Author Archives: Mark Walls

About Mark Walls

Mark Walls is a market research leader with Marsh’s Workers’ Compensation Center of Excellence.
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Health Care Reform and Workers Compensation

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Since its passage in 2010, the Affordable Care Act (ACA), commonly referred to as health care reform, has been the subject of intense political debate and a source of anxiety for many employers. Although most employers have focused on the law’s health benefit requirements, the ACA is also expected to impact how they manage their workers compensation costs in the following ways:

Workers’ Health

Proponents of the ACA say that it will lead to a healthier society. Advocates say that because more people will have access to health care, there will be a reduction in comorbidities. There is, however, no significant evidence to support this contention. For example, data from the Centers for Disease Control and Prevention indicate that heart disease remains the leading cause of death in the United States and that the percentage of Americans with a high body mass index has steadily climbed over the last 50 years—two trends that are not confined to the uninsured population.

Cost Shifting

Employers have long been concerned that injuries from non-work-related causes will be shifted to workers compensation. Doing so is tempting because of workers compensation’s combination of higher reimbursement rates for medical providers and lack of deductibles and co-payments for employees.  Some have speculated that the greater access to health insurance promised by the ACA will reduce this shift to workers comp.

It has become clear, however, that the law will not result in all Americans having health insurance coverage. With the ACA requiring that employers offer coverage to all employees working 30 or more hours per week starting in 2015, one-in-10 large companies are planning to cut back on hours for at least a portion of their workforce, according to “Mercer’s National Survey of Employer-Sponsored Health Plans” 2013.

Access to Care

Probably the most predictable outcome of the ACA is that it will increase the number of individuals in the U.S. with health insurance coverage. Despite the potential benefits, this could put additional stress on a health care system that is already short on doctors.

This is particularly troubling as it relates to specialists and the potential for delays in obtaining diagnostic tests and scheduling elective surgeries and other procedures. Longer periods of disability and complications as a result of such delays would ultimately drive workers’ compensation costs up.

With this added pressure on a limited number of medical providers, it becomes more important than ever for employers to develop medical networks that focus on quality of care and outcomes—even if it means paying more on a fee-for-service basis.

Standards of Care

Traditionally, the health care industry’s focus has been on volume; more patient admissions, tests, and procedures translated to higher revenues. Post-reform, however, the industry has shifted its focus to improving standards of care and achieving better patient outcomes.

If this transition results in less emphasis on costly procedures, which often produce questionable results, workers’ compensation costs could be reduced.

Although it remains to be seen whether the standards of care developed under the ACA for group health care would be enforced under workers compensation, this is a promising development for employers.

Workers Compensation Issues to Watch in 2014

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With 2013 behind us, here are my thoughts on some workers compensation issues to watch for in 2014:

Rates Continue to Climb

In most of the U.S., rates for workers compensation insurance continue to rise. Rates are being driven by rising medical costs, the low interest rate environment, and the general unprofitability of the line of business.

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Potential Expiration of TRIPRA

Unless Congress takes action, the Terrorism Risk Insurance Program Reauthorization Act (TRIPRA) will expire on Dec. 31, 2014. Companies with high employee concentrations in certain cities are already seeing fewer options, with some carriers scaling back their writings to reduce their exposure to a potential terrorism event.

Impact of the Affordable Health Care Act (AHCA)

There has been much speculation about the potential impact the AHCA will have on workers compensation. With a finite number of medical providers available to handle the increased utilization, it is imperative that workers compensation payers identify the providers who deliver the best clinical outcomes for injured workers.

Integrated Disability Management

More employers are realizing that the impact of federal employment laws, like the Americans with Disabilities Act and the Family and Medical Leave Act, must be considered on workers compensation claims. Companies are also recognizing the value of managing non-occupational disability so that valued employees can get back to the workplace and be productive. Integrated disability management programs are the next generation of claims-handling and will expand in the future.

State Legislative Issues

Several states that passed significant reform legislation in the last two years are working to implement those reforms. Passing a law is only the first step, as the rules, regulations, and implementation of those laws determine if they will achieve their intended purpose. The most significant states to watch are in California, New York, and Oklahoma.

When California passed SB 863 in 2012, the expectation from the state’s legislature was that it would increase benefits to injured workers, while lowering costs for employers in the state. Litigation and unanticipated consequences of the bill have resulted in increased complexity and continually rising insurance rates. There is currently talk of potential clean-up legislation to go along with continued efforts at implementation. We will know by the end of the year whether SB 863 will be able to produce the promised cost savings.

