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A 10 year anniversary Health Wonk Review & more noteworthy news

Thursday, September 22nd, 2016

It’s Health Wonk Review week! Louise and Jay Norris host a special edition at Colorado Health Insurance – not only is it a mere 46 days to the next election so that has the wonkers opining – it is also the 10th blogging anniversary for the hosting blog – The “We’re Ten!” Edition of the Health Wonk Review. There are great entries from both the usual subjects and some fresh faces. Louise is a great host, framing everything nicely. Congratulations on 10 years of blogging, Louise & Jay. *clinks champagne glass*

More news of note

Just by way of coincidence, September is our birthday month here at Work Comp Insider, too – we launched in 2003! That makes us a grizzled old timer in Internet time.

Oklahoma and opt out– in case you missed it, the Oklahoma Supreme Court Ruled Workers’ Comp Opt-Out Unconstitutional:

Justice Watt, in the Court’s highly anticipated written decision, said the OWCC previously found the Opt Out Act: “1) constituted an unconstitutional special law; 2) denied equal protection to Oklahoma’s injured workers; and 3) denied injured workers the constitutionally protected right of access to courts.”

And the high court agreed, finding that the core provision of the Act “creates impermissible, unequal disparate treatment of a select group of injured workers.”

The PCI and AIA were quick to applaud the decision. Joe Paduda hopes this is the end to what he sees as the pointless debate about Opt-Out (we hope so too). Bob Wilson looks at some of the loose ends in the wake of this decision.

Psych indicators – Most of us in the industry are pretty familiar with triggers or warning signs that would indicate an accident investigation or the need for early medical intervention — but perhapsare  less familiar with indicators that might signal the need for a psychological evaluation. Our friends at Work Comp Psych Net have posted a handy reference list of Predictive Psychosocial Triggers For Workers’ Compensation Claims.

Obesity’s toll on WC – A new study in the September Journal of Occupational and Environmental Medicine shows that obese and overweight workers are more likely to incur high costs related to workers’ compensation claims for major injuries;

But for workers with major injuries, high BMI was associated with higher workers’ compensation costs. In this group, costs averaged about $470,000 for obese and $270,000 for overweight workers, compared to $180,000 for normal-weight workers.

After adjustment for other factors—including high-cost spinal surgeries or injections—obese or overweight workers with major injuries were about twice as likely to incur costs of $100,000 or higher. Body mass index had no effect on costs for closed claims or for less-severe injuries.

Safety Culture Does Not Exist!  – This is a half-hour podcast interview with Dr. Edgar Schein, Professor at MIT Sloan School of Management. Well worth a listen. We weren’t aware of this podcast series and it looks great: The Pre Accident Podcast is an ongoing discussion of Human Performance, Systems Safety, & Safety Culture. The Dr. Schein interview is the #88th edition!

Speaking of safety …. It’s Farm Safety & Health Week from September 18-24.

More news of note

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In Oklahoma, The Times, They Are A’Changin’

Tuesday, May 17th, 2016

In Oklahoma, we are now witness to a confluence of events, unintended consequences of perhaps misguided political and business decisions, that are shakin’ the windows and rattlin’ the walls, to paraphrase the great Bob Dylan. And I’m talking actual and metaphorical.

On the actual side, consider this. Prior to 2009, Oklahoma averaged two earthquakes a year of a magnitude greater than 3.0. Last year, there were more than two a day. Cornell University Seismologists studying this say the rise in earthquakes is unprecedented in terms of sheer volume as well as in how fast the number grew. A 60 Minutes investigation revealed that Oklahoma’s biggest industry, Oil and Gas production, is the likely culprit. Why? Because when oil is pumped out of the ground, wastewater comes with it. A lot of wastewater. Billion of gallons of the stuff. So, rather than put the state under water, industry pumps all that wastewater back deep into the ground where it seeps into and around the faults and techtonic plates causing plate shifting which results in all the earthquakes.

A 2015 earthquake study from Stanford University reported:

“Stanford geophysicists have identified the triggering mechanism responsible for the recent spike of earthquakes in parts of Oklahoma – a crucial first step in eventually stopping them,” wrote Ker Than for the Stanford Review.

“In a new study published in the June 19 issue of the journal Science Advances, Stanford Professor Mark Zoback and doctoral student Rall Walsh show that the state’s rising number of earthquakes coincided with dramatic increases in the disposal of salty wastewater into the Arbuckle formation, a 7,000-foot-deep sedimentary formation under Oklahoma.”

