If you don’t know the name Arthur Larson but you work in the insurance industry, maybe you should.

 

 

Larson, who died in 1993, is most famous for his authorship of the still-used legal treatise on the Law of Workmen's Compensation, written while he was assistant professor of law at Cornell Law School, which led to his being named dean of the University of Pittsburgh School of Law in 1953.

 

 

The treatise is still in use today and has since been edited by his son, Lex, who is affiliated with Lexis Nexis. The book was formative in that it was the first document that looked to standardize workers compensation across the nation not only for the benefit of companies and legal representatives but also for the American worker. It has grown from two to 12 volumes. Larson’s Workers’ Compensation, Desk Edition eBook from LexisNexis® is now available with coverage on the exclusive remedy defense, employment status, medical and death benefits, psychological injuries, and third-party claims from various jurisdictions with appropriate WC interpretation.

 

According to Peter Rousmaniere, a blogger and expert in the compensation industry who has researched Larson's life, "Larson had the idea that (in his son Lex's words) 'if you can find common threads in the way courts in the various states were deciding various legal issues, the field of workers' compensation could be recast much more as a single, national body of law.' A currently practicing lawyer calls Larson's guide essential. He said, 'It is imperative to see the breadth of possible interpretations from various jurisdictions to fully understand what is at stake.'"

Rousmaniere goes on to write, "Larson's vision was apparent in his other writings, perceptively analyzed by his biographer, David Stebenne. Larson saw workers' compensation law not as a radical redesign of the old tort system but rather as the earliest element of a new and peculiarly American system of social benefits. Unemployment insurance, nonoccupational disability insurance and retirement programs were part of this system. He thought some programs were better run in the public sector, others in the private sector. Workers compensation was for him well designed: privately financed, with benefits set according to the injured worker's wages. He applauded state-mandated nonoccupational disability insurance, an idea since endorsed by few states."

 

 

Among advents Larson brought about were unemployment insurance, nonoccupational disability insurance and retirement programs.

 

 

Larson went on to write A Republican Looks at His Party, which propelled him to go on to be President Dwight Eisenhower’s top speech writer and director of the United States Information Agency. He was a law professor at Duke University at the time of his death.

 

PETER ROUSMANIERE is an expert on the workers compensation industry and a columnist with Risk & Insurance. His original and more-complete article on Larson can be found here.

Peter Rousmaniere can be reached at 802-457-9149 or by email at pfr@rousmaniere.com. His professional website is www.peterrousmaniere.com and his well-known blog about immigrants is: www.workingimmigrants.com

Posted in Legal Doctrines |

This week discussions on the Roundtable were all over – from postings of studies to people asking for help. Read on and find out what you missed.

Our fearless group leader and president of WorkersCompensation.com, Robert Wilson, attended the Florida RIMS Educational Conference this week. He wrote a great article gleaned from a talk there called, Darrell Brown On Medical Marijuana.

 

 

At Work Comp Roundup we do all the reading for you and bring you just the important things going on at the 2,000-strong LinkedIN WC group – Workers Compensation Roundtable.

 

 

Carey Ransom, CEO of RealPractice and an attorney in marketing and practice management software, shared a link to a story he wrote asking whether you should ask someone where they found you. Read it here. Many others shared and commented on the article

 

 

David DePaolo, president at WorkCompCentral in the greater Los Angeles area posted this study on back injuries and how they are associated with further post-settlement legal cases. DePaolo writes, “Who would have ever thought to study this? But this demonstrates the far-reaching social science tentacles of workers compensation.” DePaolo also posted this article on a new pricing tactic — auctions to negotiate contracts — that frightens attorneys. He also posted this blog he wrote: Ogilvie Court Does a Disservice to California. And another on how the complexity of workers compensation is just a part of life.

 

 

Lisa Hughes, an RN, CLNC from Louisiana posted this article asking if work-at-home employees are entitled to workers compensation. Her comments prompted others to list how this is handled in their state or nation.

