Archive for May, 2009

Annals of Fraud: Trifecta for Bay Area GC

Friday, May 29th, 2009

In the world of workers comp, there is no lack of opportunity for fraud. We’ve seen doctors rip off the system by billing for services that were either never provided or not needed. We’ve seen employees fake injuries (relatively rare) or malinger on comp long after injuries have healed. We’ve seen insurance agents pocket money intended for insurance premiums. We’ve seen insurance adjusters embezzle claims funds. We’ve seen state comp bureaus (Ohio) engage in fraud. And we’ve seen employers rip of the system in a number of ingenious ways.
Which brings us to the saga of NBC Contractors (presumably no relation to the television network), a California general contractor. Three owners of the company – Monica Mui Ung, 49, of Alamo; Joey Ruan, 31, of San Leandro; and Tin Wai Wu, 28, of Millbrae – have been charged with 48 counts of insurance fraud, labor code violations and tax fraud. Bail was set at $535,000 for each of them. (You can check out their bare-bones website here.)
With Ung listed as the (minority, female) owner, NBC Contractors qualified for preferential treatment on public projects. Between 2003 and 2007 they successfully bid on 27 public works projects, including El Cerrito City Hall and Piedmont Elementary School.
Cheater’s Delight
According the indictment, NBC used a trifecta of cost cutting measures:
1. They underpaid workers comp premiums a total of $1.45 million, by misclassifying their workers into lower risk occupations and by under-stating payrolls
2. They violated fair labor standards, by failing to pay for overtime or sick leave, impacting 19 workers a total of $3.6 million
3. They underpaid payroll taxes on workers, depriving state and federal government of tax revenues
With these (criminal) “cost savings,” NBC was able to underbid their competitors. These business practices cheated a lot of people: NBC’s own workers, their insurance carrier, their competitors, and all law-abiding businesses who played by the rules. We can only hope that the quality of their work was up to standards, which would at least keep their customers off of the long list of parties directly injured by their actions.

Bosstown’s Health Wonk Review, and assorted other news briefs

Thursday, May 28th, 2009

Check out Health Wonk Review: Bosstown edition. Tinker Ready at Boston Health News makes her debut as host with an informative and entertaining edition of the biweekly roundup of the best of he health policy blogs.
News briefs
Michael Fox of Jottings By an Employer’s Lawyer offers a great rundown of Supreme Court Nominee Sonia Sotomayor’s opinions on labor and employment law.
More state AGs file against Chrysler bankruptcy – we’ve blogged about Michigan and Ohio; now Illinois and Indiana join the list of AGs that are attempting to protect both workers and their state workers comp systems from any adverse effects. The bone of contention is that under the terms of the proposed sale, Fiat would not be required to assume workers’ compensation liabilities of injured Chrysler workers and individual state systems would be forced to deal with these uncovered workers.
Joe Paduda of Managed Care Matters has completed his firm’s First Annual Workers Compensation Bill Review Survey.
Peter Rousmaniere’s article A Brutal Interpretation in Risk and Insurance tells the story of Taha Saad’s unfair treatment under the defense Base Act. Saad, an Iraqi translator, worked for the Army until he lost his legs in an IED explosion. A U.S. Department of Labor judge recently affirmed AIG’s weekly payment of $46.15 for his permanent disability.
Clamping Down on Claim Costs – nine practical tips for managing workers’ comp losses by Lori Daugherty of Claims Magazine
Safe Lifting Portal
Hearing Conservation Training That Works
Exotic Dancers Are Employees, Not Independent Contractors

Aging America: A Looming Catastrophe?

Wednesday, May 27th, 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.

