Health Wonk Review – Bob Laszewski hosts this weeks edition of the best healthcare posts on the Web! – check out this week’s Health Wonk Review.
Pharma – Joe Paduda discusses a planned FDA ban on certain medications which is likely to take a high toll on workers’ comp since they are “old stand-bys, drugs that have long been used to manage chronic and acute pain.” Joe notes: “The loss of these drugs will certainly drive up costs, may lead to adverse events as patients try other medications to replace their now-banned drugs, and may make it harder for patients to get medications.”
Ergonomics – A few ergonomics resources:
Call Center ergonomics: sit-to-stand work stations – if you have workers who spend the better part of their day on the phone or before a computer screen, sit-to-stand works stations might help to minimize repetitive stress injuries.
Exercises that protect against carpal tunnel syndrome – a four and a half minute video with tips from percussionist David Kuckhermann.
Thanks to Ergonmics in the News for the two links above – a great source for the latest news on the topic.
Work violence – HR Daily Advisor recently ran a pair of posts addressing workplace violence prevention. The posts are authored by Dennis A Davis, Ph.D., who notes that, “Because most people follow the rules, and because most violent people give ample signs before they act, employers can be successful at preventing workplace violence.” He offers six key steps for prevention. The first post is Workplace Violence Is Not Beyond Your Control and the second is Are Your Greeters Ready to Deal With a Violent Visitor.
Illegal immigrants – Peter Rousmaniere summarizes and links to A Portrait of Unauthorized Immigrants in the United States, the latest Pew Hispanic Center report on illegal immigrants.
Archive for April, 2009
Health Wonk Review – Bob Laszewski hosts this weeks edition of the best healthcare posts on the Web! – check out this week’s Health Wonk Review.
To follow up on my colleague Jon’s Monday post on Swine Flu Meets Workers Comp, we’ve compiled a list of swine flu news and planning resources for employers.
How Employers Should Respond to the Swine Flu Outbreak – the Workplace Safety Compliance Practice Group of the employment law firm Jackson Lewis suggests 8 steps for employers to take in responding to employee concerns.
PandemicFlu.gov – Workplace Planning – HHS and the Centers for Disease Control and Prevention have developed guidelines, including checklists, to assist businesses, industries, and other employers in planning for a pandemic outbreak as well as for other comparable catastrophes.
Guidance on Preparing Workplaces for an Influenza Pandemic – a new guide for employers from OSHA
CDC Swine Influenza – news, updates, and resources from the Centers for Disease Control and Prevention
WHO Swine Influenza – global updates and news from the World Health Organization.
MedlinePlus: Swine Flu – excellent page with news, articles and links to a variety of resources.
Taking Care of Yourself: What to Do if You Get Sick with Flu – from the CDC
Taking Care of a Sick Person in Your Home – from the CDC
Global disease alert map from HealthMap
H1N1 Swine Flu
CDC Emergency Twitter feed
What’s new on the CDC Swine Flu page
CNN Health News
Y! Health Cold & Flu News
The Sioux Fall Storm are members of the Indoor Football league (not to be confused with the Arena Football League, although, truth be told, I am confused). They have won the league championship four years in a row (bet you did not know that) and were well on their way to a 5th title, having won their first six games in 2009. Then they made a big mistake. They neglected to purchase workers comp insurance for the team.
The league owners, all of whom have had hopes of a championship crushed by the relentless Storm, came up with a set of sanctions unique in the history of workers comp. The owners forced the Storm to forfeit the first six games of the season (6 and 0 instantly becomes 0 and 6). In addition, the Storm is only allowed to dress 20 players for future games (other teams can have 21). Finally, if the Storm should overcome the formidable obstacle of six losses and reach the playoffs, they are not allowed to host the initial playoff game. That sounds like roughing the franchise to me!
League owners have converted one team’s failure to buy insurance into leverage to ensure that someone else – anyone else – wins the title this year. I have no idea which teams are any good, so I have handicapped my preferences based solely upon the intriguing names:
Maryland Maniacs (I am not making this stuff up!)