 

 

Andrew Kenneally, a Boston public affairs and government relations professional posted this article analyzing the new WCRI study on physicians dispensing prescriptions in Florida. He also reminds readers they can save $100 they register for WCRI's 28th Annual Issues & Research Conference by Sept. 30. More information on the conference can be found here.

 

  

Alberto Salgado, an MPN coordinator and lead client services liaison at GENEX Services, Inc., in Orange County, California, asks: “Medicare Conditional Payments and WC – Can reimbursements to CMS be re-calculated at states' WC fee schedules (FS)?” He offers some background and has so far received one answer, “No.”

 

John Routhier, vice president of sales operations at Crowe Paradis Services Corp., in Boston posted an article he authored that explains how Section 111 error rates matter. Read it here. He writes, “Error rates are the single best way to measure not only successful reporting but also the burden your solution places on claims staff.”

 

Kevin McCarthy, vice president of national accounts at Risk Metrics Corp., Data as a Service (DaaS) for the commercial insurance industry in West Palm Beach, Florida, posted this article listing the A.M Best’s ranking of top 25 workers compensation writers.

 

 

Kevin Kidd, a workers compensation administrator at PeopleSystems in Syracuse, N.Y., asked about a specific injury case in which an employee originally felt fine and then experienced swelling later. Kidd wants to know if this can be treated as a first aid case and handled in-house. He received 10 varied responses here, most suggesting he send all information to the carrier.

 

 

Keri Rheinfrank, senior claims Adjuster at Catholic Mutual Group in Omaha, asks this question, “I wanted some feedback if possible about what others do to monitor compliance in work comp for multiple jurisdictions.”

 

 

Stephen Leider, a partner at Clinical Integration in the greater Los Angeles area offers this link to a return-to-work study. He is trying to get 1,000 responses and says the goal is “To identify best practices and barriers to successful SAW/RTW as perceived by over a dozen stakeholders in different countries (although the survey is only in English) – so we can learn from one another.”

 

 

And James Cronin, MPA, CFE, owner of Seattle Insurance and Legal Investigations states here that he is looking to find other professionals in Washington State re: Needed WC Legislative Changes.

 

 

Still pulling in discussion are these topics from last week’s roundup:

and

 

 

There is lots more going on at LinkedIn's Workers Compensation Roundtable right now and right here! Better yet, invite your friends so they too can become informed on hot topics in the Workers Compensation industry.

 

 

Workers Compensation Roundtable is jointly managed by people dedicated to the concept that workers compensation is a manageable line on your expense ledger, and that informed professionals are empowered achievers. Workers' compensation is not simply a cost of doing business, it is a cost that can be controlled. Beginning with an assessment of cost drivers, benchmarking data, and integrating the solutions, employers can reduce workers' comp costs 20 to 50 percent. With proper information, professionals managing compensation claims can reduce costs and improve outcomes for all stakeholders in the process. This group is for employers, business owners, risk managers, HR managers, insurance executives, and brokers to discuss the obstacles and strategies to overcome them.

 

 

Posted in Professional Development Issues |

Injured workers feel it is “them” against the employer. Sometimes they think insurance companies live to deny claims – of any type. So, okay – now and then we hear of an insurer who denies claims left and right, but in truth most claims are accepted.

 

 

Bad claims are not claims with serious injuries. “Bad claims” share these characteristics.

 

 

1.     Reported late to the employer.

2.     Reported late to the carrier.

3.     Incomplete paperwork.

4.     Delayed medical treatment.

5.     Prior non-work related surgery to the same injured body part.

6.     Injury reported to the wrong person.

7.     Unwitnessed injuries.

8.     Injury due to unsafe work practices.

 

 

A prior “bad claim” does not mean a new injury claims are automatically denied. It means the adjuster may take longer to complete the investigation before deciding if the claim is compensable.

 

 

Employers with few workplace injury claims may experience more “bad claims” because they have less interaction with the carrier or third-party administrator. Lack of follow through occurs when employers, not knowing what to do, send claims to the agent who may delay a few months before sending them on to the carrier. Employers must establish a workflow system for submitting all claims to avoid delays in  treatment or coverage for the injured worker and a quick claim resolution.

