Posts Tagged ‘reports’

Update On Medical Marijuana

Friday, March 3rd, 2017

Yesterday, while attending WCRI’s Annual Conference in Boston, we wrote about the National Academy of Sciences (NAS) new research results concerning the effectiveness of  medical marijuana (cannabis) in the treatment of chronic pain. The NAS research concluded there is “conclusive support” that cannabis is effective with respect to chronic pain. A number of states are allowing cannabis to be employed in this regard.

However, marijuana is federally illegal in any usage, medical or otherwise.

We learn today from the Boston Globe that a bill was introduced in the US House of Representatives by Virginia Representative Thomas Garrett yesterday to remedy this situation. From the Globe’s story:

A freshman Republican representative from Virginia introduced legislation this week that would end the federal prohibition on marijuana use and allow states to fully set their own course on marijuana policy.

The bill seeks to remove marijuana from the federal Controlled Substances Act and resolve the existing conflict between federal and state laws over medical or recreational use of the drug. It would not legalize the sale and use of marijuana in all 50 states — it would simply allow states to make their own decisions on marijuana policy without the threat of federal interference.

‘‘Virginia is more than capable of handling its own marijuana policy, as are states such as Colorado or California,’’ Representative Thomas Garrett said in a statement. Neither recreational or medical uses of marijuana are allowed in Virginia.

Senator Bernie Sanders introduced a similar bill last year, but no one would co-sponsor it, and it never even got a hearing. Garrett, however, has four co-sponsors already.

We will continue to watch this.

Who Knew? Medical Marijuana Works (at least for chronic pain)

Thursday, March 2nd, 2017

Dean Hashimoto, MD, JD, is a highly-respected researcher and teacher, practicing at Massachusetts’s Partners Health Care (think Harvard and Massachusetts General Hospital) and teaching at Boston College Law School. Today, at WCRI’s Annual Conference, his topic was Medical Marijuana and Workers’ Compensation: Recent Scientific, Legal and Policy Developments.

He led off with the results of a January,2017, scientific report from the National Academies of Sciences, Engineering and Medicine (NAS). The NAS report is a comprehensive, in-depth review of existing evidence regarding the health effects and potentially therapeutic uses of Medical Marijuana (cannabis). The report arrived at nearly 100 research conclusions categorized by the weight of evidence (conclusive, substantial, moderate, limited, no or insufficient).

One of the report’s conclusions that had “conclusive and substantial support” was this: Medical Marijuana is proven to improve chronic pain in adults. There is “moderate” support for the conclusion that Medical Marijuana improves short-term sleep outcomes for both fibromyalgia and chronic pain.

Of course, there are downsides. The report also concludes (DUH!) that Medical Marijuana carries with it an increased risk of motor vehicle crashes. Also, however, there was conclusive, substantial support that taking Medical Marijuana can lead to the development of schizophrenia and other psychoses. Yikes!

The NAS report also investigated whether there was an association between cannabis and occupational injury. The conclusion? There was no conclusion, because the available studies do not permit one to be made with any degree of certainty.

The bottom line? Medical Marijuana presents a potentially therapeutic benefit in the treatment of chronic pain.

Well, that’s not really the bottom line. No, because the larger issue is this: Medical Marijuana is being used in a number of states. Today, along with Dr. Hashimoto, we also heard compelling stories from Paul Sighinolfi, of Maine’s Workers’ Compensation Board, and Paul Tauiello, of the Colorado Division of Workers’ Compensation, describing the successful medical use of cannabis which is generating momentum in both states toward the therapeutic use of cannabis. The trouble is the usage of Marijuana in any form is federally illegal in every state. Seems there is a collision coming, and it may not be pretty.

