This week, the Workers Compensation Research Institute (WCRI) published its latest edition of workers compensation laws in the U.S. and Canada, which includes regulations and benefit levels as of January 1, 2019.
In Canada and the United States, workers’ compensation is entirely under the control of sub-national legislative bodies and administrative agencies. The differences between jurisdictional laws and regulations can be subtle and this survey gives you the ability to understand those differences.
You can’t talk about workers’ compensation insurance these days without mentioning “telemedicine” at least once. It should therefore come as no surprise that telemedicine was given its own panel discussion at the 2019 Workers’ Compensation Research Institute’s (WCRI) Annual Issues and Research Conference.
(In case you don’t know, the American Telemedicine Association (ATA) defines telemedicine as the “remote delivery of health care services and clinical information using telecommunications technology.” Think of an app that lets you video chat with a doctor, for example.)
The potential benefits of telemedicine to patients, providers, and employers could be immense. Improved access to healthcare services. Fast, personalized care. Treatment efficiencies. Reduced costs. Dr. Stephen Dawkins of Caduceus USA put it this way: “It’s crystal clear, as a provider, that telemedicine is a tsunami that will change the paradigm of medical care.”
Indeed, as Dr. David Deitz of Deitz & Associates noted, telemedicine is almost the perfect storm of improved healthcare services – and is already experiencing exponential growth in the commercial health sector. Citing the ATA, he noted that there were an estimated 1.25 million telehealth visits in 2016 alone – and that some sources estimate that over 400 million of U.S. medical visits could have been telemedicine encounters.
But has telemedicine made inroads into workers’ compensation?
Dr. Deitz pointed out that there is “essentially no quantitative data on [telemedicine] use in workers’ compensation.” Furthermore, he argued that there are several open questions when it comes to telemedicine: what are the appropriate regulations and reimbursement models? Is there a quality trade-off for telemedicine versus in-person encounters? Are there any privacy or cybersecurity concerns?
Kurt Leisure, vice president of risk services for The Cheesecake Factory, offered some preliminary answers when describing his company’s new telemedicine program for worker injuries, implemented in February 2018.
According to Leisure, the program basically works as follows. An injury occurs. If urgent, the injured worker proceeds directly to urgent care or the emergency room. If it’s non-urgent, the worker calls the company’s nurse triage system for preliminary care. If the phone call isn’t enough, the worker has the option of being escalated to a telemedicine program on their smartphone.
What have been the results so far? Generally positive, with the program leading to $153,000 in hard dollar savings in 2018. But Leisure did note that there are still wrinkles that need to be ironed out. Identification of telemedicine candidates during the triage phase needs improvement. Employee trust in the program could also improve.
But the injured workers seem to approve of the program. “Overall, I’m really excited, there’s a lot of upside potential just in our initial program,” Leisure said. “I think it will explode over time.” One particular benefit of telemedicine could be keeping workers and employers out of the courtroom. “We think the litigation rate is going to drop significantly” with widespread and effective telemedicine, said Leisure.
Indeed, despite some open questions about workers’ compensation adoption of telemedicine, the panel agreed that the industry would benefit tremendously. “Telemedicine basically gives you a conduit through which you can achieve better case management,” said Dr. Dawkins.
Unsurprisingly, the opioid crisis was a major topic of conversation at the 2019 Workers’ Compensation Research Institute’s (WCRI) Annual Issues and Research Conference.
Workers’ compensation insurance has been particularly affected by the crisis. Opioid use can, perversely, increase a worker’s risk of disability. Opioid use can lead to dependency, which results in increased dosages and higher costs. Dependency can lead to abuse; abuse can result in on-the-job performance impairment and further injuries – or it can delay a worker’s ability to return to work. In the worst case scenario, abuse leads to addiction and death.
These are just some of the reasons why opioid use can significantly increase the costs of workers’ compensation claims.
The crisis continues
The Centers for Disease Control and Prevention (CDC) found that 70,327 people died from fatal drug overdoses in the U.S. in 2017.
That’s up from 63,632 in 2016 and 23,518 in 2002, a three-fold increase in absolute terms in 15 years. But of course, the U.S. population grew over that time – and the death rate per 100,000 people is also alarming, rising from 8.2 in 2002 to 21.7 in 2017.
