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. .

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

 

©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.  https://choosebroadspire.com/us/

Express Scripts & myMatrixx Combine to Offer Best In Class Pharmacy Services

ST. LOUIS, May 17, 2017 /PRNewswire/ — Express Scripts (NASDAQ: ESRX) today announced it is taking an important step in expanding its customized workers’ compensation pharmacy solutions by acquiring myMatrixx, a pharmacy benefit solutions provider for the workers’ compensation industry. The companies will merge core capabilities to deliver best-in-class clinical expertise, advanced analytics, and customized client experiences to serve workers’ compensation clients and injured patients.

 

Express Scripts, St. Louis, Missouri. (PRNewsFoto/Express Scripts)

 

Terms of the transaction were not disclosed. Bryan Cave LLP and Skadden, Arps, Slate, Meagher & Flom LLP served as legal counsel to Express Scripts. SunTrust Robinson Humphrey acted as myMatrixx’s exclusive financial advisor and Akerman LLP served as myMatrixx’s legal counsel.

 

The combination of Express Scripts and myMatrixx will make enhanced pharmacy services offerings available to current and prospective workers’ compensation clients. The combined workers’ compensation team will be led by Artemis Emslie, currently Chief Executive Officer of myMatrixx.

 

“We are proud to create best-in-class pharmacy services for workers’ compensation programs by combining our deep expertise with the market-leading myMatrixx customer experience and technology,” said Express Scripts President & CEO Tim Wentworth. “We are well-equipped to address our clients’ evolving needs. Our unique combination of scale, technology, and a customized client experience sets the standard for workers’ compensation programs.”

 

“myMatrixx’s industry knowledge, technology and client experience have put us at the forefront of pharmacy services for workers’ compensation programs,” said Ms. Emslie, myMatrixx CEO. “With the demand for customized pharmacy solutions only growing, now is the right time to partner with Express Scripts and leverage the size and scale of the nation’s largest PBM to benefit our clients.”

 

With more than 83 million members, Express Scripts brings an ability to invest resources into advanced analytics. Express Scripts will leverage its clinical expertise innovation, client services, and strong marketplace footprint on behalf of its workers’ compensation program. myMatrixx’s strong reputation in the market for client services and agility will generate new growth opportunities and the combination will create more customer value.

 

Underlining the growing need for novel workers’ compensation solutions, earlier this month, Express Scripts released new data finding that the company’s innovative solutions lowered prescription drug spending for workers’ compensation payers overall by 7.6 percent in 2016. Much of this reduction can be ascribed to a sixth consecutive year of decline in overall opioid trend. In 2016, opioid trend decreased 13.4 percent due to a combination of Express Scripts’ clinical solutions, aggressive client management, and state and federal opioid regulatory trends.

 

 

About Express Scripts

 

Express Scripts puts medicine within reach of tens of millions of people by aligning with plan sponsors, taking bold action and delivering patient-centered care to make better health more affordable and accessible.

 

Headquartered in St. Louis, Express Scripts provides integrated pharmacy benefit management services, including network-pharmacy claims processing, home delivery pharmacy care, specialty pharmacy care, specialty benefit management, benefit-design consultation, drug utilization review, formulary management, and medical and drug data analysis services. Express Scripts also distributes a full range of biopharmaceutical products and provides extensive cost-management and patient-care services.

 

For more information, visit Lab.Express-Scripts.com or follow @ExpressScripts on Twitter.

 

About myMatrixx

 

myMatrixx® is a full-service workers compensation pharmacy benefit management company focused on patient advocacy. By combining agile technology, clinical expertise, and advanced business analytics, myMatrixx simplifies workers’ compensation claims management while providing safer medication therapy management. Located in Tampa, Florida, myMatrixx has positioned itself as a thought leader in the workers’ compensation industry.