Mike Manley On The Oregon Workers’ Compensation Premium Rate Ranking Study

Monday, October 10th, 2016

I have always tried to surround myself with people smarter than I. People such as Gary Anderberg, Peter Rousmaniere, Jennifer Christian, Joe Paduda, Bob Wilson, Mark Walls and Julie Ferguson, to name just a few of the legion. Mike Manley is in the group, too. Mike is Research Coordinator for the Oregon Department of Consumer and Business Services and co-author of what is known in the biz as The Oregon Study.

For three decades, the state of Oregon’s workers’ compensation research group has published this bi-annual study, which won the 2006 IAIABC Research Award. The executive summary of this year’s study is due to be released in the next few days, and the findings are closely watched in quite a few states. Unlike the National Academy of Social Insurance report, issued last week, the Oregon study takes the comparison beyond simple averages. Instead, Oregon derives average rates for what a hypothetical set of comparable employers would pay, thus factoring out much of the difference in states’ risk profiles.

With any comparison across states in the workers’ compensation arena, there are caveats and fine points to be considered. Naturally, there are questions that arise about the methods and interpretation of the findings.

At the Insider, it’s unusual  to have guest bloggers; we’ve only done it a handful of times over 14 years. But for important issues, we make exceptions. The Oregon Study is such an issue. So, I asked Mike if he would write something he wanted our readers to know about the upcoming study. He came up with a list of ten, and we’re going to publish every one of them right here right now. Who knows? You may be reading the latest study tomorrow, but if you are, you’ll be armed with Mike’s intelligent cheat sheet. What follows are the ten things to know about the Oregon Study, by Mike Manley.

           Ten things WC professionals should know about the Oregon Study

  1. This isn’t a report card! The study isn’t an overall evaluation of states’ workers’ compensation systems. There are other important aspects of workers’ compensation systems that are beyond the scope of this analysis. The study focuses on one aspect of workers’ compensation systems: rates paid by employers that purchase insurance.
  2. The study uses a consistent hazard mix across states. This is done by giving each state the same hypothetical distribution of risks, in order to control for the differences in risk across states. This distribution is most similar to Oregon (a national distribution doesn’t exist). Occasionally there have been concerns that this might create some kind of bias, so we’ve checked into that question. Looking at other methods that don’t use the Oregon risk distribution to standardize risk, we find no basis for this concern. The other studies have results that are very similar, once a consistent hazard mix is used.
  3. Rank values are useful, but they have major limitations for interstate comparison. So, we publish a second comparison factor, Percent of Study Median. We recommend using this measure, rather than rank values, for comparing states’ relative rate position over multiple studies.
  4. We study rates using a snapshot on January 1 of the study year. We look at where the rates are on the date of the snapshot, not whether they are going up or down.
  5. Index Rates are averages, sort of. The study’s Index Rate is different than a simple average rate. Premium rates within a state vary dramatically by the risk classification involved, and states’ economies have a different mix of these classifications. The study controls for these differences by looking at premium rates as if each state had the same mix of risks. This figure is the Index Rate, which is not the state’s actual average; instead it’s an average that has been weighted for comparability across states.
  6. High-wage or low-wage state? Don’t worry, wage rate differences across states have little or no impact on the results. Here’s why: rates in workers’ compensation are measured in dollars per $100 units of payroll. High-wage states may have higher benefit levels, but they also have higher wage bases. So, when both parts of the computation increase with higher wages, the resulting rate isn’t affected.
  7. Pure premium rates are a big part of the rate comparison, but only a part. The study also includes factors for insurer overhead and state administrative agencies’ assessments, when these can be put on a comparable basis.
  8. Study data don’t tell us why a state’s rates have been going up or down, or where they might be in the future. Nor do they tell us how effective a system is in minimizing disputes, getting injured workers back to work, paying out adequate benefits, or getting cost-effective medical treatment. Clearly, those are important performance areas too.
  9. The study doesn’t consider insurers’ profitability, discounts, dividends, or activity in the state’s assigned-risk plan. Those items aren’t available for all states, and even when they are available, they’re often incomplete during the year we’re studying. Employers that self-insure (or, in a few jurisdictions, opt not to insure) aren’t included in the study because they aren’t paying workers’ compensation premiums.
  10. Need more detail? We’ve got more! There are two publications that report Oregon’s findings in each study cycle:
  • a summary, typically published in the fall of even-numbered years, and
  • a full report with much greater detail, published the following winter.