More alarming yet, the opioid epidemic continues to drive a significant portion of total drug overdose deaths. 47,600 people died from an opioid-related drug overdose in 2017, making up fully 68 percent of total overdose deaths. That’s up from 11,920 in 2002.
As Dr. Alan Krueger of Princeton University noted, the problem is most concentrated among men and women with lower levels of education: “Americans with diminished economic expectations are particularly vulnerable to the opioid epidemic.”
But no one is immune, he added. “Essentially no group has been spared from this crisis in the U.S.”
Blue-collar trades especially impacted
Dr. Vennela Thumela of the WCRI presented recent findings about the correlates of opioid abuse and overdose. She found that mining and constructions workers were most impacted, representing the highest percentage of opioid prescriptions among all workers receiving pain medications. Higher rates of opioid prescriptions also correlated with workers who are older, male, and live in rural areas.
Dr. Letitia Davis, of the Massachusetts Department of Public Health, found Massachusetts-specific evidence agreeing with Dr. Thumela’s findings. The highest opioid overdose death rates in the state are for construction/mining workers and farming/fishing/forestry workers. Construction workers overdosed at six times the rate expected based on average experience.
In fact, per Dr. Davis, 24 percent of all opioid deaths in the state between 2011 to 2015 were construction workers.
The costs are staggering
Dr. Krueger put it bluntly: “This is a human tragedy.”
It has also been a tremendous tragedy to the U.S. economy. Dr. Krueger cited a 2017 Council of Economic Advisers (CEA) report, which estimated that in 2015 alone, the economic cost of the opioid crisis was over $500 billion – or 2.8 percent of GDP. Dr. Krueger noted that the number of opioid-related overdoses in 2017 increased by at least 50 percent since 2015 – implying a cost in 2017 alone of about $750 billion.
As Dr. Krueger put it, “We have not done enough to address the scale of the crisis. Even if it has reached a peak, it has reached a peak of an unacceptably high level.”
Looking for an excuse to brush up on your knowledge of workers’ compensation insurance and maybe catch a Cactus League baseball game? Look no further.
The Workers Compensation Research Institute (WCRI) is holding its 35th Annual Issues and Research Conference on February 28th at the Renaissance Phoenix Downtown in Phoenix, AZ. (You can register for the conference here).
Particularly interesting will be a session on the opioid crisis and its impacts on workers’ comp. WCRI will present its findings on correlates of opioid prescribing practices to injured workers, which could help predict which injured workers are likely to receive opioids.
Another important agenda item you won’t want to miss is the “State of the States” session, in which WCRI will discuss performance measures for various state workers’ compensation systems.
Anyone working to improve workers’ compensation systems or seeking to manage a changing environment would benefit from attending these and the other sessions in the conference agenda.
The Workers Compensation Research Institute (WCRI) is holding its 35th Annual Issues and Research Conference on February 28th at the Renaissance Phoenix Downtown in Phoenix, AZ. Anyone working to improve workers’ compensation systems or seeking to manage a changing environment would benefit from attending.
Some of the highlights from the conference agenda include:
A keynote address by world-renowned economist Alan Krueger on the future of work, the impact of technology on the economy, and how the opioid epidemic has affected the labor force participation rate
The latest research on opioid prescribing to injured workers
A panel discussion of Washington State’s community-based program that brings together medical providers, employers, and injured workers to help ensure timely, effective, and coordinated services
The challenges and opportunities of telemedicine
A discussion of 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
Past attendees have said that the WCRI’s is the one conference that offers an “independent point of view that covers the entire spectrum of works compensation” and that it is “a great place to learn and a great place to network.”
Click here to learn more about the conference agenda or to register.
The earthquake risk exposure for California’s workers comp market is huge, as nearly every worker in the state is covered. By contrast only about 10 percent of Californians have residential earthquake insurance.
The Workers’ Compensation Insurance Rating Bureau of California (WCIRB) has recently partnered with Risk Management Solutions, Inc. (RMS), on a report quantifying the earthquake risk faced by California workers’ compensation insurers.