Everett (WA) Destroyers
And then there is the Kent*. No, not the Kent Asterisks. This is either an expansion team or inactive franchise, currently lacking a name. Given that they represent Seattle, I think something nerdy might be in order: The Kent Keyboards? Or given the need to project a violent image, how about the Kent (Hard Drive) Crashers?
Comp in Professional Sports
We have blogged the uneasy fit between workers comp and professional athletes. There really is no class that reflects the risks of being a football player. Given that the estimated premium for covering the Storm is about $200,000, it appears that insurance coverage per player runs in the range of $8,000 to $10,000.
Storm team President Colin Steen is not happy with the penalty:
“Clearly, these outrageously harsh punitive measures, imposed by a majority vote of IFL team owners, are intended to place the Sioux Falls Storm and its players at a competitive disadvantage against the other teams in the League for the remainder of the season and into the playoffs for a mistake that was totally unrelated to competition on the field.”
Steen is correct, but unfortunately his only recourse puts the issue right back into the hands of the same resentful owners who dreamed up the sanctions. In other words, it may be roughing the franchise, but the call stands.
This situation reeks of conflict of interest. It’s admirable and necessary to enforce insurance requirements on all teams, but in this case, the penalty is totally out of alignment with the infraction. It’s piling on – a fairness problem in most endeavors, but perhaps appropriate for indoor football.
It’s only Monday morning and many of us are just refocusing after a weekend of gardening, football drafts, NBA playoffs, baseball (Ellsbury steals home!), so we are probably not quite ready to think about the unthinkable: a potential swine flu pandemic, originating in Mexico and already active in several major American cities.
Here is the official government announcement (which appears to circumvent potential panic by burying the bad news in gov-speak):
As a consequence of confirmed cases of Swine Influenza A (swH1N1) in California, Texas, Kansas, and New York, on this date and after consultation with public health officials as necessary, I, Charles E. Johnson, Acting Secretary of the U.S. Department of Health and Human Services, pursuant to the authority vested in me under section 319 of the Public Health Service Act, 42 U.S.C. § 247d, do hereby determine that a public health emergency exists nationwide involving Swine Influenza A that affects or has significant potential to affect national security.
[Where, oh where, do they learn to write like that?]
As is our custom, we focus on the implications for workers comp. Back in 2005 we blogged the ramifications of smallpox exposure from the comp perspective. The smallpox exposure – a result of the terrorism scare – proved to be a false alarm. The swine flu, unfortunately, appears to be all too real.
The Comp Dimension
It’s not difficult to isolate the kinds of activities that might expose an individual to the Swine flu. Many of these exposures are prevalent in the world of work:
: frequenting congested areas (travel terminals, public transportation, classrooms, etc.)
: touching anything handled by strangers
: eating out
: meeting business colleagues from around the country and around the world
In order for the flu to be a compensable event under comp, certain requirements must be met:
: the individual must be “in the course and scope of employment” when exposed to the virus
: the exposure must arise out of work (as opposed to being a totally random event)
: work itself must put the individual in harm’s way
An individual commuting to work via public transportation might have high risk exposure, but flu caught on a subway or bus would not normally be covered by comp. But if the exposure stems from company-provided transportation (for example, a van), the subsequent illness might well be compensable.
If one worker in a closed environment brings the flu to work, co-workers who succomb to the virus can make a good case that the illness is work related. The initiator, however, would not have a compensable claim, unless he/she could demonstrate a definitive work-related exposure.
Health workers are on the front lines of any pandemic. Even though it might be impossible to prove that they actually caught the virus at work, any and all cases of Swine Flu are likely be compensable.
If you fly on an airplane on company business and the person next to you is sneezing and coughing, your exposure is work-related and the subsequent illness is likely to be compensable. If you are flying to visit Aunt Martha, you are on your own.