Prior studies, both summary and full reports, are available at: http://www.oregon.gov/DCBS/reports/Pages/general-wc-system.aspx

 

The GB Journal: Pithy, Trenchant and Chock Full Of Stuff You Can Use

Thursday, August 11th, 2016

In March of this year, friend and colleague Dr. Gary Anderberg, Senior VP of Claim Analytics for Gallagher Bassett Services, had another one of his good ideas: Publish concise and useful information for risk managers who don’t have a lot of spare time to wade through oodles of research. In Gary’s words:

The basic purpose of The GB Journal is to keep our clients informed on new developments that impact WC, A/L, G/L and property coverages. The idea is that most risk managers are more than a little pressed for time, so a neat synopsis with a link or two for those interested in more details, will be helpful. We also see this as a neat vehicle for generating useful conversations between our account managers and our clients concerning important issues. I try to keep the average item to about 350 to 400 words and no more than three items per issue. That’s no more than five minutes of reading time total.

And presto, his GB Journal was born.

GB 11 August

I love the tagline: We deal in conclusions, not opinions.

Gary says the Journal is for clients of GB, but anyone can subscribe. He’s the sole author and publishes every other Thursday. The current issue summarizes the Workers’ Compensation Research Institute’s recent analysis of eight state’s attempts to curb physician in-office dispensing and discusses the new term of the day, BoT – Burden of Treatment.

At the Insider, for years we’ve been doing something similar when Julie Ferguson posts her News Of Note, but we have no set schedule for that and don’t limit it to three items. Gary’s approach is different, but certainly worthwhile and effective.

I like what Gary is doing. It’s good for GB’s business, but it’s also good for the workers’ compensation community at large. If you’re not already a subscriber, I recommend you become one.

 

It’s Been A Bumpy Ride Since 1972

Tuesday, June 14th, 2016

In its report to President Nixon, the 1972 National Commission on State Workmen’s Compensation Laws, created by the Occupational Safety and Health Act of 1970, concluded that workers’ compensation laws and benefits were vastly disparate among the states. Benefits in one state might be generous, while across the nearest border they’d be parsimonious.

Although Commission members differed on some points, they unanimously agreed parity among the states was highly desirable. They also recognized that to achieve this goal federal preemption as well as federal minimum standards were impractical for two reasons. First, the federal government had not demonstrated it was capable of successfully undertaking such an effort and, second, entrenched vested interests would fight to the death to preserve the status quo (I wonder what the members would say about today’s vested interests’ clawhold on the system?).

Consequently, in its report, the Commission made 84 coverage and benefit recommendations to the states, 19 of which it termed “essential” in order to establish an adequate workers’ compensation law. In the thirty-year period between 1972 and 2002, the states adopted an average of 12.9 of the 19 recommendations, or about 67% of them. The nationwide workers’ compensation crisis of the late 1980s and early 1990s put the brakes on any movement to adopt more of the recommendations.

In the recent past, workers’ compensation reform has percolated again, only this time in the opposite direction. For example, the October, 2015, Propublica/National Public Radio series, echoing back 43 years to 1972, once again threw a stark light on the continuing lack of uniformity in state benefits. In a kind of circle-the-wagons, and if that doesn’t work, head-to-the-bunker reaction, the series was roundly and caustically criticized by members of the workers’ compensation industry. But, as John Adams said in his summation when courageously defending British soldiers following the Boston Massacre, “Facts are stubborn things.” And one, inescapable fact is that in terms of the generosity of workers’ compensation benefits, in 2016 it matters greatly in which state an injury occurs.