 

 

 

 

 

Failure to report claims to the carrier ranks highest in bad claims. When in doubt, call the adjuster or carrier and ask if the claim is reportable. The sooner an adjuster is involved, the quicker the outcome.

 

 

A claim reported four months after the injury because tomorrow the injured worker scheduled for surgery makes for an unhappy adjuster who needs time to complete an investigation. And, delay does not bode well for the worker whose surgery is delayed and recovery compromised.

 

 

It is hard going back four months asking witnesses to remember what occurred; requesting and obtaining medical records; doing a proper background check to determine if there is a prior injury with the current or previous employer for the same type injury.

 

 

 
 

Posted in Insurance Issues, Rates, Premiums, TPA and Claims Administration |

 

 

 

When the San Diego Zoological Society was chosen by the Peruvian government to manage its research station in the Amazon jungle — the trackless Manu National Park — it had the responsibility of providing emergency medical care to its staff.

 

 

The hazards: poisonous snakes and crocodiles, malaria and yellow fever, parasites and fungus, as well as normal strains, sprains and lacerations.(WCxKit)

 

 

Helicopter evacuation? Forget it. The dense jungle canopy, long distance and bad weather in the rainy season make it next to impossible – even if the nearest helicopters weren’t on the other side of a mountain range.

 

 

So, the zoological society hired Medcor, an on-site medical firm based in Illinois, to help establish a wilderness medical program to manage a research station in the jungle, at Cocha Chashu in the Amazon jungle of Peru. The zoo contracted with the Peruvian government to help manage the site. Since the zoo has worked with Medcor for years in San Diego, they already had experience working together and had proved the effectiveness of this kind of risk management in other projects.

 

 

June 8, Medcor founder and CEO, Philip Seeger, and EVP Curtis Smith traveled to the jungle with the zoo’s risk manager, David Matthias, to conduct a first-hand assessment of all the travel and evacuation logistics. Medcor needed to assess the medical needs and response options for people at the station that is so remote it requires four days travel from the United States each way, the last two by small boats, 10 hours a day.

 

 

This means the 20-year-old Cocha Chashu station, according to Medcor executive vice president, Curtis Smith, is two days to the nearest town. So telemedicine is essential, particularly when the science group is too small for an onsite medical professional. Research groups vary from two people up to 30, staying from days to months.

 

 

While navigating the rivers, they test two different satellite systems to connect to Medcor’s existing triage call center. Medcor’s telemedicine service is already used by over 80,000 worksites (and many mobile workers) in the US and is available 24/7. Connecting from the jungle involves data, audio and video links – all of it battery and solar powered.

 

 

Shortly after arriving at the station, the Medcor team had opportunity to use their triage service on a real patient. The first on-site injury? An insect bite (presumed to be a spider) that was becoming inflamed. Treatment was given immediately and the patient recovered without complication, Smith said.

 

 

Medcor is also working with locals who provided travel and support services for the station. The project includes stocking the station with essential medical supplies; protecting them from insects, heat and humidity is key to having them available when needed. Supplies in place could be used by researchers being directed by Medcor clinicians remotely, or used by Medcor staff who travel on-site to support large groups.

 

Wilderness medicine is not new for the company, which supports a clinic at the base camp of Mount Everest, provides on-site medical services at Yellowstone National Park, and has ranged far afield with services on Pacific islands, as well as remote areas in the US. “Of course wilderness medicine is specialized,” says CEO Philip Seeger, “but there are many similarities to our core on-site services in the US, too, Most of the injuries we deal with are still sprains and strains, and we have to train and support our staff, get reports to our clients on time, and stay in compliance with HIPAA and other regulations. Delivering our services remotely forces us to become more efficient overall – many of those improvements also benefit our patients and clients using our services here is the US.”
 

