Archive for March, 2004

A tip of the hat…

Tuesday, March 30th, 2004

Kudos and confetti to Jordan Barab at Confined Space who marked one year of fine blogging yesterday. He is a dedicated and tireless voice for the safety of the worker and we learn something new and important (albeit disturbing) every time we visit his site. Thanks for your efforts, Jordan — it’s excellent and important work that you do — one could only hope that we would all see the day when you would have less sad news to report.
A warm note of appreciation is also in store for Anita Campbell at Small Business Trends. Yesterday, we enjoyed the unexpected distinction of having Workers Comp Insider featured in her PowerBlog Review. Very kind of you to say such nice things, Anita — it’s a mutual admiration society. Visit the sidebar at Small Business Trends to read about other business blogs that have been featured in this series – it’s a good way to explore how businesses are using weblogs.

We’ve added a few new blogs and resources to our sidebar that visitors might want to note…Benefitsblog features tax, benefits, and ERISA law commentary and news; the HealthLawBlog tracks state and local news and matters in health law; and rawblogXport focuses on job safety, union news, and worker rights — they are all worth a visit.

A few more sidebar additions: check out Occupational Hazards, a news headline aggregator on issues related to workplace health & safety; and if you just can’t get enough blogs, The Blog Herald highlights news from the blog world.

Cultural competence in healthcare and beyond

Monday, March 29th, 2004

Is your workers comp provider network culturally competent? If not, you may fostering needless disability. Georgetown University’s Center on an Aging Society has an excellent article on the issue of cultural competence in healthcare, and defines the concept as “the ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients.”

The article addresses the specialized medical needs that the changing demographics demand, both for reasons of language and other cultural and socio-economic factors. It makes the case that positive outcomes require that physicians and other providers develop cultural competence in service delivery. Barring this competence, minorities are more likely to be dissatisfied with care.

If the providers, organizations, and systems are not working together to provide culturally competent care, patients are at higher risk of having negative health consequences, receiving poor quality care, or being dissatisfied with their care. African Americans and other ethnic minorities report less partnership with physicians, less participation in medical decisions, and lower levels of satisfaction with care. The quality of patient-physician interactions is lower among non-White patients, particularly Latinos and Asian Americans. Lower quality patient-physician interactions are associated with lower overall satisfaction with health care.

In workers comp, poor quality care and dissatisfaction hinder recovery and may well prolong disability. Dissatisfaction often also turns into lawsuits that might have been prevented. The issue of cultural competence has relevance to workers compensation in terms of health-care services delivered by workers compensation provider networks, but also in other aspects of prevention and claims management as well. We’ve previously discussed some of the challenges posed by an increasingly multilingual workforce, as well as the fact that some immigrant workers are at high risk of injuries or death.

The article suggests the following strategies for improving the patient-provider interaction and institutionalizing changes in the health care system:
1. Provide interpreter services
2. Recruit and retain minority staff
3. Provide training to increase cultural awareness, knowledge, and skills
4. Coordinate with traditional healers
5. Use community health workers
6. Incorporate culture-specific attitudes and values into health promotion tools
7. Include family and community members in health care decision making
8. Locate clinics in geographic areas that are easily accessible for certain populations
9. Expand hours of operation
10. Provide linguistic competency that extends beyond the clinical encounter to the appointment desk, advice lines, medical billing, and other written materials

This list might be a useful adjunct to an employer’s current gating issues when screening medical providers for a workers comp program. It also provides a checklist of considerations for loss control, risk management, and claims staff as well.

Business blogging: It’s a blog world after all

Thursday, March 25th, 2004

Fast Company has an interesting series of articles on the corporate weblog as a knowledge management tool. The primary article makes the case that weblogs are a cost effective, flexible, and efficient way for teams to communicate via intranet. It cites one example of use by an insurer:

The Hartford Financial Services Group is already finding success using blogs in one of its mobile groups. A team of 40 field technology managers, who serve as links between The Hartford’s network of insurance agents and the home office, set up a blog in August. They use it to share information about e-commerce features and solutions to technology problems. Before, email and voice mail sufficed, but email threads would die, and there was no way to search past shared information. “We don’t get a chance to talk with each other as often as we’d like,” says Steve Grebner, one of The Hartford’s field managers, who thinks of the blog a little like a town square. “To me, it’s like there’s 14–or 40–brains out there, and you might as well tap into that knowledge base.”

