Category Archives: Workers Comp

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Workers Comp Turns 100

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100th birthday

2010 marks the 100th anniversary of workers compensation. That’s right — that little program that ensures that a worker will be paid if he or she is injured on the job now officially dates back a century.

These days, everyone is familiar with workers comp and we may even take it for granted sometimes.

Nancy Hamlet, senior vice president of Healthcare Solutions, wrote a feature for the November issue of Risk Management magazine (available online November 1st) that explores the long history and evolving future of workers comp. She notes that the first statewide workers comp law was adopted in Wisconsin in 1911, but “scholars have found evidence that the concept of formalizing payments to injured workers existed as early 2050 BCE.” Hamlet added:

The early Greeks, Romans, Arabs and Chinese all had compensation schedules for certain losses as well. For example, an Arab who lost a finger received more than someone who lost a thumb; the value of a lost ear was calculated based on its surface area.

Workers comp has (thankfully) evolved into a system that delivers value to both employers and employees by striving for fair compensation for workplace injuries. Workers comp systems vary from state to state, however. The Insurance Information Institute (III) has penned a lengthy article on the current state of workers comp in America (available online). The article examines some recent state activities, including:

Oklahoma: In an effort to make the state more attractive to new business, Oklahoma legislators passed a number of workers compensation bills in May, including HB 2652, which would modify the workers compensation court, effective November 2010. Oklahoma is one of a handful of states where the courts administer the workers compensation system.

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Among other things, it will reduce the number of judges on the court, require them to have at least five years of workers compensation experience prior to appointment and require Senate confirmation for new judges appointed by the Governor to fill vacancies.

In addition, it would extend their terms from six to eight years.

Texas: A pilot return-to-work program, adopted as part of comprehensive workers compensation reforms that took place in 2005, has now been made permanent. The program, which was designed to promote early and sustained return to the workplace after a work-related injury, reimburses an employer with less than 50 employees for expenses incurred in making workplace modifications so that the injured employee can return to the work. Maximum reimbursements, which under the pilot program were $2,500, have been raised to $5,000. Insurers are required to inform policyholders of the existence of the program.

New York: In accordance with the provisions of the 2007 workers compensation reform bill, employers who establish a safety incentive program, a return-to-work program and a drug and alcohol prevention program will be eligible to receive premium credits. Employers setting up safety programs that conform to the regulations issued by the Commissioner of Labor or a return-to-work program will receive a 4% credit in the first full year and a 2% credit each consecutive year. Drug and alcohol prevention programs are eligible for 2% premium credits.

Florida: In May 2009 lawmakers passed HB 903 in response to a state Supreme Court decision that reinstated hourly attorneys’ fees. Hourly fees had been the largest cost driver in the state’s workers compensation system. Under the new law, attorney fees in workers compensation cases will now return to the sliding scale set out in reform legislation passed in 2003. As a result, the 6.4% workers compensation rate increase imposed in April after the ruling was rescinded, and the 18.6% rate decrease that would have taken effect before the ruling was reinstated in July 2009. Rates declined again effective July 2010, the eighth consecutive drop, bringing the overall rate decrease since the reforms were passed to 64.7%, according to the insurance commissioner.

California: The Workers Compensation Insurance Rating Bureau is calling for a 29.6% rate increase to take effect in January 2011. A hearing will be held at the end of September. The insurance commissioner rejected the last request for an increase.
The bureau’s recommendations are advisory only. The bureau noted that even with the proposed increase, rates would still be 53% lower than those in effect on July  1, 2003, the year reforms were adopted that have stabilized the system.

Hamlet notices a few more trends, which she includes in her article on the topic. Those are the upward pressure on medical care costs* due to the increasing obesity of Americans and an aging workforce; the growing digitization of medical care records, which will speed the review process and help the injured worker return to worker faster; and the impact of personalized prescription drugs.

*The III notes that spending on medical care for workers comp claims climbed a cumulative 200% between 1993 and 2007.

A Spike in Insurance Fraud Across the U.S.

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As you may have guessed, the country’s economic conditions have caused a nationwide spike in insurance fraud.

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A recently released report by the Coalition Against Insurance Fraud points to the economy and continuous pressures on state budgets as the reason for a spike in fraud cases.

Overall, the economy in 2009 appears to have had a significant impact on the incidence of fraud.

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On average, fraud bureaus reported the number of referrals received and cases opened increased in all 15 categories of fraud

included in the survey.

Overall, the economy in 2009 appears to have had a significant impact on the incidence of fraud. On average, fraud bureaus reported the number of referrals received and cases opened increased in all 15 categories of fraud included in the survey.

