Archives for March 2017

Workers Comp Statistics Madness Shocker Appears Last Week

March 30, 2017 By JL Risk Management Consultants

How Can Workers Comp Statistics Madness Be Cured?

One of the supposedly important Workers Comp Statistics based articles appeared last week. The study and article compared (Affordable Care Act) Medicaid expansion states with states which decided not to allow the expansion. The conclusion drawn was:

Tag workers comp statistics Madness Graphic

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States that allowed Medicaid expansion under the Affordable Care Act experienced a lower Workers Compensation Loss Ratio than the states that did not allow Medicaid expansion.

I coined the madness term back in 2013. The madness originated from other articles and studies, not insurance or WC.

Cutcompcosts.com and J&L Risk Management Consultants decided to not mention the company in this article. We wished to avoid a lawsuit by pointing out the main shortcomings of the study.

The main thesis consisted of comparing the Workers Comp Loss Ratios <<<not one of my favorite workers comp statistics. The reason why consists of better statistics (hundreds) provided by actuaries and rating bureaus. If you disagree, please use our contact us or comment on the article. Many proponents think it is one of the best workers comp statistics. I think otherwise.

Diagram of workers comp statistics Graphic

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The researchers often miss the intervening statistic. The old study example of ice cream sales compared to assaults comes to mind. The more ice cream sold equates to higher assault rates. However, the Summer is the intervening statistic or :

Higher Ice Cream Sales = Summer
Summer = Higher Assault Rates<<<due to more people outside in public
So, higher ice cream sales results in higher assault rate

Studies of this type litter the Internet. That concerns me.

Workers Comp has been rated by using the Experience Modification Factor since it began – well, in the 1930’s. If you search the J&L Risk Management website, you will see many articles on the E-Mod.

The E-Mod is a delayed system. You cannot tell actually what happened fully in any state with WC until 4 years after a policy commences. The aforementioned loss ratios are not designed to be a rating factor of any type. My actuarial background says no.

If your company is self insured, then the Loss Development Factor (LDF) reaches further into the past – up to 10 years. To say the Loss Ratio produces a premature measurement is a large understatement.

Therefore, as with ice cream and assaults, one should examine other intervening variables – LDF or E-Mod. Workers comp statistics can be great – with the right ones.

©J&L Risk Management Inc Copyright Notice

California Workers Comp Status Conferences – Adjuster Guest Author

March 22, 2017 By JL Risk Management Consultants

Setting California Workers Comp Status Conferences

This article on setting California Workers Comp Status conferences definitely applies to Workers’ Compensation claims at the WCAB level. However, I think that the technique could be useful in other jurisdictions so use your own judgment and apply the techniques as they apply to your business.

Graphic of California Workers Comp Status Conferences Techniques

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Have you ever been frustrated with a case that just seems to be going nowhere? Do you have a case that is ready to settle, but can’t get a hold of opposing counsel? Do you work in a busy California WCAB venue, or another venue that allows the setting of
status conferences?

If the answers to any of these questions are “yes”, then I think this tidbit of information would be helpful to you. Having worked in our industry for 16 years now, with 15 years of that being adjusting claims, I know that in our industry, everyone is busy on a daily basis.

From phone calls to emails to faxes, the days just go by so fast. Many times, co-defense or counsel for the opposing side are just simply busy at hearings.

Pen And Paper California Workers Comp Status Conferences Vector

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So my tip to get the communication going again, and to move the case along when you are trying to settle is to set a “Status Conference”.

This type of conference does not trigger closure of discovery, but it does basically “force” the parties to appear at the WCAB and discuss the case. Make sure your counsel is prepared for the hearing, and that you have given them benefit printouts, current medical reports and proper settlement authority.

Be sure to make an offer at the hearing for settlement based on the evidence at hand in the case. Make the offer in writing, thus “requiring” that counsel shows it to their client.

Please consider any unresolved factors like EDD liens, Retro Temporary Disability or additional body parts in your valuation of the settlement.

More often than not, when I use this approach, we settle the case faster. If not, then at least we have a solid plan and usually a counter demand (to get authority for if needed to get closer to settlement).

Now move forth and use this technique. But of course listen to the advice of your counsel as they usually know the venues and judges pretty well!

An excerpt from “Setting Status Conferences” (The Work Comp Diaries by Dean Sultani).

