Archive for February, 2007

News roundup: fraud, kudos, back pain, WV, and more

Monday, February 12th, 2007

Fraud watch – Last week, Florida uncovered major workers comp fraud ring. “Three Floridians including two insurance brokers have been charged with fraud and conspiracy for allegedly providing hundreds of workers with falsified workers’ compensation insurance certificates to more than 300 Florida construction contractors.” The fraud included the creation of fake documents and records, including certificates of insurance, payroll records, paychecks, and IRS reporting documents. It is estimated that about $4 million was bilked from the system and hundreds of workers were left uncovered. Here’s another article on the matter from the Miami Herald.
Kudos – It’s with mixed feelings that we say thanks and a warm adieu to fellow blogger Jordan Barab who has closed shop at Confined Space after more than 2,800 posts, a real loss to the blogging community. But Jordan moves on to a position at the House Education and Labor Committee, so we wish him well and hope that his advocacy for worker safety will be a message that is heard by policymakers. Read his last post to learn more. Plus, he left a list of recommended list of health, safety, and labor blogs for further reading. One of the ones we will be sure to visit, and that we recommend to you, is the Weekly Toll by Tammy Miser. If you are a regular reader, you know that we are very concerned about workplace fatalities, so we think a blog devoted to news and updates about workplace deaths is an important addition to the blogosphere, athough nothing would make us happier than to have Tammy go out of business.
Scaffolding in NYC – In response to the high number of scaffolding deaths in Manhattan last year – 20 fatalities, up from 11 in 2005 and 5 in 2004 – New York will be implementing some major scaffolding safety initiatives. Among them, a Scaffold Safety Unit will be established in the Department of Buildings and ten new inspectors will be armed with stop work orders as they conduct daily sweeps. (Thanks to rawblogXport for the tip).
Back pain – Did you know that if you live in Bend, Oregon, you are six times as likely to have back surgery than if you live near Yankee Stadium? Joe Paduda uses low back pain to illustrate why the health-care system is so dysfunctional.
West Virginia – Peter Rousmaniere writes about West Virginia’s workers compensation transformation in his monthly column for Risk and Insurance. The state has completed its first year in its migration from a monopolistic state fund to a competitive environment. In 2005, the state established a mutual insurance company, the private BrickStreet Mutual Insurance Company; by 2008, private insurers will be allowed to write policies.
Handy news tools – Newsmuseum offers a snapshot of today’s front pages in 440 newspapers from around the globe. Another good resource for more than 12,000 online newspapers can be found at
Geek stuff – How long will your password hold up to an attack? These charts on password recovery speeds are quite the eye opener, and make a good case for why your passwords should be a combination of letters, numbers, and case. And speaking of security, Tom Mighel of Inter Alia explains why you should have three e-mail addresses.

Kudos to “Working Immigrants”

Friday, February 9th, 2007

Congratulations to Peter Rousmaniere on his one year “blogiversary” – it’s been just over a year since he launched Working Immigrants to serve as resource for the exchange of information and ideas about the business of immigrant work: employment, compensation, legal protections, education, and mobility. To commemorate his one year mark, he’s compiled a post listing notable entries from the first year of his blog, a “greatest hits,” of sorts.
Those who follow the blog regularly are aware that Peter is diligent about tracking research reports and public policy matters, and his blog has become an authoritative resource and repository for facts and data on the topic of immigrant workers. His “notable posts” entry serves as a handy cheat sheet on such matters as the size of the illegal work force, where illegal workers work, what the economic impact of the illegal work force is, and much more.
Thanks for an invaluable resource, Peter, and here’s to many more years of blogging!

It’s Health Wonk Review day – 25 and counting

Thursday, February 8th, 2007

David Harlow of HealthBlawg is the excellent host of this week’s Health Wonk Review and he notes that it is our silver anniversary, the 25th edition. We have a fine host for such a momentous occasion, too – his post is a thing of beauty, he has done a masterful job of providing context for all the entries.
For those of you who may be wondering, the title of David’s blog is not a misspelling, but a deliberate fusion of the word “blog” and “law” to arrive at “blawg,” the preferred term used by legal bloggers (because “blog” just wasn’t an ungainly enough term in its own right?) David is a health care lawyer and consultant who helps various health care providers, vendors and payers to navigate regulatory maze. His unique perspective and expertise is a good addition to our wonky circle – you may want to drop by HealthBlawg now and again to see what’s on his mind.