 

Media Contact:

Ellen Drazen

(314) 684-5355

evdrazen@express-scripts.com

 

To view the original version on PR Newswire, visit:http://www.prnewswire.com/news-releases/express-scripts-and-mymatrixx-combine-to-offer-best-in-class-pharmacy-services-for-workers-compensation-programs-300459277.html – See more at: http://phx.corporate-ir.net/phoenix.zhtml?c=69641&p=irol-newsArticle&ID=2273690#sthash.1V3b2ynl.dpuf

Workers’ Compensation Prescription Drug Spending Decreased 7.6% in 2016

St. LOUIS, Apr. 4, 2017 – Express Scripts (NASDAQ: ESRX) lowered prescription drug spending for workers’ compensation payers by 7.6 percent in 2016, according to the 11th edition of its Workers’ Compensation Drug Trend Report.

 

“In a year when many payers wrestled with drug price increases that dominated the news, Express Scripts protected clients from this impact,” said Dr. Brigette Nelson, senior vice president of workers’ compensation clinical management at Express Scripts. “By practicing pharmacy smarter, we helped clients balance appropriate care for injured workers while keeping costs down.”

 

 

Decrease in Opioid Use Drives Down Trend

 

In 2016, opioids remained the most expensive therapy class at $391.35 per user per year (PUPY). Thirteen of the top 25 workers’ compensation medications were opioids.

 

However, for the sixth year, overall opioid trend decreased. In 2016, trend decreased 13.4 percent due to a combination of Express Scripts’ clinical solutions, aggressive client management, and state and federal opioid regulatory trends.

 

This stark decrease in overall pharmacy trend — heavily driven by decreased opioid utilization — proves key stakeholders are taking action to combat the epidemic of opioid abuse and misuse:

 

  • Payers: Through point-of-sale programs, physician outreach, patient education and advanced analytics, Express Scripts’ solutions enable payers to combat the safety and cost concerns associated with opioid use from every
  • Prescribers: Scrutiny of opioid prescribing patterns drove the creation of new guidelines from the Centers for Disease Control and Prevention (CDC), as well as the Surgeon General’s Report on Facing Addiction in America.
  • Regulatory: Many states have adopted or are considering formularies, opioid prescribing limits or other medical treatment

 

 

Bending the Curve on Compound Spending 

 

For the third year in a row, spending on compounded medications decreased. In 2016, trend was -28.6 percent. These drugs still remain very costly, yet with a 31 percent decrease in utilization, it is clear that effective management strategies can reduce unnecessary costs and waste associated with more than 1,000 clinically unproven ingredients.

 

 

Optimizing the Dispensing Channel

 

Medication dispensed directly to injured workers by prescribers may result in additional costs as the drugs are typically repackaged or relabeled and often are not subject to the same pricing regulations as those dispensed by a pharmacy. Injured worker safety is also a concern.

 

“Physician-dispensed medications lack the point-of-sale safety edits which occur at a retail or home delivery pharmacy,” Nelson said. “This puts injured workers at risk for potential drug interactions or duplication of therapy.”

 

According to 2016 data, the average cost of a physician-dispensed medication was $219.25, compared to $110.16 for a pharmacy-dispensed medication. Express Scripts Workers’ Compensation clients therefore paid an average premium of about $109 for physician-dispensed medications and bypassed pharmacist review at the point of sale.

 

When prescriptions are filled through more costly channels, such as an out-of-network pharmacy or third-party biller, payers incur additional cost, with no additional value. This results in waste in the healthcare system.

 

For long-term medication needs, drugs delivered directly to an injured worker’s home cost payers 15 percent less than those purchased from a retail pharmacy, while adding convenience for the injured worker.

 

 

Continued Vigilance for Specialty Medication Trends

 

Spending on specialty medications to treat conditions such as hepatitis C and HIV stabilized in 2016. While these drugs represent less than 1 percent of all medications used by injured workers, the extreme high cost per prescription requires payers to stay vigilant.