As I write this, the U. S. Geological Survey reports a 3.8 magnitude quake hit about 28 miles northeast of Oklahoma City on Sunday. And for good measure, two other slightly less severe quakes struck within eight hours earlier than the 3.8 quake.

On the metaphorical side, a different kind of earthquake, a political one. And by that I mean the abrupt turnaround of Oklahoma’s Governor Mary Fallon and the Republican controlled legislature regarding adopting Obamacare. Seems the state is nearly bankrupt in terms of funding health care. Hospitals and nursing homes face closure. It is a crisis of monumental proportion. But wait – there’s the Obamacare cavalry coming over the crest of the hill! Politicians now realize that federal funding for Medicaid expansion (Governor Fallos says it’s not an “expansion;” it’s a “realignment.”) looks like a pretty good port in the storm. Naturally, critics are lining up to decry the move, but the legislature appears to be coming around to it.

Who knew? Perhaps when next I look out my 3rd story window pigs will be flying by.

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WCRI: Day One, Part Three: The 2nd Opt-Out Session

Thursday, March 10th, 2016

Bruce Wood, of the American Insurance Association, led off the second Opt-Out session by reminding participants that the 1972 National Commission “considered and rejected employer or employee choice of benefit plans.” So, right away we knew where Mr. Wood was heading. He boarded the Trey Gillespie train and left the station smartly. His conclusions:

  • Opt-Out raises fundamental issues of public policy that policymakers have failed to consider;
  • Opt-Out lacks an organizing principle that reflects acceptable social policy; and,
  • Opt-Out is flawed and should not be enacted.

You know where Mr. Wood stands.

The second presenter was Elizabeth Bailey, VP of Workers’ Compensation & Safety for Waffle House, Inc. Waffle House, headquartered in Georgia,  is in a number of states, Texas being one of them. The company has been a Texas Non-Subscriber (it’s Opted-Out) since 2002, and, according to Ms. Bailey, has enjoyed spectacular results ever since. Such as:

  • Within one year, claims cost per restaurant dropped 57%;
  • Indemnity claims went from 15.03% of total claims to 3.23%;and,
  • Indemnity costs declined 99%

Wow!

Ms. Bailey described how Waffle House has increased its safety and health efforts while providing equivalent benefits as those required by the workers’ compensation statute. The company’s economic results are certainly stellar, but at what cost to employees? We were left wondering. However, as David Deitz pointed out in the question period, Ms. Bailey was the only Opt-out presenter who “presented” any data.

 

The third presenter, Alan Pierce, is a Massachusetts plaintiffs attorney, but that doesn’t begin to describe his standing in the legal community. He is one of the nation’s foremost advocates for injured workers and is the past chair of the Workers’ Compensation Section of the American Bar Association and the Massachusetts Bar Association. As expected, he offered an eloquent precis suggesting that workers’ compensation is not a benefit, but rather an employee right. He, too, cited the 1972 National Commission pointing out that most of its recommendations have never been adopted. Mr. Pierce is always interesting.

The last presented was Oklahoma Insurance Department Chief of Staff James Mills. I was somewhat surprised to hear him defend the Oklahoma Opt-Out statute. Essentially, Attorney Mills said that he was open to any program or law that might have the chance of benefiting both employers and employees and likened the statute, which had 57 legislative authors, to some other ideas that needed time to grow and prosper. Who knows? Maybe that’s what will happen to Opt-Out.

But I wouldn’t hold my breath waiting for that to happen.

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WCRI: Day One, Part Two: The 1st Opt-Out Session

Thursday, March 10th, 2016

The afternoon of WCRI’s 2016 Annual Conference was devoted to Opt-Out. The first of two sessions was a Point-Counterpoint exercise. Trey Gillespie of the Property & Casualty Association of America led off. To Mr. Gillespie, with Opt-Out it’s 1910 all over again. He described Opt-Out in Texas and Oklahoma as allowing employers to deliver sub-standard care to injured workers without government oversight. Showing stark contrasts between what is allowed in Opt-Out and required in workers’ compensation, he suggested that employees were at the mercy of employers, which could sometimes be good and sometimes be bad. Opt-Out’s a kind of Employer Personal Responsibility Plan.

Bill Minick, of PartnerSource, followed with a presentation in favor of “Options to Workers’ Compensation.” Minick has been the loudest proponent and most significant advocate for Opt-Out. He and Opt-Out were the subject of a Propublica investigative journalism story late last year. He described Opt-out as a substantial improvement on a failed system and painted a picture of employers being able to provide better care for injured workers at less cost, because regulatory and bureaucratic requirements have been stripped out. Essentially, Minick claims that the workers’ compensation system makes employers go from Massachusetts to Rhode Island by way of Alex Swedlow’s California. He’d rather just drive the 30 miles down Route 95.