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Are Workers Comp Insurance Agents Not Yoda Any Longer?

March 16, 2017 By JL Risk Management Consultants

Workers Comp Insurance Agents vs The Interweb of Things

Workers Comp Insurance Agents are not the subject of almost any of my 1,700 articles. The insurance industry grinds to a halt very quickly without agents or brokers. Agents operate like a car engine.

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One of the first things I express during presentations is do not blame your workers comp insurance agent for anything you hear from me today. Agents operate in an infrastructure that was built for them long ago.

Agents and Brokers actually referred J&L 70% of our business when we experienced tough times in the early 2000’s. <<Tip of the hat.

I just read an article in the Triad Business Journal that made my eyes open before my second jolt of java. J&L Risk Management Consultants sells services every day. We identify with searching and obtaining new clients from not too different of an angle.

By the way, The National Network of Biz Journals cranks out the best business info on the planet. I learned how to change my Linkedin Profile for the better. I then found the passage below. The same article’s story on the Blackberry (follow the link in the 2nd paragraph) cheered me up on a dreary cold morning.

Check this out—–substitute in any service or product for car industry –amazing insight.

Salesman Workers Comp Insurance Agents Demonstrating Apple Ipad

Public Domain-Tomwsulcer

“Look at the new car industry. Not long ago, new car salespeople were viewed as Yoda, the wise and knowledgeable being in Star Wars. Those salespeople knew everything about the features, functions and deals. Buyers relied on them to share their wisdom so that educated car purchase decisions could be made because they had no other way to know the information.

We don’t need new car salespeople to play the Yoda role anymore. The internet puts every bit of information (and even more than what the salespeople shared) at our fingertips. As a matter of fact, more and more, people are making their purchasing decisions without ever setting foot in the dealership. They research online and make a buying decision.

If you are a new car salesperson clinging to the Yoda past, you probably aren’t selling many cars today. You’ve not adapted your approach with the changes in the buying process, which puts you at risk.”

Real Estate Workers Comp Insurance Agents With Couple

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When J&L searched for our insurance packages, we turned to Insurance Noodle for a number of years. I never talked to an agent for 7 – 8 years, well, except for friends of mine that sell insurance of different sorts. This happened 15 years ago. Now, I email our two agents twice per year at the most. We researched and found the biggest bang for the buck on the Internet.

Workers Comp insurance agents that disagree, please email me, comment, or use our Contact Us Page.

Yoda is a trademark of LucasFilms, Ltd. Insurance Noodle is a screen mark of BIN Insurance.

©J&L Risk Management Inc Copyright Notice

Major Workers Comp Changes On Horizon Fed .25 Point Increase?

March 15, 2017 By JL Risk Management Consultants

The 10 Ways The Fed May Cause Major Workers Comp Changes

Graphic of major workers comp changes on Road With Coins Dollar and Building at the Back

We could be on the verge of major workers comp changes. The Fed Head Janet Yellen and her Board just increased the Federal Bank lending rate by .25%. This may not be a jolt to the insurance markets – yet. Read the article linked to in the second sentence. Yellen may institute a stealth increase soon.

A scenario follows which may cause a Hardening of the Markets. I warned about this before when China was affecting the world money markets. Now, the money market changes are much closer to home.

The Fed increases the prime lending rate a few times over the next two years.
Naturally, the investment and debt interest rates will follow.
Insurance carriers have been able to support a soft market by making up their lower premiums with outside stock investments – check any insurance carrier’s financial statements.
Over the last 50+ years, when interest rates look better, people and companies move their funds from stocks to money market accounts.
Over the same last 50+ years, the numbers show that stocks earn much more than any type of interest bearing account
Insurance carriers will not be able to earn the same returns, stocks earnings always beat interest bearing accounts
As mutual funds and investors in general put money on interest, the stock market usually suffers – not a market correction
Wikimedia Commons flickr.com-epSos.de
The carriers have to make up the prior soft market underwriting losses somewhere – namely premiums
Due to these major workers comp changes, carriers will become risk averse and stop underwriting certain riskier markets
The above nine steps are not a crisis of any kind. They represent the start of a Hard Market.
Bonus thought – as the dollar strengthens (as it has for three months), foreign investments will suffer as bringing funds back into the US will cost much more than in 2016 and previously. Ouch for foreign investments

A friend of mine says that even a broken clock tells the correct time twice a day. He could be correct in this case. The stealth concern is that the US printed money by the basketful.

