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WCRI 2017 Conference – Blogging Live – Morning Sessions


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
  • 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

Physician WCRI Conference With Nurses
  • 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

United States Of America WCRI 2017 Conference Department Of Labor Logo
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


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


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
  • 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

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

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 

Pharmaceutical trends

  • Consist of 12% ?
  • New state formulary
  • July 2017 formulary  implementation
  • 40% of medical reviews are pharmaceutical
  • 100% of all opioids are subject to mandatory UR
  • Bulk chemicals are very controversial
  • Most popular drug is Hydrocodone with Acetaminophen

Lien Filing fee correlates with reduction in liens filed,, repealing caused a sharp increase, reenactment dropped liens again

King vs. CompPartners – major case on UR physicians

  • significant challenge to UR,
  • medical relationship with UR physician and claimant
  • should UR physician advise, warn, and inform claimant?
  • CA supreme court will review it soon

Marijuana in Worker Comp Risk Management

Six States that allow marijuana for Workers Comp (reimbursement)

Six States that disallow marijuana for Workers Comp (non-reimbursement)

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James J Moore - Workers Comp Expert

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Management Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications


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