The Christina Grillo Case and Lessons Learned: Why Families Facing a Medical Malpractice Lawsuit need a Structured Settlement

The Christina Grillo Case and Lessons Learned: Why Families Facing a Medical Malpractice Lawsuit need a Structured Settlement






Speaker 1: This is Ringler Radio, where you get all the latest news and information about settlement solutions, litigation, mediation, and structured financial security from Ringler, the largest and most experienced company of settlement consults in the United States.


Ringler has been helping injured people and their families since 1975. Ringler Radio is made possible in part by American General, Liberty Mutual, MetLife, Mutual of Omaha, New York Life, Pacific Life, and Prudential.


Now, join Ringler Radio host, Larry Cohen.


Larry Cohen: Hello, and welcome to Ringler Radio, everyone. I’m Larry Cohen, the head of Ringler Northeast Operations, and we’re certainly glad you could join us again today.


Well, Christina Grillo Sullivan was born on January 9, 1982. In what should have been a normal delivery for her mother, Josephine, turned into an emergency C-section, leaving Christina severely brain damaged, resulting in cerebral palsy, seizures, and blindness.


Soon after, Christina’s family filed a medical malpractice lawsuit, citing negligence by her physician. But Life Care Plans estimated the lifetime cost of medical care for little Christina to have been an excess of $20 million. The defendant’s attorneys offered a structured settlement, costing $1,267,000 that would have, over the lifetime of the child, paid out well over $100 million dollars. Quite a tax-free ability for Christina to be taken care of.


But Christina’s lawyers rejected the structured settlement offer, and settled the case for a lump-sum cash payment of $2.5 million, from which they took a $1 million fee and $77,000 in expenses.


They also failed to protect the availability of governmental benefits and sadly, as we’ve seen so often before, the money, unfortunately, was gone within a few years, and the family left to pick up the pieces and pay millions for medical treatment.


Christina’s family nurtured and cared for her relentlessly and lovingly at home for 32 years until she passed away on September 17, 2014. Today on Ringler Radio, Christina’s mother, Josephine Grillo Sullivan, now the executive director of the Christina Grillo Sullivan Foundation, will share with us how she’s honoring Christina’s life by assisting families living with a brain-injured loved one.


We’ll also discuss the high-profile and precedent setting case of Grillo Vs ] and what its outcome has meant for others who are faced with a choice, at settlement, of taking cash or structure.


Joining me today in this discussion as my cohost is my Ringler colleague Anne Lawter, from the Troy, Michigan office. Anne has nearly two decades of experience in medical malpractice and personal injury litigation.So with that, welcome to the show Anne. Thanks for being my cohost.


Anne Lawter: I’m very happy to be here with you and Josephine today.


Larry Cohen: Thank you.


Josephine, welcome to the show. It’s a pleasure and an honor to have you here. We’re really looking forward to hearing what you have to say, today, about your daughter and about what’s transpired with your foundation.


Josephine G. S.: Thank you for having me. I really look forward to being your guest, with Anne, and your listeners.


Larry Cohen: Terrific.


Josephine, let’s begin by having you tell us a little bit about Christina and the impact she had on you and your family. She seems like an unbelievably fascinating and wonderful girl.


Josephine G. S.: Well, how long do you have Larry and Anne?


Larry Cohen: (laughs)


You take as long as you want. I’ll stop you when it’s time. Go ahead.


Josephine G. S.: She was an absolute angel here on earth. I visually see her laughing and smiling. They were absolutely contagious, and that’s without ever speaking a word. She just inspired so many people around her. It’s where we are today.


It didn’t matter that she didn’t speak a word. She taught us so much, truly: what was important in life, which is unconditional love. I guess she really gifted us with her innocent trust and her dependency upon us.


I’ll tell you what, Larry: she really, really taught us how very, very precious this life is, and not to take one moment for granted. I just can go on and on about her, but she truly taught us about hope and faith and that’s truly what’s gotten me this far in this moment in life.


Larry Cohen: She was a blessing. For your family to have nurtured her as you did is wonderful to see and you to be commended for that too.


Anne Lawter: Josephine, I understand that Christina’s birth is what led to a medical malpractice case. Is that correct?


Josephine G. S.: That is correct.


Anne Lawter: If you could, just give us an overview of the main portions of the case.


Josephine G. S.: It was an evening that I had arrived at the hospital and the nurse on duty wanted to send me home. As I recall, she was saying I was having Braxton Hicks which is false labor pains. The doctor was asleep down the hall but the nurse didn’t want to disturb him. And that was until Christina’s heart rate started to drop. And then the last thing I remember there was that my body was going into shock and jumping up and down on the gurney. Then I had awoken to two nurses talking an saying that my precious baby wasn’t going to survive the night. It had taken over seven minutes to resuscitate here.


So I guess three weeks in the hospital neonatal unit, the doctor came up to me and said that they had done all that they could and that they were terminating life support. They were going to administer Christina last rites, and I’m sitting here thinking back as I do from time to time … There was a room off the neonatal unit and we were put in there, my family and I. We were all to say goodbye, and gently passing her from one loving family member to the other and we were just kissing her soft little newborn face.


But she surprised us all. She started breathing on her own and obviously was left here to do all the things that she has done for so many. We actually lived in Fort Worth at the time, in Arlington, and I had heard about a case, an attorney, and had gone to see him in Houston. He said if the baby was still alive to take the case. They had came back and said that the nurse was credible and the hospital had made an offer of $50,000 and they suggested that I take it.


Looking at both of them I just said there was just no way I could care for Christina over her lifetime. Two weeks later I get a phone call and they told me to come pick up my papers, that they were withdrawing from the case.


So that’s when I had located new counsel which was Tom and Tommy and they too delayed about two years until the hospital saw the motion to dismiss and then at that they prepared the case for trial.


Larry Cohen: You know Josephine, through this trauma of the injury to your daughter and through the birth etc., finally you received an offer from the defendants’ attorney which included a tax-free structured settlement as a part of it and yet your own attorney rejected that offer and decided to go with a lump sum settlement. Of course that decision had some severe consequences as you moved down the road. Tell us about the impact of that decision on your family as you moved along. What was the impact?


Josephine G. S.: To clarify to your listeners, the attorney decision to go with that lump sum settlement, it was so insufficient to cover her basic medical needs, but also was not conveyed in writing, nor did I have a clue what a structured settlement was or the benefit of the weighted age as I do today. That $1,267,579 was with a Cost of Living Increase (COLA) of 7.2%.


Larry Cohen: Wow.


Josephine G. S.: Yeah. That’s the looming increase. It would have paid Christina in excess of $200 million-


Larry Cohen: Yeah, with that kind of a COLA it’s amazing.


Josephine G. S.: And today, of course we all know how devastating that was not to have done that. The attorney’s fees would have been based on the cost of the structure, not the gross amount received, so actually Larry 40% of $2.5 is double the attorney fees. I guess that was their answer.


Larry Cohen: Wow. Wow. Am I right in that you were never given the opportunity to understand what a structure was? It was never really explained to you, is that right?


Josephine G. S.: No, not at all.


Larry Cohen: Wow.


Anne Lawter: So Josephine as I understand it, after that experience of taking that settlement, there came a time that you and your family had exhausted your funds and yourself and you instituted a malpractice case against the attorneys and that guardian ad litem for legal malpractice, regarding the fact that Christina’s case should have never been settled for a lump sum and the consequences that followed. Can you tell us about that?


Josephine G. S.: Yes I can. It was for the longest time, because we knew something was wrong, not until I spoke with an attorney named Todd who is in Dallas … He told me that he had never heard of a brain-damaged baby case not being settled with a structured settlement. Again, I had told him, “What does that mean?” And he kindly gave me the phone number of a structured settlement broker that has now become my friend over the past 25 years and that’s Mr. Neil Johnson.


I can remember meeting with Neil in an Italian restaurant over in Dallas and over two hours he explained in detail what a structured settlement was and the benefit of a rated age and what that would have meant to the value of Christina’s settlement. Larry and Anne, I left that meeting in tears. I wasn’t angry, I was just saddened that someone could do something so unconscionable.