Businessman Major Workers Comp Changes Embracing Dollar Sign

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The interest rate on a large amount of currency – we do have a ton – needs only small interest increases to cause a spike in inflation > Think about Greece in the EU.

Will 1 – 11 above happen? The Fed would have to increase interest rates over the long term each time they meet. Carriers may decide to take it on the nose just to keep business.

Are the conditions right for a hard market? Major workers comp changes may occur if the interest rate spikes.

©J&L Risk Management Inc Copyright Notice

Does Affordable Care Act Repeal and Replace Mention Workers Comp?

March 14, 2017 By JL Risk Management Consultants

The Affordable Care Act Repeal and Replace – Any Mention of Workers Comp?

The Affordable Care Act Repeal and Replace is now working its way through Congress, Senate, and President. Last week’s WCRI meeting showed the Work Comp community’s concern over any Federalization of Workers Compensation (c).

Picture of Hands Carrying Baby Feet Affordable Care Act Repeal and Replace In Black Background

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Former Senator Tom Coburn and former House Member Henry Waxman both reiterated what most of the Federal Government confirmed in any meeting. The Feds are not that concerned over Work Comp. I think one of the two said “There are bigger fish to fry.”

I carried the inquisitiveness of the WC community when I read the two current pieces of legislation that are on the table. By the time I finish this article, another version will likely be in play.

Both versions are below:

Budget Reconciliation Legislative Recommendations Relating to Repeal and Replace of the Patient Protection and Affordable Care Act
SUBTITLE _ — REPEAL AND REPLACE OF HEALTH-RELATED TAX POLICY

Tax Affordable Care Act Repeal and Replace Paper

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These two pieces of legislation carry the main thrust of the repeal and replace moniker. If you search them for Workers Comp, WC, Workers Compensation, etc. you will come up with zero instances.

No one wants to fiddle with Workers Compensation right now. The level of concern will grow later when being able to sell insurance across state lines hits the airwaves. In other words, if an agent sells health insurance across state lines, workers comp may soon follow the same path.

WC has been villainized over the past few years as a possible failure or at least failing in its original mission. If that is true, then why do the Feds not act on it? Senator Coburn and House Member Waxman discussed the Affordable Care Act Repeal and Replace over and over again for most of their hour. Workers Comp took up approximately five minutes as the two gentlemen were at the WCRI Conference, not the AHRI Conference. (ACRI = Affordable Care Research Institute). < my apologies to WCRI. If not for the location, the two may not have mentioned Workers Comp at all.

©J&L Risk Management Inc Copyright Notice

North Carolina Rate Bureau Adds New Rules Including PEOs

March 9, 2017 By JL Risk Management Consultants

North Carolina Rate Bureau Adds New Rules – Changes Others

The North Carolina Rate Bureau (NCRB) mostly followed the new national rules from NCCI on most of their rule changes. However, the Bureau added in a few changes that did not follow NCCI.

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You may find the document at the North Carolina Rate Bureau website. The circular letter was entered behind a password protected website. I have summarized the letter below.

Premium Audit Compliance – The NCRB followed most of the nation for premium audit non-compliance with a few exceptions that are specifically North Carolina-based
- Insureds that fail to respond to a carrier’s request to audit or refuse to allow access to records needed to complete the audit, may be subject to a charge of up to three (3) times the estimated annual premium for their policy.
- Carriers must endorse the policy with the Audit Noncompliance Endorsement (WC 00 04 24) at inception to be allowed to impose the charge. This endorsement is required on all policies in the Assigned Risk market.
- An insured that fails to respond to an audit request or refuses access to records needed to complete an audit will not be eligible for assigned risk coverage through the North Carolina Workers Compensation Insurance Plan.
Assigned Risk Plan – these are the following carriers for the North Carolina Assigned Risk Plan
- The Servicing Carriers selected are:
  - AmGuard Insurance Company
  - LM Insurance Corporation (The Liberty group was previously accepting direct assignments)
  - Travelers Property & Casualty Company of America
- In addition to the servicing carriers, there are multiple direct assignment carriers writing residual market coverage for North Carolina. As of January 1, 2017 the direct assignment carriers are:
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  - ACE American Insurance Company
  - American Interstate Insurance Company
  - American Zurich Insurance Company
  - Auto Owners Insurance Company
  - Builders Mutual Insurance (previously Builders Premier)
  - Cincinnati Insurance Company
  - Continental Casualty Company
  - Hartford Underwriters Insurance Company

What is the difference between a Servicing Carrier and a Direct Assignment Carrier?

