Risk Roundup – Emily Holbrook hosts Cavalcade of Risk #171 at Risk Management Monitor – be sure to check it out.
One to watch: Wal-Mart Class action & WC – In Business Insurance, Roberto Ceniceros writes about a Wal-Mart class action settlement that raises big workers comp questions. Josephine Gianzero et al. v. Wal-Mart Stores Inc. resulted in a settlement for 13,521 plaintiffs. It raises several issues of concern related to workers comp: the case was a breach of the exclusive remedy provision – an issue that is always of some concern to employers – and it raises questions about medical claims management.
According to Ceniceros: “The settlement involving Wal-Mart’s claims administration unit and Concentra Health Services Inc. in Colorado also is troubling since it is believed to be the first payout resulting from recent suits alleging that employers’ and workers comp service providers’ claims management practices violated the Racketeer Influenced and Corrupt Organizations Act, several observers say.”
This is quite the hot potato and of concern to TPAs, several of whom declined comment on the case. As Ceniceros reports, “The issue is sensitive because the lawsuit raises the question of how far claims administrators can pursue management of questionable medical treatments found through common practices, such as utilization reviews, without violating the law, the source said.”
(Here’s a summary of the case when the class action was certified in 2010.
How to keep injured workers from turning to lawyers – In the current issue of CFO, Richard Victor writes about a recent Workers Compensation Research Institute (WCRI) study that sheds light on why injured workers feel the need to hire an attorney: How to Keep Unneeded Lawyers Out of Workers’ Comp . It’s a good article and worth the read – here’s a snippet:
“Not surprisingly, the study found that workers are more likely to seek attorneys when they feel threatened. Sources of perceived threats can take different forms. The character of the employment relationship, for example, was a factor for the 23% who strongly agreed that they hired attorneys because they feared being fired or laid off. Fifteen percent also strongly agreed that they needed attorneys because their employer could perceive their claims as illegitimate.
Miscommunication in the claims process was another significant factor. In fact, 46% said they hired attorneys because they felt the claim had been denied when, in fact, it had not yet been accepted into the process. Attorney involvement among workers with the most severe injuries were 15 percentage points higher than those with mostly minor injuries.”
Related: We refer you to one of our favorite articles on the topic by plaintiff attorney Alan S. Pierce: Top Ten List as to Why Injured Workers Retain Attorneys
More Charges; Big Branch Probe Widens – Ken Ward reports that today, federal prosecutors have charged a longtime Massey Energy mine manager with being part of a decade-long conspiracy to defy safety laws and dupe government inspectors. Expect more to come:
But in new court documents, Goodwin and Assistant U.S. Attorney Steve Ruby allege a broader conspiracy by as-yet unnamed “directors, officers, and agents” of Massey operating companies to put coal production ahead of worker safety and health at “other coal mines owned by Massey.”
It is the first time in their probe of the Upper Big Branch Mine Disaster that prosecutors have filed charges alleging Massey officials engaged in a scheme that went beyond the Raleigh County mine where 29 workers died in an April 2010 explosion.
Follow the ongoing story and find links to other coverage at Ward’s Coal Tattoo blog.
Pharma Costs – Joe Paduda links to and comments on a recent Express Scripts drug trends report. The long and short of it? Pharmacy price increases are driven by brands.
Fighting Fraud – Southern California has 65 billboards warning about work comp fraud. To raise public awareness or criminal penalties associated with fraud, the boards will be placed on billboards and transit shelter posters placed across San Diego County.
Strange Risks – Can you insure against acne attacks or hair loss? Lori Widmer has an entertaining read in this month’s Risk Management Magazine: The Stranger Side of Risk.
Other noteworthy items
- 10 politcal players to watch on immigration reform
- Prescription drug monitoring programs are underutilized tool
- Repeat Offender Settles with OSHA for Cave-in Hazards at Mass. Worksites
- Exploring links between working conditions and obesity in low-wage workers
- Another challenge to the Affordable care Act
- “Going and Coming” or “Continuous Employment?” Georgia Court Rules on Work Comp Case
- Occupational safety, health makes good business sense
- Solvents & thinners – low risk chemicals or killers?
- How much does it cost companies to lose employees?
- NIOSH: Promote work-family balance to reduce workplace injuries
Tags: crime, exclusive remedy, lawsuits, litigation, managed care, Upper Big Branch Mine
