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Home » Archives for June 2019

Archives for June 2019

Breaking – Pharmaceutical Study – WCRI Covers Trends In 27 States

June 27, 2019 By JL Risk Management Consultants

WCRI Pharmaceutical  Study Shows Decreased Use In Almost 27 States

WCRI  (Worker’s Compensation Research Institute – Boston, MA_  just released a vast pharmaceutical study that covered trends in 27 states. 

workers comp pharmaceutical study pic biogesic

Wikimedia Commons Psiĥedelisto

 

One of the authors was Dr.  Vennela Thumula.  I have had the pleasure of speaking with her at length concerning some of the studies at the yearly WCRI conference. 

PBM (Pharmacy Benefit Management) remains a hot topic in Worker’s Comp arena over the last 10 years with costs spiraling out of control.  The opioid epidemic reached far into work comp medical cost considerations. 

From WCRI –

Workers’ compensation prescription drug payments per medical claim decreased by 15 percent or more in 25 of 27 study states over a three-year period from the first quarters of 2015 to 2018.

That equates to a massive reduction in pharmacy spend from in the three year period covered by the study.   A 15% reduction was tabulated in approximately 93% of the states covered by WCRI.

From WCRI –

The following are among the study’s findings:

  • Once prominent in some states, compounds now account for a very small percentage of prescription payments in most states.
  • The payment shares for opioids declined in all 27 study states to varying degrees.
  • Dermatological agents have become more prominent in many states. Payment shares increased by more than 10 percentage points in 8 of the study states, led by Pennsylvania with a 23 percentage point increase and Illinois with a 21 percentage point increase.
  • Twelve of 27 states experienced modest increases of at least 3 percentage points in payment shares for anticonvulsants.
  • The payment shares for musculoskeletal therapy agents and NSAIDs changed little over the study period in many states

One negative outcome would be the decrease in NSAIDs which have shown to be just as effective as opioids in pain reduction.  

The 27 states in the study are Arkansas, California, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Jersey, New York, North Carolina, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Wisconsin.

 

To learn more about this pharmaceutical study or to purchase a copy, visit https://www.wcrinet.org/reports/wcri-flashreport-interstate-variation-and-trends-in-workers-compensation-drug-payments. The authors of this study are Dr. Vennela Thumula, Te-Chun Liu, and Dr. John Ruser.

 

©J&L Risk Management Inc Copyright Notice

Filed Under: WCRI Tagged With: first quarters of 2015 to 2018, musculoskeletal therapy, PBM, very small percentage

Premium Audit Report vs Bill vs Statement- Important Reader Question

June 27, 2019 By JL Risk Management Consultants

Newsletter Reader Asks What Is the Difference Between a Premium Audit Statement, Premium Audit Bill, and Premium Audit Report?

A premium audit report, statement, or bill all refer to the premium audit process.   Many employers think these mean the same report.   Each one is a different report on the same result. 

cat playing with work comppremium audit report lizard

Public Use License – Basile Monin – Wiki

Each insurance carrier possesses its own business language for each of the three terms.    Any confusion on the three terms results from how each carrier bills for their premium audit results.   No one standard exists for the premium audit billing process.

Premium Audit Report

The premium auditor generates a premium audit report once they finish auditing your payroll and other company records.    The premium auditor may meet with the employer contact to provide a verbal report of their findings before they leave the company premises.    The auditor usually covers how they arrived at their numbers.   

The auditor usually provides the auditor’s workpapers at this meeting.   If the auditor does not, the employer can ask for a copy.   The workpapers can usually clear up many of the questions an employer asks about the results.  

The auditor may take the audit material obtained from the employer offsite.   Much debate exists on whether an auditor can carry any of the company financials offsite.  

Unless there are extenuating circumstances, we recommend that an employer provide the auditor with a comfortable work environment to complete their task.   No policy provision allows for material to be taken off the employer premises during an audit.

The offsite decision remains totally up to the employer. 