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Compensable Sunshine, Revisted

Tuesday, May 26th, 2009

Our blog last week linking skin cancer to workers comp has already generated a few comments. “Workers comp attorney” raises some interesting questions:
(1) How much weight do you give to the person’s leisure activities and/or length of employment? It seems these would certainly be factors in assessing whether the employment is the predominate cause.
When assessing the work-relatedness of skin cancer, claims adjusters will look carefully at non work exposures: hobbies such as hiking, fishing, boating, outdoor sports, surfing, swimming or simply tanning. Balanced against these exposures will be the work setting: outdoors all the time (eg, roofing, migrant farm work, paving) or just incidentally (framing carpentry).
While the case law is still rather limited, there are examples of compensable skin cancers involving a limousine chauffeur (!) in New York and an architect in Texas. [NOTE: a sun screen manufacturer, unsurprisingly, is keeping close track of case law developments!] It is safe to assume that the burden of proof remains on the employee to show that the cancer is work related, but this burden is now supported by substantial medical evidence. Indeed, the existence of government funded education on the risk – here is a CDC link – would tend to support claims of compensability.
As far as length of employment goes, it usually does not matter. As in the case of repetitive motion injuries, the most recent employer is usually on the hook for coverage, even if the employee has only been working for a few weeks.
(2) What steps could employers take to prevent work-related skin cancer other than the mentioned provision of sun screen and policies to enforce dress code?
Employers should just stick with the basics: provide – and enforce the use of – sun screens; require head gear. In the vast majority of exposed workers, this is not happening. There is research showing an increase in skin cancers among Latinos. I wonder if this is related to the negative cultural images associated with protective gear. [NOTE: my teenage daughters hate my wide-brimmed sun hat. It’s just not cool!] [I wear it anyway.]
(3) What about research indicating that some, if not all, sunscreen products are carcinogenic?
While there is some evidence that tanning booths may be associated with cancer, I am not aware of any medical evidence to support a connection between sunscreens and cancer. In any event, the risk of not using a sunscreen far exceeds the risk of using one.
4) What balance should be sought between skin cancer and heat-related illnesses (if any “balance”) as far as prevention is concerned?
Skin and heat protection are not mutually exclusive. People have been covering up in desert cultures for centuries by wearing light colored, loose clothing and head gear. (I hardly need add that American workers would vehemently reject any protective measures that made them resemble middle-eastern sheiks!)
Proactive, Reactive, Inactive?
Another reader wonders how many companies have actually implemented the recommended preventive measures. That’s a great question. Judging by limited observation of workers in the sun, smaller employers have done little if anything to prevent risk. Any time I see a worker in the hot sun, shirtless and hatless, I assume that the cancer issue is simply being ignored.
What, if anything, will mobilize employers to take action to limit sun exposures? It usually comes down to money. Employers who operate in states that view skin cancer as potentially work related will eventually find it cheaper to provide (inexpensive) sunscreens and hats to their workers in the great outdoors. If state courts reject these claims, the workers will bear the burden.
Let’s hope that employers take action before the courts force the issue. We have a known risk and we have proven remedies. Reason says that employers, at a minimum, will immediately share this information with exposed workers. But then again, how often is the voice of reason heard in the American workplace?

Working Outdoors: Skin Cancer and Workers Comp

Thursday, May 21st, 2009

With the full heat of summer bearing down on us, the Insider has deputized its readership to become informal safety inspectors: the next time you leave the office, observe any people who are working outdoors. Your checklist should include the fundamental safety drill: fall protection for height exposures; personal protective equipment such as hard hats, work boots and goggles; secure scaffolds and ladders; proper use of machinery (lawnmowers, clippers, circular saws, etc.); proper lifting and efficient material handling.
Here is a safety issue that you are likely to observe in the breach: protection from skin cancer. Exposure to the direct rays of the sun, especially at midday, is a significant safety hazard. Alas, when most people labor in the full sun, they usually take action against the heat, at the expense of protecting themselves from the sun’s rays.
Cancer prevention dictates the wearing of long-sleeved shirts, a hat with neck flaps, sunscreen for exposed skin and sunblock for the nose and lips. When was the last time you saw a landscaper, carpenter or roofer dressed appropriately? When the heat rises, the shirts tend to come off. Bandanas and “do-rags” – considered cool in working circles – keep sweat out of the eyes, but they do little to protect the skin from the sun’s rays. Hats with flaps? Dude, you must be kidding. Goggles and hardhats? They are the first to go when the heat rises.
As for the advice to “avoid exposure between the hours of 10 am and 2 pm,” that is simply not going to happen. There is work to be done and those are prime hours for doing it. Siestas might be culturally acceptable in the tropics, but in our productivity-driven culture, siestas are not an option.
The Compensability Conundrum
As we have pointed out in prior blogs, the connection between work and occupational disease is often difficult to prove. With the exception of public safety employees, most workers face formidable odds in collecting comp for occupational diseases. There often are factors that mitigate against the acceptance of a claim: family history, smoking, fair skin, etc. Workers must be able to prove that workplace exposures are the “predominant cause” of the cancer. Sure, a laborer is under the sun at work; but he or she might also have significant exposure during leisure time, going to the beach, fishing, or just working in the garden.
It’s always interesting to see how state legislatures translate emerging hazards into proposed legislation: lawmakers tend to react in a limited, ad hoc manner. See for example this proposed bill in the New York legislature:

This bill would provide,with respect to active lifeguards employed, for more than 3
consecutive months in a calendar year, by certain local agencies and the Department of Parks and Recreation, that the term “injury” includes skin cancer that develops or manifests itself during the period of the lifeguard’s employment. This bill would further create a
rebuttable presumption that the above injury arises out of and in the course of the lifeguard’s employment if it develops or manifests during the period of the employment.

Note that the symptoms must develop during employment: this in itself may prove problemmatic, as many cancers occur some time after the direct exposure. Beyond that, the bill establishes a compensability presumption for one very limited class of workers, lifeguards. It does not address the myriad workers who face similar hazards on a daily basis (even if their work uniforms involve more than just a bathing suit).
Despite the fact that many workers will develop skin cancers which are likely to be work related, the number of compensable incidents will remain modest. The comp deck remains stacked against workers in the general area of illness.
Compensability and safety are two separate issues. We may not be able to do much about expanding coverage for work-related cancers, but we can take aggressive action to prevent them. It all comes down – as it does so often – to management: do you tolerate your workers’s ad hoc efforts to combat the heat, or do you enforce “best practices” in cancer prevention. Do you make sunscreens and head protection readily available on the jobsite, or do you allow your workers the “individual freedom” to do as they please?
We all know how most managers respond. They take the path of least resistance. The risk of an accident is one thing, the seemingly remote risk of illness is quite another. It will take many more tragic cases of work-related cancers before a true prevention mobilization takes place. For workers struggling under today’s galring sun, we can only hope that a word to the wise is sufficient.

Cavalcade of Risk; our Twitter debut; a few good blogs

Wednesday, May 20th, 2009

Hot off the presses – Richard Eskow has posted the most recent edition of Cavalcade of Risk. He’s got a good round-up of risk-related posts, but he had hazardous duty posting it due to a huge number of spam submissions. Spammy, fly-by-night blogs seem to be proliferating, grrr. Guess that is one of the risks inherent in business blogging.
In other news …
We’ve just joined the rank of Twitterers – just getting our feet wet so far, but check us out twitter.com/workcompinsider. Twitter seems to be a love it or hate it type of thing for people … some critics go to pretty creative lengths to weigh in with their opinion.
A few good blog finds this week to add to your reading list:
Risk Management Monitor – the official blog of Risk Management magazine, providing daily stories, commentary, interviews, podcasts and videos related to the world of risk management and insurance. Meet the bloggers.
And two international entries:
Ramazzini – a blog on work and health by Annet Lenderink, trained occupational physician and a journalist, who works as coordinator of knowledge dissemination at the Netherlands Center of Occupational Diseases. The blog is named after the Italian founder of Occupational Medicine Bernadino Ramazzinni (1633-1714).
Safety At Work Blog – an Australian blog focusing on news and opinion on important workplace safety issues. The blog was founded by workplace safety consultant and Kevin Jones. Meet Kevin and the other blog contributors and you can also follow them on Twitter.