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New York streamlined its assessment process, resulting in a significant reduction of the assessment rate for most employers. Since these rates are adjusted annually, it remains to be seen if these assessment savings will continue into the future.

The big news in Oklahoma is the bill that allowed employers to opt-out of workers compensation starting in February 2014. There have been delays in developing the rules and regulations supporting the opt-out plans, and this has in turn delayed carriers’ development of policies to cover new benefit plans. It appears unlikely that everything will be in place in time for employers to opt out beginning in February.

Vendor consolidation

In the last few years, there has been significant vendor consolidation in the workers compensation industry. First on the third-party administrator side and most recently in medical management. All this consolidation is making buyers of these services uneasy.

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They question how this will impact the quality of the services they receive and wonder how their goals of reducing costs align with the vendors’ goals of increasing revenues.

Analytics

Despite the huge amount of premium, exposure and claims data produced by the workers compensation industry, many complain about the lack of actionable information. As an industry, we will see a continued focus on the use of more meaningful analytics that can assist in identifying savings opportunities, formulating action plans, and measuring the impact of change.

Assessing ROI for Medical Cost Management Efforts

Programs including bill review, utilization review, and nurse case-management are all necessary components of any successful workers compensation program. It is important, however, that these programs are constantly monitored to ensure they are being used appropriately.

Please join me Jan. 15, for a webinar discussing these issues and other potential legislative developments to watch in 2014.  Click here to register

TRIA’s Impact on Workers Comp

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Because of the significant financial impact of the Sept. 11, 2001 terrorist attacks, Congress created the Federal Terrorism Risk Insurance Act (TRIA). Its purpose is to provide a financial backstop to the insurance industry that would cap losses in the event of another large-scale terrorist event. TRIA was initially set to expire at the end of 2005, but it has been extended twice and is now set to expire Dec. 31, 2014.

When most people think of TRIA, they think of property insurance. Without TRIA, many high-profile properties would be difficult to insure in the commercial marketplace. However, TRIA also plays an important role in workers’ compensation coverage, and its pending expiration is already impacting some renewals.

Workers’ compensation insurers are particularly concerned about large accumulations of employees in small areas, also known as employee concentrations.

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When carriers model employee accumulations, they not only look at a single employer’s concentrations, but also their aggregate accumulation exposure for all their policyholders in a particular zip code or city and in some cases across multiple correlated lines of business. Because workers’ compensation underwriters are required to provide terrorism coverage by law, the only way to limit their exposure is to reduce the amount of capacity they offer.

If TRIA is allowed to expire or is modified significantly, employers in certain cities and industries with large employee concentrations will likely experience capacity shortages.

In fact, the uncertainty around TRIA’s reauthorization is already leading some workers’ compensation carriers to decline or non-renew risks in certain geographical areas, or ask for large rate increases.

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The healthcare, public entity, higher education, and financial sectors are particularly affected by employee concentration issues at the moment.

To mitigate the impact of TRIA’s uncertainty, employers should differentiate their risk. Since both insurers and reinsurers use catastrophic models to estimate their loss potentials, it is critical that employers provide the highest quality of exposure data to help distinguish their risk profiles from their peers.

Additionally, companies with multiple shifts or those that operate in a campus setting should make sure to report both the total number of employees and the number of employees working during peak shifts—as well as the actual buildings where the employees are located. The number of employees working during peak shifts is the actual exposure to a terrorist event, not the total number of employees.

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Also, companies with a large percentage of their workforce in the field or telecommuting, rather than in the office where their payroll is assigned, should give this information to insurers. Providing very detailed information can help overcome some potential pitfalls of the catastrophic models and better reflect an employer’s exposure to catastrophic losses.

Employers with a large concentration of workers, especially those in major metropolitan areas, should be prepared to provide the following information to underwriters:

  • Employee marital or dependency status, including dates of birth for dependents.
  • Employee telecommuting/hospitality practices and impact on concentration.
  • Physical security of the building, including information about guards, surveillance cameras, parking areas, and HVAC protections.
  • How access to the building is controlled.
  • Construction of the building and location of the offices.
  • Management policies around workplace violence, weapons, and employment screening.
  • Employee security procedures.
  • Emergency response/crisis management plans and procedures.
  • Fire/life safety program.
  • A list of security staff.

As we move into 2014 without Congressional action on TRIA, the reaction of the marketplace is expected to become more pronounced. It is imperative that employers prepare to address the concentration issues with their carriers. This will help lessen the impact of these concerns and position employers to receive optimal terms on their risk management programs.