 

“Managing specialty spend requires clinical expertise and strategic guidance,” Nelson said. “Clinicians at Express Scripts and our specialty pharmacy Accredo® have disease-specific experience to ensure safety, promote adherence and provide individualized clinical counseling for injured workers with the most complex conditions.”

 

The comprehensive review of trends in prescription drug spending for workers’ compensation plans is available at express-scripts.com/corporate.

 

 

About Express Scripts

 

Express Scripts puts medicine within reach of tens of millions of people by aligning with plan sponsors, taking bold action and delivering patient-centered care to make better health more affordable and accessible.

 

Headquartered in St. Louis, Express Scripts provides integrated pharmacy benefit management services, including network-pharmacy claims processing, home delivery pharmacy care, specialty pharmacy care, specialty benefit management, benefit-design consultation, drug utilization review, formulary management, and medical and drug data analysis services. Express Scripts also distributes a full range of biopharmaceutical products and provides extensive cost-management and patient-care services.

 

For more information, visit Lab.Express-Scripts.com or follow @ExpressScripts on Twitter.

 

Media Contact:

Ellen Drazen, Express Scripts 314-684-5355

evdrazen@express-scripts.com

4 Questions On Urine Drug Testing To Deliver Better Work Comp Outcomes

Urine drug testing (UDT) is one of the more controversial and misunderstood tools in the workers’ comp system. While medical guidelines support the tests for injured workers who are prescribed opioids, stories of over testing injured workers —and overcharging payers — abound. There are also questions about what type of testing to use, the frequency of the tests, and what to do with the results.

 

UDT used judiciously and paired with clinical expertise can be invaluable in ensuring injured workers get the right medications at the right time. Understanding some of the basics will help you get the best bang for your UDT buck.

 

Types of testing

 

  • Forensic. UDT has been around for decades, beginning with its use to identify illicit drug users in criminal and civil proceedings as well as the workplace. This forensic, or ‘gotcha!’ model is designed to determine yes or no that someone is taking certain, typically illegal drugs. An initial screening — presumptive — test is performed and any positive results are sent for confirmation. The types of tests include in-office point of care. Results from these tests can come in minutes. However, they are not necessarily designed to detect the use of medications at therapeutic doses, something critical in a clinical setting. Also, the tests are not available for all drugs, such as synthetic drugs of abuse. Since oxycodone is a semi-synthetic opioid, it may not always be detected in these tests.
  • Clinical. This model puts the focus on the patient-provider relationship and is used as part of patient care in various settings, including pain management. The idea here is to identify the presence of specific prescribed medications, non-prescribed medications and illicit substances to benefit the therapeutic goals of the patient. Definitive testing, typically used in this model, provides information about specific drugs and metabolites and can detect drugs at much lower concentrations, which presumptive tests do not. The results of these tests, however, may not be available for 24 hours or more.

 

The type of test used for an injured worker depends on a variety of factors, including the physician’s assessment of the patient’s risk. The types of medications also has a bearing on the most appropriate tests. If there are multiple opioids, for example, presumptive tests may not provide enough information to help the physician.

 

Why Test:

 

Guidelines published for prescribing opioids to injured workers support the use of UDT to help identify safe and effective treatment options.  Some of the reasons to undertake UDT include:

 

  • Risk assessment. Research shows many prescribing physicians are not aware of their patients’ past and current drug-taking behavior. Clinical UDT provides clear evidence of the patient’s drug taking behavior, which is vital to the provider’s treatment plan, risk assessment, and interaction with the patient.
  • Clarification. In addition, patients often do not know specifically which drugs they are taking. So the drug test can add to the provider’s understanding of the patient’s current medical treatment.
  • Data consistently shows about 18 percent of workers’ comp patient samples do not indicate they are taking the prescribed drug. Given the problems with diversion, misuse, and abuse, it is clear that workers’ comp patients may be complicit — wittingly or not — in the inappropriate consumption of prescription drugs.