Then there’s opt-out. Given the complexity and bureaucracy of the workers’ compensation system, I certainly cannot blame employers for saying, “We want out.” However, if employers are allowed to create their own systems, what happens, as I’ve written before, “down the street, around the corner at Kenny’s Citgo when one of Kenny’s five employees is injured on the job?”

And now, in a little uphill blowback, the Florida Supreme Court has ruled it is unconstitutional to cut off temporary total disability benefits at 104 weeks to a worker who remains totally disabled and unable to work and has not reached maximum medical improvement. This harkens back to the 1972 Commission’s Recommendation 3.17, which said total disability payments should be paid for the duration of the disability without regard for dollar amount or time. It will be interesting indeed to see how Florida deals with this ruling. It is a serious setback for employers.

I have to admit a nationwide lack of uniform benefits makes no sense to me. I just don’t get it. The 1972 Commission also had a remedy for this. It recommended, “that compliance with these recommendations should be evaluated July 1, 1975, and, if necessary, Congress, with no further delay in the effective date, should guarantee compliance.” Well, that never happened did it?

So, where are we?

We’ve advanced some distance, but, as John Burton, the Chair of the 1972 Commission, suggests, if we continue to advance at this rate, the 19 essential recommendations will be law throughout the land sometime in the 23rd century.

As with everything else in business, this all comes down to money.

WCRI’s Annual Conference: Two Days of Research Data. What Could Be Better?

Monday, February 15th, 2016

The Workers’ Compensation Research Institute, located in the heart of Geek Heaven, Cambridge, Massachusetts, begins its 32nd Annual Issues and Research Conference in less than a month, 23 days to be precise. The conference is always interesting and often highly informative. Looking at the Agenda, this year’s effort seems to hit on both marks.

The theme is Understanding Today to Prepare for Tomorrow, which I guess could be anyone’s daily Mantra, but is exactly what the WCRI has been doing since its founding in 1983.

A lot has happened in the workers’ comp world since then. Perhaps the most astonishing development is the tremendous rise in medical costs. In the mid-1980s, medical costs comprised about 44% of total loss cost dollars, while indemnity payments took the lion’s share of 56%. Today, we see something entirely different, with medical costs taking up around 60% of the total. How times have changed!

However, comparing medical to indemnity costs is a bit like the old apples and oranges cliché. By that I mean that medical costs, despite fee schedules, have been able to go on there own little rocket ride to the moon in most states. Indemnity payment increases, on the other hand, are everywhere limited and tied in some way to the rise in the average weekly wage in the various states. And since 1973, average hourly wages, measured in constant 1984 dollars, have increased by a paltry 4%. This is one of the reasons why, despite a continuing decrease in injury frequency, a concomitant increase in severity doesn’t move the indemnity needle.

WCRI’s conference will dive into workers’ comp’s thorny issues with both feet. The session entitled Impact of Fee Schedules on Case-Shifting in Workers’ Compensation promises to be interesting, indeed. The relationship of case-shifting to the ACA has been something that many have opined about, but now I presume we’ll see some solid data.

Another session that looks as if it will present both interest and fireworks is the Opt-Out Panel. Actually, there are two Op-Out Panels. WCRI is devoting nearly three hours to the subject. Seat belts should be fastened.

I’m looking forward to this year’s conference. It’s happening  March 10-11 at the Westin Copley Place Hotel. Hope to see you there.

There’s No Fairy Godmother For This Cinderella

Monday, July 13th, 2015

I’d like to make a bet with you. Here it is. I bet you will answer “Yes” to at least one of the following three questions:

  1. Do you know anyone who works as a Personal Care Aide or a Home Health Aide?
  2. Has anyone in your immediate family, now or in the last 10 years, been taken care of by a Personal Care Aide or a Home Health Aide?
  3. Do you personally know anyone who  now or in the last year employed the services of a Personal Care Aide or a Home Health Aide?