My basic problem with Opt-Out, wherever it is, is that some employers with resources and good intentions welcome the chance to design their own injury benefit plans that will provide benefits at least as good as traditional workers’ compensation at significantly less cost. This, in itself, is a good thing. Some large employers in Texas, such as Costco, seem to have done that. Trouble is, not every employer is Costco. As I wrote when I evaluated Opt-Out in 2014, I’m concerned about Kenny’s Citgo, down the street and around the corner, where Kenny and his five hourly workers labor without the benefits of a mandated workers’ compensation plan, because Kenny has Opted-Out. There are more Kenny’s than Costcos.

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Texas Workers’ Compensation Opt-Out Report: A Herculean Effort Lighting a Path to the Future (Or Maybe the Past)

Thursday, December 13th, 2012

Unlike any other US state, Texas has never required its employers to buy or provide statutory workers’ compensation. Texas employers who opt-out of this traditional form of injury benefit system are called non-subscribers. In 1993, 44% of Texas employers were non-subscribers, and they employed 20% of the employees in the state. By 2008, employer non-subscribers had shrunk to 33%, but their percentage of the state’s total workers had grown to 25%. No one knows for sure, but estimates are that as many as 114,000 Texas employers have opted-out.
Until now, with the exception of two academic studies, one in 1996 examining lost injury days, the other, a 2010 survey of large, multi-state non-subscribers, no one has ever fully examined the Texas opt-out phenomenon. But, with the release today of the 87-page “Workers’ Compensation Opt-Out: Can Privatization Work? The Texas Experience and the Oklahoma Proposal,” that has changed.
Funded by the big TPA, Sedgwick CMS, published by the New Street Group and written by Primary Researcher Peter Rousmaniere and former Risk & Insurance editor and New Street Group founder Jack Roberts, this thorough, well-researched and entirely lucid analysis is certain to propel the opt-out debate now and in the foreseeable future.
In Texas, It’s 1910 All Over Again
To get a grasp of the back-to-the-future Texas opt-out, think 1910, the year before states began enacting workers’ compensation laws, the grand bargain in which employers promised to replace lost wages and cover medical costs due to injury and workers agreed not to sue employers when the workers were injured on the job.
Lots of employers buy workers’ comp in Texas, but for those who don’t it’s 1910 all over again with virtually no state oversight. Let me be clear about that: In Texas, there is no requirement for non-subscribers to pay for work injuries in any way. There is one important difference, however. The Texas legislature has statutorily removed the three major defenses used by employers prior to workers’ comp statutes being enacted to defend themselves against worker suits: contributory negligence, assumption of risk and the negligence of fellow employees. Also, without workers’ comp, there can be no “exclusive remedy,” and for non-subscribers there isn’t. Large non-subscribers, such as Costco, have been very creative in dealing with that.
Rousmaniere and Roberts discovered that Texas opt-out was a bit of a carnival sideshow until ten to fifteen years ago when large employers like Costco, whose program they analyze in depth, cottoned on to the idea that they could provide a sleek, fast-moving, common-sensible injury benefit management system if they wove it into their ERISA plans. ERISA, the Employee Retirement Income Security Act, is a federal program which allows employers to design their own benefit systems, and substantially more than a cottage industry has evolved in Texas to help them do that for worker injuries. The operable phrase in that last sentence is “design their own.”
Designing Their Own
Suppose someone, your boss for example, said to you, “There’s no more workers’ comp. Design me a plan that will provide our workers who get injured immediate medical care and wage replacement. Make worker participation mandatory. Keep the administration to nothing more than what is absolutely needed for it to run smoothly, and, before I forget, keep all the lawyers out of it.”
What would you do? Well, large employers in Texas have had about fifteen years to think about that, and at least one of them, Costco, has created the ideal program I would design myself if I had a magic wand. I say “at least one,” because Costco is the only employer Rousmaniere and Roberts point to, although they do report on interviews with many professionals involved in Texas opt-out. They also suggest that Costco is fairly typical of the large employer opt-out experience.
After much research and planning, Costco became a non-subscriber in 2007. At that time, the company operated 15 large warehouses throughout Texas, carried a payroll of $87 million and employed about 4,000 workers. Its loss costs had grown to around $150 per employee, or 97 cents per hundred dollars of payroll. In the four years following non-subscription, losses fell to 46 cents per hundred dollars of payroll, a decline of 52%, with high employee satisfaction for the system.
Here are the main points of Costco’s worker injury benefit program, and remember, Costco was able to start with a blank piece of paper:

  • Work must be the “sole cause” of injury, not just a “contributory factor.” More about this below.
  • Injuries “must” be reported by end of shift, but in no case later than 24 hours after happening. Failure to do this will negate any benefits. Workers who don’t report in time are on their own; most use group health to cover medical costs, but, as one can imagine, a worker is more likely to win the Powerball than to not report within 24 hours.
  • Employees receive a taxable 80% of pre-injury wages with no waiting period. They’re paid from day one.
  • Upon hiring, workers are required to accept binding arbitration for disputed claims, and Costco picks the arbitrators. If unsatisfied with the arbitrator’s ruling, employees do have the option of bringing suit for employer negligence in civil court, but since 2007 only three such suits have been brought; two were settled modestly, and the third is pending
  • Chiropractic care is not allowed (Costco’s analysis of its losses concluded that excessive chiropractic care was a major driver of loss costs and unnecessary for employee recovery)
  • There are no permanent partial disability awards
  • Wage and medical benefits end after 156 weeks, but, in rare cases, future medicals can be settled (Rousmaniere and Roberts don’t address this, but I’m wondering about the degree to which CMS plans on extending its long, bony Medicare fingers into this pie)
  • Costco carefully picked an emergency care and specialist medical provider network comprised of highly reputable physicians, with as many as possible being board-certified occupational medical physicians. Costco routinely pays its providers full invoiced charges
  • If employees fail to follow through on medical recommendations or miss appointments for no good reason, benefits are terminated
  • For the rare event when injuries extend beyond 156 weeks, Costco has purchased insurance to cover the tail
  • Because any disputes go quickly to arbitration, attorney involvement is nearly non-existent

With loss costs reduced by 52% and employee satisfaction high, Costco obviously has a winning program. Costco has seamlessly woven injury benefits into its ERISA plan, blending them with its group health and short and long-term disability programs.
One thing that Costco wrestles with is co-morbidity. Imagine a Type-1 diabetic warehouse worker without safety shoes who drops some heavy object on his or her foot. Because of the diabetes, the foot is much more susceptible to infection, which actually happens. Then, because diabetes seriously inhibits healing, the infection worsens, and the foot is amputated. In statutory workers’ comp, this would be covered, but what about at Costco. I asked Peter Rousmaniere about this. He wrote back:

“You are right, this would be excluded… With Obamacare assuring universal health coverage, the opt-out employer’s message will be something like, “Don’t expect indemnity payments for a work injury if there is a good chance that your personal health condition will contribute to it.”