Servicing Carrier

Provides coverage to eligible employers on behalf of all pool participants.
Is fully reinsured through the National Reinsurance Pool.
Selected for a 3 year period through a bid process.
Quota determined as part of bid process.

Direct Assignment Carrier

Not reinsured through the National Reinsurance Pool.
Solely responsible for financial results of assignments.
Notification to NCRB annually on desire to be a Direct Assignment Carrier.
Quota is equal to percentage share in voluntary market.

PEO Regulation Changes

Stack Retouch North Carolina Rate Bureau Papers

Wikimedia Commons – Niklas Bildhauer

The North Carolina Rate Bureau decided that wording on policy endorsement forms needed to clarify which employees are to be covered by policies issued to the PEO and their client company(s).

Rule 3.D was revised to more clearly define how policies are to be written and endorsed to ensure that workers compensation insurance coverage is being provided for employees of PEOs and their clients in accordance with North Carolina statutes and regulations.

Class Code Changes

These will be analyzed along with the National changes to the codes by NCCI. The North Carolina Rate Bureau followed NCCI on most classification codes with a few exceptions.

There are additional changes that will be covered in a future post once fully analyzed.

©J&L Risk Management Inc Copyright Notice

2017 WCRI Conference 2nd Morning Session Blogging Live

March 3, 2017 By JL Risk Management Consultants

2017 WCRI Conference 2nd Morning Session

Live Blogging – typing it as it happens

STATE OF THE STATES

The start of the 2017 WCRI Conference 2nd morning session will discuss some of the latest findings and trends seen across WCRI’s core benchmark studies, including WCRI’s 18-State CompScope™ Benchmarks reports, a multistate benchmarking program that measures the performance of a growing number of state workers’ compensation systems.

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This session will be helpful to stakeholders and public officials who are looking to better manage change and avoid the historic pattern of crisis-reform-crisis that has frequently characterized workers’ compensation in the past.

Carol Telles – WCRI

Less hospital use in the 18 states WCRI analyzed
Since 2000 33% increase in outpatient admissions
2000 – 2008 increase in hospitalization – then decrease
Kentucky and Minnesota were the two most significant decreases almost 4%
New Jersey back surgeries (outpatient) increased but inpatient decreased
2000 – 2014 60% increase in ASC’s – ambulatory surgery centers
North Carolina and Georgia had most significant decreases in inpatient surgeries
ASC’s are 50% cheaper
Wisconsin had highest charges for hospital outpatient physical medicine
Texas has highest decrease in radiological studies outpatient

Will Browder

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Indiana had one of lowest indemnity payments per claim
North Carolina had one of highest indemnity payments per claim
Iowa has highest maximum weekly benefit level – $881
North Carolina House Bill 709
- 500 TTD week cap
- 300 TPD week cap
- Suitable employment definition narrowed

Dr, Rebecca Yang

Attorney Involvement

Illinois had highest attorney involvement 52%
New Jersey had 49% attorney involvement
Wisconsin and Texas had lowest attorney involvement
Texas
- limits attorney hourly fees to $200
- Limits on lump sum settlements
Wisconsin
- Clear standards for TD benefits
- Two PPD structure
New Jersey
- PPD not paid voluntarily
Illinois
- No standards to PPD ratings
- Lump sums based on multiple factors not just PPD
- PPD benefit is much lower so TTD benefit period lengthened
- Medical experts just one aspect in final determination of PPD

COULD VALUE-BASED HEALTH CARE WORK FOR INJURED WORKERS?

Health Care Icon 2017 WCRI Conference 2nd Morning Session For Injured Worker

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Currently, physicians and hospitals treating injured workers are paid using a fee-for-service approach, which reimburses based on the volume of services provided. Across the country, health plans and health care providers have been adopting the principles of “value-based health care” where providers’ compensation is based on the value of services and their impact on patients’ health and where alternative forms of reimbursement, such as bundled payments or capitation, are employed. Join us as we invite a leading expert on the topic to explain what “value-based health care” is and how it would apply to workers’ compensation.

