Illinois lawmakers double down on drug formulary proposal


A second bill that would create a closed drug formulary for injured workers in Illinois was introduced Thursday, in line with a yearslong trend among lawmakers there aiming to mandate how drugs are prescribed under workers compensation.

H.B. 4087, which was referred to the rules committee, calls on the Illinois Workers’ Compensation Commission, upon consultation with the Workers’ Compensation Medical Fee Advisory Board, to adopt an evidence-based drug formulary by Sept. 1.

The bill would require prescriptions in workers compensation cases to be limited to the drugs on the formulary and also states that “custom compound medication for longer than the one-time 7-day supply shall be approved for payment only if the compound meets specified standards.”

The similar H.B. 1546 was introduced in January and has since stalled in committee. Legislators have been trying since 2019 to create a drug formulary in Illinois. 

 



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Illinois comp bills address injury causation, fee schedules


Illinois lawmakers are considering two bills that would establish limits on causation for compensable workplace injuries and redraft medical fee schedules in workers compensation.

H.B. 4082, introduced Wednesday, would set parameters on what constitutes an injury that occurs “out of and in the course of employment.” The bill states that such an injury would be compensable “only if the accident significantly caused or contributed to both the resulting condition and the disability.”

The bill also states that “an injury does not arise out of and in the course of employment if (1) the hazard or risk was not incidental to employment and was a hazard or risk to which the general public is also exposed, (2) the injury did not occur at a time and place and under circumstances reasonably required by the employment, or (3) the disability resulted from a personal risk.”

H.B. 4079, also filed Wednesday, would charge the Illinois Workers’ Compensation Commission with developing a new medical fee schedule for most services in comp, basing some of the fees on geographic regions. The fee schedule, as it is currently, would be based on fees paid under Medicare.

 



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Virtual reality fosters positive injured worker outcomes: Experts


ORLANDO, Florida — The role of medicine in workers compensation is continually evolving, as newer technologies emerge and change the nature of care for injured workers, panelists said Tuesday at the National Council on Compensation Insurance’s Annual Insights Symposium.

During a session on the future of medicine, Dr. Gerry Stanley, senior vice president and chief medical officer of Harvard MedTech, spoke about technological advances in comp, including virtual and augmented reality platforms used to treat injured workers.

“Now, we can take care of patients in their homes or wherever they’re living,” Dr. Stanley said.

He said the use of virtual reality in treatment for comp patients became more popular as a result of the pandemic.

“As we move into the future, we’re going to take a lot of lessons from our past,” he said. “How can we support people in a more holistic manner so we can get those workers comp outcomes that we want?”  

Injured workers who feel isolated benefit from being placed into a virtual world that resembles the real world, thereby increasing their motivation to get healed and return to work, Dr. Stanley said.

Virtual reality enables injured workers to transcend the feeling of being a “widget on a board being moved around” in the comp system, he said.

Dr. Michael Choo, chief medical officer of Walnut Creek, California-based medical management service company Paradigm Corp., addressed the common fear of artificial intelligence replacing medical professionals.

“I do think that AI will play a role, but I don’t think there’s going to be any sort of replacement,” Dr. Choo said.

Kenji Saito, president of the American College of Occupational and Environmental Medicine, said a personal touch will always be needed in comp to foster healthy worker outcomes.  

 

 



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Workers comp remains strong as labor market rebounds: Expert


ORLANDO, Florida – As the threat of a recession looms, the workers compensation insurance industry remains relatively healthy, an industry expert said during a presentation Wednesday at the National Council on Compensation Insurance’s Annual Insights Symposium.

A recession this year would likely lead to a deceleration of commercial lines’ net written premium growth, taking pressure off the current hard market as demand for property/casualty insurance slows, said Robert Hartwig, clinical associate professor and director, Risk and Uncertainty Management Center, at the University of South Carolina’s Darla Moore School of Business.

During a presentation on the labor market, economic uncertainty and the combined effect on workers comp, Mr. Hartwig said the insurance industry will likely continue to remain stable despite what has been occurring in the banking sector, including recent large bank failures.

“The P&C insurance industry is strong, stable, sound and secure,” he said.

Workers comp remains the only major commercial line seeing declining rates. “That really, really sets workers comp apart,” from other major lines, Mr. Hartwig said.

Property/casualty insurers have seen rising investment income, which has helped offset underwriting losses, he noted.

Mr. Hartwig said the labor market remains strong, with the unemployment rate at a generational low. Workers ages 25 to 54 are back at work in large numbers post-pandemic, and the percentage of employees quitting their jobs is down sharply, he said.

“Labor markets can reasonably be expected to remain tight,” he said.



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MedRisk announces Danielle Lisenbey retirement, leadership changes


MedRisk LLC on Wednesday announced the retirement of its CEO Danielle Lisenbey, who joined the company in 2020.

Prior to her work at the King of Prussia, Pennsylvania-based managed physical rehabilitation company, Ms. Lisenbey was global president of Broadspire Services Inc., the third-party administrator of Atlanta-based Crawford & Co. She was among Business Insurance’s Women to Watch in 2013.