 

 

Posted in Medical Cost Containment & Managed Care, Travel and Overseas Employees, WC in Other Countries (International) |

For failing to provide a safe work environment for workers installing an electrical grid upgrade both The Hartford Financial Services Group Inc. and Grubb & Ellis Management Services Inc. were cited by the Occupational Safety and Health Act (OSHA) for serious violations of workplace safety standards for exposing workers to electrical hazards at The Hartford's corporate headquarters and data center in Hartford, CT.

 

 

Employers are charged by OSHA with the responsibility of providing safe and healthful workplaces for employees and OSHA sets and enforces these standards by providing training, education, and assistance.

 

 

The Hartford was issued one serious citation and may be fined as much as $7,000. Grubb & Ellis was issued six serious citations with $34,000 in proposed fines. OSHA issues a serious citation when there is substantial probability that death or serious physical harm could result from a hazard about which the employer knew or should have known.

 

 

OSHA found The Hartford's data center policy required electricians employed by its maintenance contractor, Grubb & Ellis, to perform work in live electrical panels for computer equipment without first de-energizing (shutting off) the panels. Grubb & Ellis failed to de-energize the electrical panels before having its employees perform installation work and grid upgrades.

 

 

1.      Assigning employees to work on live parts and circuits on the electrical systems;

 

2.      Failing to train workers on electrical safe work practices and use of protective equipment needed to guard against electrical hazards;

 

3.      Failing to have in place a specific hazardous energy control procedures to prevent the activation or the release of hazardous energy from equipment during maintenance and repair work;

 

4.      Failing to develop and adequately train all authorized employees on hazardous energy control and procedures for safely applying, using, and removing energy control devices.

 

"Employers must understand they or their contractors must first de-energize electrical equipment and circuits before employees work on them," said Paul Mangiafico, OSHA's area director in Hartford. "Working on live electrical equipment needlessly exposes workers to potential death or disabling injury from arc flash, arc blast, or electric shock. Proper and effective safeguards must be in place and in use at all times."

 

 

Each employer has 15 business days from receipt of its citations and proposed penalties to comply, meet with OSHA's area director or contest the findings before the independent Occupational Safety and Health Review Commission.

 

 

Detailed information on electrical hazards and safeguards at: http://www.osha.gov/SLTC/electrical/index.html

 

 

Posted in Safety and Loss Control |

 

 

Indeed, whether in the Peruvian jungle or at the Mount Everest base camp, Medcor is there for more than 170 worksites, including factories, distribution centers, studios, farms, and mobile or temporary units.

 

 

Founded in 1984 by CEO, Philip Seeger and COO Ben Petersen, Medcor operates many onsite clinics across the United States to support employers who want to control costs, improve outcomes, provide rapid medical response when it is really necessary and avoid claims when they are not necessary – and this means planning ahead even when the worksite is far from the typical office.

 

 

 

 

Although its core business is focused on providing on-site medical clinics to large worksites and providing injury triage to small worksites across the country, Medcor has a great deal of expertise in the fascinating field of wilderness medicine.

 

 

The company provides on-site medical services at Yellowstone National Park, operates a clinic at the base camp of Mount Everest and has operated clinics on pipelines and windfarms and projects in locations  such as Midway Island, of the northwest Hawaiian islands. Medcor has also has served those affected by hurricanes Katrina and Rita, and provided on-site medical services at the World Trade Center after the events of 9-11. Medcor is currently back on site sat the World Trade Center supporting rebuilding projects.

 

Not your typical day at the office for Medcor team members in Peru where they are setting up a remote clinic to support research scientists. From left, Phillip Seeger, Medcor founder and CEO and Dave Matthias, risk manager for the San Diego Zoological Society.

 

There are also a variety of other similar companies that provide remote medicine services. Many of them are highly specialized, focusing on evacuations, off-shore oil rigs, pipelines or military bases.

 

 

Medcor Executive Vice President Curtis Smith notes there are at least eight benefits of having an onsite clinic for employers with remote locations:

 

 

Benefits may extend further for U.S.-based companies including compliance with U.S.-based workers compensation and other laws which are likely to be claimed as an applicable standard for expat employees and the parity of service/benefits with other employees who are not in remote locations.