That’s a good use for weblogs, but it would be a shame if business America largely confines blogging to internal use. The article points to a few problems with taking a business blog to the public sphere – one, a company’s reluctance to give employees a voice:

Letting employees speak directly to customers requires a huge amount of trust. A loose cannon might reveal corporate secrets, give out the wrong message, or even open up the company to legal trouble.

If the fear is giving the keyboard over to the rank and file employee, why aren’t more CEOs keeping weblogs? Perhaps many companies may well be having trouble finding their web voice, which requires a greater level of transparency and authenticity than most other media…corporate communications are generally carefully crafted and packaged by PR and advertising people. For some businesses, a filtered voice is their only public “voice” to the world at large.

It is precisely this tendency to view marketing from such a narrow channel that leads to another unsettling corporate approach to weblogging. As the article in Fast Company points out, many a business foray into the blog world is a ham-fisted or blatant attempt to exploit the medium for a marketing end. Companies that view blogs as “ads” or that see the blog network as merely a channel in which they can foist or insinuate press releases will be doomed to failure.

But there should definitely be a place for serious business blogging as a public communications tool. Every business is – or should be – a topic expert on whatever it is they manufacture, deliver, sell, or service. Anyone who has an interest in the particular product, service, or industry at hand would likely find informed comment and trend monitoring of great value.

Some businesses are doing this well. Anita Campbell and David Patterson at Small Business Trends are a case in point. And even in a niche as narrow and esoteric as workers comp insurance, we are encouraged to see the nascent network of interested parties that is emerging. Hopefully, we will stay tuned for more.
Oh, and did we mention that Fast Company has a weblog too?

Mandatory fun: when recreational activities are compensable

Sunday, March 21st, 2004

Roberto Ceniceros of Business Insurance reports that the New Jersey Supreme Court recently awarded workers compensation benefits to an employee injured in a go-cart accident that occurred after hours. This finding reversed an earlier decision that dismissed the case as extracurricular horseplay.

There are a lot of gray areas when it comes to compensability and recreational activities are among them. Generally, recreational activities would not be compensable. The foundation for determining compensability is “arising out of and in the course of employment. On first blush, an activity like riding a go-cart after work doesn’t sound as though it meets that standard.

But there are certain circumstances when a court may decide that an injury resulting from a recreational activity would indeed be compensable. When an employer requires participation in a recreational activity, for example; or if it can be shown that the employer was deriving significant benefit from the employee’s activity at the point of injury. Sometimes, when the injury occurs on the employer’s premises — even if it stems from an activity that is recreational and voluntary in nature — it may be deemed compensable. There are no black and whites. Laws vary stated by state, as do court interpretations.

Employers should be cautious in the types of recreational activities they mandate, whether the coercion is implied or overt. Sometimes a company’s cultural values can be so strong as to make participation in teams or activities seem anything but voluntary. Most of us have seen companies where the pressure to join an after-hours sports team or some other activity can be quite intense. That could mean trouble in the event of an injury, particularly if that pressure came from a manager or supervisor.

Workers compensation and related news from the weblog world

Saturday, March 20th, 2004 brings us the story of California’s $7 billion workers compensation miscalculation.
“The reform savings calculations resulting from the late last year (September 2003) Reform and subsequent predicted figures were recalculated by the Workers’ Compensation Insurance Rating Bureau (WCIRB) and found to contain egregious errors which retranslated into a newly predicted potential savings for this year, 2004. The prediction in savings is to about 7 billion dollars overall for the Workers’ Compensation system.”