Rousmaniere admits that this “sounds draconian,” but he believes that this issue, as well as what to do about degenerative conditions, such as what to do about the 55-year old wall board hanger whose rotator cuff finally gives out, will gradually self correct with help from the ADA as well as the Affordable Care Act. The jury on this is decidedly out. But, just for a moment, imagine that he’s right. What we could be moving toward, after decades of failed experiments, is the first manageable and potentially successful version of 24-hour care.
The Other Side of the Coin
One thing is clear from the Rousmaniere and Roberts study: Costco and other large employers like Target and Safeway, two other non-subscribers, have the resources and core values necessary to provide compassionate care for injured workers while bringing them back to work as fast as medically possible in a businesslike way. But what about Kenny’s CITGO, down the street on the corner with five employees, all of whom, including Kenny, live paycheck to paycheck? And Kenny is just as free to non-subscribe as Costco.
Kenny and others like him are the Third World of non-subscription. Operating with no regulatory or legal oversight by the state, he can do what he pleases or what he perceives he can afford, which is probably not much. If one of his workers is injured, and Kenny decides to offer nothing in the way of injury benefits, the worker is on his own. He can certainly sue Kenny for employer negligence, and Kenny won’t have those three pre-workers’ comp era defenses to rely on. However, no attorney is going to take the employee’s case because Kenny won’t have the resources to pay if he loses, which he probably would. But, to quote Rousmaniere and Roberts, “That is a hollow victory, indeed.”
And on a grander scale, what about the large employer with significant resources, but who also may have more than a bit of malevolence in its DNA and wants to play schoolyard bully (see Massey Energy)? In an environment without one scintilla of regulation will the bully treat workers fairly?
The Oklahoma Proposal
After studying the lay of the land for the Texas opt-out and seeing where the Punji Pits are (see Kenny’s CITGO and Massey Energy), Oklahoma legislators crafted a remarkable piece of opt-out legislation that narrowly lost 42 to 50 in the Oklahoma House of Representatives in late April, 2012.
The Oklahoma proposed legislation would have corrected many of the perceived flaws in the Texas opt-out system. For example, Oklahoma would require any employer choosing to opt-out to provide similar, in some cases better, benefits than the statutory system. Also, injury benefits would be required to be part of an ERISA-approved plan, although there is significant uncertainty if this provision would withstand a constitutionality challenge. Further, employers applying to opt-out would have to pay a fee of $1,500 annually to do so. This would more than likely eliminate the Kennys of the world, employers who just don’t have the resources to “pay to play.”
Rousmaniere and Roberts expect Oklahoma legislators to do some tinkering and re-file during 2013. They think there is a good chance that this time the legislation will pass. Whether Governor Mary Fallin, who campaigned on a platform of workers’ comp reforms, will sign it is another matter.
Summary
This 87-page report is a Herculean effort, and, in my view, the worker’s compensation insurance industry owes Rousmaniere and Roberts a huge debt for spending close to a year to produce it. Sedgwick should be commended for funding it. Perhaps we can forgive Rousmaniere for a bit of acquired bias, but he’s seen, up close, what a conscientious, fair-minded employer can do if given the chance. I come away from his report finding myself agreeing with him as he wrote me the other day: “Every state should offer and every medium and large sized employer should consider opt -out.” But to this I add, “With a healthy dose of regulatory and state oversight. Not everyone is Costco.”

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Health Wonk Review, Worker Memorial Day, OK, Obesity, Appendectomies & more

Thursday, April 26th, 2012

Health Wonk Review – Jennifer Salopek and Sarah Sonies have posted Health Wonk Review: Shiny Happy (Mostly) Edition, an excellent hosting debut at Wing of Zock, a blog sponsored by the Association of American Medical Colleges for practitioners of academic medicine. Make sure you click through to learn the origins of the fanciful name of the blog.
April 28 is Worker Memorial Day – an event dedicated to remembering those who died on the job from workplace injuries and diseases. It’s also a time to commit to doing better, to renew efforts for safe workplaces. The National Council for Occupational Safety & Health has a list of Workers Memorial Day events throughout the country, as well as fact sheets and resources in both English and Spanish.
Oklahoma decides against “alternative workers comp” – Last week, the Oklahoma Senate gave the nod to a bill that would allow some employers to opt out of workers comp system by offering a comparable alternative, but the OK House rejected the opt-out measure. Last week, Senator Harry Coates had issued an editorial discussing the opposition viewpoint: Be careful what you ask for. See Dave DePaolo’s take on OK’s non-subscription model and the recent Walmart opt out in Texas.
Is it OK to discriminate against obese people? – In what may be a first among hospital hiring restrictions, Victoria Hospital in Texas has stated they won’t hire very obese workers. HR pro Suzanne Lucas (also known as “Evil HR Lady”) asks if it is okay to discriminate against obese people, offering 5 reasons why she feels it is a bad policy. In addition to potential illegality, another issue she raises is that many health professionals consider the BMI or Body Mass Index a faulty indicator of health. The first link quotes a physician as noting that “A professional football player might have a body mass index of 32, which is technically obese, but only have 7 percent body fat.” (Be sure to check out the Flickr gallery of real people and their BMIs that Lucas links.) Now whether or not this is the wrong “solution,” the fact that obesity is a workplace problem is not at issue. A new Cornell study says that obesity accounts for almost 21% of U.S. healthcare costs, and “An obese person incurs medical costs that are $2,741 higher (in 2005 dollars) than if they were not obese.”
Usual and customary? – How much will an appendectomy cost you in a California hospital? It might depend on your insurance coverage. In one hospital, the cheapest procedure was $7,504 and the highest cost in the same hospital was $171,696. See more in Merrill Goozner’s post on the Anatomy of A Walletectomy.
Jail time for scofflaws/ – Jon Gelman notes that North Carolina is raising the stakes for employers that don’t carry workers comp – “the first contempt hearing is scheduled for May 22 when 125 uninsured employers have been noticed to appear in court.” The state says pay up or go to jail.
Sex, workers comp & horseplay – Joe Paduda posts about compensable sex on the road, an Australia case where a worker was injured while in flagrante delicto. My colleague discussed this case previously in his post Compensable Sex, Down Under? We don’t get to talk about sex very often on this blog, although there was a spanking incident a number of years ago (sadly the link to the news item appears broken.) The spanking post dealt with an instance of horseplay – an issue that Cassandra Roberts poss about at LexisNexis in her post A Roll In the Hay: Delaware’s Horseplay Defense and Australia’s Sex Romp Case Revisited, where she lists an array of quirky cases in which the horseplay defense failed.
More Noteworthy News