I had filed a cause of action [inaudible 00:11:50] because I was unable to find counsel that would represent Christina because everyone that I had spoken to was fearful of retribution with judges and other attorneys in the future. So the two-year statute of limitations was tolling so I filed a lawsuit.


The odd thing is Neil, he believed in us and researched and found one of the companies that actually has quoted a structured settlement in the underlying case. So I actually went to go and deposition John [Camp 00:12:26]. He was a defense attorney for the hospital. When I was asking him the question, “Was Christina ever offered a structured settlement?” And Larry and Anne, just sitting there and looking across at this attorney for the hospital … He just snapped his pencil in half like it was a twig and he looked me in the eye and said, “As I sit here today, I do not recall.”


I was just-


Larry Cohen: Yeah, sounds like he knew the bad news was coming. It’s interesting.


Josephine G. S.: Right, right.


Larry Cohen: You know Josephine, what’s resulted from your fight against your attorneys for doing what they did is given rise to what’s now commonly called the Grillo waiver. It’s a document that acknowledges in writing that the plaintiff understands the potential consequences of accepting a lump sum settlement in lieu of a portion of it being structured. I kind of think it’s akin to informed consent, where you really understand what you’re turning down if you want to turn it down, or what you’re getting if you decide to accept it. That seems so logical today but obviously wasn’t back there when you were in need of something like that. It’s through your situation that people in the future are not going to have to suffer through that circumstance like you did. At least something came out of that that hopefully will help others.


Josephine G. S.: And I sit here and I smile. I smile that her little life was for a reason and it was to help so many actually become better loved and taken care of by their families. Because, Larry and Anne, a family taking care of someone like Christina, it is so tolling on everyone. If the funds would have been there … You think about it, just momentarily, that life could have been different, but actually when you do think about it a little bit more it’s where it needed to be. Because if we had not have experienced that  we wouldn’t be here today and she would not have already started to help thousands of people.


Larry Cohen: Your story’s a humbling one, it really is, for all of us, to have gone through what you did and taking care of Christina for those many years. It’s as I say, a humbling story.


We’re going to take a quick break right now, and we’ll be right back in a minute right here on Ringler Radio with more with Josephine Grillo Sullivan. We’ll be right back.


Speaker 1: This is Ringler Radio, brought to you from Ringler, the nation’s leading provider of fair settlement solutions. Did you know that Ringler is involved in a third of all structured settlement cases in the country? Ringler advisors work with all the parties in a lawsuit settlement to find the best possible financial solution for the people involved. Everybody wins. There’s a Ringler consultant in all the major cities in the US. No one had more experienced experts in the settlement business than Ringler. Check out our website at for the best information for injured parties, attorneys, and claims professionals to find the Ringler advisor nearest you.


When it’s your interest at stake in a lawsuit settlement, you want only the best, most objective financial plan. You can count on Ringler advisors to create customized plan that meets the financial needs of you and your family for the future. Visit to learn more.


Larry Cohen: Welcome back to Ringler Radio. Glad you could join us. I’m joined today by my co-host Anne Lawter and our special guest, Josephine Grillo Sullivan, executive director the Christina Grillo Sullivan Foundation. Josephine, you and your family, your husband Craig and your son Christian, have devoted your lives to the memory of Christina in many ways. Of course one of them is the mission to influence legislation to encourage structured settlements. You even set a precedent with the second court of appeals case opinion holding guardian at litems accountable for breaching their fiduciary duty.


Talk to us a little bit about how you’re looking to change the law when it comes to structures versus lump sum payments when people have to make that pretty momentous decision.


Josephine G. S.: That process actually had been started by the passage of Senate Bill 731 in 1999. For three legislative sessions, that’s six years, we fought for that legislation that would make it mandatory for a structured settlement to be presented in writing when it involved a minor child or a non-competent adult. That was in a 76 Texas legislative session. It was passed and codified into Texas Section 139.001-5. Larry, I believe that probate courts truly, truly have too much power without accountability. I actually have proposed a five-member oversight panel when it comes to the health, safety, and wellbeing, consisting of a physician, a lawyer, two citizens, and legislative member because the abuse of the probate system has been well-documented and persons are being stripped over their rights with limited recourse.


Larry Cohen: Well I know who to nominate as one of the citizen members of that commission. (laughter) That’s for sure.


Josephine G. S.:  


Anne Lawter: That sounds like a great idea, Larry. Josephine, you had an opportunity to be right there with the legislature and give testimony. You and Christina both testified at the time that the law was being discussed. Can you tell us about that experience and how it affected you to be able to take Christina with you to talk to the legislators?


Josephine G. S.: I guess it was just one of the many times she was by my side, again for the six years we traveled back and forth to Austin and other hearings across the state of Texas. To describe it, she was instrumental in I think them actually listening and seeing because when you have someone that is severely brain-damaged, it actually … You’re creating an awareness. I don’t think people can really completely understand until they walk or see your shoes, just for a bit. So it was very important and the response was what was needed, when she was traveling with me.


Larry Cohen: Christina’s memory also takes shape, Josephine, in the form of your foundation’s work to support families with brain injured loved ones. I know we all want to hear about that, and also tell us about the Life Care Resource Guide. These are pretty inspirational things you’re doing.


Josephine G. S.: Well the Life Care Resource Guide actually takes into account the medical diagnosis of an individual. What we do as a foundation, because the stress of family helping to support that person … We actually help them because it’s so daunting. We have volunteer nurses, therapists, and they actually go in and look for the resources around their demographic area and that’s how we create their life care plan. The therapies, the equipment, do you need dealers, doctors, hospitals, day-habs? It’s just whatever is needed for that family to be able to take care of their loved ones.


Larry Cohen: That’s interesting, Josephine. That’s tremendous work you’re doing for the brain injured families. I’m sure they appreciate everything that your foundation and the Life Care Resource Guide can provide for them.


On your foundation’s website, there’s an interesting yellow butterfly which we’ve learned has some special significance, but I’m not sure what that is. So talk to us about Christina and the significance of the yellow butterfly. What is that?


Josephine G. S.: Well Larry, they say that our Heavenly Father allows our loved ones that have gone to heaven to come through the veil. It started after Nina had gone to heaven. From time to time when we would be at the point of such unbearable grief, a yellow butterfly would come and appear. I guess the first time was at a football game, oddly enough, ’cause Nina went everywhere with us. She loved to cheer on her brother’s college team and to encourage him because he was so devastated after losing her. He was about to graduate from college. So we went to the football game, trying to make it as normal as possible and went and even stood in the handicapped section where she used to stand, where we rolled her up in her wheelchair. And here comes this yellow butterfly, and I started crying.


I guess to me it was a symbol that maybe she was saying, “I’m okay. I’m here.” And it had landed on the railing where her wheelchair used to sit. There was a lady standing next to me and she hugged me and I explained to her. If you can imagine … Of course a football stadium’s all concrete. It’s not like there’s trees or anything around that a butterfly would show up. But there again, here comes another football game and here comes this yellow butterfly landing on the same spot. So to me it was more Christina saying, “You know Mom, I’m okay. I’ll always be here with you.” And it just to this today really means a lot.


Larry Cohen: Oh, no question. It gives you goosebumps, that story. It’s really amazing. And you know you hear stories like that, and I think it all comes down to having faith that things are a little bit better up there. I think that’s what she is telling you. That’s a very interesting and heartfelt story.


Josephine G. S.: I really would love to share with your listeners, the one day … Because there is an angel that the butterfly is in the wing of the logo … I was running on the beach one day … I’m a runner. And I just couldn’t bear to see Craig crying over the loss of Nina and when I got back in the car, just shut the door and was yelling at the top of my lungs. And it’s so out of nature for me to do that, but I guess grief took over. Asking her where she was … That day we were actually donating one of her wheelchairs. So we had gotten back in the car and drove back home and got the wheelchair out and was putting it in the car of a lady that actually has helped us for many years. She started crying and then I started crying uncontrollably, and then there goes Craig.


Then all of a sudden she says you know, “Look up.” And I would invite your listeners to go to the website. It was the shape of an angel cloud. There wasn’t another cloud in the sky. It was absolutely breathtakingly beautiful. There again, it was another sign that … “You know Mom, you’re on the right track. We’re doing okay, and keep going.”