 

Posted in Medical Cost Containment & Managed Care, Travel and Overseas Employees, WC in Other Countries (International) |

Safe Work Australia Chair, Tom Phillips, recently announced the release of a research report: Durability of carbon nanotubes and their potential to cause inflammation.

 

 

The structural similarities of some forms of carbon nanotubes with asbestos have raised concerns about possible health effects for humans. This study examined the durability of carbon nanotubes and the tendency to cause lung inflammation, two indicators of potential asbestos-like behavior, if inhaled. (WCxKit)

 

 

Commissioned under the Nanotechnology Work Health and Safety Program and funded by the Department of Innovation, Industry, Science and Research, the Commonwealth Scientific and Industrial Research Organisation (CSIRO), the University of Edinburgh in the United Kingdom (UK) and the UK Institute of Occupational Medicine undertook this experimental research.

 

 

Key findings in the report include:

 

1.      Some types of carbon nanotubes can be durable, but others may also break down in simulated lung fluid.

 

2.      Carbon nanotubes of certain length and aspect ratio can induce asbestos-like responses in mice, confirming previous findings. However, this response may be reduced if the nanotubes are less durable.

 

3.      Tightly agglomerated particle-like bundles of carbon nanotubes did not cause an inflammatory response in mice.

 

4.      Shorter carbon nanotubes or bundles of carbon nanotubes may not be an asbestos-like hazard, but they can still cause an inflammatory response and be hazardous in the lungs.

 

 

“This project is an excellent example of Australia and the United Kingdom collaborating to undertake world class work health and safety research," said Phillips.

 

 

“These results indicate that durability and hazards of all types of carbon nanotubes are not necessarily the same. However carbon nanotubes should be handled with high levels of caution in the workplace to avoid inhalation."

 

 

Safe Work Australia continues to support research on carbon nanotubes to further the knowledge of work health and safety issues, and has commissioned other work which uses the research findings to protect workers.

 

 

 

Posted in Safety and Loss Control, WC 101, WC in Other Countries (International) |

 

So you want to pursue a career in the insurance industry? It is a good choice; the insurance world is essentially recession-proof and in times of poor economic performance, the insurance industry is booming! Or, maybe you are looking for a promotion or a little more security in the job you have.

 

 

When you think about it, everyone needs insurance, whether it is personal lines of insurance (auto, house, boat, etc.) or commercial lines (employer, work comp, premises, liability, etc.) everyone needs an insurance policy of some sort to protect their investments or their businesses.(WCxKit)

 

 

Requirements for getting into the claims adjusting field vary by carrier, but below we discuss seven items that are standard requirements. Already working in claims? Try to check off as many of these attributes as you can.

 

 

There was a time that a high school diploma would get you a job in claims. But times have changed, and to be considered for a career in claims you must have a bachelor’s degree in an insurance-related field, such as accounting, finance, economics, law enforcement, or human resources. If you can manage going back to school (on-line degrees are becoming easier and more legitimate), consider bumping up your education.

 

 

That is not to say if you have a degree in mathematics that you cannot get in, but if your studies included one of the disciplines listed above you have a better chance. Although some would argue with me, more often than not, carriers want someone who has zero experience in the industry. This way, people do not bring in bad habits learned at other carriers. Every carrier has a specific way of handling claims, and if they can train you from the ground up, it is seen as an asset, depending on the job position.

 

 

Since you would be a fiduciary agent for your new employer, you need to carry a decent credit score. This will show your employer you take care of financial obligations in your personal life. Remember, you may be responsible for tens of thousands of dollars that are not yours. You have to represent the company at all times, whether you are working in the office or you are down at the courthouse trying to negotiate a file toward settlement.

 

 

The carrier will view your credit score as the way you handle your own financial obligations, and if you can show that you are responsible in your personal life, chances are you will act the same with their money as well. Already have a job? Remember your credit report may be just a Google search away from your boss’s fingertips – stay as clean as you can.