Dr. Alexandra Page, Principal, Musculoskeletal Health Care Solutions

Value = Quality/Cost
Components
- Evidence Based Medicine
- Clinical Practice Guidelines
- Shared Risk
- Outcome Measures – Return to work
Accountable Care Organizations (ACO’s)

Questions

Doctors should share risk
Kaiser at Work

APPRAISING THE “GRAND BARGAIN” IN 2017

Grand 2017 WCRI Conference 2nd Morning Session bargain

Wikimedia Commons – AngMoKio

The workers’ compensation system was created over 100 years ago, and it has evolved over the years to meet numerous challenges. To lower costs, many states have enacted policies to control care and benefits (e.g., allowing the employer to choose the doctor or tightening eligibility for workers’ compensation benefits). For some, these measures have controlled costs without impeding care or access to benefits. For others, the policies enacted across the country have gone too far in reducing benefits and the amount and quality of care to injured workers, eroding the Grand Bargain and leading to constitutional challenges in some states. Join our diverse and distinguished panel of experts as they discuss whether the workers’ compensation system is still fulfilling its mission or needs revisiting.

Prof. Emily Spieler, Northeastern University School of Law
Dr. David Deitz, Principal, David Deitz & Associates
Dr. David Michaels, Former Assistant Secretary of Labor for Occupational Safety and Health (OSHA)
Mr. Bruce Wood, American Insurance Association

Why is Workers Comp being discussed nationally now?

Workers compensation has been a flawed system
PPD compensation
- Many states went to an impairment-based systems
- Used AMA guides – some with modifications
Raising bar on compensability
Utilization Review
TTD caps
Is the Grand Bargain over?
Many workers in the Workers Comp system are not doing that well
No generalized disability system – policy debate
Employer cost vs. social insurance
Workers comp credibility as social insurance
Very complex system
Oregon ruled that Workers Comp is unconstitutional – became a tort system – no avalanche of tort litigation
Causation issue becoming very thorny – bottom line is people need care

Do injured workers share a large brunt of the cost of being out of work?

Injured workers may not want to report an injury
SSDI takes on quite a bit of the brunt of associated costs
Are there impediments in the WC system that keep care/benefits/wage loss from being provided
Case shifting from SSDI to WC?
2010 Study – WC does not cause increases to SSDI costs
NCCI – 12 weeks is average TTD period
West Virginia – PTD awards-odd lot doctrine – system collapsed due to unsustainability
What should the comp system pay for?
Amputation study – 30 – 40% of amputation injuries not reported as WC?

Level and Quality of Medical Care in WC

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Core problem – diverging from direction of general healthcare
Don Burwick – triple aim – key – how are we delivering quality healthcare
WC is headed in wrong direction
Workers Comp medical system – should it be rolled into health? Yes, but not the disability system

Unsafe Employers

German WC system has many more safety inspectors
Insurance carriers do bear some of the responsibility for safety
Better linkage between OSHA and insurance carriers
Many employers do spend funds on safety
Insurance carriers reporting to OSHA may not be good idea as injuries may not be reported
Experience Rating system has an element of confidentiality

Federal Oversight of Workers Compensation System

Disparity of benefits between state
Scheduled injuries is only one aspect of system
Some states have eliminated schedule
States have done a good job overall to move swiftly in the 1990’s
All Federal systems in WC (FECA, Longshore, etc.) are very outdated and inefficient
Lack of consensus may enable attorneys to expand to a tort system
Indiana increased benefits
Unemployment insurance is a good example of the Feds working with the states

Questions

Question And Answer 2017 WCRI Conference 2nd Morning Session Graphic

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Technology is missing from WC agenda
Is the safety net gone from the WC system? Possibly with Opt Out
Subcontractor system has changed the system
Impact of Fraud? – Fraud is not medical provider centered
Statistics in Amputation study – OSHA logs – reporting issues? Data did not match – many studies that show amputations are not getting into the system
How does WC adapt to the future needs of workers? Need to think about TTD of workers that are not in present WC system.