Larry Cohen: It’s amazing stories.


Anne Lawter: Yes, Josephine. The perseverance that you and your family have shown in carrying on Christina’s legacy is amazing and the work that you’re doing to help other families that take care of brain injury victims is just amazing. Can you tell us how if someone wanted to get involved with the foundation and volunteer, how they could do that?


Josephine G. S.: I surely can. I just wanted to say one more thing in regards to her logo. Her loving brother Christian actually did those strokes of love on his tablet and created that logo. I wish I had more time to tell you about Christian, because what an amazing young man and what an amazing brother he was to her and still is.


Larry Cohen: Well you know they have an amazing mother too, don’t forget that.


Josephine G. S.: Thank you. And in regards to, Anne, thanking you for how people can assist Christina’s foundation, the foundation that bears her name and the foundation that has helped so many not only changing the structured settlement industry but allowing structured settlement brokers to assist so many. If you could please go to her website, because the foundation is helping so many families and we just need their support, and through donations. It’s Because we’re a 501(c)(3) public charity, anything that you donate can and will be tax exempt as allowed by law. I guess not only as the executive director but as a mom who loved and cared for her daughter for so many years, almost 33 incredibly blessed years, this is the way that you can honor Christina. Become a Nina moment, and please go to her foundation and donate.


if you want to talk to me personally, I would love that. You can dial the 1-866-637-8392, that’s extension 21. And my email address is and I would love to hear from you. Again, Anne and Larry, I cannot thank you enough for allowing me to be a part of Ringler Radio and I just-


Larry Cohen: It’s our pleasure, believe me. This has been an inspirational show. It’s not just educational but inspirational and I think all of our audience would respond positively to that statement. Anne I know is someone that’s been in this industry, and we all deal every day with these issues of, “Are they gonna take a structure or are they gonna take a cash settlement?” We’ve seen the pain that comes from those who don’t really have the decision explained properly to them. I think what you’ve done Josephine, not just through your foundation helping others, but also through the toughness and the fight, having to file the pro se litigation even, that just shows the spirit you’ve had. You really helped a lot of people. I just want you to know that.


Josephine G. S.: The appeal case, as well, it was just-


Larry Cohen: Oh yeah, oh yeah. No question about it.


Anne Lawter: Josephine, having practiced as an attorney for almost two decades, I just cannot commend you enough for having the courage to be able to take something on yourself and having the courage to move forward with that or striving to make a difference in others’ lives as you have. My heart just bursts with joy in knowing what a major contribution you and Christina have made.


Josephine G. S.: Thank you so much. I will tell you, last night we had our second practice for the adaptive tennis program that we just started with the Special Olympics. At the end, because those children are so intellectually and physically disabled, at the end when you’ve got the smiles and the success and their parents are cheering them on, even if it’s just to hit a ball one time with the tennis racket, it just enlightens your heart. At the end when they took the picture, and the reason I’m saying this, is I had gotten everyone in the stands. We all got together and it was like one, two, three, and then everyone said, “Nina!”


Larry Cohen: Oh wow.


Josephine G. S.: The picture was taken and it was absolutely beautiful. So I will end on that note-


Larry Cohen: No question, no question. That’s terrific. Terrific way to end it. And I just want to say again, Josephine, tremendous having you here and I’m glad you gave out all the information to how to reach you and the foundation. Anne, if someone wanted to reach you, how would they do that?


Anne Lawter: They can reach me in the Ringler office in Troy at 248-457-1212 or at


Larry Cohen: Terrific. All of you out there, you can reach any Ringler associate. You can find them, you can even look at their pictures if you want, by going to the Ringler website, On that website you’re going to find tremendous amount of information, helpful information, the kind of explanatory information that we only hope that at one point back in the day that Josephine might have had.


Josephine, you’ve been an inspiration to us. If you want to hear any of the Ringler Radio shows,,,, or an iTunes where you can download the show and listen at your leisure and hopefully be inspired by Josephine as we all were today.


So with that I want to say thank you Josephine for being a tremendous guest and inspiring all of us. And as I said before, humbling all of us too at the same time. Thank you very much for being here.


Josephine G. S.: Thank you both and many blessings to you both as well.


Larry Cohen: Thank you. And Anne, thanks for being a great co-host.


Anne Lawter: Yes, thank you Larry and thank you Josephine.


Larry Cohen: And for the rest of you out there, be inspired and go have a great day. Bye-bye.


Speaker 1: The views expressed by the participants of this program are their own and do not represent the views of, nor are they endorsed by, Legal Talk Network, its offices, directors, employee, agents, representatives, shareholders, and subsidiaries. None of the content should be considered legal advice. As always, consult a lawyer.


Thanks for listening to Ringler Radio, celebrating more than a decade of podcasting, and over two million listeners. Think of Ringler, the objective settlement advisors with more than 140 consultants in 60 cities nationwide. Visit today.



4 Things to Consider in Complex Work Comp Causation Cases

work comp causationMembers of the claims management team are challenged daily to run an effective operation.  One of these issues claim handlers confront are questions of medical causation before admitting primary liability on a workers’ compensation claim.  Unfortunately, most members of the claims management team do not have a medical degree, but they do have many resources at their disposal to meet these challenges and make even complex decisions with certainty.



To Admit or Deny Primary Liability


Questions of medical liability for a work injury are often more complex than those that involve a “legal” basis for denial.  When reviewing questions of medical causation, claim handlers need to consider the following issues:


  • Evidence of clinical medical findings to substantiate a work injury;


  • Evidence of the requisite workplace exposure—which are often complicated by claims or repetitive use allegations; and


  • Medical literature that connects or links the work activity to the alleged injury.


In many instances, claims handlers are left to rely on training, experience and gut instinct to make decisions.  Time is of the essence given statutory parameters following receipt of the First Report of Injury.  Failure to do so can result in admissions against interest and/or penalties.



4 Things to Consider in Complex Work Comp Causation Cases


Members of the claims management team need to be proactive when it comes to admitting or denying a workers’ compensation claim that boils down to issues concerning medical causation.  There are important steps one can take to make a reasonable and well-informed decision.


  • Investigate the mechanism of injury: This consideration includes the question of “how” an injury occurred.  The claim handler will have medical records that detail how the injury took place.  In other instances, they may have the opportunity to conduct a more in-depth investigation.  This can include a recorded statement from the injured worker or witnesses.


  • Determine the exact medical diagnosis: This includes obtaining as many medical records as possible immediately following the work injury.  This starts with learning where the employee received post-injury care and the names of prior medical providers.  In many instances, state and federal privacy laws allow claim handlers to receive medical records without a signed authorization.


  • Review all diagnostic tests and studies: Reviewing the reports from medical studies can provide insight into the origin of an injury.  Examples of this include injuries to the upper extremities, shoulder areas and cervical spine.  A review of EMGs, CT scans and MRI can narrow the point of injury and its origin.


  • Roundtable with the claims team: This is a value resource to review the facts and question the plausibility of a claim. Roundtable sessions with a claims management team are important for many reasons.  This includes the ability of claim handlers to learn from each other’s experience and plot claim strategy.  It can also be an opportunity to poke holes in the employee’s version of events and plan a defense.



Battle of the Medical Experts


In many litigated claims involving injury causation, there is a “battle of the experts.”  While the employee always carries the burden of proof, many jurisdictions view the evidence in a light most favorable to the employee.  The result in the need to provide the medical expert with as much information as possible prior to the adverse examination.  A well written IME report and excellent bedside manner for courtroom testimony is a must.





In every workers’ compensation claim, a strong defense starts with the claim handler working the file.  This requires that person to use their skills and resources to conduct a diligent investigation and examine the important issue of medical causation.  Claim handlers have many resources.  By using them, they can position their file load for success and reduce costs in their workers’ compensation program.




Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .



Workers’ Comp Roundup Blog:


©2017 Amaxx LLC. All rights reserved under International Copyright Law.


Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

Dr. Jacob Lazarovic Joins Amaxx As Medical Advisor

Kennebunkport, Maine. September 13, 2017 – Amaxx, the nation’s leading resource for workers’ compensation cost containment best practices is proud to announce the addition of Jacob Lazarovic, MD as Medical Advisor.  Dr. Lazarovic will work directly with Amaxx Virtual Consulting professional services clients on the evaluation and implementation of workers’ compensation medical cost containment best practices.


Jacob Lazarovic, MD brings to Amaxx 30 years of experience in medical management and managed care. He has been published extensively in industry journals and has held several senior medical management positions at companies including HealthAmerica, Blue Cross/Blue Shield of Florida and Vivra Specialty Partners.


Dr. Lazarovic comes to Amaxx from Broadspire, where he spent 18 years as Chief Medical Officer. In this role, his department produced clinical guidelines and criteria to support sound medical claim and case management practices; participated in analysis, reporting and benchmarking of outcomes and quality improvement initiatives; developed educational and training programs that updated the clinical knowledge and skills of claim professionals and nurses; provided expertise to enhance the medical bill review process; and operated a comprehensive and unique in-house physician review (peer review) service.


“I am thrilled to be working with Dr. Lazarovic,” said Michael Stack, CEO of Amaxx, adding, “I’ve worked with Dr. Jake for many years in his role as Chief Medical Officer at Broadspire prior to his retirement, and have tremendous respect for what he accomplished for that organization.  I value the opportunity to work with him more closely, as well as share his knowledge and expertise with my client base.”


Dr. Lazarovic, who is based in Boca Raton, FL stated “it is a pleasure to be working with Michael and Amaxx.  I look forward to focusing on the clinical aspects of its consulting activities, enabling clients to better ensure that the medical services they manage are of optimal quality, availability, and cost-effectiveness.”



Workers’ Comp Mastery Training


Join Michael Stack & Dr. Lazarovic in their Workers’ Comp Mastery training session “How to Leverage Evidence Based Medicine to Create Better Workers’ Comp Claim Outcomes” on Tuesday, September 19, 2017 at 2:00 pm EST.  Learn how to leverage evidence based medicine tools, review case examples, as well as best practices on integrating evidence based medicine into your program.



About Amaxx


Amaxx helps employers in all industries reduce workers’ compensation costs through education, publishing and consulting. The injury management system taught is a best-in-class process based on 25 years experience lowering employer’s workers’ compensation costs while improving overall program efficiency.  Contact Michael Stack,




Safe Patient Handling and Mobility Claims Coding: A Pragmatic and Functional Approach

Authors: Vicki J. Missar, Michael Fray, Candy Raphan, Mary Matz, Wendy Weaver


Whitepaper originally published by The Association of Safe Patient Handling Professionals (ASPHP). All of the authors of this white paper are members in good standing with ASPHP and serve as Board members.  







Healthcare organizations are now engaged in Delivery System Transformation (DST), whereby performance-based incentive payment programs are used to support and reward hospitals for investing in projects that advance care and population health while lowering costs. In these efforts, it becomes critical to understand causes of patient handling and mobility workers’ compensation injury claims. Until now, programs that are self-administered or utilize a Third Party Administrator (TPA) have differing, if any, codes to determine employee injury trends. Unfortunately, these coding structures, particularly when it comes to causes, lack any real, actionable data to establish investment needs for safe patient handling interventions. Healthcare organizations are left to drill down to the accident-description level and extract key causes of the patient handling injury, a time-consuming and unrealistic option given the human resources demand within healthcare. This paper proposes a condensed, yet powerful, sub-level coding structure for safe patient handling claims that any claims reporting system can easily adopt. As a result, this coding structure will eliminate the need to manually sort through lines and lines of data for relevant trends. Adopting this proposed coding structure nationally will reward the safe patient handling community with a consistent and transparent approach to claims. As a result, it will enable facility-level comparison of key functions and tasks associated with patient handling claims, peer-to-peer benchmarking of these causes and return on investment calculations at the fingertips of the end user.





Healthcare companies in today’s business environment experience an unprecedented amount of change in terms of change drivers and pace of change: technology, shifting workforce demographics, global opportunity and competition, new sources of competitive advantage and rapidly evolving risk and regulatory requirements. Healthcare is an industry in the midst of fundamental transformation across the entire value chain and to all sectors, including physician groups, individual hospitals, senior care facilities, managed care organizations, insurance companies, wellness organizations, and integrated healthcare systems. As organizations address new business realities driven by healthcare reform and DST, they must reassess their data-mining capabilities around leading loss drivers that impact employee health and safety. With the right data and trending capabilities, safe patient handling claims can be easily dissected and solutions funded.


An apparent need exists to develop a standardized coding method focusing on the sub-category of activity type associated with patient handling injuries. So far, no national standard addresses the way these claims are coded in a Risk Management Information System (RMIS). This lack of uniformity leads to time-consuming efforts to extract key trending and cause analysis for meaningful solutions.


Standardization is applicable to overall workers’ compensation management, as well as risk managers, safety practitioners and occupational health professionals concerned with preventing safe patient handling and mobility (SPHM) injuries. The current mechanism to track injury types and occurrences proves neither healthcare specific nor customized by individual stakeholders. In addition, there’s a lack of detail-level standardization to provide easily identifiable and actionable data. Table 1 shows a snapshot of a healthcare organization RMIS loss run. The vague nature of the injury and cause descriptions provide little intelligence on the tasks (e.g. transfer type, toileting, bathing, etc.) performed at the time of injury. Therefore, a significant blind spot remains for safe patient handling professionals, and need for improvement on a national level is evident.



Table 1: Snapshot of a RMIS Loss Run for a Healthcare Organization



Current State: The Era of Big Data


Claims administrators require the ability to pare down injuries to focus on cost and frequency. Data available through loss run or other high-level data output provide only a general understanding of cause (See Table 1). The table does not provide sufficient detail to describe how the action being performed caused the injury. Technology is available via RMIS to affect change, but it cannot be used productively without changing and improving the information captured. A small addition to the current coding will make patient handling claims/injuries more transparent and actionable, create a best practice in the industry and produce long-lasting benefits.


Multiple methods are used in an attempt to address the need for this transparency which will bring patient handling claim trends forward. The following are examples:


  • Manually reviewing narrative reports to ascertain cause, associated circumstances and activities performed at the time of injury
  • Creating manual methods to map injuries with specific sites within a facility
  • Manually creating and using customized codes specific for a healthcare system or facility
  • Benchmarking national research reports that take years to publish
  • Using the National Institute for Occupational Safety and Health (NIOSH) Occupational Health Safety Network (OSHN) coding system (NIOSH, 2015)


Manual attempts at transparency are generally labor-intensive and may be highly burdensome. In an environment where human resources are stretched and patient and staff safety have become national priorities, the current state requires change.



Patient Handling Claims


Frequent injuries to patients and residents—regardless of the healthcare setting—have created a national call for action as demonstrated by several laws passed over the past few years. In addition, the American Nursing Association has issued an interprofessional national standard with the goal to put an end to these life-altering and career-ending injuries. The Occupational Safety and Health Administration (OSHA) points to manual patient handling as the cause of the high incidence, and severity, of injuries in the healthcare industry (OSHA, 2003). In 2013, the most frequent national, nonfatal occupational injury and illness, as well as injury and illness requiring days away from work, transfer, or light duty, were within healthcare and social assistance categories (Bureau of Labor Statistics (BLS), 2014). BLS data for 2013 demonstrate this impact  on caregivers. As seen in Figure 1, nursing assistants and orderlies accounted for some of the highest rates of nonfatal injuries and illnesses resulting in lost work days. These rates are approximately three times that of construction laborers and similar to that of firefighters. Compounding the personal and organizational impacts of such severe injuries, the financial cost of these injuries is profound (Institute of Medicine, 2011).



Figure 1: BLS Musculoskeletal Injury Rates for 2013 (per 10,000 work hours)



As illustrated above, injuries to caregivers, who are providing essential services for the infirm, are clearly significant. A typical certified nursing assistant, one who provides the majority of direct patient care, averages 4.5 injuries per year, according to a study by Khatutsky (2012). However, while the study listed patient handling as a key loss driver, the study did not define the cause or activity (toileting, repositioning, etc.) involved in the injuries. Lack of easily accessed injury details on a sub-category level is a significant disadvantage for many SPHM professionals. Without that detail, there is no mechanism to facilitate implementation of effective Safe Patient Handling and Mobility Programs using RMIS data. Practitioners are left with manual, time- consuming data-crunching processes.