If the next two – premium audit statement or premium audit bill – arrive without the audit workpapers and the premium audit report, a request should be made in writing to the insurance carrier. for both of these important documents.  

The premium audit report may contain the audit workpapers.  

Premium Audit Statement

Picture of fountain pen premium audit report made by Pelikan

Wikimedia – MAKY.OREL

The premium audit statement or PAS usually breaks down the premium auditor’s finding into a summary form that shows Classification Codes and payroll amounts.   Often, the premium audit statement will not show  the final billed numbers.   

The premium audit report may be enclosed with the premium audit statement.  

Often, the PAS will denote – This Statement Is Not Your Final Bill.   Some carriers do not send the premium audit statements to their insured employers.    The carriers often combine the premium audit statement and bill into one. 

If your company receives a premium audit statement without the workpapers, we recommend you request those by mail or email to the contacts on the PAS.   

The premium audit statement should not be confused with a statement if your company is overdue with a premium payment.  

Premium Audit Bill

Blurry picture of dollars premium audit report on hand

Wikimedia – At.morey.tota

The premium audit bill closes  out the audit process.   The premium audit bill may contain all the premium audit report, workpapers, and premium audit statement all in one package.   

As mentioned previously, each carrier has its own method of billing out your audited premiums.   No premium billing standard exists other than the rating bureau rules, and the policy provisions. 

Any undisputed parts of the premium bill should be paid timely.  One large error made by employers comes from not paying the undisputed premiums if one part of the bill is disputed. 

Conclusion or Confusion

If my attempt to explain these somewhat confusing terms has confused you further, please contact J&L through our Contact Us page with any questions.   We answer most inquiries within one business day.

The auditor workpapers represents the auditor’s detailed work.   Always make sure you ask for these and do review them even if they are contained in the premium audit report, statement, or final bill.

©J&L Risk Management Inc Copyright Notice

Filed Under: Premium audit Tagged With: extenuating circumstances, large error, PAS, standard exists, verbal report

A Work Comp Claims Department and Chernobyl – One Major Similarity

June 20, 2019 By JL Risk Management Consultants

Work Comp Claims Department and Chernobyl –  Manuals Will Not Fix  The Problem

picture work comp claims department chernobyl

Wikimedia Commons – Public Use License

How does a Work Comp Claims Department and Chernobyl end up in the same passage?  

The article title originates from an extremely highly lauded book – Midnight in Chernobyl.   The author’s breadth and depth of what occurred will astound any reader.   I cannot recommend the book enough if you want to know what really happened at the greatest nuclear disaster on earth.

How does the affable claims department  receive such a comparison?   One of the passages in the book jumped off the page.   

From page 68  of the book-

the atomic chieftains of NIKIET and the Kurchatov Institute apparently believed that a well-written set of manuals  would be enough to guarantee nuclear safety. The designers assumed that, so long as they followed the new instructions closely, human beings would act as promptly and unfailingly as any of the plant’s electromechanical safety systems.

Picture of nuclear power plant work comp claims department in Germany

wikimedia.org – Heinz-Josef Lücking

But the staff of Soviet nuclear power plants, faced with ever-increasing production targets and constantly malfunctioning or inadequate equipment, and answerable to a bewildering and dysfunctional bureaucracy, had long become accustomed to bending or ignoring the rules in order to get their work done. And the updated instructions they received from NIKIET were neither explicit nor explained.

One of the new directives stipulated that a minimum number of control rods should henceforth be maintained within the core at all times—but NIKIET did not emphasize that this limit on the operational reactivity margin, or ORM, was a crucial safety precaution intended to prevent a major accident. Deprived of information about why such rules might be important, the operators went on with their work as usual, ignorant of the potentially catastrophic consequences of breaching them.