Collision course: the potential impact of Chrysler’s bankruptcy & sale on state workers’ comp systems

Tuesday, May 19th, 2009

Roberto Ceniceros of Business Insurance has been tracking the potential impact that a Chrysler bankruptcy and sale could have on state workers comp systems. In a story last week, he reports that Michigan Attorney General Mike Cox has taken legal action to protect the state. Cox stated that Michigan’s Self-Insurers’ Security Fund could face insolvency as a result of Chrysler’s bankruptcy and sale.
Now, Ohio state officials are raising concerns about how the Chrysler sale could affect Ohio’s workers comp system. This week, Ohio’s Attorney General Richard Cordray has filed a “limited objection” to the pending sale. “While Chrysler’s bankruptcy filings show the automaker is committed to fulfilling its workers comp obligations, the filings do not hold a new owner to the same conditions, the attorney general said.” According to a news report in Columbus Business First, there are about 5,000 Chrysler workers in the state.
It is likely that this issue is on the radar screen for other stat attorneys general, too. Ceniceros states that, “As of Dec. 31, Chrysler had 38,257 U.S. employees. It purchases workers comp insurance in some states while self-insuring in others, according to various state regulator databases.”
And beyond Chrysler, there is the matter of whether General Motors is another likely candidate for bankruptcy – many expect this to be the case – see key dates in GM run-up to bankruptcy deadline. GM is a much larger company so problems could be multiplied, a matter that we discussed in our December posting about Maryland officials monitoring GM solvency related to workers comp.
For more on the way bankruptcy works for both insured and self-insured entities, see our postings of Robert Auerbach’s three-part series on bankruptcy and workers compensation, part 2, part 3.

Albania Deleon: Death in the Classroom

Monday, May 18th, 2009

Albania Deleon is a entrepreneur. A legal immigrant and naturalized citizen from the Dominican Republic, she founded and operated Environmental Compliance Training (ECT) in Methuen, Massachusetts, the largest asbestos removal training school in New England. Between 2001 and 2007, she trained over 2,500 people in the intricacies of asbestos removal. Except that she didn’t. Instead, she would fill out tests for certificate applicants and enter a passing grade. For $400, the (usually undocumented) worker was handed a certificate and then placed in a job through Deleon’s other enterprise, Methuen Abatement Staffing. Her temporary workers handled hazardous abatement jobs throughout New England. (You can read the sorry details in a fine article by Beth Daley of the Boston Globe here.)
By the way, the training involves a total of 32 hours – not much of an investment in a life or death matter. (Some ECT students paid $350 and actually completed the training; for an additional 50 bucks, you could skip the training, pocket the certificate and get right to work, earning upwards of $15 per hour.)
ECT “graduates” went in to hundreds of schools, hospitals, churches, libraries, and homes throughout New England to remove asbestos. Most of them had no idea what they were supposed to do. Now there is deep concern that the workers, mostly young men from Central America, breathed the fibers, which can lodge in the lungs and lead to death decades later. Most had no idea how to properly wear a respirator.
In addition to their own exposure, these workers may have exposed their families to the cancer risk. Asbestos workers, if not properly trained, can inadvertently carry the fibers home on their clothes or hair.
More than a third of the 12,750 asbestos worker licenses and renewals issued in Massachusetts between 2002 and 2007 went to ECT “graduates.” In New Hampshire, it was more than two-thirds.
Crocodile Tears
In November 2008 Deleon was convicted on 28 felony counts. Shortly before her sentencing, she wrote a rambling, hand-written letter to the sentencing judge. Among other things, she wrote:
“I pray that God will forgive my soul and allow me to atone the rest of my life repaying and repairing the harm I have done. This is my solemn promise…I commit myself to work ceacelessly [sic] to make restitution to the government and to the keeper of my soul until I draw my last breath life (sic).”
The reference to “last breath” is especially ironic, given that many of her “students” – along with innocent family members – will suffer excruciatingly painful deaths, as their breathing slowly and inexorably shuts down.
Facing more than 7 years in prison, Deleon skipped town. There is a warrant out for her arrest. Oh, she abandoned her 3 year old son in the process. Alas, it appears that “the keeper of her soul” doesn’t have a whole lot to work with…