Reaffirming the Core Problem


There is a significant lack of easily accessible, detailed causative factors related to patient handling and mobility incidents available to healthcare sectors and stakeholders on a cumulative level. Patient handling and mobility incident causality data is generally a labor-intensive extraction effort using manual processes Without key elements, justification for the financial support of development, implementation and maintenance of SPHM programs may not be attained.


Collection and reporting of patient handling and mobility injuries must be easily implemented, concise and user-friendly to be sustainable. Above all, this proposed standard collection and reporting of more detailed data elements associated with patient handling and mobility injuries must also address the realities of the normal working environment and the various documentation requirements posed to the practitioner on a daily basis. In the era of big data, we must simplify the approach.



Future State:  Keep it Simple and Transparent


Figure 2 provides a basic workflow for any healthcare system to investigate and adjudicate claims. The current U.S. workers’ compensation structure lacks uniformity across casualty claim service organizations related to patient handling and mobility injury identifiers. This inconsistency prohibits the ability to affect change through benchmarking or modeling at the local, regional and national levels. These critical data elements promote effective resource allocation, pre- and post-loss program development and implementation. Some of the key data elements not currently documented range from the most obvious, such as making an occupied bed, to other notable elements such as managing aggressive behavior. These causes provide the information to propel effective change and mitigate costs of these pervasive and many times debilitating injuries.


Other categories used to define specific types of movement and activities will create consistency across claims platforms as well as the much needed transparency for better injury cause identification and implementation of relevant, impactful solutions tied to the visible trends. This provides a mechanism to quickly and credibly identify a host of benefits:


  • Trend injuries by patient handling task/activity (e.g. repositioning up in bed, limb holding, toileting, vehicle transfers)
  • Identify predictive causes of injury
  • Track frequency of specific injury types
  • Effectively simplify big data into actionable elements
  • Measure return on investment with SPHM programs
  • Identify impact of patient handling and mobility equipment and programs
  • Add additional dimension to the description of injuries
  • Provide a method to benchmark outcomes
  • Develop a sustainable best practice


Clearly the benefits demonstrate the need for moving forward with a simplified method. This approach will have a broad appeal as it closes a significant gap in the scope of the data being collected and allows SPHM professionals to compare data across peer groups in a consistent manner. Collecting more detailed information regarding the injury will also streamline RMIS coding constructs and allow providers to set up identical coding for all healthcare-related clients.



Figure 2:  Current and Proposed Claim and Reporting Processes


The detailed injury information proposed to be added to the intake process and RMIS systems will have a profound impact on the ability to extract actionable data elements. By instituting standard coding for the type of “Patient/Resident Handling and Mobility Activity” and “Patient/Resident Handling and Mobility Equipment Use” as shown in Table 2, risk managers or consultants to healthcare companies can retrieve actionable data from their claims administrators or internal systems.


Table 2 also shows the proposed national standard for additional elements, and it comprises a simple, yet easily implemented coding structure to add increased value to the claims intake and reporting process. By adding these critical categories, the benign loss run categories of “patient handling” or “strain—pushing/pulling” for example, bear more meaning and record vital information. (‘Patient’ is used in this paper to include all healthcare recipients; patients, residents, clients, etc.)



Table 2:  Proposed Patient Handling and Mobility Injury Codes



It is accepted that some patient handling injuries are difficult to classify and fall into the “no defined/listed cause (21)” category because they are cumulative in nature and may not have a specific cause. It is not uncommon to hear a caregiver say she has been lifting patients all day and now experiencing back pain. No specific task is identified as the cause nor can the caregiver suggest what caused the pain or injury other than, “lifting patients all day.” Such cumulative injuries are included in the “no defined/listed cause” sub-code. Additionally, RMIS includes cumulative trauma as a cause, so that code was not included in the proposed structure. Importantly, although cumulative trauma codes do not provide a clear understanding of what activity led to caregiver discomfort or pain, knowledge of trends in cumulative trauma provides actionable data in and of itself.Table 2 shows the codes defining patient handling, which will provide a clearer picture of the injury the caregiver experienced while performing a specific patient handling and mobility task. These definitions are supported by other incident reporting systems (e.g. NIOSH, Veterans Health Administration (VHA), etc.). Only a single code is required from each column. Ultimately, the data will provide information that may point to a single causative factor for that injury, such as the use or non-use of a SPHM assistive device.


Some workers’ compensation personnel may not be entirely familiar with the range of equipment used to support SPHM including ceiling and floor-based lifts, air-assisted lifting and lateral transfer devices, slippery sheets, friction reducing devices, roller boards, powered wheelchair/bed movers, powered toilet lift seats and more. Some beds, stretchers and gurneys are also included as SPHM equipment when they perform functions to help move and handle patients. However, walking aids such as walkers, canes, and crutches, as well as push wheelchairs and fixed or manually adjusted beds/trolleys/gurneys are NOT considered SPHM equipment. Slings (Table 2, Item 12) are used with patient lifting equipment to move and/or lift a patient or body part.



Stakeholder Value


Evidence-based information clearly demonstrates that certain categories of the data are linked to cost drivers. It is important to effectively utilize that information to more globally understand the overall results. Understanding the collection, reporting and data available to SPHM injury stakeholders and the impact that this information will have is imperative. The information in Table 3 will guide the improvement of the SPHM program functioning overall and reduce the negative effects of unnecessary patient handling and mobility injuries.



Table 3: List of Stakeholder Benefits and Corresponding Details


When Table 3 was developed, each of the named stakeholders’ perspectives was assessed through its own respective lens. For the reader to clearly understand how standardization of coding will impact each of the named stakeholders, a brief description and situational illustration is offered for each label in Impact of Coding Improvements.



Impact of Coding Improvements


Data Integrity and Consistency – Accurate, complete and concise capture and report of all requested data elements. Without standard data elements that are practical to obtain and easily recorded, the risk of incomplete and inaccurate information increases, reducing the possibility of any analysis or conclusions to be drawn organizationally or nationally.


Benchmarking – Comparing one’s SPHM program and performance metrics to industry bests or best practices. Comparative analysis provides a point of reference to internal and/or global results that may be either compared or assessed. Benchmarking provides a method through which each organization/facility may measure its SPHM program success against that of others; providing information to facilitate change.


Predictive Analytics – Extracting information from existing data sets to determine patterns and predict future outcomes and trends. Through the use of a set of standardized data elements, these trends may be used to draw sound conclusions and provide direction for future program decisions, such as determining SPHM program and equipment needs.


Claims Management – Advice or services related to claims for compensation, restitution for loss or damage due to injury or illness incurred in the practice and performance of patient handling and mobility activities. Standardized data elements provide claim managers valuable information to complete a thorough investigation and adjudication of each claim.


Capital Equipment Purchase Justification – Typically capital equipment is defined as items of considerable value that have durability and that are used to provide a service or increase revenue over the lifetime of the item. This may also be considered a tangible corporate asset. For the subject at hand, the justification of capital equipment purchases may be considered the more significant obstacle to development of a SPHM program. Data collected as a result of customized coding identifies cost drivers that in turn provide justification and validation for SPHM program capital expenditures.


SPHM Program Operating Cost Justification – Operating costs are expenses related to the operation of a business, or to the operation of a device, piece of equipment, or facility. They are the cost of resources used by an organization to maintain its existence. SPHM Program and equipment costs are considered operating costs. In healthcare, there is much competition for these funds. For this reason, there must be iron-clad justification/s for SPHM program and equipment costs. SPHM justification must include direct and indirect SPHM operational costs including equipment, staff training, staffing, and others. As well, benefits and cost savings for both patients and staff must be included. Staff cost savings relate to decreases in the rate of injuries, lost time, and modified duty injuries. Decreases in patient adverse events result in huge cost savings for an organization when there is an effective program.