The timing of an earthquake event emerged as one of the critical factors when assessing the risk to employees. Recent earthquakes such as the Loma Prieta and the Northridge happened during off-peak hours; had the timing been different, the human impact could have been much worse. As expected the highest concentration of employees coincides with the highest hazard regions.
Commentary on workers compensation insurance by I.I.I Chief Actuary James Lynch is being published in the upcoming issue of the Rutgers University Law Review.
Lynch’s piece, “Comment to Economic Incentives in Workers’ Compensation: A Holistic International Perspective,” was written in response to an article by Stanford Professor Alison Morantz and others. The two spoke at a 2015 conference about the Grand Bargain in workers compensation.
Speakers discussed whether recent events were jeopardizing the so-called ‘Grand Bargain’ – workers forfeit their right to sue for on-the-job injuries in exchange for predictable benefits from a no-fault system. Professor Morantz’s article compared social safety net programs (including workers comp) worldwide and “discusses several mounting pressures that are jeopardizing the capacity of the U.S. workers’ compensation system to carry out its intended goals.”
In his response, Lynch noted that much of the current research in U.S. workers compensation “involves finding ways to reduce incentives that drive costs higher with no discernable benefit to the worker.” One example cited: When New York doctors book surgery for comp patients in New Jersey, they charge an average of $4,954, or 266 percent more than if the same surgery with the same surgeon took place in New York. (The I.I.I Blog featured this research two years ago.
Neither Morantz’s nor Lynch’s article was online as of February 16, but both should become available at the law review website soon.
If I were to pick out the hottest topics in workers compensation these days, these three would be near the top:
• How technology will affect the industry.
All three will be prominently featured at the Workers Compensation Research Institute’s Annual Issues & Research Conference March 22 and 23 at the Westin Copley Place, Boston.
The research organization, known by its acronym, WCRI, has for more than three decades conducted deep, objective research into what makes the workers comp system tick. Its conference annually hosts about the deepest dive you can find into the intricacies of the largest commercial line of business. I attend every year, and am happy for the privilege.
This year attendees will hear the latest on how opioids affect the ability of workers to return to their job; how Americans deal with prescription drugs in the workplace; and how a major employer – United Airlines – addresses the issue.
And a University of Georgia researcher, Dr. David Bradford, will discuss his studies on the effect of medical marijuana programs on prescription drug spending.
And opening speaker Erica L. Groshen, former head of the U.S. Bureau of Labor Statistics, will look at how artificial intelligence, robots, driverless cars and such will affect the labor force. From the conference website:
She will argue that much of the hype about the future of work is either far too optimistic or to pessimistic. In addition, she will talk about how the official statistics are more important than ever.
They are the information infrastructure that we all need to see through the haze, so that we make good decisions for our companies, our communities and ourselves.
The dangers of inactivity have been well publicized. You may have seen the fear-inducing headlines that too much sitting is killing you. So it’s not surprising that office workers are turning to standing desks and exercise balls as alternatives to the office chair. However, these alternatives come with injury risks of their own, which could trigger a workers compensation claim. Exercise balls offer no back support and prolonged standing is linked to reduced circulation and discomfort in the feet and the lower back.
For the people who have eschewed chair alternatives, a recent article in the Workplace Safety section of the Travelers website lists what to look for in an office chair according to Travelers risk control ergonomics professionals:
A pneumatic height adjustment.
A height adjustable lumbar support.
A seat back which can either be locked in an upright position or inclined up to 110 degrees.
Adjustable padded armrests with rounded edges.
An adjustable seat pan.
A five caster base with appropriate casters for the flooring surface.
The tool provides business leaders with specific information about the cost of substance use (including prescription drug abuse and misuse, alcohol abuse and misuse, opioid and heroin addiction as well as abuse of other illicit drugs and marijuana) in their workplace based on size of employee base, industry and state.
Posted here, the NSC calculator combines latest government and private sector research to estimate annual costs in three categories: time lost form work, job turnover and retraining, and health care costs.
A new NSC survey found only 39% of employers view prescription drug use as a threat to safety, and only 24% feel it is a problem, despite 71% saying they have experienced an issue.