Health Wonk Review: the biweekly smorgasbord of the best fare in the health care policy blogs

Thursday, May 14th, 2009

smorgasbord.jpg Welcome to Health Wonk Review, our bi-weekly smorgasbord of the best that the policy wonks have dished out on some of the most noteworthy healthcare blogs over the prior fortnight. We have an extensive sampling of tasty and nutritious treats, with lots of brain food among the fare – so without further ado, we offer this week’s buffet.

  • The love fest at the White House with health care providers generated great headlines, but, where’s the beef? Merrill Goozner at GoozNews points out that the promises made by the trade associations and physicians held not a few ironies: Just Don’t Ask CBO To Score It.
  • To say that Joe Paduda of Managed Care Matters is skeptical about said love fest is an understatement. He is shocked and blown away that the politicians in Washington actually believe the health care-insurance industry’s self regulation will reduce the nation’s health care costs.
  • Will the consortium of private sector stakeholders be able to cut $2 trillion in healthcare costs as they claim? Jason Shafrin of Healthcare Economist casts a critical eye on this in his post Letter to Obama: We’re gonna save $2 trillion .
  • When it comes to financing health care reform, Anthony Wright of Health Access WeBlog suggests that policymakers take a two birds with one stone approach by seeking options that not only raise funds but also help the health system.
  • Are hospitals really taking a hit from the current health care system? That’s a question posed by InsureBlog’s Henry Stern, who deconstructs the latest survey results from the American Hospital Association in his post, Economy Tanks; Hospitals, Patients Hardest Hit.
  • Brady Augustine of MedicaidFrontPage posts about Wellcare being taken to the woodshed for the sins of its prior executives who lived high on the hog while shortchanging vulnerable citizens. He discusses lessons learned, offering his thoughts on how to avoid such a scenario in the future.
  • How Hard Can It Be To Coordinate Care? Rich Elmore of Health Technology News interviews Dr. Mai Pham, who turned up some startling results in a study of the number of physicians and practices that are linked to a primary care provider for coordination of care.
  • Jeffrey Seguritan looks at a study of Medicare’s unplanned hospital readmissions at nuts for healthcare, noting that readmissions seem to indicate low quality of hospital care and drive health spending. He suggests that hospitals should be incentivized to cut readmissions, but current
    policy proposals should be wary of system-gaming and should consider illness severity.
  • Yikes. David Harlow of HealthBlawg posts about the Virginia prescription record security breach, in which millions of prescription records were lifted from a state government website and replaced with a $10m ransom note. He suggests that organizations that hold electronic protected health information should use this incident as a learning experience for planning and executing programs yo increase data security, as well as preparing for communications both to prevent breaches and to respond to any breaches that do occur.
  • Roy M. Poses of Health Care Renewal has frequently tackled the topic of conflicts of interest in health care, offering examples of published defenses based on logical fallacies. Most examples were written by people who had their own ties to health care corporations and appeared mainly in the op-ed pages of newspapers, but in his post Attacking “Crusaders” Against Conflicts of Interest with Logical Fallacies, he offers an example in a scholarly journal, published as an anonymous editorial. He says we can expect to see more accusations of witch-hunting, prudery, moralism, lack of realism, and the like leveled against those who oppose such lucrative financial
    relationships.
  • Louise of Colorado Health Insurance Insider posts about how Reid is absent in Sick Around America, apparently fallout with Frontline after last year’s acclaimed Sick Around the World. Louise offers the scoop on the controversy.
  • At Disease Management Care Blog, Jaan Sidorov examines the ugly politics that emerged around the issue of using gender in health insurance underwriting in his post Snatching Humiliation From the Jaws of Compromise.
  • President Obama recently spoke about his grandmother’s death and the questions it raises about end of life care in an interview published in the New York Times Magazine. Joanne Kenen of New Health Dialogue discusses Obama’s Grandmother and the National Conversation on Healthcare, adding her own patient-centric questions that need to be part of the dialogue.
  • Jocelyn Guyer of Say Ahhh! tells us that there was mostly good news for children in the Senate Finance Committee’s Health Reform Proposal.
  • Glenn Laffel of Pizaazz discusses a particularly vexing clinical and policy problem involving a defective defibrillator produced by Medtronic, that is currently in the bodies of a quarter of a million people. Leaving the failing device in place may kill patients, but removing it may do the same.
  • Pop goes the health care bubble? At the Health Care Blog, George Lundberg looks at Enron, the dot.com era, and the real estate-financial collapse, all recent examples of growth and expectations far exceeding substance, and makes the case that the health care bubble will be soon to follow.
  • David Williams of Health Business Blog asks why employees should be penalized for smoking or being overweight but not for having unprotected sex with multiple partners in his post on the ethical considerations of financial penalties for unhealthy behaviors.
  • Eric Turkewitz of New York Personal Injury Law Blog notes that doctors still top our the pay charts, but complain about malpractice premiums anyway. He cites a survey which states that out of the ten top paying jobs, nine go to medical professionals.
  • Tinker Ready of Boston Health News posts about a new Partners/Harvard HIT blog on clinical informatics. Incidentally, Tinker will host the next issue of Health Wonk Review.
  • In his post Even more ‘Fierce’, Neil Versel of Healthcare IT Blog discusses a new publication FierceEMR, which includes one of his articles about live video links from ambulances to a trauma center in Tucson, Arizona.
  • Although the influenza A (H1N1) or swine flu outbreak is gradually falling out of U.S. news headlines, Kara Rogers of Britannica Blog notes that the full extent of the outbreak may not be known for some time because other countries are only now experiencing their first cases or are experiencing an increase in confirmed cases as their backlogs of samples are tested.
  • Is our food policy behind the current swine flu pandemic? Eric Michael Johnson discusses how we can best promote national health by changing how our food production policies at The Primate Diaries.
  • And here at Workers Comp Insider, we’ve noted that there’s a new OSHA sheriff in town. Long-time worker safety advocate and former safety blogger extraordinaire Jordan Barab is serving as Acting OSHA Administrator.