Direct and Indirect Operational Costs – Direct costs of medical care (including rehab), indemnity (lost wages) and legal services are only several line item expenses to consider when assessing the fiscal impact of a musculoskeletal workers’ comp injury incurred due to SPHM activities. To be included with these obvious core costs are other expenses that must be accounted for when evaluating at the entire monetary effect of these injuries. Professionals also acknowledge injury indirect costs which include wages paid to injured workers for absences not covered by workers’ compensation insurance; administrative time to investigate the incident and perform other related supervisory duties; employee training and costs for replacing the injured workers; and lost productivity and accommodation of injured workers. While specific stakeholders are able to use data on certain line items to provide financial and other useful information, all stakeholders need to see the full picture of how SPHM injuries can affect the facility’s fiscal health and overall employee satisfaction.


Identification of Specific Cost Drivers – Specific activities or actions that have been identified to have costs associated to them. Customized coding will provide detailed activity descriptions to allow quantification of data and associated costs resulting from injuries.


Labor Retention and Recruitment Efforts – Data supports the fact that successfully competing for educated, trained and experienced healthcare workers in today’s market does not just depend upon wages, salaries, benefits, work shifts or available days off. Musculoskeletal injuries, cumulative or traumatic, have a significant effect on the professional and personal lives of the injured. Some injuries can disable and/or destroy a career. Competent caregivers also acknowledge that their safety and health closely relates to the welfare of their patients/residents. Having a SPHM program in place within a culture of safety demonstrates to recruits and affirms to current employees that the facility supports and protects them.


Patient Safety and Quality of Care – Currently, organizations must pay for negative patient outcomes related to hospital stays. Increasing evidence points to the importance of mobilization of all patients in the recovery process, which patient handling equipment facilitates. Falls, skin breakdown, UTIs, pneumonia, and other hospital-acquired injuries/illnesses are positively impacted when SPHM programs foster equipment use.


Utilization of Best Practices – There are tried and true processes for SPHM program development, implementation and maintenance. The ANA Safe Patient Handling and Mobility Interprofessional National Standards relay those national experts agree upon. The Veteran’s Health Association has the largest and most successful SPHM program in the United States, incorporating best practices found to be valuable in other organizations as well. When these best practices are supported, patient and staff injuries are impacted positively.


Quality Improvement Programs – These specific and defined process-based, data-driven approaches to improving the quality of a product or service are significant in all modes of healthcare provision. In the context of this paper, patient handling injuries drive many of the quality improvement programs’ focus. Customized coding will provide a consistent method from which data may be obtained and analyzed in the context of performance-based measurements.


Caregiver Safety – Occupational health and safety programs continue to identify risk factors and specific interventions to mitigate injuries due to patient handling. Rates of musculoskeletal injuries from overexertion in healthcare are among the highest when compared with other industries. A primary focus of this paper is to identify those data elements, which will provide sound and reproducible data to drive the continued development and improvement of SPHM programs.


Public Relations and Brand Protection – Communication systems provide immediate and up-to-date information to the consumer seeking products or services. These channels, whether newswires or social networking sites, provide the conduit for widespread public relations and positive branding. Public acknowledgment and reporting of a SPHM program developed, installed and maintained in the facility bespeaks the culture of safety that has been promoted and secured by administration. Knowledge that the facility cares not just for the patients/residents but also for the employees focuses on the humanity of the healthcare entity and instills consumer trust.



Engagement Blueprint


To gain consensus and buy-in for consistent coding, first think and act locally, then move to global applications. Figure 3 shows a simple process for adopting the proposed category in a gradual yet meaningful way. Step 1 involves adding proposed codes to the incident reports and other data capture processes to get consistent points adopted on the front end. As with any change, stakeholder education is critical. Steps 2 and 3 are at the administrator level, whereby stakeholders gain approval to institute the new coding in RMIS or other data capture systems. For example, adjustments to intake scripts would need to include the new coding, ensuring these questions are answered at the claim-reporting level. Because the new coding is simple in nature, there should be minimal impact to a data warehouse/RMIS system.



A Call to Action


Early adopters of more detailed coding practices have clearly demonstrated a positive impact on overall loss costs when compared to those that have yet to embrace this practice. These organizations are likely to garner peripheral and significant benefits such as staff retention, attraction of clinical talent in an environment with skilled nursing and medical professional shortages and productivity drains to name a few. However, administrators require tangible metrics to support the business case for development and maintenance of robust SPHM programs.



Ongoing state legislative activities are gaining momentum to encourage development, adoption and standardization of programs. This movement will likely continue. Federal adoption and support of SPHM standards and practices have yet to be enacted. However, without a standard from which to measure outcomes, comparison and trending, enumerable losses will continue. Moving forward, stakeholders will need to take a pragmatic and incremental approach to engage all participants in the process. As engagement increases and results are measured, further expansion of codes may be introduced as practically appropriate.





Fundamentally, caregiving is a humanitarian effort based on respect and concern for others. As science and the ability to treat and cure has progressed through the years, longer lives lived with chronic, debilitating and frail conditions and the needs for more challenging rehabilitation efforts have resulted.


The caregiving workforce and the patients/residents are all aging. And more than ever, the condition of the financial bottom line is tenuous and difficult to control.


It can easily be acknowledged that the implementation of a successful SPHM program, led by an expert in the field and supported by others who are educated and experienced in the scope and practices of the program, makes a significant difference in the health and welfare of the caregivers, the cared-for and the service-providing entity.


Be reminded of Table 3, illustrating the value of this proposition, and all the ways that patient handling and mobility injuries can negatively affect lives, jobs and the bottom line. The proposal for standardized coding herein is simple and easy to implement so that healthcare organizations can maintain the practice and contribute meaningfully to decreasing staff injuries, improving patient/resident care and prolonging solid careers.


With inclusion of the proposed categories, improved data and its analysis will become consistent and available to all; providing the information necessary to improve safety programs. Assistive patient handling and mobility equipment is available and will continue to improve when the exact needs for the implicated tasks are consistently coded and brought to light.





  • American Nurses Association (ANA). (2013). SPHM Interprofessional National Standards Across the Continuum. Publisher: Silver Springs,
  • National Institute for Occupational Safety and Health coding system [Occupational Health Safety Network (OHSN) (2015)
  • Bureau of Labor Statistics 2014 BLS Newsletter 2014.
  • S. Department of Labor, Occupational Safety and Health Administration. (2013). Hospital eTool: Healthcare Wide Hazards – Ergonomics. Available at: Accessibility verified 1/29/2016.
  • Institute of Medicine (IOM) (2011). Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies
  • National Institute for Occupational Safety and Health (NIOSH). NIOSH Standard Occupational Data Architecture (SODA 2.0) Draft document dated June 24,
  • Khatutsky, G., Wiener, J. M., Anderson, W. L., & Porell, F.W. (2012). Work-related injuries among certified nursing assistants working in US nursing homes. RTI Press publication No. RR-0017-1204. Research Triangle Park, NC: RTI Press. Retrieved from



Disclosure Statement


The Association of Safe Patient Handling Professionals (ASPHP) does not endorse one particular company or organization. Reference within this paper to any specific commercial or non-commercial product, process, or service by trade name, trademark, manufacturer or otherwise does not constitute or imply an endorsement, recommendation, or favoring by the ASPHP.


The views and opinions of the authors of content provided in this paper do not necessarily state or reflect the opinion of the ASPHP and cannot be used for advertising or product endorsement purposes.





All of the authors of this white paper are members in good standing with ASPHP and serve as Board members.  Wendy Weaver is the past Executive Director of the organization.





Mike Fray PhD, BSc(Hons), BHSc, MCSP, FHEA Senior Lecturer

HEPSU, Design School, Loughborough University UK


Vicki  Missar,  MS, CPE, SSBB, CSPHP, CHSP

Associate Director, Global Risk Consulting Aon 


Candy Raphan, RN, BSN, ARNP-C, MAOM Regional Vice President

Client Services Medical Management Broadspire®



Patient Care Ergonomics Consultant President, Patient Care Ergonomic Solutions


Wendy Weaver, MEd

Gateway Coaching & Consulting, LLC

Medicare is Taking Action… and Other Workers’ Comp News Tidbits

Medicare Set Aside Compliance – Medicare is Taking Action

As the Centers for Medicare and Medicaid Services (“CMS” or “Medicare”) ratchet up their active monitoring of Medicare Set Aside (“MSA”) accounts, using a professional administrator to help make sure reporting is in order is becoming even more critical.