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Those 15 categories of fraud are:

  1. Agent fraud
  2. Auto – staged
  3. Auto – padding/false claim
  4. Auto – give up
  5. Commercial – arson
  6. Disability
  7. Drug diversion
  8. Homeowners – arson
  9. Homeowners – padding/fake
  10. Liability – false claim
  11. Life insurance
  12. Medical – false claims
  13. Work comp – worker
  14. Work comp – employer
  15. Bogus health insurance/discount health plans

The biggest number of fraud cases occurred in the area of bogus health insurance. The report pointed to the reported rise in unauthorized entities selling fake coverage combined with the emergence of medical discount plans as the reason for the dramatic spike in this area.

Drug diversion came in second with survey respondents pointing to the fact that fraud involving the diversion of prescription drugs, mainly painkillers, appears to continuously increase — a trend over the last few years.

What’s in a Name?

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As we begin the week, the influenza outbreak continues to gather steam. According to the World Health Organization (WHO), 20 countries have officially reported close to 1,000 cases of A (H1N1) influenza infection.

Of these a little more than half are in Mexico, where 25 people have died from the disease. According to the BBC, more than 200 cases have been confirmed among 30 U.S. states, with more expected in the coming days. The disease remains at a level 5 WHO alert, one step below pandemic status.

With news like this, it’s easy to over-react. But it pays to keep some things – like the disease’s relatively low death rate thus far – in perspective.

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After all, this disease has also caused a fair amount of collateral damage. While the WHO does not encourage full-bore border closings or national travel restrictions as a reaction to the outbreak, it does suggest that people who are already ill should delay international travel.

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Likewise, groups such as RIMS have suggested restricting nonessential travel, and numerous airlines have reduced flights and have gone to using smaller planes.

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Mexico has been particularly hard hit by all of this, as would be any nation that relies on tourism income to any appreciable degree. Toronto certainly learned that the hard way during its experience with SARS.

Perhaps the most dramatic, and most unnecessary, reaction to the outbreak thus far has been the nationwide swine cull in Egypt, which illustrated just how hard the pork industry has been hit by this, and by extension, the secondary businesses (e.g., restaurants, grocery stores) it deals with.  Last week, the WHO advised against referring to the outbreak any further as “swine flu,” since it raised inaccurate notions over the safety of pork products. The European Union has done likewise.

This blog will also do the same, referring to the disease henceforth by its proper name, influenza A (H1N1). This denotes that the current influenza outbreak is a type-A H1N1 virus. To prevent further confusion, this blog has also edited past posts to change the name of the disease where necessary.

An Interview With Dr. Steven Weisbart

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Dr. Steven Weisbart, senior vice president and chief economist of the Insurance Information Institute, spoke with us today in regards to A (H1N1)u and its implications on businesses.

In terms of workers comp and business interruption, do you see any impact in those areas due to this outbreak?
Not in terms of business interruption, the disease is typically not an insured peril for that so I would say, unless we’re talking about very specialized events that have specialized event interruption insurance, there would be no business interruption implications that I could see.

In terms of workers comp you’d have to demonstrate in satisfactory fashion that contracting the disease arose out of, or in the course of, employment. I would think that that would be somewhat hard to prove unless maybe a cluster of employees at a given employer came down with it and then you could argue that they gave it to each other at the workplace. So I think it would be kind of a case by case thing. Obviously employers would be well advised to take the kind of mitigation measures and prevention measures like keeping sick people at home. But there may be some workers comp claims out of this.

If the CDC imposes travel restrictions, would your outlook change on that?
No. I mean, there are cases where order of government authority is a covered peril, but that typically has to do with situations like if there’s a fire, or other kinds of physical situations that the police or fire department require you to not travel to a physical location.

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This is different I think. So as a broad statement, I would say no, that doesn’t change my outlook.

Do you think this is likely to hit phase 6 as issued by the WHO and if so, would that change anything in terms of workers comp or business interruption?
There’s certainly a chance to get there and I think it depends on how the course of the disease goes. We’ve apparently had a very different experience in the U.S. than from what’s going on in Mexico. If Mexico had had our experience, I don’t think we’d be where we are today. But I don’t think anything would change from now in regards to workers comp or business interruption. I think the reason claims would or wouldn’t be paid would be true under current or worse conditions.

Every year the average flu kills tens of thousands of people in the U.S. and hundreds of thousands of people worldwide. With that in mind, do you think this is a complete overreaction from the public and the media?
Oh no. We’ve been worried about infectious influenza certainly in recent years since SARS and the bird flu strain was identified and I think that given the seemingly rapid spread of infection that this is an appropriate level of concern. It appears, at least in the U.S., that this is not as deadly as it appears to have been in Mexico but there’s nothing to say the strain couldn’t mutate and become deadly, so I think we should be as alert and as extensive in communication about this as possible. I don’t think this is an overreaction at all.

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Do surgical masks really help?
The only masks that might be of some help are the N95 masks and the reason they might be of some help is because they are much finer in their ability to block out droplets that might contain the virus. Anything that is not as fine a filter as an N95 would probably be of no help at all.

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