The comp system is not well equipt to deal with illness. It’s usually very difficult, if not impossible, to determine exactly when an individual actually caught the virus. With state laws varying in their assumptions of compensability, with a multitude of insurance carriers and third party administrators making compensability determinations, we will see a crazy quilt of decisions regarding the compensability of swine flu.
There is a lot of money at stake in these compensability decisions. For mild cases, the issue is moot. It’s the more severe cases – prolonged illness and even death – that raise the greatest concerns. While thus far the fatalities have been limited to residents of Mexico, if the feared pandemic occurs, there will be prolonged illness and even fatalities in the states. Then the crucial decisions regarding compensability will directly impact the future cost of workers comp insurance.
What is to be Done?
So how should employers handle flu exposures? For a start, educate employees on prevention. The above government website has some helpful hints – and they are actually written in plain English; unfortunately, they are only written in English.
Any employee showing up at work with flu symptoms should be sent home immediately. And if any employee appears to come down with the flu while “in the course and scope” of employment, employers should report the illness to the insurer/TPA, so that a proper compensability determination can be made. As in all things comp, it is usually a mistake for the employer to make assumptions about compensability. When in doubt, report the illness and let the experts determine what to do.
As the world lurches from one crisis (economic) to another (pandemic), it is all too clear that we have fulfilled the Chinese (?) curse: “May you live in interesting times.” We do, indeed.
SuperSaver at My Wealth Builder hosts this week’s edition of Cavalcade of Risk with an assortment of posts on five categories of risk: Insurance, Health, Business, Investment and Personal.
RIMS Update – Joe Paduda is blogging about RIMS – follow his comments for day 1 or day 2, or follow his Twitter feed.
AIG has been in the news mostly for its ingenious method of losing money: insuring the riskiest possible financial transactions and tanking after these risks go bad. But give the biggest insurance company in the world some credit. They still know how to make money the old fashioned way: collecting premiums and denying claims. To be sure, this strategy is not easy to do in the states, where public scrutiny is never more than a phone call away. But it works rather effectively in Iraq.
T. Christian Miller from Propublica and Doug Smith from the LA Times have described in great detail how AIG transformed Iraq into a business opportunity with an enormous upside. AIG is the predominant workers comp carrier in the war-torn country, insuring civilian workers. When these workers are injured – and the injuries can be devastating – AIG has routinely denied their claims for basic medical care, artificial limbs and desparately needed counseling for post-traumatic stress syndrome. More than 1,400 civilian workers have died and 31,000 have been wounded or injured in the two war zones.
Insurers have collected more than $1.5 billion in premiums paid by U.S. taxpayers and have earned nearly $600 million in profit, according to congressional investigators. That’s nearly 40 percent profit after expenses – an unheard of loss ratio in the states.
Collect and Deny
The AIG strategy is deceptively simple: first, charge exorbitant fees for premiums, roughly 100 percent of a worker’s pay. (Don’t feel sorry for the companies paying these premiums; they are fully reimbursed by taxpayers.) Then, accept all the small claims and fight almost any claim involving lost time (more than four days of disability). Delay, delay, delay. Never make a payment until ordered to do so by a court.
The denial rate on serious claims is pretty astonishing: about 44 percent. How could you argue that any injury – let alone a serious one – is not work-related, as civilian employees are in Iraq for one purpose, supporting the war effort? In addition, fully half the claims for PTSD are denied. All this in the context of a war where catastrophic injuries are all too common and legitimate PTSD is as prevalent as cuts in a glass factory. How many state-side workers have watched co-workers blown to pieces by roadside bombs? Do you think that such incidents might qualify as PTSD?
AIG used the argument of extremely high-risk working conditions to boost the premiums. Then they turned around and used the strategy of denial to boost profits. Who says capitalism is dead?