There is no doubt that CMS is taking compliance with the Medicare Secondary Payer Guidelines more seriously these days.  Just take a look at the sequence of initiatives they have put into motion over the past several years to prevent wrongful payments from the Medicare fund – from implementing mandatory reporting to earlier recovery processes to expanding the scope of MSAs to liability and non-fault cases. (see Exhibit A for a brief timeline of Medicare’s actions)



The Mission of WILG to Help Injured Workers

The Workers’ Injury Law & Advocacy Group also known as WILG, is the national non-profit membership organization dedicated to representing the interests of millions of workers and their families who, each year, suffer the consequences of work-related injuries or occupational illnesses. In this podcast, Ringler Radio host Larry Cohen and co-host, Duke Wolpert talk to attorney Michael K. Gruber, President of WILG, about his mission for 2017 and what to watch for in legislation that might impact workers.



Elite Women in Insurance 2017

Despite women’s growing presence in the insurance industry, few have successfully broken through into leadership roles – but the women featured on the following pages prove that’s slowly changing. Nearly 20% of the 2017 Elite Women hold top CEO or leadership positions, including the first female to start an insurance provider in the US. But the list doesn’t end there – it also includes countless executive officers, division heads, agency managers and more who have overcome obstacles and broken barriers to become some of the industry’s top professionals.



2017 RAND Study Evaluates Occupational Disability Guidelines (ODG)

RAND Corp. published its review of the (1) Technical Quality and (2) Clinical Acceptance of the Occupational Disability Guidelines (ODG) published by Work Loss Data Institute (WLDI). This paper briefly discusses the RAND report. WLDI publishes the ODG, arguably the most successful treatment guidelines in the occupational medicine space. Over 100,000 users support the platform. Continually updated, ODG incorporates over 10,000 ICD-9 codes, 65,000 ICD-10 codes, and 10,000 CPT codes



Optimistic Voices

Workers’ comp industry optimists expect that President Trump’s economic policies will help propel additional insurer premium volume growth through 2017 and even beyond. Recent growth in employment and wages are expected to generate billions in new workers’ comp premiums written. Factors like lower business taxes, reduced regulatory burdens and shifts in trade policy espoused by the president could fuel further growth.




Michael Stack - AmaxxAuthor Michael Stack, Principal, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .



Workers’ Comp Roundup Blog:


©2017 Amaxx LLC. All rights reserved under International Copyright Law.


Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

Why “Abuse Deterrent” Is A Misnomer

Instead of mandating first-line coverage for ADF opioids, we must remain committed to reducing opioid misuse through a comprehensive, well-coordinated solution that includes law enforcement, providers, plan sponsors and patients.

According to the U.S. Food & Drug Administration (FDA), opioid formulations with abuse-deterrent properties are meant to target expected routes of abuse, such as crushing in order to snort or dissolving in order to inject. However, the FDA fully acknowledges that these products are not abuse proof.


Over the last two years, approximately 50 pieces of legislation requiring coverage of Abuse-Deterrent Formulations (ADF) of opioid products have been introduced in more than 30 different states.


Although the bills around ADF varied, the legislation generally seeks to address common objectives:


  • Mandate preferential formulary placement for ADF products, and/or
  • Prohibit utilization management tools like step therapy and prior authorization for ADF products.


The proffered goal of these bills – to reduced opioid abuse – is laudable in light of our nation’s crisis of opioid misuse and abuse. However, this type of legislation presents several problems:


  • The FDA fully acknowledges that these products are not abuse proof. Last week, the agency held a public workshop to gather data and methods for evaluating the impact of ADF.
  • A legitimate worry is that ADF opioids will lead prescribers into thinking the products are less addictive and overprescribing patterns will continue.
  • While ADF opioids make tampering more difficult, these products cost a lot more than their non-ADF counterparts. Required ADF legislation has been estimated to cost the state of California $4.5 million, with another $3.2 million borne by plans sponsors and patients in the state. By enacting these bills, states deprive plan sponsors from exercising some of their control over formulary design.


Instead of mandating first-line coverage for ADF opioids, we must remain committed to reducing opioid misuse through comprehensive, well-coordinated efforts among providers, payers, state and federal governments and law enforcement – with an emphasis on drug safety, counseling and patient support.



Author: Express Scripts Lab team—a diverse group of dedicated and passionate healthcare professionals. Some of us are behavioral scientists, some pharmacists, some statisticians, and some doctors. Together, we’re committed to the Express Scripts mission to make the use of prescription drugs safer and more affordable for the tens of millions of patients who rely on us.


About: Express Scripts Advanced Opioid ManagementSM solution works across the care continuum from safe disposal, to tools for physicians at the point of care and safety checks for dispensing pharmacies. This solution helps to significantly reduce unnecessary prescribing, dispensing and use to help avoid unnecessary hospitalization, ER and drug treatment costs, while ensuring access to medication patients need.

Porter Leslie Announced As The President of Ametros

WILMINGTON, Mass. – Ametros, the industry leader in post-settlement medical administration, announced the promotion of Porter Leslie to President of Ametros. The announcement was made by Marques Torbert, CEO of Ametros.


“Porter has a track record of executing strategic initiatives with remarkable success,” remarked Marques, “In his new role, he will help the company get closer to achieving its mission of revolutionizing the insurance and healthcare services industry by developing more cutting-edge products and innovative services to benefit our clients and members.”


Porter joined Ametros in 2015 and in his previous role as Chief Strategy Officer, had been instrumental in driving growth and change across various disciplines within the company, including IT, marketing, new product development, and strategic partnerships.


“We have built a phenomenal team with close to 50 employees, who provide nationwide support for anyone who needs help managing their healthcare after settlement,” commented Porter. “I feel privileged to be asked to lead some of the smartest and dedicated minds in the industry.  There is no limit to what we can accomplish together.”



About Ametros


Ametros is changing the way individuals navigate healthcare by providing them with the tools and support necessary to make savvy decisions on how to spend their medical funds. Ametros’ team works closely with patients, insurers, employers, attorneys, medical providers and Medicare to create a seamless experience for their clients. Their depth of expertise in the Medicare Set Aside, property and casualty insurance, healthcare, legal, financial and software industries positions them to offer the best solutions in the marketplace. Their flagship products, CareGuard and Amethyst, are revolutionizing the way funds from insurance claim settlements are administered after settlement, for Medicare Set Aside accounts and any other medical allocation. Ametros is backed by Clarion Capital Partners, LLC, a New York based private equity firm. For more information, visit

Broadspire® Names Dr. Marcos Iglesias Chief Medical Officer

ATLANTA, June 22, 2017 (GLOBE NEWSWIRE) — Broadspire®, a division of Crawford & Company®, and a leading global third-party administrator, today announced that Dr. Marcos Iglesias has been named the company’s new chief medical officer, effective June 26. Dr. Iglesias assumes the position from Dr. Jacob Lazarovic, who announced his retirement after 18 years with Broadspire.


“Providing appropriate clinical oversight for injured employees is a critical aspect of the services we provide, and so we are excited to have Dr. Iglesias join Broadspire to provide strategic leadership in this area; his extensive medical and business background, particularly in injury management, makes him an excellent fit for us,” said Neil Lentine, chief operating officer at Broadspire.


Dr. Iglesias brings with him extensive practice and administrative experience in a number of medical areas, including occupational medicine, workers compensation, utilization management and disability management. Prior to joining Broadspire, Dr. Iglesias practiced medicine for 16 years and then held a number of senior management positions with insurance companies; most recently he served as vice president and medical director at The Hartford Insurance Company. Prior to that he held the positions of medical director at Midwest Employers Casualty Company and Lincoln Financial Group.


“Broadspire is known in the industry for its successful medical management approach, which includes making certain that injured workers receive clinically appropriate and cost effective care,” said Dr. Iglesias. “I am excited to join a company that has always been at the forefront of managed care thought leadership, and I look forward to working with the entire clinical team, as well as Broadspire customers, as we work to provide the best care for those affected by injury.”