Any department in any company may possibly function like the NIKIET.   However, the manuals that I read the most over my career were claims manuals.   I designed, evaluated, and corrected many claims manuals over the years.   I recommend reading the passage very carefully as this appeared just before the accident

Performing claims audit – with the viewpoint of former adjusters, supervisors, managers, and VP;s – remains one of our most requested services.  The first document  any reviewer, auditor, or claims analyst asks for is the manual.   Why?

Magnifying glass work comp claims department on audit paper

Wikimedia – Public Use

The claims manual supposedly directs the work comp claims department how to process and adjust claims in that certain company.   The manuals can be expansive or a few pages.    Whenever any self-insured employer asks about how their claims are handled, I suggest asking for a copy of the Third Party Administrator’s (TPA) claims manual.   Some TPA’s work comp claims departments are not that forthcoming with divulging their operations manual.   

Some TPA’s admitted they had no claims manual.  A few even asked me to write one for them.  Nowadays, that request seldom occurs due to the ability to compose a claims manual using online assistance.  If a work comp claims department does not cover a certain subject, one needs to refer to the industry standard.

I try not to be so critical of claims departments as some of my fellow blog article producers.   After riding the adjuster seat for many years, the critic task seems easy to do in most cases.  

The last bolded passage causes much chagrin in work comp claims department.   Teaching the work comp claims department why their operating manual is so important may be an on overlooked task that may cause a claims disaster. 

One of my largest concerns that relates to claims manuals arises when I periodically review a certain set of claims.   For instance, I reviewed the claims processes three years ago (i.e. June 20, 2016).  I look at the electronic manual’s computer file data that says something like:

  • File created February 1, 2010
  • File last updated  June 20, 2016

You can find that info on any computer file.   This file notation meant that last time any update to the claims manual occurred three years ago when I updated it during a claims review or the carrier/TPA had hired me to update the manual. 

My recommendation remains that each section of a claims manual should be taught for at least an hour per month by the senior adjusting, supervisory and managerial staff of the work comp claims department.

©J&L Risk Management Inc Copyright Notice

Filed Under: claims department Tagged With: atomic chieftains, Chernobyl, file notation, inadequate equipment, last bolded passage, NIKIET

Work Comp Claims Adjuster Survey – Finally – Your Opinion Matters

June 19, 2019 By JL Risk Management Consultants

Register Your Opinion Anonymously – National Work Comp Claims Adjusters Survey

The Work Comp Claims Adjusters seem to be the quiet majority (Orwell 1984 reference) of most insurance companies and Third Party Administrators. 

picture of work comp claims adjusters mars surveyor

Mars Surveyor – NASA

Any person that works in the worker’s comp claims arena knows that sometimes they are completely left out of any decisions and rarely (like never) asked their opinions on anything.   Many articles on studies appear in this blog with the theme – Hey, did they ask a claims person before publishing this study?

Your chance to register your opinion comes around rarely.   Rising Medical (Chicago Bill Review-Rehab Nurses-other services) provided any adjuster with a chance to have their say in the process.   Rising Medical will then compare the answers by the claims staff to the Executives.  

Working my way up through the Work Comp adjuster ranks to a VP level, I can attest that the Claims Executives can easily become out of touch with the front-line workers, as in most companies.  

The only drawback that I see in this process is that claims workers did not have a hand in designing the study.    I could be wrong on that point, as I am only referencing the press release.

Rising Medical kind of “gets” the worker’s comp claims staff’s challenges.  Check out this video if you are having a bad claims day.

From Rising Medical:

Picture of medical work comp claims adjuster volunteer

wikimedia – Mstyslav Chernov

The Workers’ Compensation Benchmarking Study’s annual survey is underway. Now in its seventh year, the 2019 study will – for the first time ever – survey frontline claims professionals (instead of claims executives) to ascertain alignment between industry leadership and staff who directly handle workers’ compensation claims. As the industry’s largest talent constituency, with the greatest influence on financial and injured worker outcomes, visibility into how their views mirror or differ from claims executives will highlight opportunities to advance the entire industry.