I suppose you could argue that this reporting is just piling on poor AIG.The behemoth just cannot catch a PR break. Oh, well, dear reader, don’t waste too much energy feeling sorry for AIG. After all, you are paying for AIG big time: in the bailout that exceeds $200 billion; in the war-based premiums that generate profits nearing 40 percent; and in all likelihood, in the social costs of caring for devastated civilian employees, who have so much difficulty accessing the comp benefits to which they are entitled.
AIG may not know diddly about the risk in risky financial vehicles, but they certainly know how to make money in conventional comp insurance. Of course, it helps that the injured workers are so invisible, like obscure figures in a desert sand storm, struggling blindly to find some kind of shelter in a harsh and unsympathetic world.
In catching up on blog reading this weekend, we find we missed an important piece of good news last week: via Liz Borkowski at The Pump Handle, we learn that longtime safety advocate and erstwhile safety blogger Jordan Barab has been named Deputy Assistant Secretary for OSHA and Acting Assistant Secretary. We couldn’t be more pleased and extend our heartfelt congratulations to Jordan on his appointment. Anyone familiar with his excellent work at Confined Space knows that Jordan has been a passionate and tireless advocate for worker safety. Thousands turned to his excellent blog for safety updates and education – we certainly were and still are among that number – if you haven’t got his site bookmarked, run don’t walk. Although he hasn’t updated since being appointed an advisor to the House of Representatives a few years ago, it remains one of the web’s most valuable safety resources. Unfortunately, so many of the serious and egregious safety issues that he blogged about are still open issues that need addressing, so he has his work cut out for him. .
Many of his blog readers may not be aware that worker safety has been a lifetime commitment for Jordan. To quote Borkowski:
“Of course, Jordan also lots of work experience not directly related to his blogging: He spent 16 years running AFSCME’s health and safety program; served as a Special Assistant to the Assistant Secretary for OSHA; was a recommendations specialist for the Chemical Safety Board; and then became a senior policy advisor to the House of Representatives’ Education and Labor Committee. (He mothballed Confined Space upon starting the Committee job.)”
We sincerely hope that “acting” will lead to a permanent appointment – we can’t think of anyone more deserving of the post!
Here are what some other bloggers are saying about the news:
OSHA Healthcare Advisor
AFL-CIO Now Blog
Safety news Alert
Glenn Laffel has a a new edition of Health Wonk Review posted over at Pizaazz – the “US Health Care Carousel of Progress” edition. Glenn is one of our newest contributors to HWR – check out his blog, too.
Coal Mining – Check out Coal Tattoo, a blog by Ken Ward Jr. award-winning reporter at The Charleston Gazette who has been covering the Appalachian coal industry for nearly 20 years. We’ve previously featured some of his reporting in our post The sad, quiet death of Bud Morris – father, husband, motorcycle afficianado. Unfortunately, he is reporting on sad, quiet deaths all too often. He talks about the interesting origen of his blog name on his bio page.
Good asbestos resource – The Mesothelioma Cancer Center is a valuable resource. The site has more than 3,000 pages of information on asbestos, mesothelioma, and other cancers that are caused by asbestos exposure (lung cancer, breast cancer, prostate cancer, etc.).
Substance abuse – OSHA reminds employers that April is Alcohol Awareness Month. Safety Advisor offers us a look at some sobering facts about alcohol and employee health. OSHA offers various tools addressing workplace substance abuse and Drug and Alcohol-Free Workplace Programs.
Lightning safety – With the good weather coming, Eric at The Safety Blog offers some good seasonal safety advice: Lightning Safety Guidelines.
Today, we thought we’d focus on risk in the larger sense rather than just in the workplace. This is prompted by our having chanced upon an interesting article by John Goekler, who poses the question, The Most Dangerous Person in the World? Not to offer a spoiler, but he answers this question at the outset of the article, and the answer isn’t particularly surprising: “…unless you’re serving in a war zone, the most dangerous person you’re ever likely to encounter – by several orders of magnitude – is the one you see in the mirror every morning.”
