Tag: Workers Comp

The U.S. Occupational Safety and Health Administration announced Tuesday that it cited an Alabama concrete company over the November 2023 death of a worker who was crushed by a shipping container.

OSHA cited Moundville-based Ballard Contractors Inc. for seven “serious” violations and one “other-than-serious” violation, saying the company failed to protect workers from fall, struck-by and crushed-by hazards.

The worker was guiding an 8,575-pound shipping container into place when one of the chains used to lift it snapped, according to OSHA.

The agency said Ballard Contractors failed to ensure that rigging equipment was properly rated and could handle the shipping container’s weight; permitted employees to work beneath a moving load; failed to perform periodic inspections of slings; and failed to ensure proper fall protection was in place.

OSHA said the company has since entered into an informal settlement agreement that resolves the citation.

OSHA records show that the agency initially proposed an $82,271 penalty that was reduced to $68,077 at the time of the informal settlement agreement.

 

Workers compensation midyear renewals were stable, with employers continuing to benefit from a competitive market, experts say.

The coverage line remains profitable for insurers as costs remain in check, and there is little sign of the market changing in the medium term, they say.

“The workers comp line remains very stable,” said Benjamin Powers, Atlanta-based head of primary casualty North America for Willis Towers Watson PLC. 

Many insurers are supplementing other lines with workers comp due to its “positive rate trends,” Mr. Powers said.

“That’s why we’re seeing negative rate in comp,” he said.

Workers comp renewals were “one of the bright spots for both employers and carriers,” said Kapil Mohan, a Chicago-based senior vice president with Rolling Meadows, Illinois-based Gallagher Bassett Services Inc.

Insurers continue to profit from underwriting workers comp policies because of lower loss ratios, and employers saw flat or slightly declining costs because of overall market conditions, he said.

“There isn’t anything that I would say is on the horizon that’s going to significantly change that, or at least no one expects that,” Mr. Mohan said.

Medical inflation is averaging about 3.3% in a flat-to-negative rate environment, and experts are monitoring how rising medical costs may affect workers comp, Mr. Powers said.

“Carriers would like to push rate because of medical cost inflation, but with the whole supply and demand that’s happening, we have an abundance of workers comp capacity in the marketplace,” he said. 

A June benchmarking report by Lockton Cos. LLC showed that pricing for guaranteed cost and loss-sensitive workers comp programs continued to fall in the first quarter of the year.

The report said guaranteed cost programs, where premiums are determined at renewal, were expected to see flat to 5% rate decreases in the second quarter, and loss-sensitive programs, where premiums are adjusted based on individual claims experience, were expected to see a 2% to 3% rate increase.

According to the National Council on Compensation Insurance, workers comp insurers have reported 10 consecutive years of combined ratios under 90%.

While NCCI continues to monitor medical inflation as a potential negative trend for the sector, other cost drivers have been favorable for employers and insurers, said Jeff Eddinger, senior division executive with Boca Raton, Florida-based NCCI. 

“NCCI has been filing almost exclusively decreases to the loss costs for the last several years,” Mr. Eddinger said. “The reasons for that are continued improvement in claim frequency, workplaces continue to get safer, and what we call moderate increases in claim severity or the average cost per claim.”

The decade of workers comp profitability has “perpetuated a favorable market condition for buyers,” said Debbie Goldstine, Chicago-based executive vice president, U.S. casualty, and technical intelligence and emerging risks practice leader at Lockton.

“Unlike liability, where claim costs have escalated due to economic and social inflation, work comp has benefited from highly stable loss trends, where annual increases in severity have been at or below general inflation,” Ms. Goldstine said. “Add to that a favorable interest rate environment, which will continue to provide a nice little tailwind for insurers … (and) it means a very competitive environment for buyers.”

A greater emphasis on workplace safety and a focus on loss prevention and cost control have all “had a positive impact on the renewal market,” Mr. Mohan said.

There are some issues to watch that experts say could potentially affect workers comp, including increasing mental injury claims and a rise in workplace violence, but overall, the picture is generally positive for the line, experts say.

“Our outlook is that work comp will continue its run of profitability for the foreseeable future,” Ms. Goldstine said

 

The California workers compensation system saw a 9.5% drop in private self-insured claim volume in 2023, representing the largest year-to-year decline in more than 15 years, according to a report released Monday by the California Workers’ Compensation Institute.

CWCI analyzed data from the state’s Office of Self-Insurance Plans and found that private self-insured employers covering 2.34 million California workers in 2023 reported 94,386 workers comp claims, down from 104,278 claims in 2022.