Noteworthy blog and Twitter finds

Wednesday, May 13th, 2009

We surf the web so you don’t have to! From time to time, we like to bring your attention to some new or noteworthy blogs related to workers’ comp, healthcare, or other work-related matters. Now we’re finding some Twitter feeds, too. Here’s our current crop:
Judge Tom Talks – Judge Tom Leonard is one of ten judges at the Oklahoma Workers’ Compensation Court, and in his blog, he offers his thoughts about issues affecting the efficient handling of claims. Congrats to Judge Tom for recently passing his one year “blogiversary.”
MySafeWork Blog is the blog of Canadians Rob Ellis and Jessica Di Sabatino, who lost a son and brother to a workplace accident in 1999. David was only 18 when he died and his Dad and sister have been devoted to educating young workers – as well as parents and employers – about the importance of workplace safety related to youthful workers.
New Englanders and those interested in healthcare should take note of Boston Health News, authored by Tinker Ready. She is a health care journalist who has covered health and science news for a variety of notable publications, including The Boston Globe, The Washington Post, the Los Angeles Times, and Esquire, to name a few. We discovered her blog through Health Wonk Review, which – incidentally – we are hosting here tomorrow!
We note that NIOSH has a Twitter feed. Not sure how long the National Institute for Occupational Safety and Health has been tweeting, but it has been a useful format for disseminating news about the H1N1 outbreak.
In addition to his Workers Compensation blog, noted workers comp trial attorney and author Jon Gelman can also be found on Twitter at jongelman.
SafetyNewsAlert – edited by Fred Hosier, this site is more of an e-zine than a blog, but has useful articles, news, and links on various workplace health and safety issues.
Lloyd’s has several bloggers now, all accessible from the Lloyd’s blog page.