I like my odds. According to the Bureau of Labor Statistics, six of the ten fastest growing occupations from 2012 to 2022 will be in the health care industry and numbers two and three on the list are – you guessed it – Personal Care Aides and Home Health Aides, growing by 49% and 48%, respectively, closely following Industrial-Organizational Psychologists, a profession that is expected to grow by 53% during the ten year period.

While Psychologists are projected to have the greatest rate of growth, they’ll only be adding about 900 jobs to the economy. This is dwarfed by the numbers of new jobs for the Aides, 581 thousand and 424 thousand, respectively. Taken together, they’ll be adding more than a million workers to the economy. A hefty number, indeed.

The rate of injury for both of the Aide groups is 2.5 times the rate for all public and private sector workers.¹ You would think that would get somebody’s attention, maybe somebody at OSHA, for example. And, you know what? It did. This from OSHA:

The Occupational Safety and Health Administration (OSHA) announced a new National Emphasis Program (NEP) to focus outreach efforts and inspections on specific hazards in nursing and personal care facilities with high injury and illness rates.

“Nursing and personal care facilities are a growing industry where hazards are known and effective controls are available,” said OSHA Administrator John Henshaw. “The industry also ranks among the highest in terms of injuries and illnesses, with rates about two and a half times (emphasis added) that of all other general industries. By focusing on specific hazards associated with nursing and personal care facilities, we can help bring those rates down.”

Only one problem with that: It was written exactly 13 years ago this month!

Now read this:

Non-fatal injuries to health care workers requiring days away from work are on the rise, according to new data from the Bureau of Labor Statistics released Nov. 9, and OSHA Administrator Dr. David Michaels has vowed to launch a National Emphasis Program on Nursing Home and Residential Care Facilities.

“It is unacceptable that the workers who have dedicated their lives to caring for our loved ones when they are sick are the very same workers who face the highest risk of work-related injury and illness,” said Michaels.

According to BLS, the incidence rate for health care support workers increased 6 percent to 283 cases per 10,000 full-time workers, almost 2.5 times the rate for all private and public sector workers (emphasis added) at 118 cases per 10,000 full-time workers. The rate among nursing aides, orderlies and attendants rose 7 percent, to 489 per 10,000 workers. Additionally, the rate of musculoskeletal disorder cases with days away from work for nursing aides, orderlies and attendants increased 10 percent to a rate of 249 cases per 10,000 workers.

“The rates of injuries and illnesses among hospital and health care workers underscore OSHA’s concern about the safety and health of these workers,” said Michaels.

That was written by OSHA in November, 2011.

A National Emphasis Program is becoming kind of predictable for OSHA. Maybe we’ll see another one around 2020. Until then, or until ever, Personal and Home Health Aides will be the Cinderellas of the health care universe. Except their story won’t have a “happy ever after” ending, and they’ll never get to meet a Prince.²

 

¹ And this rate of injury does not include the thousands of Aides who are hired to take care of Grandpa and Grandma in the home and who are paid minimum wage.

² Paying lip service to this issue goes back at least as far as 1997 when the BLS, using 1994 data, published an Issues Paper, and said this:

Overall, the 1994 injury rate in home
health care services (474 lost workday
cases per 10,000 workers) is about 50
percent higher than the injury rate in
hospitals, the institutional setting from
which many home-care patients are
released, and 70 percent greater than the
national rate.

 

Related: A Living Wage For Caregivers, New York Times, 10 July 2015

 

Hospital Medicare Charges: You Don’t Always Get What You Want

Monday, June 8th, 2015

In early June of this year, the Centers for Medicare and Medicaid Services (CMS) let loose a treasure trove of data. One data set lists inpatient charges of 3,000 hospitals for the 100 most frequently billed diagnoses of 2013. The differences between what the hospitals billed and what Medicare paid are eye-popping, as are the differences between what hospitals within just a few miles of each other charged.

