Category Archives: Governance, Risk & Compliance

Workers Compensation Issues to Watch in 2014

Posted on by

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.

online pharmacy tadalista with best prices today in the USA

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.

online pharmacy naprosyn with best prices today in the USA

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.

online pharmacy pepcid with best prices today in the USA

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

Construction Fraud Costs An Estimated $860 Billion

Posted on by

Infrastructure Construction

Fraud in the construction business is “commonplace and in some cases endemic across Australia, Canada, India, the UK and the US,” according to a new report from Grant Thornton, amassing a global price tag of up to $860 billion today—between 5% and 10% of total revenues. The accounting and advisory group projects that annual fraud cost in the sector could rise to .

buy arava online healthdirectionsinc.com/flash/swf/arava.html no prescription pharmacy

5 trillion by 2025.

“The greatest threat of fraud comes from within—from employees and senior management,” said David Malamed, fraud expert at Grant Thornton Canada.

buy tamiflu online healthdirectionsinc.com/flash/swf/tamiflu.html no prescription pharmacy

While the risk of insider fraud is highest, the odds of fraud in a construction project increase drastically with the number of stakeholders.

buy zocor online healthdirectionsinc.com/flash/swf/zocor.html no prescription pharmacy

The primary sources of major frauds in the sector include billing fraud, bid rigging, money laundering or tax avoidance, theft or substitution of materials, bribery or corruption, false representation (of documents, figures, certificates), change order manipulation and fictitious vendors, LiveMint reported.

“Individuals and organizations need to invest the time and money to put a fraud prevention and detection plan into action before they become a victim,” said Bo Mocherniak, Grant Thornton’s national leader for construction, real estate and hospitality. “The push for fraud prevention requires strong governance and leadership, and must start at the very top of the organization.”

But one of the primary nations at risk offered promising news for public risk managers this month on the efficacy of anti-corruption efforts in the sector. In Canada, the Quebec government announced a $240-million savings on road contracts alone for the first 10 months of the year. According to the Globe and Mail, Minister of Transportation Sylvain Gaudreault said the building and maintenance of roads and bridges in the province has dropped 16% below the estimated costs projected for 2013, crediting the battle against corruption and collusion for forcing builders and engineering firms to play by a tougher set of rules.

Gaudreault’s administration has focused on more rigorous oversight and enforcement to minimize graft losses over the past year. Moves are currently on hold in the formation of a formal transportation agency tasked with approving and monitoring road construction and maintenance contracts, but the minister has hired 321 employees – including 118 engineers – to “reinforce” the expertise in his department. The local government has also promised legislation in the coming weeks aimed at recovering at least part of the money obtained by construction and engineering firms through collusion and fraud, the Globe and Mail reported.

TRIA’s Impact on Workers Comp

Posted on by

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.

online pharmacy clomiphene with best prices today in the USA

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.

online pharmacy prevacid with best prices today in the USA

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.

online pharmacy phenergan with best prices today in the USA

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.

New Preliminary Cybersecurity Framework Champions Risk Management

Posted on by

Cybersecurity

In February, President Obama issued an executive order instructing the Commerce Department to lead a task force of security experts and industry insiders to develop a voluntary framework to reduce cyberrisk. Last week, the National Institute of Standards and Technology officially released an initial draft of the cybersecurity framework and announced a 45-day open comment period for public input.

The full Preliminary Cybersecurity Framework can be viewed here on the NIST website. After the review period and subsequent revisions, a more complete version will be released in February.

Risk management is a primary focus of the new framework, from the language used to analyze potential exposure to express endorsements in the policy itself. According to a press release, “The Preliminary Framework outlines a set of steps that can be customized to various sectors and adapted by both large and small organizations while providing a consistent approach to cybersecurity. It offers a common language and mechanism for organizations to determine and describe their current cybersecurity posture, as well as their target state for cybersecurity. The framework will help them to identify and prioritize opportunities for improvement within the context of risk management and to assess progress toward their goals.”

Under Secretary of Commerce for Standards and Technology and NIST Director Patrick Gallagher, who was tasked with overseeing development of the framework, emphasized the risk management as a critical component of strengthening national infrastructure in line with the president’s executive order. “We want to turn today’s best practices into common practices, and better equip organizations to understand that good cybersecurity risk management is good business,” Gallagher said.

buy xifaxan online orthomich.com/img/blog/jpg/xifaxan.html no prescription pharmacy

“The framework will be a living document that allows for continuous improvement as technologies and threats evolve. Industry now has the opportunity to create a more secure world by taking ownership of the framework and including cyber risks in overall risk management strategies.

buy trazodone online orthomich.com/img/blog/jpg/trazodone.html no prescription pharmacy

”

The framework outlines key functions that should organize cybersecurity activities: Identify, Protect, Detect, Respond and Recover. These functions are designed to aid the risk manager in evaluating, communicating and fortifying against cyberrisks. The document even suggests itself as a potential opportunity for risk managers to seize the opportunity to get involved in proactive cyberrisk strategy. It reads, “The functions also align with existing methodologies for incident management, and can be used to help show the impact of investments in cybersecurity.”

Authors also added the following visual to highlight the critical role of risk management at every level of suggested implementation:

Risk Management in Cybersecurity Framework

In a blog post, the White House encouraged businesses to evaluate the initial framework and their current cyberrisk position, and to consider their cyber risk appetite in the form of a projected target state for cybersecurity.