 

How Often to Test

 

How often should an injured worker on opioids be monitored through UDT? This is one of the key questions and problems surrounding UDT. Too much testing is a waste of money, while too little testing may lead to missed opportunities for intervention and cause the claim to deteriorate.

 

Physicians can determine how often UDT should be conducted based on the injured workers’ risk of medication misuse, abuse or diversion; and the importance of adherence, such as if the injured worker is being weaned off certain drugs.

 

  • Low risk. Injured workers who have little to no risk should be tested annually.
  • Moderate risk. Injured workers who have some red flags indicating they are potentially at risk should be tested a few times per year.
  • High risk. Injured workers with a high propensity for medication abuse should be tested frequently, in some cases even monthly.

 

 

What to Do With The Results

 

One of the problems with UDT is the lack of follow through after an unexpected or inconsistent test result. Faced with evidence that the injured worker is not taking her medications as prescribed, and/or is taking medications that were not prescribed — including illegal substances — some intervention is necessary. The results may be a clue that the injured worker is getting medications from more than one provider. At the very least, the provider should discuss the results with the injured worker. Unexpected results occur on average more than half the time.

 

Once the test results are available there are several steps that may be beneficial.

 

  • Work with a PBM. A pharmacy benefit manager can help interpret the test results and provide guidance on what the next steps should be. An unexpected test result may be due to a variety of factors; such as drug-drug interaction, or a contaminated or diluted sample. The answer is not always black and white, and a PBM or other expert can help decipher what the results actually mean.
  • Additional clinical outreach.
  • Follow-up testing.
  • Peer-to-peer review.
  • Change in medication therapy.

 

Conclusion

 

UDT can provide much needed information to help guide a claim. However, it should be part of an overall strategy and not the only tool used. It’s important to know the benefits and limitations of UDT and use it to help understand the whole picture of the injured worker.

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

Author Michael Stack, Principal, COMPClub, 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 of COMPClub, an exclusive member training program on workers compensation cost containment best practices.

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Live Stream WC Training: http://workerscompclub.com/livestreamtraining

 

©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.

 

Tower MSA Partnership with American Airlines and PRIUM Yields Legacy Claim Settlements

In a widely acclaimed presentation at the recent 2016 National Workers Compensation and Disability Conference, Jennifer Saddy, Workers’ Compensation Director for American Airlines and Mark Pew, Senior Vice President of PRIUM, detailed the successful cooperation among American, PRIUM and Tower MSA to reduce pharmacy costs, litigation referrals and Medicare Set Aside costs ultimately leading to significant claim settlements.  Tower MSA is grateful to Jennifer and Mark for highlighting how Tower MSA’s Identification, Intervention and Involvement services were a key contribution to the success of this legacy claim reduction program.

 

For more information on American’s program please read the Risk & Insurance article Make a Decision and Move the Needle: American Airlines needed to take aggressive action to resolve 6,000 lingering workers’ compensation claims.

 

 

For more information on Tower MSA’s legacy claim reduction services please contact us at 888.331.4941 or info@towermsa.com.

 

 

Author: Daniel Anders, Tower MSA Partners

 

Kids’ Chance of America and State Organizations Celebrate 2016 Awareness Week

Kids’ Chance Awareness Week 2016 kicks off today, November 14, 2016 and continues through November 18. The White House and President Obama have recognized the importance of Awareness Week and our mission to provide scholarships to children of workers who have been catastrophically or fatally injured on the job.  Collectively, Kids’ Chance organizations have awarded 5,593 scholarships across the country, totaling over $16,592,000 dollars.

 

At Kids’ Chance of America, we believe we can make a significant difference in the lives of all children affected by a workplace injury by helping them pursue and achieve their educational goals. In 2015, scholarship applications increased significantly but we know there are more students in need of assistance. Kids’ Chance Awareness Week is designed to increase visibility through outreach events in each state to spread the word about Kids’ Chance scholarship opportunities.