Jottings By an Employer’s Lawyer points to an upcoming debate over domestic violence legislation that would have FMLA type implications for employers.
“Although domestic violence is certainly a problem and one that does need to be addressed by both the employer community and Congress it should be done in a much more organized fashion than passing a complex, expansive bill in the middle of an election year. The legislation would cover victims of sexual and domestic violence, which is defined to include “an individual who has been a victim of domestic or sexual violence and an individual whose family or household member has been a victim of domestic or sexual violence.” Those protected would be entitled to Title VII type protection against discrimination, FMLA type leave and a liberalization of requirements for unemployment.”

Jordan Barab’s Confined Space has many worthwhile items, as usual. Today, he has an item about the Mexican government’s reaction to the AP story about the workplace death toll of Mexican workers, a follow-up to an item that he covered earlier in the week.
He has an item on a new publication from NIOSH, “Does it really work? How to evaluate safety and health changes in the workplace.” And he’s also been blogging blow-by-blow coverage of the recent popcorn lung suit, in which he notes that “Workers in this country are the proverbial canaries in the coal mine. The health effects of chemical aren’t adequately studied, and when they are, the results are hidden — until someone notices that workers are starting to get sick and die.”

State resources – Ohio, Utah, Pennsylvania

Wednesday, March 17th, 2004

UtahDavid Fletcher’s Government & Technology Weblog is a weblog that describes itself as “news and perspectives from a long-time egov advocate.” Among other things, David tracks how technology is making the government in the state of Utah more accessible to the people, and how technology is being used by governmental sites in general.

PennsylvaniaPAWC is a weblog by Judge Robert Vonada, a workers’ compensation Judge in the Altoona Field Office of the Bureau of Workers’ Compensation Office of Adjudication. He blogs development’s in the state’s workers’ comp practice and procedures.

Jobs that lure Mexican workers to the U.S. are killing them

Sunday, March 14th, 2004

In documenting what is referred to as a “worsening epidemic that is now claiming a victim a day,” a study by the Associated Press (AP) is exploring the reasons why Mexican workers are about 80 percent more likely to die from a work injury than native-born workers, and more than twice as likely to die on the job as other immigrant workers.
Some of the investigations findings:

  • Mexicans now represent about 1 in 24 workers in the United States, but about 1 in 14 workplace deaths.
  • The death rates are greatest in several Southern and Western states, where a Mexican worker is four times more likely to die than the average U.S.-born worker. yet despite this, OSHA has only a single Spanish-speaking outreach worker in its eight state Southeastern region.
  • While Mexican worker deaths were concentrated in the agriculture industry overall, the construction industry was also deadly, and far more so to native Spanish-speaking workers, including Mexicans, than to native born workers.
  • Both AP and an OSHA spokesperson state that these accidental deaths are almost always preventable.

Why this troubling trend? According to the AP report:
“Public safety officials and workers themselves say the answer comes down to this: Mexicans are hired to work cheap, the fewer questions the better.
They may be thrown into jobs without training or safety equipment. Their objections may be silent if they speak no English or are here illegally. And their work culture and Third World safety expectations don’t discourage risk-taking.
Federal and state safety agencies have started to recognize the problem. But they have limited resources – only a few Spanish-speaking investigators work in regions with hundreds of thousands of recent arrivals – and often can’t reach the most vulnerable Mexican workers.
President Bush’s recent proposal to grant illegal immigrants temporary legal protections energized the national immigration debate. Yet in these discussions, job safety has been an afterthought. Meanwhile, Mexicans continue to die on the job.”

Indeed, it would seem that a guest worker program that lacks any provision for worker rights might actually exacerbate the problem. Immigrant workers are already reluctant to speak out about workplace safety violations or to report on the job injuries. This is due to several factors: many workers come from countries that do not have worker protections and do not know their rights here; language is often a barrier; some workers come from cultures where authority simply isn’t challenged, or where on the job risks are even greater than those they face here; and many immigrants are desperate to support families, so reluctant to come to the attention of authorities in any way. If employers are given the ability to revoke guest worker status, who will be protecting already disempowered workers from abuse of that privilege?