The 2019 confidential survey will continue throughout May. All frontline participants and study stakeholders will receive a copy of the 2019 Study Report which can be used to validate operational alignment, verify existing strategies, advocate for resources in support-challenged areas, and identify opportunities to impact claim outcomes. Claims executives are encouraged to share the survey link with their frontline teams as an investment in this industrywide effort.

The Workers’ Compensation Benchmarking Study is a national research program examining the complex forces impacting claims management in workers’ compensation today. The study’s mission is to advance claims management in the industry by providing both quantitative and qualitative data. Through survey research with claims leaders and practitioners nationwide, the program generates actionable intelligence for claims organizations to evaluate priorities, challenges, and strategies amongst their peers.

You will receive a copy of the study for your time.   I call this one a deal.  Do not procrastinate.  The survey may close out soon. Work Comp claims adjusters – have your say. 

©J&L Risk Management Inc Copyright Notice

Filed Under: claims adjuster Tagged With: completely left out, drawback, procrastinate, quantitative and qualitative data

New York Opioid Dealer Law – Long Island Lawmaker’s Aggressive Stance

June 14, 2019 By JL Risk Management Consultants

Public Use License NASA Long Island

A suggested New York Opioid dealer law caught my eye as I paged through numerous workers’ compensation articles this week.   A Long Island lawmaker suggested a death sentence for any illegal opioid transactions.

According to the associated article and video:

Long Island Assemblyman Mike LiPetri is proposing a new law that would charge drug dealers with homicide if they illegally sell an opioid to someone who later died from an overdose. LiPetri calls it the “Death by Dealer” law.

The New York State Senate passed the bill, but the State House has not to date.   The bill if passed in the House would not carry a death sentence.  The dealer would be incarcerated with a life sentence. 

A psychologist commented in the article that putting someone in jail for life may not solve anything as the dealer may be in the middle of an addiction to the same opioids. 

Someone from my hometown in Oklahoma was arrested, charged, and convicted of selling part of their opioid prescription to pay for all their prescribed medications.  The sentence was 15 years minimum.  

I usually avoid writing opioid articles.  The Worker’s Comp world has generated almost too many to read in the last few years.   One of the better study and article producers on opioids is WCRI.  Check out their page here for a few recent articles on opioids.

One of the more interesting comments came from one of the manufacturers of a very addictive opioid.  He said the drug would cause a prescription blizzard.   You have to read the article to believe that comment.

The opioid blizzard cost the Federal, state, and local governments $37 billion in lost tax revenue. 

Two interesting articles that I wrote over the years on prescriptions are:

  • Mentally Ill Use 300% More Opioids
  • NSAIDS Provide Same Relief as Opioids

Assemblyman Mike LiPetri’s bill could pass the State House.  I will write another article or update this one if the  New York Opioid Bill becomes law.

©J&L Risk Management Inc Copyright Notice

Filed Under: Opioid Tagged With: arrested, Death by Dealer, Mike LiPetri, State House

Blue Cross Blue Shield Program Great Risk Management

June 12, 2019 By JL Risk Management Consultants

Blue Cross Blue Shield Program Cuts Healthcare Costs 

A Blue Cross Blue Shield program email appeared in my email inbox last week.   The email pointed out that I could have a well-being appointment and pay no co-pays or deductibles.   The program even covered the labs at 100%.

Blue Cross Blue Shiled Program Severe Ankle Fracture Xray

Wikimedia Commons -Chaim Mintz

The Affordable Care Act contained the same type of language.   The health insurance carriers covered any yearly check-up at 100%.   The concept likely originated with well-baby care appointments.   I just had my yearly physical,  so the appointment seemed unnecessary for me.

The Blue Cross Blue Shield program does not represent

I do realize many companies practice pre-employment job physicals.   Those physicals address the employee at the beginning.  What happens after they have been working for five years?

The Blue Cross Blue Shield program starts with a 15-minute assessment where they will provide a $25 gift card.  Do you think that the health insurance carrier would offer to pay $25 per person  if it was not an important assessment of a policyholder’s health condition?