The inpatient data shows Medicare paid about $62 billion to cover more than 7 million discharges. Our good friends at Modern Healthcare have analyzed the data. This, from Modern Healthcare’s Bob Herman:

Hospitals have been under intense scrutiny for their billing practices, often triggered by extremely high charges—or sticker prices—for common procedures. Consumer groups and patient advocates argue hospital pricing is shrouded in secrecy, which has put patients on the hook for costly bills. But hospitals have said the listed charges are irrelevant because they only serve as a starting point for negotiations with insurers and that patients rarely, if ever, pay those prices.

The CMS data is shining a light on the process. The agency has now released data from 2011, 2012 and 2013. Charges for various inpatient and outpatient procedures differed significantly again in 2013 as they did in prior years. In many instances, charges fluctuated greatly among hospitals in the same region.

A Modern Healthcare analysis of the inpatient payment data shows Philadelphia, Los Angeles and Newark, N.J., had the largest gulfs in charges between the top and bottom hospitals. For example, in Philadelphia, the average difference in average hospital charges across all procedures was $123,847. In Los Angeles—an area rife with academic medical centers such as Cedars-Sinai Medical Center—the average difference between the highest-charging hospital and the lowest-charging hospital was about $112,000.

Did you catch the part about the listed charges being irrelevant, because they’re only starting points for negotiations? Reminds me of the last time I bought a car.

You might be tempted to say, “That’s crazy! Why do hospitals do that?” Let me answer with a little story.

A few years ago, I was a Trustee at a major teaching hospital in Massachusetts, a tertiary care facility, one of the biggies. At one Board meeting early on in my trusteeship I asked the CEO how the hospital was compensated for uninsured people who were indigent. His answer? “We charge them the moon.” Note to reader: he’s talking about the indigent patient, here. “Then, when the state’s uncompensated care pool gets around to paying us, we’ll get a lot more than if we just charged them what the procedure cost, in which case we’d get a lot less than what the procedure cost.” I never forgot that lesson in hospital economics.

So, you see, when hospitals say their charges are “starting points,” they’re telling the truth. And that is one spooky scary example of what a first-class horrendoma the American healthcare system (if you can call it that) has become.

Cavalcade of Risk and other news items of note

Wednesday, August 22nd, 2012

Emily Holbrook does a stellar job hosting Cavalcade of Risk #164 at Risk Management Monitor. A sampling of recent posts on varied topics may tell you why Risk Management Monitor is on our regular reading list and one of our favorite blogs: The Formal Demands of a Somali Pirate, The 3 Most Curious Claims, and Insurance Claims from Colorado Wildfires at $450 Million and Growing.
Industry pulse – At propertycasualty360, Stephen Klingel offers an explanation of conflicting signals in the latest NCCI Workers Comp State of the Line report. He discusses why the market remains “worrisome” despite a number of positive developments. On the plus side, we see that claims frequency is down and written premium is up, but the industry’s reserves are deteriorating and the residual market is growing – indicators that bear watching. He cites claim frequency, the underwriting cycle. uncertainties related to healthcare and financial services reforms, and efforts to expand alternatives to Workers’ Comp as additional areas of concern that NCCI is monitoring.
Paid sick leave & workers comp study – A recent NIOSH-related study revealed that workers with paid sick leave were 28% less likely to report an occupational injury that needed medical care than workers without paid sick leave. Also, workers in high risk jobs appeared to benefit more. The survey encompassed 38,000 workers and was based on data collected by the National Health Interview Surveys from 2005 through 2008. While survey authors caution that the survey does not establish a a cause-and-effect relationship between paid sick leave and the incidence of workplace injuries, it does raise the issue that workers who do not have paid sick leave may feel economically pressured to work while sick, exposing them to greater likelihood of injury.
Right to safe workplaces – Kevin Jones raises the question of whether safe work is a basic or fundamental human right on the Australian SafetyAtWorkBlog. He raises this question both specifically for Australia, but also from a global perspective.
Healthcare & politics – Wondering about the healthcare implications of Romney’s vice presidential pick? Joe Paduda is on the case: At Managed Care Matters, he posts about Paul Ryan’s evolving stance on deficits and Medicare spending.
Healthcare workers and mass trauma – Dr. Camilla Sasson was on duty in the Emergency Department of the University of Colorado Hospital on the night of the Aurora shootings. She talks about her experiences that night on the RWJF Human Capital Blog, offering insight into the extreme stress that healthcare workers face during and after a mass casualty event – as well as how patients help the doctors heal.
Other news of note