An “Office of the Chair” group has been created to lead in the interim and complete the appointment of a new CEO. The Office of the Chair will be led by Executive Chairman and former CEO Mike Ryan.

The company also announced that Sri Sridharan, the company’s chief client officer, was promoted to president of MedRisk and will be a member of the group. Chief Financial Officer Tom Weir was also named a part of the interim group, which will oversee strategic planning and direction.

Jamie Davis-Motsinger has also been appointed chief client officer, transitioning from chief sales officer.

 

 

 



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Workers comp premium increased 11% in 2022: NCCI


ORLANDO, Florida – The workers compensation industry is healthy, with net written premium increasing 11% in 2022 to $47.5 billion, a level similar to 2019 prior to the start of the COVID-19 pandemic, experts with the National Council on Compensation Insurance said Tuesday during its Annual Insights Symposium.

Last year was also the sixth consecutive that the overall workers comp combined ratio was below 90, and the ninth straight year of comp underwriting profitability, said NCCI Chief Actuary Donna Glenn.

“Workers comp continues to be the most profitable property and casualty line of business,” Ms. Glenn said during a presentation on the State of the Line Report. “Frequency has returned to a 20-year average decline, and COVID-19 has diminished considerably.”

Despite what NCCI lauded as good news, the industry saw a notable rise in claim severity, with medical claim severity increasing about 5% and indemnity claim severity rising about 6% year over year, she said.

Meanwhile, overall lost-time claim frequency has declined slightly during the past two years, which could in part be attributed to workplace safety improvements, automation and employee experience, she said.

There were rises in workplace injuries in specific sectors in 2021 and 2022, including package delivery and warehousing, two industries that Ms. Glenn said saw many new hires.

Strains, slips and falls continue to comprise the most common workplace injuries, and there has been a recent increase in caught-in-between injuries as well as burns and abrasions. The largest decrease in claim frequency was tied to a drop in motor vehicle accidents.

Manufacturing added many new hires in 2021 and 2022, and claims frequency could be tied to shorter worker tenure combined with insufficient training, Ms. Glenn said. Similar claims frequency occurred in package delivery, which saw a “significant rise in workplace injuries,” she said.

Yet “the long-term decline (in overall injuries) appears to be continuing despite some increases in specific areas,” Ms. Glenn said.

The industry continues to monitor medical cost changes, and medical lost-time claim severity estimates for 2022 are 5% higher than in 2021, Ms. Glenn said.

On premium collected, Ms. Glenn said economic factors such as payroll play a large role in the net written premium increase, and that sectors such as transportation, warehousing and utilities continue to see larger than average growth.

“Despite many moving parts, wage growth over the last few years has brought workers compensation premium back to where it was in 2019,” Ms. Glenn said. “Employment is back to pre-pandemic levels, and wages are driving the overall payroll gain.”

The workers compensation combined ratio was 84 in 2022, compared with 87.2 in 2021, and Ms. Glenn said comp continues to be in a strong financial position, with nearly a decade straight of underwriting profitability.

As for COVID-19, Ms. Glenn said workers are continuing to contract the virus on the job, “but the numbers have diminished considerably.” COVID-19 claims represented 1% of total losses over the years 2020 to 2022, she said.

During a question-and-answer period, Dan Benzshawel, NCCI executive director and actuary, said worker wages continue to outpace average comp claim costs and that frequency remains the main cost driver in the workers comp system.

Carolyn Wise, NCCI manager and associate actuary, said she expects a continuing decline in claims frequency, linking the projected drop to workplace automation and the “general movement toward safer jobs.”

Ms. Wise said 2022 saw above-average increases in medical severity but that medical fee schedules for physician services and facilities in some states continue to act as good “cost containment mechanisms.”

“While prices matter, utilization matters too,” Ms. Wise said.



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MGA launches risk management, comp program for struggling companies


Seaglass Insurance Group on Tuesday announced the launch of a workers compensation program for distressed businesses with high injury rates in the manufacturing and social service sectors.

The Estero, Florida-based managing general agent, licensed in all states, provides services to drive down workers compensation insurance costs and strengthen workplace safety culture by focusing on mitigation of key loss factors with customized risk management.

The new “distressed/high mod program” will help companies establish vigorous risk management protocols that will lead to reduced insurance expenses and a safer work environment, according to a statement.

 

 



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Montana cancer presumption bill becomes law


Montana Gov. Greg Gianforte signed a bill expanding the types of cancers that are presumed compensable for firefighters.

The governor on Thursday signed S.B. 310, which creates presumptions that cervical cancer is work-related after 15 years of service and that testicular cancer arose from employment after 10 years of service.

Mr. Gianforte also signed H.B. 702 on Thursday, extending a program that reimburses private employers for workers compensation costs associated with student interns. The program was scheduled to sunset June 30.

WorkCompCentral is a sister publication of Business Insurance. More stories here.



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