Among his professional achievements, Dr. Iglesias is Board Certified in Family Medicine (ABFM) and Utilization Review and Quality Assurance (ABQAURP). He is a Fellow of the American Academy of Family Physicians (AAFP), the American College of Occupational and Environmental Medicine (ACOEM) and the American Institute of Healthcare Quality (AIHQ). He is also certified in Health Care Quality and Management (CHCQM).


Dr. Iglesias received his medical degree in Medicine and Family Medicine from the University of Toronto and later received a master’s in Medical Management from the Marshall School of Business at the University of Southern California.



About Broadspire®

Broadspire®, a leading global third-party administrator, offers casualty claim, medical management, accident and health, and disability and leave management solutions, helping increase employee productivity and reducing the cost of risk through early intervention, professional expertise and data analytics. As a Crawford Company, Broadspire is based in Atlanta, Ga. Services are offered by Crawford & Company under the Broadspire brand in countries outside the U.S.



About Crawford®

Based in Atlanta, Crawford & Company (NYSE:CRD‐A) (NYSE:CRD‐B) is the world’s largest publicly listed independent provider of claims management solutions to insurance companies and self‐insured entities with an expansive global network serving clients in more than 70 countries. The Crawford Solution® offers comprehensive, integrated claims services, business process outsourcing and consulting services for major product lines including property and casualty claims management, workers’ compensation claims and medical management, and legal settlement administration. More information is available at


For more information please contact: Nancy Hamlet/404.300.1918



Comprehensive Solution to Reduce Opioid Abuse & Other Top News Tidbits

A Comprehensive Solution to Reduce Opioid Abuse

In a recent pilot study of just more than 100,000 Express Scripts members new to opioid therapy, we observed a 38% reduction in hospitalizations and 40% reduction in emergency room (ER) visits in the intervention group versus control group during six months of follow up. Half of patients received an educational letter from the Express Scripts Neuroscience Therapeutic Resource Center (TRC) and half no intervention at all. A subset of patients receiving the TRC educational letter who had high-risk patterns of opioid use also received a counseling call from a Neuroscience TRC specialist pharmacist.



Best Practices from our Care Advocate Team

Ensuring the injured party is taken care of after settlement so that they can get the treatment and guidance they need is our number one priority.  Our Care Advocate team takes on this critical responsibility.

After settlement, the injured individual becomes our client (or “member”) and works directly with our Care Advocates.  We’d like to highlight a few of the services and practices we’ve implemented to go above and beyond for our members to help make the transition to their post-settlement care seamless.



Not So Secret Tips for Quick and Successful MSA Submissions

It’s no secret quick and successful Medicare Set-Aside submissions to the Centers for Medicare and Medicaid Services (CMS) are driven by medical records which meet CMS requirements for review and approval of the MSA. At Tower MSA Partners we strive to work with our customers to prepare and submit to CMS MSAs meeting these requirements. By doing so, we limit the time for CMS to review the MSA and avoid unexpected MSA counter-highers which may jeopardize settlement of a workers’ compensation case or at least delay resolution.



Ringler Associates President Geoff Hunt Talks about the Acquisition of Galaher Settlements

Geoff Hunt, president of Ringler Associates, discusses the company’s recent acquisition of Galaher Settlements and explains how the move will benefit everyone, including purchasers of structured settlements.






The Difference Between Active and Passive Injury Care

There are two possible approaches to injury care – active and passive treatment. While both can help get your employees on the road toward recovery, only active treatment limits long-term impact and keeps employees in the work environment as much as possible.








Author Michael Stack, Principal, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .



Workers’ Comp Roundup Blog:


©2017 Amaxx LLC. All rights reserved under International Copyright Law.


Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.



Impact of OSHA’s New Electronic Recordkeeping Rule On Employers & Their TPAs


This Interview with Broadspire’s CEO Danielle Lisenbey was originally published in Crawford’s On the FrontLine Magazine – Spring 2017


The Occupational Safety and Health Administration (OSHA) implemented a final rule in 2017 requiring employers that must record workplace injuries and illnesses for OSHA to submit reports of such incidents electronically. For the first time, OSHA will post on its website establishment-specific data, rather than only aggregated industry data. The goal is to encourage employers to identify workplace hazards and improve their safety records. We ask Broadspire’s Danielle Lisenbey for her views.



What does OSHA’s new rule mean for employers and TPAs?


OSHA has long required employers to keep a log of certain workplace incidents that result in injury or illness. That basic recordkeeping requirement is not new, but what is new is that OSHA is now asking employers to submit certain forms electronically. That will greatly facilitate the administration’s ability to make employer specific data publicly available. Employers and their third-party administrators (TPAs), including Broadspire, will work closely to make sure the appropriate data is submitted to comply with all applicable OSHA rules. Our mantra as a TPA is “early reporting and early intervention lead to better outcomes.” The new OSHA rule ultimately ties into that.



Which industries are primarily affected by the new electronic tracking rule?


The new recordkeeping rule applies to a significant number of  employers. Under the final rule, employers with 250 or more employees that are required to maintain OSHA injury and illness records must submit their logs, summaries of injuries and illnesses, and  incident reports.


Employers with 20 to 249 employees in industries classified as having high rates of occupational injuries and illnesses must submit an electronic summary report. Industries on OSHA’s list include construction, manufacturing, healthcare, transportation and others – all of which are important sources of employment and productivity.


Industries that OSHA considers to have lower injury rates, which include insurance and financial services, and some retail businesses, are partially exempt from such reporting. The reality is, however, that OSHA’s new rule will cover a large number of U.S. employers and their workers.



How does Broadspire see this new rule benefiting employers and workers?


The intent of OSHA’s new final rule is to increase workplace safety and motivate employers to reduce injury and illness  for  their workers.  That is a noble goal and we not only support it; it is at the heart of our business.


Broadspire exists to help employers reduce claims frequency and severity. We believe that the more data an employer has, the better it can plan ahead and mitigate situations that can cause injury or illness. OSHA’s new rule will make more workplace data accessible, which will encourage employers to focus more attention on the causes of occupational injuries and illnesses. That’s a positive thing for  all concerned.


Workers will benefit because they will be healthier and safer. Employers will benefit from reduced downtime and increased productivity, which in turn will benefit communities through economic growth. Truly, improving workplace safety pays big dividends, well beyond an employer’s door.



What are the downsides or unintended consequences of the new OSHA rule?


Some observers have expressed concern that online publication of employer-specific reports could create cyber exposures, increase litigation and might even discourage some employers from tracking minor incidents to artificially improve their safety results. While public disclosure may not be the preferred method to motivate employers to improve safety, greater transparency and competitiveness are likely to accelerate changes.


It is our belief that the vast majority of employers required to report to OSHA will submit injury and illness reports fully and accurately. We also believe that the general population of employers will see the data points as helpful to keeping them focused on the big picture, which is to make workplaces safer. We certainly hope that OSHA has considered the implications of this final rule and will swiftly address any problems should they arise.



What is Broadspire doing to help prepare its clients to comply with the rule?


Broadspire is deeply invested in helping employers to improve their claim outcomes and to reduce the costs of workplace injury, illness and disability. Early access to data is key, and TPAs can step up and help employers build out their data sets.


Between the data and benchmarking that we provide, and the reports that OSHA intends to make available, the ultimate objective is to reduce loss costs for the employer and improve the care of the injured worker. It’s a win-win for both employer and employee. Compliance is a big part of what we do every day for our clients, and we are having ongoing conversations with our clients to ensure they submit the appropriate data to OSHA by the July 1, 2017, deadline.


Read more On the FrontLine Magazine.



Danielle Lisenbey, Broadspire President & CEO. As president and CEO, Lisenbey’s goal is to make Broadspire the number one choice for companies seeking claim, disability and medical management services to help increase their employee productivity and contain costs. On the road to excellence, however, Lisenbey knows you don’t have to sacrifice integrity for achievement. She believes in always doing the right thing. Although tough when called for, she prides herself on being fair and demonstrating integrity in everything that she does.

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