 

There are currently 36 Kids’ Chance state organizations with several others in development. Kids’ Chance of America’s goal is to establish a Kids’ Chance presence in every state so that all eligible students have the opportunity for assistance. Find out if there’s a Kids’ Chance in your state.

 

We welcome you to join our community of supporters and help us spread the word about this great organization.  Together we can bring more money to more kids!

 

For more information, please visit our website at www.kidschance.org.

 

 

Media Resources

 

Kids’ Chance Awareness Week is November 14-18, 2016. A Media Kit is available to download as well as an Awareness Week button to place on your website to help us gain momentum and broader visibility.

 

As members of the workers’ compensation community, we appreciate your consideration in sharing this story. If you have any questions, please contact the Kids’ Chance office at admin@kidschance.org.

 

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Ringler Rings In Their New Brand

Companies from time to time rebrand their look and messaging to connect better with audiences. We’re excited to tell you about our own rebranding at Ringler that’s being launched today! It’s the first real change that you can see since Ringler was founded in 1975. Ringler is still the largest settlement planning company in the nation with the experienced and trusted advisors creating the most objective settlement plans for all parties. Listen as Ringler Radio host Larry Cohen along with Geoffrey E. Hunt, Ringler’s President and CEO and Mark Vogel, head of the Ringler Leadership Team talk about what’s new and what it means for claimants, attorneys and our partners.

 

Page URL

http://ringlerradio.com/podcasts/ringler-radio/2016/09/ringler-rings-in-their-new-brand/

 

MP3

http://ringlerradio.ringlerradio.netdna-cdn.com/wp-content/uploads/2016/09/RR_080816_Rebrand.mp3

Pay-As-You-Go Solution for Workers’ Comp from The Hanover Lets Insureds Pay Premiums in Real-Time

WORCESTER, Mass., Aug. 19, 2016—The Hanover Insurance Group, Inc. has launched Hanover EZPay, a pay-as-you-go solution for workers’ compensation policies that allows insureds to pay their premiums in real-time, based on payroll, helping independent insurance agents provide better service to their clients.

 

This new payment solution offers businesses the option to pay their premiums as part of their payroll processes, either by self-reporting payroll at the end of each pay period or by linking Hanover EZPay with their payroll company.

 

“Hanover EZPay allows agents to provide their clients with increased flexibility and peace of mind by offering a payment option that fits with the flow of their business,” said John C. Roche, president of commercial lines at The Hanover. “For many agencies, this also helps increase customer satisfaction and retention, making it beneficial for both the agent and the customer.”

 

Business owners can now pay their workers’ compensation insurance premiums as each payroll cycle is processed, helping to improve their businesses’ cash flow and reduce audit exposures with real-time premium calculations. This option also offers businesses automatic premium withdrawals and does not require down payments or monthly billing fees.

 

The introduction of Hanover EZPay is further commitment to The Hanover’s workers’ compensation business, helping to enhance its agents’ ability to provide high-quality, easy-to-use products to their customers. This new payment option is available exclusively for The Hanover’s elite agent partners across the country and cannot be obtained directly through the company.

 

To learn more about The Hanover or Hanover EZPay, please visit hanover.com or hanover.com/billing.

 

ABOUT THE HANOVER


The Hanover Insurance Group, Inc., based in Worcester, Mass., is the holding company for several property and casualty insurance companies, which together constitute one of the largest insurance businesses in the United States. For more than 160 years, The Hanover has provided a wide range of property and casualty products and services to individuals, families, and businesses. The Hanover distributes its products through a select group of independent agents and brokers. Together with its agents, the company offers specialized coverages for small and mid-sized businesses, as well as insurance protection for homes, automobiles, and other personal items. Through its international member company, Chaucer, The Hanover also underwrites business at Lloyd’s of London in several major insurance and reinsurance classes, including marine, property and energy. For more information, please visit hanover.com.