Goeckler lists various mortality statistics, offering some perspective on an individual’s risk. The so-called “lifestyle diseases” top the list of killers, but there are other interesting and surprising factoids about microbial agents and toxic substances. Death by occupational trauma is in his top ten, just after mortality by overdosing on non-steroidal anti-inflammatories and slightly edging out death by foodborne agents. (See also: odds ratio versus relative risk)
His essay is an interesting read and his larger point worth noting: “The things we fear most may be least likely to occur, which means the time, trauma and treasure we invest in them is a complete waste.” He offers this in the context of fear of terrorism, but it could be whatever bugaboo the mass media is hyping at the moment. One of our favorite annual scare stories is shark attacks – the Florida Museum of Natural History offers a helpful guide to The Relative Risk of Shark Attacks to Humans, as compared to other risks.
You’re probably safe from a shark attack, but what about the likelihood of a cardiac event? Use the cardiac risk calculator to estimate your chance of having a cardiac event, dying from heart disease, and your overall chance of dying in the next decade. It’s a handy little tool, and it might be worth sharing with your work force to get their attention on the so-called lifestyle issues that are taking such a toll on us all. Goekler’s article is a good reminder that if you want to keep your workplace safe, focusing on employee wellness may be worth the investment and the effort. Just don’t relax on other areas of safety – we’d like to see that occupational trauma statistic dropping further and further down the list.
The Sunday Times had an article about tough times in Palm Beach, where the super-wealthy reside. They like to shop at Trillion, a store that kind of indicates, by the name, that if you have to ask how much something costs you don’t belong in the store. The last time Bernie Madoff was in Trillion, he fell hard for a $2,000 pair of worsted spun cashmere pants, which Trillion didn’t have in his size. So Trillion ordered the pants from Italy. They arrived, alas, after Madoff had been busted. I don’t think he’ll be needing the pants where he currently resides. His new outfits – undoubtedly lacking that fine cashmere “hand” – are provided free of charge by the state of New York.
But this is not a posting about Bernie. The subject is one Victor Leon, a 26 year old illegal immigrant who fell off a roof three years ago. He was paralyzed and now lives in constant pain. He’s run up about half a million in medical expenses at St. Mary’s Medical Center, with the prospect of further surgery to come. You might expect that workers comp will reimburse St. Mary’s, but that is unlikely to happen. The hospital, like Leon, is on its own.
What about Comp?
In most states, despite his illegal status, Leon would be covered by workers comp, up to but probably not including the voc rehab he clearly needs. Coverage is apparently not a given in the Sunshine state. A post-injury urinalysis run at the hospital found traces of cocaine and marijuana in Leon’s blood. His employer, Altec, believes that the failed drug test, combined with Leon’s undocumented status, are grounds for denying his claim. Leon’s lawyer, supported by a toxicologist, asserts that the test does not prove that Leon was impaired at the time of the incident. Leon admits to taking “about four puffs” the night before, but he had a good night’s sleep (alas, the last of his life) and was fully alert the next morning at work.
OK. If comp does not apply, Leon can sue his employer, right? Well he tried, but failed there, too. A civil court judge ruled that Altec owed Leon nothing, because they carried workers comp for their employees…Which takes up back to Leon’s comp claim, which was, of course, denied. Leon is caught up in a rather ferocious version of Catch 22.
Leon’s life is ruined, not because of greed or malice (sit still, Bernie!). He lied in order to get work. He performed his job to the best of his ability. He was seriously injured through an unfortunate miscommunication with a co-worker. While he has benefitted from good medical care, he is penniless and now homeless. He would return to Mexico, but if he does, all hope of winning his legal case would be lost.
So there you have it: A tale of two broken lives in America. One man dreams of the $2,000 pants he almost got to wear and the other dreams of being able to pull on a pair of cheap jeans. There are probably some compelling lessons to be drawn from these parallel stories. I’ll leave it to our readers to figure out exactly what those lessons might be.