Workers’ Comp Annual “Must-Read” Doc: The NCCI Issues Report

Thursday, May 3rd, 2012

Workers’ comp geeks and nerds, your wait is over: NCCI’s 2012 Workers’ Compensation Issues Report is out. For the uninitiated, NCCI stands for “National Council on Compensation Insurance, Inc.” NCCI manages the nation’s largest database of workers compensation insurance information, supplying data to more than 900 insurance companies and nearly 40 state governments.See the NCCI state map for a quick glance of states that use NCCI as their licensed rating and statistical organization. NCCI describes the services it offers as “analyzes industry trends, prepares workers compensation insurance rate recommendations, determines the cost of proposed legislation, and provides a variety of services and tools to maintain a healthy workers compensation system.”
So the Annual Issues Report is a rather big deal – arguably one of the most important workers’ comp documents of the year. It offers an annual checkup on the health of market, along with discussion of trends, legislative changes, and the like. Plus, informed commentary on hot topics from various industry leaders.
The cornerstone document in the report is President and CEO Stephen Klingel’s annual update, this year entitled Workers Compensation Market Struggles to Identify a Direction (PDF). Klingel notes that it’s no easy matter offering any forecasts because we are in a time of uncertainties and adjustments as we make the long, slow climb from the recession. A few of his observations we found noteworthy:

  • In what is referred to as “the most surprising and disturbing negative
    development,” claims frequency saw its first increase in 13 years.
  • After 6 years of decline in the residual market (aka, “market of last resort” or “the pool”), NCCI is seeing initial signs of an increase.
  • Direct written premium is showing some growth.
  • State results show deterioration, with the ratio of increases in loss costs to declines doubling in just two years, a trend that is expected to continue in 2012.
  • Key quote: “With investment yields at historic lows, the current levels of underwriting losses are not sustainable. Even with what appears to be a temporary increase in investment gains, the combined ratio needs to decline substantially to earn a reasonable return on capital.”

Goring forward, uncertainties prevail. There are many wild cards that make forecasting difficult, with two big ones being the effect of the economic recovery and the 2012 election. And while there have been both troubling indicators (a rise in frequency, signs of residual market growth) and more positive indicators (improved investment scenario, growth in written premium), it is too soon to say if any of these are the beginnings of a trend.
Here’s an overview of other articles included in the Issues Report – all available for download, and all worth your time.

  • Robert P. Hartwig looks at the labor market recovery and the impact on insurers
  • Harry Shuford talks about the economy and what it will take to get us moving again
  • Peter Burton offers a legislative outlook, in which he recaps some of the major changes in 2011 and looks ahead to 2012
  • Joe Paduda looks at some key issues driving medical costs, opioid overprescribing and physician dispensing
  • Nancy Grover offers an overview of the state of insurance technologies
  • Tanya Restrepo and Harry Shuford write about the aging workforce and its effect on comp
  • Jim Davis and Yair Bar-Chaim examine the first rise in injury claims frequency in more than a decade
  • Dennis Mealy and Karen Ayres discuss the history of ratemaking in workers compensation
  • Charles Tenser examines four of the most discussed legal challenges involving workers comp