Are immigrants currently protected by workers compensation benefits, or does their alien status exclude them? According to the National Employment Law Project, most states do afford coverage:

“The majority of the states’ workers’ compensation laws include aliens in the definition of covered employees. Entitlement to lost wages under state workers’ compensation laws turns on state statutes and their definition of worker or employee. State courts in California, Colorado, Connecticut, Florida, Georgia, Iowa, Louisiana, Nevada, New Jersey, New York, Pennsylvania, and Texas have specifically held that undocumented workers are covered under their state workers’ compensation laws.”
” … like Virginia, a number of other states also explicitly provide for workers’ compensation benefits for “lawfully or unlawfully employed” employees. They are: Arizona, California, Colorado, Florida, Montana, North Carolina, South Carolina, and Utah.12 There is only one state, Wyoming, which has a statute specifically limiting coverage to documented aliens.”

What can we as an industry do about this troubling trend? Clearly, there are those employers who fall into a category of outright exploiters, and for those, nothing short of enforcement and meaningful penalties will suffice. OSHA is giving at-risk populations some attention in its 5-year plan, yet the agency’s enforcement efforts are stretched increasingly thin under the current administration. The insurance industry should play a leadership role in focusing attention on the issue, simply for reasons of good business sense if not for the moral imperative alone. And for responsible and well-intended employers, a solution begins first, with recognition and awareness of the problem, and second, with meaningful prevention and training measures.

Additional resources:
U.S. Equal Opportunity Commission, Compliance Manual on National Origin Discrimination
National Employment Law Project – Immigrant Worker Project
National Immigrant Law Center
Workers Comp Insider – Mandatory English at the Workplace

Number of uninsured workers at large employers growing

Tuesday, March 9th, 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 – 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.”

March is workplace eye safety month

Friday, March 5th, 2004

“In observance of March as Workplace Eye Safety Month, the American Academy of Ophthalmology, the Eye M.D. Association, and Eye M.D.s across the nation want to alert Americans to the possibility of eye injuries in the workplace.
According to Prevent Blindness America, each working day in the United States more than 2,000 employees sustain job-related eye injuries, making workplace injury a leading cause of ocular trauma, visual loss and blindness. Of these, 10 to 20 percent will be disabling because of temporary or permanent vision loss.”

The following are resources for employers and employees on regulations, personal protection equipment and eye injury prevention.
OSHA – eye and face protection
Toolbox talk – eye safety
10 Ways to Prevent Eye Injuries at Work
Eye injuries in construction

Compare your workers compensation losses with others in your industry

Wednesday, March 3rd, 2004

Marsh offers an interactive tool to let you compare your workers comp losses with others in your industry. It entails entering a few bits of information, and it then generates bar charts that depict industry numbers and your variance from the norm. Of course, it’s a rough benchmark, but it still offers an industry-specific yardstick, and most of us are eager to see how we measure up to our peers. The site has other interactive tools too – test your liability limits, or benchmark your Directors & Officers liability.
The site also has a library of articles on various business insurance issues, including one entitled Controlling Workers’ Compensation Costs. Here is an excerpt:
“The average cost of a claim involving an employee who lost time from work was $30,000 in 2002, according to data gathered by Marsh. In the aggregate, these costs have a big impact on an employer’s bottom-line. A business with $100,000 in workers’ compensation losses and a one-percent margin (such as in retail) needs to generate $10 million in sales to pay its workers’ compensation claims.”
Obviously, we think the best way to forestall these punishing costs would be to prevent claims from occurring in the first place; Marsh suggest that employers view workers comp initiatives in terms of pre-loss and post-loss initiatives. They offer their views on an effective claims management component:
“To address post-loss issues, employers may need to sharpen their focus on the injury and claims management processes. This could involve establishing consistent policies for reporting claims and procedures for dealing with workplace injuries and providing medical referrals. A key element in any employer’s post-loss activities involves implementing a return-to-work policy that gives employees an opportunity to begin working on a modified schedule as soon as they are physically able. Transitional or temporary work programs offer significant benefits to the employee and potential cost savings for the organization.”
At Lynch Ryan, we are ardent believers in the need to measure and benchmark losses against the industry and also against a company’s own performance over time, so we are happy to see this handy tool from the folks at Marsh. If you haven’t visited the Marsh site lately, you might find some valuable risk management or HR resources.