 

CONTACT:


Emily P. Trevallion
etrevallion@hanover.com
508-855-3263

 

Abby M. Clark
abclark@hanover.com
508-855-3549

 

Henry Stimpson, Stimpson Communications, 508-647-0705, Henry@StimpsonCommunications.com

 

All products are underwritten by The Hanover Insurance Company or one of its insurance company subsidiaries or affiliates (“The Hanover”). Coverage may not be available in all jurisdictions and is subject to the company underwriting guidelines and the issued policy. This material is provided for informational purposes only and does not provide any coverage. For more information about The Hanover visit our website atwww.hanover.com.

Personal Comfort Doctrine Does Not Provide Comfort In Workers’ Comp

Under any workers’ compensation act, an injury is compensable if it “arises out of” and occurs within “the course and scope” of an employee’s work activities.  One area that is subject to frequent litigation is instance where an injury occurs during work breaks, or other non-work related activities. These personal comforts give members of the claims management team pause as to whether such an injury is compensable.

 

 

A Not So Uncommon Scenario

 

It is break time at the Acme Widget Company. Joe Friday missed breakfast and the company cafeteria is not yet open for lunch. Thankfully, there is a great coffee and donut shop across the street, which is frequented by employees before, during and after work. Joe decides to head over and grab a fresh jelly donut and cup of coffee. While carefully crossing the street he is struck by a car that did not stop for a traffic signal and suffers a broken leg. Would this claim be compensable?

 

 

Understanding the “Personal Comfort” Doctrine

 

The “personal comfort doctrine is a legal principle created by the courts to address the nature of typical workplace environments. Under this doctrine found in most jurisdictions, employees can engage in activities to provide personal comfort and still be covered under the protections of a workers’ compensation act. Such common activities include using a restroom, smoking or coffee breaks, eating food and drinking non-intoxicating beverages.

 

Application of this doctrine varies in every jurisdiction. In reviewing such matters, courts will examine various issues. These factors include:

 

  • Whether the activity was “contemplated” as part of the employment;

 

  • The nature of the activity prior to the accident; and

 

  • Any benefit to the employer when the employee engages in the activity resulting in injury.

 

 

Application of the Doctrine

 

Most workers’ compensation acts are interpreted in a light favorable to the employee. This result in injuries occurring during normal work hours, but off the employers premises or not directly related to one’s position, to be compensable.

 

Examples of injuries successfully using the personal comfort doctrine are numerous. In one example, an employee was crossing a street to get a pack of cigarettes. Although the injury did not occur on the employer’s property, the court found injuries similar to Joe Friday’s to be compensable.  Holly Hill Fruit Products, Inc. v. Krider, 473 So. 2d 829 (Fla. Dist. Ct. App. 1st Dist. 1985).

 

The reasons for this finding include the following:

 

  • The employee’s conduct was an “inevitable attendant danger;”

 

  • The actions of the employee were conducive to a pleasant work environment; and

 

  • While the employee was off the worksite for a short period, he did not remove himself from his employment activities.

 

 

Avoiding Unnecessary Workplace Exposures

 

Proactive members of the claim management team can work with interested stakeholders to reduce exposures and avoid “personal comfort” doctrine issues. Proactive steps can include:

 

  • Providing or making essential items available to employees on the worksite or premises. This includes having refreshments available free of charge or at an on-site store. By doing so, they maintain more control of their worksite;

 

  • Prohibiting smoking on company premises. Employers are recognizing the health benefits of tobacco-free workplaces. They can also coordinate with their health plan providers on accessibility of smoking cessation products or services to reduce the dependence on cigarettes; and

 

  • Establishing clear company policies regarding departure from the company premise during the workday. This can include a clear statement that leaving the workplace for any non-work related reason removes them from their employment and workers’ compensation activities.

 

 

Conclusions

 

It is important for interested stakeholders to understand the “personal comfort” doctrine.  This can assist with properly managing a claim where it is at issue and help employers minimize their risks to promote a safe work environment.

 

 

Author Michael Stack, Principal, COMPClub, 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 of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 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.

 

 

 

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