Comments

Huge gaps in medical care in the Workers Comp system as compared to the healthcare system
Indemnity benefits should be the focus – cash benefits- inequities across state lines-communication is the critical part as WC is not separate but included in the whole workplace scenario- if you wait until an employee is injured to be nice to employee, that is rather late
Cannot adjudicate what is not filed in the system, credibility issue – how WC is viewed is critical to its survival
Opt out is a big concern
Injury prevention should not be ignored, how can we use the WC system to enhance safety

End of 2017 WCRI conference 2nd Morning Session

End of 2017 Conference

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WCRI 2017 Conference Afternoon Sessions – Blogging Live

March 2, 2017 By JL Risk Management Consultants

WCRI 2017 Conference Afternoon Sessions – Blogging Live

Please note I only input the trends and not the exact numbers from some of the studies. These studies are still in their preliminary phases.

WCRI OPIOID RESEARCH & HOW STATES ARE COMBATING THE OPIOID EPIDEMIC

This is the start of the WCRI 2017 Conference afternoon sessions. Join us as we learn about WCRI’s latest research on interstate variations and trends in the use of opioids for workplace injuries across 25 states.

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We will also feature policymakers from different states who will share their initiatives to combat the opioid epidemic, to prevent inappropriate opioid use, and to provide help for those battling addiction.

Dr. Vennela Thumula, WCRI
Judge Omar Hernandez, Massachusetts Department of Industrial Accidents
Mr. William Emrick, Acting Commissioner, Kentucky Labor Cabinet

More Than 70% of injured workers with pain meds are still receiving an opioid

Cannot live blog exact studies – preliminary

Positive Results

Arkansas had 83% of injured workers with pain meds prescribed had an opioid
Kentucky and New York had largest reductions in opioid use
Michigan and Maryland had over 35% reductions in opioid use
Kentucky and NY had PDMP requirements with the best results
New York introduced Chronic Opioid Guidelines
Quantity limits introduced in KY, -, –
Kentucky shifted a large amount of pain prescriptions from opioid to non-opioid

Negative Results

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Louisiana and Pennsylvania have highest amount of opioids per claim
Massachusetts and Wisconsin have the highest amount of mixing opioids with benzodiazepines
Louisiana and Florida have highest amount of mixing opioids and CNS Depressants

Kentucky’s Battle with Opioids

Kentucky, West Virginia , and West Virginia had an extremely high opioid epidemic
Senate Bill 176 was introduced in 2005 to created a PDMP
SB 176 was turned away
HB 1 introduced in 2012 – pill mill bill – not just Workers Comp claimants, general public
KASPER – electronic reporting of all schedule prescriptions
KASPER has to be checked regularly by physicians
KASPER has to be in all medical records
Criticisms – complicated the treatment system, etc.
HB 217 to eliminate problems by HB 1
HB 296 requires Workers Comp Commissioner to establish a specific PDMP
Heroin overdoses up in Kentucky, no studies related overdoses to reduction of opioid use as unintended consequences

Massachusetts Opioid Crisis

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Opioid Alternative Treatment Pathway
Judges are in a dilemma – will usually send the case along to litigation, let the opioid alternative alone
One year to hearing
Post lump sum hearings – no compensation at risk
Medicals are lifetime in Massachusetts even if case settled

Proposed Opioid Alternative Treatment Process

Voluntary program
Pilot program for two years
Monthly status updates to Workers Comp Advisory Council

ALTERNATIVES TO OPIOIDS IN TREATING PAIN

As injured workers are steered away from treating their pain with opioids, some in the workers’ compensation community have asked, “What is the alternative for treating pain?” Join us as we learn about two emerging alternatives: marijuana and evidence-based non-pharmacological treatments, including mindfulness-based and cognitive behavioral approaches. The session will feature the latest research on these alternatives as well as first-hand accounts from state government officials on how one alternative, medical marijuana, is being incorporated into the treatment of injured workers in their state workers’ compensation systems as well as what it is like to be managing a program that is very new and federally illegal.

Mr. Paul Sighinolfi, Executive Director of the Maine Workers’ Compensation Board
Mr. Paul Tauriello, Director of the Division of Workers’ Compensation, Colorado Department of Labor
Dr. Dawn Ehde, University of Washington
Dr. Dean Hashimoto, Chair of the Health Care Services Board, Commonwealth of Massachusetts

National Academy of Science Report on Medical Marijuana

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Improvement in chronic pan
- Substantial evidence
- Very little known about efficacy
Increased risk of vehicle crashes
Development of schizophrenia and psychosis
Marijuana cannot be associated with an increase in job injuries
25% decrease in opioid mortality rate in states that had medical marijuana
20% decrease in opioid addiction rate in states with medical marijuana
Federal laws are main obstacle
Lack of prescription standards, routes of administration, dosage
Difficult to conform to federal banking and other laws.