 

 

Having a background as a police officer or some other work experience in law enforcement will help put you ahead of other applicants. These fields carry a certain degree of responsibility and investigational skills that transfer over to the insurance field.

 

 

Since you will be investigating every claim for compensability, being very experienced at doing detailed investigations is a great asset. Every claim you handle will need some degree of investigation. It also means you complete a thorough and detailed investigation. Investigation is probably the most important task because results deem if a claim will be paid. A particular claim may start as nothing major, but every claim has a chance to morph into a monster potentially worth hundreds of thousands of dollars. Being comfortable doing detailed investigations is something every carrier is looking for.

 

 

Obviously work in claims carries the responsibility to read and interpret the legal system, sometimes in many jurisdictions at the same time. Having a law degree and/or prior work involving the legal system is another great asset you can have that will carry into the insurance field. Every claim will need to be deemed compensable or not, and the basis of your decision will depend on your investigation and how the injury or damage relates to legal statutes within the jurisdiction you are handling.

 

 

Being a claims adjuster requires you to handle several issues at the same time. Every day you would have a list of things to accomplish on certain files. Additionally, you have to accomplish tasks in order of importance. I do not see many adjusters in the business who are not organized or have some system in place to handle files. A typical adjuster has about 150 files, sometimes more, and all of those files are at different stages in the claim. If you are organized and detailed, you will survive. If you are unorganized and do not have a system in place, you will drown in a sea of paperwork, phone calls, and emails.

 

 

All carriers require you to either be licensed or to secure a claims adjuster license within the first 90 days of hire. This is a comprehensive, state-administered, pass-or-fail test. The test can be quite daunting; especially to those with no experience, but with some studying and hard work it is achievable. Carriers provide you with study materials, and will give you a few tries. Securing your license is a must. If you do not already have one you should plan on getting one as soon as possible as part of your new-hire process.

 

 

HIPPA stands for the “Health Insurance Portability and Accountability Act of 1996.” Since you will be dealing with medical records, social security numbers, and other personal identifiers, every carrier requires you to pass a HIPPA compliance test. You have to be able to be trusted with your claimants’ personal information. Handling and disposal of those records is very important. Carriers can face fines and penalties if they are caught violating the HIPPA terms, and they are constantly educating you in proper ways to handle personal information. You should be aware of HIPAA, and the overall guidelines contained within before starting work with a carrier.(WCxKit)

 

 

In conclusion, a career in the insurance world is very rewarding, and job security within this industry is like no other. With some hard work, organization, and studying there is no doubt you will succeed.

 

 

Posted in Communication with Employees, Professional Development Issues, Seminars and Courses |

 

An appeal for more protection for outdoor workers has gone out after more than a dozen men were admitted to the hospital in the last week with severe heat exhaustion.

 

 

According to a report from the Gulf Daily News, the workers all arrived at Salmaniya Medical Complex (SMC) by midday as a result of Bahrain's soaring summer temperatures, which peaked at 41 degrees Celsius (105.8F) with humidity levels rising beyond 85 percent.(WCxKit)

 

Bahrain has a ban on outdoor work between midday and 4 p.m. throughout July and August. However, an emergency doctor warned the situation could become "critical" with the advent of Ramadan – when eating and drinking in public is outlawed. Ramadan takes place during the ninth month of the Islamic calendar and is a month of fasting meant to teach Muslims about patience, spirituality, humility, and submissiveness to God

 

 

According to the chief resident at SMC, “Though there is an afternoon work ban in place, workers and their employers should be aware that with the advent of Ramadan, the situation could become critical. It could be very harmful for workers going without water in extremely high heat and humidity, so other steps should be taken to protect them.”

 

He added all of the workers who came to hospital were suffering from severe cramps and nausea.(WCxKit)

 

Meanwhile, a Labor Ministry official reported the afternoon ban on summer work between midday and 4 p.m. was being implemented effectively.

 

Posted in Risk Management, Safety and Loss Control, WC in Other Countries (International) |