Risk roundup, elephants in the room, dental claims, yelling as an essential function, and more

November 30th, 2011 by Julie Ferguson

David Williams of Health Business Blog hosts the biweekly roundup of posts in the Insurance Fest Edition of Cavalcade of Risk. Check it out! Plus, poke around David’s blog – lots of good information, such as his recent posts on What does an Explanation of Benefits (EOB) actually explain and part 2.
The elephant in the room – Last week, my colleague reported on several issues and trends under discussion at the WCRI Conference. One of the key issues that has attracted some media attention is Richard Victor’s conference summary about the elephant in the room – employment. Insurance Journal’s Andrew Simpson has more on the tough challenges that face the workers’ comp system in the coming years as we cope with the “unprecedented disruption of the labor market.”
Ghosts of crises past… – Peter Rousmaniere recalls the workers comp crisis of 1991 private sector markets in some states came close to collapsing. He discusses ensuing legislative reforms and changes in employer and claims payer practices, which are are still making their impact known in today’s market.
Meanwhile, in England… – Jon Gelman notes that Britain’s Department of Work and Pensions has concluded that the principle of “no fault” should be eliminated from the workers’ comp system. “In a review published next week there are calls for a ‘rebalancing’ of safety laws and a dramatic reduction in the number of rules in the workplace.” Jon notes that our US system was modeled after Britain’s.
California Network Utilization Study – If California proves to be the national pacesetter that it so often is, look for network utilization to increase. According to a recent study by the California Workers’ Compensation Institute (CWCI), the use of Physician Networks in California workers’ comp is at a record high. Network physicians now provide more than 75% of all first year physician-based treatment, and receive two thirds of the dollars paid for physician-based services rendered in the first year. You can download the full report (and other reports too) from the CCWI Research page.
Dental claims – If you think it’s difficult to find a physician who understands workers comp issues, how about a dentist? At Risk Management Magazine, Laura McClain explores some of the complexities involved in dental claims, such as the fact that the average dental claim requires 17 dental provider visits. She notes that risk managers generally rely on their PPOs to manage dental injuries, but suggests that because these claims require a more specialized approach, risk managers need to give them special attention.
Essential Functions – We couldn’t find a better example of why it’s important to document the essential functions of a job that the recent case that Jon Hyman Of Ohio Employers Law Blog discusses in his post, “SAY IT! SAY IT!” Yelling as an essential function. Hyman’s take away for employers: “Just because the ADA (as amended by the ADAAA) renders virtually every medical condition a protected disability does not render employers defenseless. Essential functions come in all shapes and sizes. When handling an accommodation request from a disabled employee, do not omit consideration of all facets of the job.”
US Road Casualties Mapped – Transportation related accidents are not only one of the leading causes of work-related fatalities in the US, they are one of the leading causes of death, period. Between 2001 and 2009, 369,629 people died on US roads. Now, courtesy of the Guardian’s Data Blog, you can see US traffic fatalities – every one mapped across America for those years on an interactive map. You can zoom in to search by your location. (Thanks to Liz Borowski at the always excellent Pump Handle for the pointer).
Cool Tool – NIOSH offers a Noise Meter shows how long it takes before a particular sound level becomes dangerous to the human ear. You can listen to the sounds and sound intensities of everyday objects. It’s an interesting little toy to share with workers to call attention to prevention efforts. Also see the other NIOSH resources on noise and hearing loss prevention.
Still an important health issue… – omorrow is World HIV-AIDS Day. The CDC has a good workplace resource: Business and Labor Responds to AIDS, which includes info on policy development, supervisory training materials, and educational materials.
News of Note

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