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Call to action for teen farmworker safety: Two boys lose legs in OK grain bin auger accident

Tuesday, August 16th, 2011

Two Oklahoma teen athletes had their lives changed forever after becoming entangled in a grain bin auger while working on a farm. News reports state that 17 year old Bryce Gannon was working at a grain bin elevator when his leg was caught in the auger. In an all-too-familiar attempted rescue scenario, his co-worker 17 year-old Tyler Zander went to his aid and also became entangled. Emergency rescue personnel had to cut apart the 12-inch metal auger in order to free the young men.
Grain bin auger accidents are brutal and severe events in which body parts become entwined in spinning equipment. They are somewhat similar in nature to power take off (PTO) shaft accidents which claimed the life of baseball great Mark Fidrych. We posted about his death and the story of PTO injury survivor Kristi Ruth who was injured when her arm was pulled into a posthole digger’s PTO while working on her family’s farm.
A case report of a farm worker fatality from a grain bin auger entanglement offers more (gruesome) detail about how such injuries occur, along with these safety recommendations.

  • Ensure that workers do not enter grain bins while the unloading mechanism is operating
  • Establish lockout/tagout procedures and ensure workers follow them any time a worker enters a grain bin or other confined space
  • Provide employees with proper training in lockout/tagout procedures and procedures for safe entry into confined spaces, such as grain bins
  • Consider utilizing grain bin and auger designs that can help ensure safety for workers such as self-unloading or bottom-unloading bins

Last year at this time, we were reporting the suffocation deaths of two teen farmworkers in a Michigan grain bin accident. 2010 was a record year for grain bin fatalities. prompting OSHA to issue fines and to put grain bin operators on notice and to ramp up inspections on dairy farms.
Teen farm safety: new rules in limbo
Celeste Monforton of The Pump Handle discusses this accident and calls the Obama administration on the carpet for stalling on regulations that would strengthen protections for young farm workers, while at the same time giving lip service to child labor protections and transparency. She notes:

The fatality rate for young workers performing hazardous tasks—-like working with a grain auger—–is two times the fatality rate for all U.S. workers. The Fair Labor Standards Act (FSLA), administered by the U.S. Department of Labor’s Wage and Hour Division (W&H) stipulates dozens of work activities that are too dangerous for workers of certain ages. Individuals under age 18, for example, are prohibited from working most jobs in coal mines, from forest-fire fighting, and from operating meat slicers and cardboard balers in grocery stores. However, the safety rules governing young workers employed in agricultural jobs have not been updated for 40 years.

Elizabeth Grossman also recently posted about teen workers and farm accidents at The Pump Handle: Hazards of the harvest: Children in the fields. This post includes a recounting of a recent farm accident which resulted in the deaths of two 14-year old girls on an Illinois farm. The girls were electrocuted while detasselling corn.
Grossman notes that, “The hazards of farm work are underscored by the fatality rate for young people working on farms: 21.6 deaths per 100,000 young workers, compared to 3.6 fatalities for the same number of those working in all other industries, this according to data published in 2010.”
Grain bin auger safety resources
Grain Auger Safety sheet with quiz from the Texas Department of Insurance.
Accident Extrication Procedures for Farm Families and Employees from the University of Georgia
Safety With Grain Augers from the North Dakota State University
Grain auger safety – from the University of Ilinois Extension

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Risk carnival, election wrap-up, and tooting our own horn

