investment in and commitment to the benefits of recovery and return to work.

| Permalink | 1 Comment

January 28, 2004

 

Thanks to Pulse for pointing us to the study Changes In Health Insurance Coverage During The Economic Downturn: 2000 - 2002. The study reports that the uninsured population has grown by 3.8 million during that time period. Low-income Americans, particularly males and nonparents, fared the worst, as gains in public programs failed to offset lost employer-sponsored coverage. Look to the possibility of more uninsured workers trying to secure coverage where they can - this includes potential cost shifting to the workers' comp system.

| Permalink

January 12, 2004

 

Last week, NCCI reported on a recent study on workers' compensation claim frequency and, as they reported last year, frequency continues to decline. They cite several potential reasons for this - employer safety initiatives, increased use of robotics and power assisted processes, and ergonomics, to name a few. Here is a breakdown by size of claim - note that the highest decreases are in the smaller claims, and the decreases in high-dollar claims are significantly less pronounced:

  • For claims less than $2,000, a decline of approximately 35%
  • For claims between $2,000 and $10,000, a decline of 18%
  • For claims between $10,000 and $50,000, a decline of 8%
  • For claims more than $50,000, a decline of 8%

The severity decrease is the good news. The flip side of the coin is that medical and indemnity costs are galloping full steam ahead in the wrong direction. Not so good at all.

In the early and mid-'90s following reforms, indemnity was relatively stable. But according to NCCI actuary Tony DiDinato, "The last seven years have seen the trend turn upward once again, with workers compensation indemnity claims increasing an average of 7.4% annually since 1996. In 2001 and 2002, respectively, claim costs rose 7.3% and 6.0%."

DiDinato goes on to characterize medical claim cost trends are alarming, "with double-digit increases the last two years." He attributes this to increased utilization and prescription drug costs. (Prescription drugs were recently discussed here and here).

Cleary, employers are making progress in workplace safety (although we would advocate that any injuries are too many injuries) but it would appear that they must do a much better job of managing injuries from the point they occur right on to an employee's successful return to work. Perhaps the "buyer's market" of the late 1990s lulled some employers into forgetting how vital this is?

It brings to mind an old Bob Dylan lyric: "And here I sit so patiently, waiting to find out what price you have to pay to get out of going through all these things twice."

| Permalink

December 15, 2003

 

The Ohio Bureau of Workers Comp and Ohio State University have teamed up on a research project that studies back injuries and reinjuries that can occur when people return to work. As an offshoot of the research, they developed an interactive lifting resource with guidelines intended to help employers and physicians in developing realistic transitional work programs. Considering that back injuries cause more time away from work than anything besides the common cold, it's a resource worth checking out.

| Permalink

October 20, 2003

 

The good news? In 2002, workplace deaths fell by 6.6% (excluding 9/11). This marks the lowest level in the ten years the census has been conducted. The bad news? Some jobs are still way too risky.

The Bureau of Labor Statistics just issued its annual report on the most dangerous jobs, on-the-job fatality rates, and other work-related injury and death statistics.

Another positive note in this year's report is that workplace homicides continued to drop, falling to 609 - a sharp contrast to the 1984 high of 1,080. But disturbingly, homicide is the chief cause of workplace fatalities among women. Overall, highway accidents are the single biggest killer, representing a quarter of all work-related deaths. The full report can be accessed at the BLS site.

| Permalink | 1 Comment

October 3, 2003

 

State budget woes are taking a toll on Texas. Recently, the Research and Oversight Council (ROC) on Workers' Compensation announced it would be closing shop after a line item veto of funding by Governor Rick Perry.

Gene Acua, a spokesman in the governor's office, says the governor felt the agency's operation was not cost-justified. The ROC had requested $979,290 for fiscal year 2004 and an additional $979,290 for fiscal year 2005.

Apparently, many of ROC's functions will be transferred to the Texas Department of Insurance (TDI) through a memorandum of understanding. We'll have to see if the research reports and Texas Monitor continue. The agency's reports can still be found at the former site for now.

| Permalink

September 24, 2003

 

Robert Hartwig of the Insurance Information Institute says that worries about "anemic profits, dreadful underwriting results, the state of the stock market, solvency concerns and a tort system run amok" are still keeping property/casualty CEOs awake at night despite the hard market being in its third year. Read his analysis in an article appearing in NCCI's 2003 Issues Report. (this link is a pdf file)

| Permalink

Subscribe

Submit your email to be notified when this site is updated

Need help with your workers' comp program?

Monthly Archives

About this Archive

This page is an archive of recent entries in the Research category.

News roundups is the previous category.

Safety & Health is the next category.

Find recent content on the main index or look in the archives to find all content.

OpenID accepted here Learn more about OpenID