Would Workers’ Compensation carriers and self-insureds benefit from a well-being appointment?  The worst claims I have ever handled started as

  • Medical only claims ignored by the employer and claims staff – leaving the closure to an algorithm -see claims festering
  • Work-related medical conditions where the employee worked with the condition to keep their job. 
  • Serious unknown preexisting condition at the time of hire.  I will leave this one alone due to ADA/HIPPA other than to say an aggravation of a preexisting condition counts just like an on the job injury.  I have one on my screen out of WV where a bad knee at the time of hire is a worse knee now that the condition has been aggravated by another accident.
  • Loss of medical control at the beginning – where the $400 claim turns into the $750,000 claim over two years.  I used to have the claim on a  flowchart for presentations to governmental organizations.

A recent WCRI study proposed that a person with health insurance has better workers’ compensation outcomes. The study points out the need for well-being appointments with the employees’ healthcare provider.   We have come full circle back to the reason for my email from the Blue Cross Blue Shield program. 

©J&L Risk Management Inc Copyright Notice

Filed Under: healthcare Tagged With: ADA/HIPPA, aggravation of a preexisting, Blue Cross Blue Shield, physicals address, worse knee

Our OSHA Consultant – Safety Metrics Part 3 of 4 – The Lunch Numbers

June 6, 2019 By JL Risk Management Consultants

Safety Metrics, Keeping  your Cool in a Hot Zone – The Safety Lunch

Safety metrics is the way we will measure our safety program.   Without measurements we have nothing.

On our third install we will follow Nate and Fanta  out to lunch.     

      Fanta )   “  So Nate  what  kind of  foods  do you like. “ 

      Nate )        “ Oh, almost anything. I especially like hot and spicy.”

      Fanta )     “ How about Mexican ? “ 

       Nate )     “ You read my mind.” 

      Fanta )     “ You know the old expression, ‘ great minds think alike.”

Nate  and Fanta arrive at the restaurant in about ten minutes. They are seated quickly.   Imagine being a fly on the wall.  Fanta is asking questions and Nate is dominating the conversation with answers, which he punctuates  with chips and salsa.

Nate )  In my opinion, one of the most important numbers or statistics that can be used to track our progress would be OSHA’s  incident rates. “

This  author, taking the role of the fly on the wall will give a brief synopsis of the jargon Nate is spewing,  between his tacos and burrito.  

The key to the OSHA Recordable Injury and Illness rate is a constant of 200,000 hours.  This translates to 100 employees working full time.  With this number a 12 man shop,  can compare its safety record  to a similar company with 12,000 employees.     

 

           R.I.I.R =          Number of recordable times 200,000/ Number of actual work hours   

 

Nate ) “But without knowing what our claims were last year, we can not calculate the rate. “ 

Fanta )   “ lets use an imaginary claims number so I can see how it works. We have  375 employees,  all  full time. So that is    750,000 hour.”             

Nate )     “ O.K.  lets say we had 50 recordable.  It would look like  this.”

        50 recordable   times 200,000   /   750,000 hours worked = 13.33

Nate )  “ then we look at the SIC Standard industrial codes to see how our rate compares with other companies that are in our same field.

Beep,  plunk,  Fanta and Nate both get texts from Mr.  Mony.

Nate )  “Thank you for lunch. It was really good.  Next time, let me buy you lunch.”

Fanta )  “ Anytime you want,  in fact why don’t you take me out for dinner. “   

 

What was the text from Mr. Mony  we will answer that in our fourth installment.

As for the food establishment, they may lose their four star rating.   Waiter there is a fly on the wall, hurry and bring me a  fly swatter.” 

©J&L Risk Management Inc Copyright Notice

Filed Under: Safety Tagged With: brief synopsis, chips and salsa, Nate and Fanta, SIC

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James J Moore
Raleigh, NC, United States

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt 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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