Wednesday, November 3rd, 2010

This week’s Cavalcade or Risk is posted by Ironman at Political Calculations. This biweeky roundup of risk posts is a sampling or “carnival” or topic-related posts. Ironman grades the entries for topicality, quality and readability – check it out.
Election results – Washington’s Initiative 1082 to privatize workers’ comp was soundly defeated last night, as about 58% of the voters opted to keep the system that has operated since 1911 in place. Obviously, this is a disappointment to private insurers and independent agents that hoped to open the state.
In Louisiana, it looks like Amendment 9 passed, but news reports we found are still vague. This change would require that claims would have to be re-argued before a panel of at least five appeals court judges before an agency’s decision could be reversed or changed.
In Arizona, Oklahoma and Colorado, voters cast ballots on constitutional amendments that would bar healthcare reform’s mandate that individuals buy insurance. Opt-out measures were passed in Oklahoma and Arizona, but was defeated in Colorado. Missouri had rejected the mandate in August, but not by a a state constitutional amendment.
At Comp Time, Roberto Ceniceros took a pre-election look at what gubernatorial wins might mean in California and New York. He notes that Jerry Brown was very quiet on the issue of workers compensation in California, but in New York, Andrew Cuomo has employee misclassification on his radar screen. As the state’s Attorney General, he recently joined attorneys general from Montana and New Jersey in an intent to sue FedEx.
And as long as we are on politics, it seems like a good time to bring up today’s news that the Treasury expects to earn a profit on AIG investments. Overall, despite the controversy, the Troubled Asset Relief Program (TARP) bailout looks as though it is earning a healthy return.
CT Commissioner resigns – somewhat upstaged by yesterday’s election brouhaha was news that Connecticut’s Insurance Commissioner resigned abruptly. National Underwriter reports that Thomas Sullivan resigns amid pressure over healthcare rate hikes. He faced criticism after approving a 47% rate hike by Anthem BC/BS of CT.
Workers Comp Insider again named to top WC blogs
We were gratified and pleased to be named to 2010 roster of the LexisNexis Top 25 Workers Compensation and Workplace Issues:

“Consistently at the top of the heap when it comes to workers’ comp blogs, the Workers’ Comp Insider is a rare combination of breadth and depth. Now in its eighth year, the Insider covers comp issues, risk management, business insurance, and workplace health and safety from Anchorage to Miami. It provides in-depth analysis concerning workplace legislation, occupational medicine, and best practices from Maine to Hawaii. It should be in the “favorites” folder of every comp attorney’s web browser.”

We thank you, our readers, for your continued interest and support. We were happy to see many friends and colleagues on the list as well – we’re honored by the company in which we find ourselves. Be sure to check out some of the other fine blogs on the list. Also, if you haven’t discovered the gem that is the LexisNexis Workers’ Compensation Law Community, we urge you to check that out, too.

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All Hallows Eve Edition of Health Wonk Review and other noteworthy news

Thursday, October 28th, 2010

The pre-election season used to be dubbed the silly season, but this year it might better be termed the scary season – things are getting pretty acrimonious. Following up on the scary theme, Meredith Hughes, Allison Levy, and Sam Wainwright of New Health Dialogue Blog team up to bring you Health Wonk Review: All Hallows Eve Edition. It’s an entertaining and substantive issue, and the last issue before the election.
And in other news of note:
Joe Paduda of Managed Care Matters tackles the issue of physician dispensed drugs in work comp and explains how repackaged drugs can add to costs by an alarming magnitude. In 2007, California closed this loophole that allowed repackaged drugs to go “off the grid” in terms of existing pricing controls, and other states are now looking at this issue. Joe’s post compiles research and explains why this is an issue you should know and care about.
Roberto Ceniceros of Comp Time looks at the NFL’s recent focus on helmet-to-helmet hits. He links to a press release from the NFL Players Association, which makes the point that player safety extends beyond the field, calling on the league to “call on the league to end “nasty litigation against nearly 300 players’ workers compensation cases and stop saying ‘no’ to the disability benefits of NFL legends.”
Yvonne Guibert of Complex Care Blog discusses obesity and comorbidities and the impact on claims costs. She offers research and resources to help employers grapple with this issue. The current issue of Human Resource Executive also carries a good article on how obesity adds to healthcare costs, along with some approaches that employers are taking to mitigate the problem.
For all practical purposes, Texas is the only state in the union that allows employers to opt out of mandatory workers comp coverage. Peter Rousmaniere takes a look at how the opt-out option has affected employers in the current issue of Risk and Insurance. And on the topic of opting out, see Good News for Texas Non-subscribers, Bad News for Excess Carrier, a post by Michael Fox of Jottings By An Employer’s Lawyer.
Advanced Safety and Health News Blog discusses and links to federal OSHA’s recently issued special evaluation of state-run OSHA programs. “The reports provide detailed findings and recommendations on the operations of state-run OSHA programs in 25 states and territories. The review was initiated after a 2009 special OSHA report on Nevada’s program, identified serious operational deficiencies in that state.”
Judge Tom of the eponymous blog schools us on Oklahoma’s law on recreational injuries and workers comp. In 2005, the law was tightened to exclude any injuries that stem from recreational and social activities, even those occurring on the employer’s premises. He notes: “The larger, unanswered question is whether employers no longer have tort immunity for injuries sustained at recreational and social functions such as Christmas parties, company sponsored sports leagues, the Orcutt basketball pick-up game, attendance at charitable events to name a few.”
Short takes
Weekly Toll: Death in the American Workplace
High Unemployment Rate a Drag on Workers’ Compensation Insurers
Health care group spends $4 million on safety, saves $14 million
Specialist and primary care pay per hour
FedEx to Pay $2.3 Million Over Independent Contractors