Random Views from the World of Comp: Mental/Mental Denied, A Justice named Crook and a Crook Named Blizzard

Wednesday, February 7th, 2007

Today’s scan of the world of comp begins sadly in Nebraska, takes a brief detour in Wisconsin and ends with the Coingate saga in Ohio.
Mark Zach was a state trooper in Lincoln, Nebraska. In 2002 he stopped a low-life named Erick Vela for carrying a concealed weapon. But he accidentally transposed the serial number on the gun, so it did not register as stolen. A week later, Vela and his buddies robbed a bank and brutally murdered four people.
Trooper Zach, devastated by the consequences of his error, committed suicide. His widow filed for workers comp benefits. The case was first denied, then granted on appeal, and then finally denied again by the Nebraska Supreme Court, which stated: “We conclude that under current Nebraska law, a compensable injury caused by occupational disease must involve some physical stimulus constituting violence to the physical structure of the body.” In other words, job-related mental anguish, by itself, does not result in a compensable injury (or in this case, compensable death). The court acknowledges that a persuasive argument for paying this claim can be made, but their hands are tied by the language of the statute. Nebraska, like 42 other states, does not allow for “mental/mental” claims. Attorney Donald DeCarlo has written a nice summary of mental/mental stress claims here.
Double Dipping?
We find an interesting case in Wisconsin, where Glen May, a Daimler-Chrysler employee, collects double for single injury. He hurt his knee at work and underwent ACL reconstruction a few weeks later. The pain and swelling persisted, so he underwent a second surgery on the knee. His own doctor recommended a 10 per cent disability rating, the minimum under state rules. Writing for a majority at the state supreme court, Judge Patrick Crooks awarded May a twenty per cent rating, ruling that, based on the dual surgeries, the benefits could be “stacked.”
In her dissent, Justice Patience Roggensack noted (impatiently?) that the commission erred by ignoring the recommendation of the treating physician, who stated that the knee did not get any worse after the second surgery.
Coingate, Again
The comp scandal in Ohio just won’t go away. A Florida-based investment advisor named Clarke Blizzard (with that name, he belongs in northern Michigan) has been charged with one count of conspiracy. He pulled in $2.5 million in fees and commissions while brokering investments for the Bureau of Workers Comp. He is charged with paying $20,000 in bribes to the former CFO of the Bureau, Terry Gasper (currently doing hard time for racketeering and money laundering). The bribes apparently covered college tuition for Gasper’s son (let’s hope the boy is majoring in business ethics) and another check made out to Gasper’s girlfriend (who undoubtedly is faithfully waiting for Terry’s release). With the bribes totalling just one per cent of his take, Mr. Blizzard could boast of a pretty remarkable return-on-investment – at least until the indictment came down hard like a storm off the Great Lakes.

Working and surviving in extreme cold

Tuesday, February 6th, 2007

Brrrr … after a mild winter here in the Northeast, we are waking up to temperatures in the single digits this week and wind chill that makes it feel 10 or 15 degrees colder. The cold is no doubt exacerbated because we had a relatively quick temperature plummet rather than a sustained low – we haven’t had a chance to gradually acclimate.
For some people, extreme temperatures are more than just a passing annoyance – they pose health and life-threatening risks. News reports are attributing at least seven deaths to the freezing temperatures. While many of us can just can crank the thermostat up a degree or two in our home or office, many workers have to brave the elements as part of their jobs – police, postal workers, construction workers, maintenance workers, and recreational workers, to name but a few. Firefighters who face dangerous conditions under ordinary circumstances face added challenges in frigid weather. And some at-risk work populations face even higher risks in the cold. These include older workers, workers who have predisposing health conditions such as cardiovascular disease, diabetes and hypertension, and workers who are taking certain types of medications. Precautions should also be taken for workers who work alone or in isolated areas.
OSHA’s Cold stress equation offers a graphic depiction of risk levels associated with various temperature ranges and wind speeds, as well as information on how frostbite and hypothermia affect the body. (Chart in Spanish). It includes the following sensible tips:

  • Recognize the environmental and workplace conditions that lead to potential cold-induced illnesses and injuries.
  • Learn the signs and symptoms of cold-induced illnesses/injuries and what to do to help the worker.
  • Train the workforce about cold-induced illnesses and injuries.
  • Select proper clothing for cold, wet, and windy conditions. Layer clothing to adjust to changing environmental temperatures. Wear a hat and gloves, in addition to underwear that will keep water away from the skin (polypropylene).
  • Take frequent short breaks in warm dry shelters to allow the body to warm up.
  • Perform work during the warmest part of the day.
  • Avoid exhaustion or fatigue because energy is needed to keep muscles warm.
  • Use the buddy system (work in pairs).
  • Drink warm, sweet beverages (sugar water, sports-type drinks). Avoid drinks with caffeine (coffee, tea, or hot chocolate) or alcohol.
  • Eat warm, high-calorie foods like hot pasta dishes.