Some states have allowed coverage in WC

California – Cockerell vs Farmers Insurance
Maine – Series of Cases
Massachusetts – unpublished
Colorado – ?
New Mexico

Colorado

Obama administration – Ogden Memo loosened the Federal enforcement
First to allow recreationally
Smoothest harmonization
Marijuana – $1.3 billion sales – 30% increase over last year

Maine

Certification as FDA has not approved, so no prescriptions can be written
Typical patient 58 year old with back pain
Condition specific recommendation or certification
November 2009 – 2.5 ounces
Added in intractable pain as a condition
Burgoin case – ALJ ruled that marijuana was reasonable necessary, appealed to Supreme Court, cost of medications vs. just marijuana indicated a 75% in medication costs.

Questions

Centered on concerns about

Operating a vehicle or
Being under the influence on-the-job
Better way to treat pain that just prescribing marijuana – should be a total approach
Marijuana is another tool in the toolbox of pain treatment

Non-pharmaceutical Pain Management

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Biopsychosocial Model of Pain
Who manages the pain – the individual themselves
Physical activity-Exercise
Cognitive Behavioral Therapy – CBT –
- changing the negative thinking
- better than no treatment
- magnitude of pain relief is similar to analgesics
Mindfulness Meditation
Should be integrated into overall pain treatment
Collaborative Care – integrated healthcare – Care Manager is the hub of treatment

Questions

How does one have the Workers Comp community accept the psychological treatment part of an injury as the attempt is to avoid this type of treatment – screening at 6- 10 weeks of care for high risk to send to collaborative care

WCRI 2017 Conference – Blogging Live – Morning Sessions

March 2, 2017 By JL Risk Management Consultants

WCRI 2017 Conference – Complete First Day Live Blog

Morning Sessions of WCRI 2017 Conference – Please excuse any typos, etc. This is a live conference blogging. It will be updated every 10 minutes.

Dr. John Ruser – CEO

Business People WCRI 2017 Conference Room

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Launching new website next week.
New Logo
Grand Bargain
Research the focal point
Opioid epidemic
Some data is preliminary – do not share

Impact of 2016 Elections on Healthcare and Workers Compensation

Dr. John Ruser – Moderator

The Honorable Henry Waxman – Former Member US House of Representative

All three branches have to get along better
President Trump has not reached out to the Democrats
Dr. Tom Coburn and he are good friends
Affordable Health Care Act -repeal and replace
Now Republicans have majority much like Dems the first two years of President Obama’s term

Features of ACA

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More complicated than even President Trump anticipated
President Trump may not be able to create a complete new market
Mandate created
Most people want to be insured – need to have a third party in the purchase
Competition between insurers
Mandate is to make sure that the healthy people also participate
Catastrophic care and Healthcare Account (HSA)
To make the system work insurers have to stay in the system
Medicare Part D – was not that helpful
Republicans wanted to shift money from poor to tax cuts

Workers Compensation Case Shifting

Yes, there will be case shifting to Workers Compensation
Deduction on tax returns is a very delayed benefit
Medicaid covered a large number of ACA applicants
Setting a limit on what states will get will make a skimpier Medicaid program
Naturally will shift cases to Workers Comp if Medicaid is not there
Medicare has been successful
If people do not have insurance – going to other programs

Does not object to tax cuts – but have to borrow money from the future to fund tax cuts, never paid for the wars

The Honorable Dr. Tom Coburn – Former Senator from Oklahoma

President Trump Executive Orders – Congress ceded much power
Limited action by Federal Government
17th Amendment not good

Features of ACA

Pharmacist And Woman With Baby WCRI Conference Picture

Wikipedia – Elmvh

Amish families buy healthcare at lower due to their own healthcare market they created
Oklahoma City hospital – provides healthcare to indigents
Disagree with Senator Waxman – have to create a marketplace
$1,200 deductibles
MRI at 10 PM for $100 in Tulsa
Medicaid system does not provide quality – outcomes better if you self-pay
Could fix ACA system -but Republicans/Democrats are too polarized
Bill Hatch -Upton Bill in place to completely replace ACA – go look at the bill as it will likely be the new law
$120 billion deficit on Medicare

Federal Government is out of control. Congress wants to look good not do a great thing for the US.