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Posted in News roundups | Comments Off on All Hallows Eve Edition of Health Wonk Review and other noteworthy news

Oklahoma: OK!

Monday, September 14th, 2009

The Insider just returned from a speaking engagement in Stillwater, Oklahoma. The occasion was the annual workers comp conference sponsored by the judiciary that manages comp in the state. I was invited by fellow blogger Judge Tom Leonard, whose blog provides valuable information to comp practitioners in the state.
As a relatively high-cost state, Oklahoma is experiencing rumblings in the state legislature to switch to an administrative – as opposed to judicial – system. In theory, this makes sense, as a formal judiciary with its due process rules can slow down the resolution of claims. But this is no simple problem, with no simple solutions. The first event at the conference featured a panel of legislators who were involved in crafting the systemic fix: in general, republicans were pushing for change, while democrats cautioned that the interests of injured workers may be compromised.
While the Insider does not take a formal position on the controversy, we did caution all parties to “beware the law of unintended consequences.” Every “fix” contains the seeds of both success and failure. The prudent legislator would do well to examine the problem from all sides and fashion a dispassionate solution – much as the talented and compassionate judges currently operating the Oklahoma system approach every claim.
Six Humongous Problems
The insider was invited to provide a national perspective on workers comp to the conference’s 400 participants. We focused on six looming crises facing comp across America. Here is a brief summary of our concerns:
1. The Original workers comp model is obsolete: Comp is nearing its 100th anniversary (New York 1911). The workplace at the beginning of the 20th century was very different from what confronts us today. Legislatures struggle to modify the initial legislation to keep pace with change.
2. The economic collapse is a game changer: The comfortable assumptions of financial planners (stocks rise inexorably over time) have disintegrated in the world-wide collapse that began just over a year ago. This collapse has implications for workers comp, with employment shakier than ever and the retirement plans of millions in tatters. Which leads to:
3. The Aging American workforce is going to get older: With baby boomers approaching retirement age, the workforce is already at its oldest. As retirement accounts sink with the economy, more and more workers are finding themselves in a bind. They do not have enough money to retire. These older workers bring skill and experience to the workplace, but their aging bodies are breaking down. The comp system is not built to handle workers in their late 60s and 70s who plan to keep on working. Will comp become the retirement plan of choice for workers with no other choices?
4. Undocumented workers are half in and half out: most states cover the medical costs and indemnity for injured, undocumented workers, but draw the line at vocational rehabilitation. By definition, these folks are not “available for work.” Will Congress create some form of amnesty, thereby opening the door to complete workers comp coverage for foreign workers?
5. Insurers are in big trouble: There may be low hanging fruit in the insurance world, but not in workers comp. There is a nation-wide suppression of rates, which is compounded, of course, by the idiocy of carriers who drop steep discounts on top of inadequate rates. Carriers may dream of a hardening market, but it never seems to arrive. Meanwhile, the bottom line continues to erode.
6. The federal government might mess everything up: The Medicare Secondary Payer program has invaded the settlement process for comp claims, creating chaos and uncertainty and increasing the costs. [Check out Judge Leonard’s blog for some excellent materials on the Secondary Payer program.] Now we have national health insurance on the immediate horizon. No, it’s not “death panels” or alleged coverage for undocumented workers that concern us. It’s the more basic issue of who will choose doctors, under what circumstances, and what impact this might have on workers comp.
We have covered all of these crises in the Insider and will continue to do so in the coming months. I’m not sure that the good folks in Oklahoma found much solace in the fact that their own little comp crisis is dwarfed by issues that transcend state lines. Meanwhile, I did learn a thing or two about Oklahoma. It all comes down to this: Sooners versus Cowboys. No, I’m not going to explain. You have to be there to really understand.

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Posted in Best Practices, Insurance & Insurers, State News | 3 Comments »

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