Here are a few other good cold-weather resources
Canada’s National Occupational Health & safety Resource offers fact sheet about working in cold environments that includes a guide for threshold limits and warm-up schedule for four hour shifts, along with information about personal protective equipment and preventive tips.
The Centers for Disease Control offers Extreme Cold: A Prevention Guide to Promote Your Personal Health and Safety that offers information for both home and work environments, including a temperature with wind chill chart and tips for weather-proofing your home and car.
Cold impacts on human health and comfort
Create a winter car survival kit.

The Saga of Ted Johnson: Sports Medicine with a Bitter Taste

Monday, February 5th, 2007

Ted Johnson was a linebacker for the New England Patriots. His specialty was stopping the run. As any viewer of the recent NFL playoffs knows, run stoppers use their heads: first, to think strategically — where to go in the course of a given play – but then literally: torpedoing head first into the body of an opposing player. That’s how you “stop the run.” The result? All too often what football practitioners call “dings” and what the rest of us call concussions.
Ted Johnson has three superbowl rings, a broken marriage, a life in tatters and, it appears, a broken brain. At age 34, he has incipient Alzheimers. His persistent depression has led him to abuse medications. The brain damage he suffered in football appears to be permanent, placing him on an inexorable downward path (see our recent blog on permanent brain damage and depression among football players here).
Johnson thinks he knows exactly when the brain damage occurred. In 2002, he suffered a concussion in a game. In middle of the following week, he was given a “no contact” jersey for practice, which legendary coach Bill Belichick converted for unknown reasons to “full contact.” In a subsequent drill, Johnson suffered another concussion. He eventually returned to full action, again, suffering countless “dings” over the course of three more seasons in the NFL. We may never know whether the two successive incidents were the cause of his current problems, but there is little question that he has suffered permanent brain damage.
All of which brings us to the issue of sports medicine and the concept of returning to work as quickly as possible.
Modified Duty in the Working World
Workers comp practitioners understand that injured workers recover quicker if they are able to return to the workplace and perform some or all of their pre-injury duties. Treating doctors determine what the employee can and cannot do. Employers match the restrictions with available work. For some employees with extensive restrictions, that might mean performing job functions totally unrelated to the original job. Any work can be performed, as long as it is valuable to the employer and within the capacities of the recovering employee. The important part of modified duty is getting dressed and going to work: the worker feels productive and feels like part of the team.
The whole system falls apart if two conditions are not met: the doctor must accurately specify the restrictions necessitated by the injury, along with appropriate time frames; and the employer must make sure that the employee follows those restrictions carefully, never exceeding the doctor’s limits. If any ambiguity or doubt arises, the employer communicates with the doctor to clarify which work activities are acceptable and which are not.
Modified Duty in the NFL?
Now let’s return to the violent world of the NFL. There is a lot of money at stake. The pressure to win from week to week is intense. Indeed, winning is the only way the entire league measures performance. As Vince Lombardi said, “If winning isn’t everything, why do they keep score?”
With all this focus on winning, it’s not surprising that the league itself does not know how to handle concussions. There is no explicit protocal for treatment and no required period for “time away from work.” (With high profile cases of brain damage such as Johnson’s, maybe that will change.) At the same time, there really is no “light duty” available for injured players. Whenever a player takes the field, it’s all full duty – full duty with a vengeance. The opposing side shows no mercy. If they can exploit the injury to their advantage, they will do it. Players whose injuries prevent them from returning to the playing field indefinitely are placed on “injured reserve.” Once on this dreaded list, they are ineligible for the remainder of the season.
In Ted Johnson’s case, the doctor apparently restricted his activity for a few days following the initial concussion. The trainer set him up for limited duty. For reasons that may never be clear, the coach ordered him to participate in full contact drills. Johnson did not object. As one teammate said of him, “Teddy was one of those guys who…played by the code. He played hurt. He played tough, he played physical and he never let his teammates down. He was there for you every play.’’ Despite all of his recent problems, despite his bitterness directed at his former coach, he talked about returning to the Patriots as an active player just a few months ago.
Ted Johnson has become a symbol of all that is ambiguous about professional football. His precipitous demise reminds us that sports medicine analogies have their limits. The pressures of our working world – the need to get valued employees back to “full duty” as quickly as possible – must always be tempered by the needs of the worker and the time frame of the healing process itself. Life, fortunately, is not a football game. We have many ways to measure success and accomplishment, only one of which involves the final score.

Cavalcade of Risk #18 – the Paduda edition

Thursday, February 1st, 2007

If you hear a faint hint of mariachi when you read this week’s edition of Cavalcade of Risk, that’s because Joe Paduda is hosting it from a beach-side hammock in Puerto Morelos, Mexico. Several of this edition’s posts deal with analyses of Bush’s health care proposals from last week’s State of the Union address. Plus, there’s a variety of posts on other topics ranging from weighty articles on risk to practical insurance-related tips for you or your business.