Workers Compensation Case Shifting – WCRI 2017 Conference

Medicaid is working in Oklahoma
Deductibles shot up under ACA
Freedom always beats governmental control
Rhode Island Medicaid system works
Medicine is getting ready to change – precision care
Workers Compensation will benefit from this care
Most cancers will be cured in 15 years
$105 trillion unfunded liabilities
$1,700,000 per millennial over their lifetime
Medicaid is not the answer – does not guarantee good care
Medicare Part D not that great

Letter to DOL on Federal Oversight of Workers Comp -WCRI 2017 Conference

Wikipedia – U.S. Department of Labor

Senator Waxman – should be some type of oversight for minimum standards – not a big issue right now

Senator Coburn – let states handle it – not a big issue right now

Senator Coburn – If you are not taking care of a person’s injuries – 27,000,000 on SSDI – system bankrupt – 2004 most people were just approved for SSDI as the department was so far behind they were just approved – Opiates are a big problem

Senator Waxman- SSDI should not be a replacement for Workers Comp, 80% of people had insurance that were on SSDI, SSDI should not be a replacement for other insurance systems including Workers Comp

QUESTIONS

Senator Coburn

Healthcare transparency – publish price and outcomes, no transparency, insurance companies have contract with hospital to not disclose prices,
Healthcare is not an individual right but should be provided to all, great book on American Compassion – how people were personally responsible for the first 175 years
North Carolina Medicaid program- holistic care but still requires responsibility, Oklahoma Opt Out will need to be looked at again
SSDI is safety net for Workers Comp denials
SSDI should not be a substitute
$600 – $800 billion wasted in healthcare, eliminating waste would pay for everyone’s healthcare, price vs. quality
ICD10 was a huge cost $12 billion with no benefit to healthcare

Senator Waxman –

Healthcare is basic human right, single payer system, personal responsibility, social responsibility is part of being compassionate people,
Repealing ACA would reduce public health, more money into prevention if there are cuts and increase to military spending
Very worried about what is/may be coming out of Congress, whole healthcare system may be in dire trouble and headed in wrong direction

WORKER OUTCOMES AND RETURN TO WORK

Dr. Bogdan Savych, WCRI
Dr. Glenn Pransky, Liberty Mutual Research Institute for Safety

This is very similar to Six Secrets to Cutting Workers Comp costs – See Return To Work and Employee Treatment

I had performed studies on public entity files

Return to Work

Man Talking To Colleagues WCRI 2017 Conference Room

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MA
KY
GA (18%) did not have successful Return To Work

Largest Predictor in Successful Return to Work was Trust In Workplace

22% of workers that did not Return To Work did not trust workplace

firm shrinking
poor relationship
pessimist by nature

22% of unsuccessful return to work had attorney

Need to focus on worker – employer communication <<<<very important

People felt very positive about positive and early communications

Characteristics of return to work coordinators – most important was ability to communicate

This is very similar to my recommendation – adjusters main job is communication

Sheet on Communication Tips to Help Shorten Disability Leaves – the main concern once again is that the employee thinking they will be treated well. I will see if I can get a copy to share with everyone in the future.

Question from Peter Rouismainerre – any other factor that are as important? Unsure

AN ALTERED STATE: CALIFORNIA’S POST-REFORM OUTCOMES AND COMING ATTRACTIONS
Mr. Alex Swedlow, California Workers’ Compensation Institute (CWCI)

California is now several years into the post-2013 reform era. Placing the reforms in historical context, Alex Swedlow will unpack the intended and unintended consequences of the reforms and discuss some of the competing issues that continue to challenge the system, including fee schedule and utilization controls, confronting fraud and abuse, dispute resolution, cumulative trauma, the highly anticipated drug formulary, and the arrival of legalized marijuana.

SB 863 performance

Woman Overjoyed WCRI 2017 Conference Room

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Good news

Medical cost increase trend has stabilized

Cannot cite this part of presentation – considered preliminary – but all positive results

CA paying twice for spinal surgery hardware
30% reduction in spinal surgeries
Opioids – 27% of all prescription are opioids , but an increasing trend
24% increase in opioid prescriptions
Opioid strength has fallen
412% increase in average medical costs 1990 – 2015
Still most expensive state for Workers Comp
#1 in medical cost containment expense
Loss Adjustment Expenses is almost as high as Indemnity and Medical Payments