While claim volume and frequency declined, private self-insured employers’ total paid and incurred losses rose in 2023. Paid losses totaled $340.2 million, up 9.5% from 2022. Incurred losses rose 6.4% to $864 million.

The data analyzed in the report included the total number of covered employees, as well as both medical-only and indemnity claim counts.

The U.S. Occupational Safety and Health Administration said Monday that it cited a Texas tank cleaning company over the death of a worker late last year.

OSHA cited La Porte-based Qualawash Holdings LLC, operating as Quala Services LLC, for eight “repeat” violations and proposed $810,703 in penalties over the December 2023 fatality, which occurred while the worker was cleaning the inside of a tank.

The company, which specializes in cleaning tank trailers used to transport hazardous waste, was cited for similar violations in June 2020 in connection with the November 2019 death of two workers.

In the latest citation, OSHA said Quala Services failed to ensure atmospheric testing was done inside the tank before allowing employees to enter it.

OSHA also said the company failed to implement measures to prevent entry into permit-required confined spaces, failed to provide an attendant while employees worked inside confined spaces, and overexposed employees to carbon monoxide.

When the employee didn’t return home after his shift, his family urged the company to check the tanker, where the employee was found unresponsive, according to OSHA.

The agency said Quala Services never implemented safety reforms following the previous two employee deaths.

The company has 15 business days to contest the citation and proposed penalties.

While workers in some occupations today suffer from repetitive motion injuries, such occupational hazards are actually nothing new — ancient Egyptian scribes suffered from degenerative physical changes attributed to their job tasks, says a recent study published in Scientific Reports. 

The study said the scribes – Egyptian men in the third millennium B.C. — sat cross-legged or in a kneeling position for extended periods and that the repetitive tasks related to writing and the “adjusting of the rush pens during scribal activity” caused an “extreme overloading of the jaw, neck and shoulder regions.” 

The degeneration to jaw joints could have been due to the scribes chewing the ends of writing instruments, and thumb degeneration might have been due to their “repeatedly pinching their pens,” the study states.

The study’s authors, who examined the skeletal remains of 69 adult men, 30 of whom worked as scribes, found that degenerative joint damage was more prevalent among the scribes compared with those who worked in other jobs.

The researchers also noted that statues and wall decorations found inside Egyptian tombs depict scribes sitting in various improper positions while working – corroborating the findings.

Artificial intelligence that mines injured workers’ medical and claims records is helping employers and insurers cut costs by spotting difficult or suspicious claims, but the technology remains a tool for claims handlers rather than a replacement. 

By analyzing injury and claims handler notes, background reports, prognosis details, and emails and transcripts of phone calls, AI can help claims staff predict the trajectory of a claim and intervene. 

Some experts say the technology, which has saved employers and insurers millions in workers comp costs, holds promise in uncovering workers comp fraud — both among claimants who fake or exaggerate injuries and medical providers who prescribe bogus or unrelated treatments, or charge for unfulfilled treatments. 

The Coalition Against Insurance Fraud  says that typically 1% to 2% of workers comp claims are fraudulent, and the organization published a report in 2023 that found that up to 16% of comp claims have some elements of fraud, accounting for $9 billion in losses for insurers and employers. 

There is little, if any, available data on fraud uncovered with AI, but experts say the industry is poised to deploy the technology. Several companies have launched products in recent months or are in the process of developing the capabilities to find fraud patterns in claims data. 

“We can use techniques like pattern recognition and predictive models, which can analyze historical claims data to identify any kind of patterns indicative of fraud,” said Sam Krishnamurthy, Alpharetta, Georgia-based chief technology officer in digital solutions with Crawford & Co. 

AI has been found to be “incredibly powerful in the extraction of information,” said Jeff Gurtcheff, chief claims officer at CorVel Corp.

On the claims side, workers comp fraud often shows similar characteristics, and technology can aggregate details found in mounds of claims data. The reports generated can help uncover patterns such as exaggerated injuries, lack of proof that an injury occurred at work, and malingering, experts say.

For provider fraud, spotting similarities or, in some cases, anomalies in prescribing and treatment patterns among doctors could help uncover fraud rings, they say, adding there is also some promise in finding litigation patterns among plaintiffs attorneys. 

“The more unstructured and structured data we have we can create a target data discovery model, which is a very powerful approach for detecting and mitigating fraudulent behaviors,” Mr. Krishnamurthy said. 

“We then use these advanced data analytics and machine learning techniques, not only to uncover the hidden patterns, but mainly to also detect these anomalies and prioritize them for investigation. And that will eventually lead to more efficient and effective fraud prevention strategies.” 

In June, Sunnyvale, California-based Clara Analytics Inc., which provides insurance technology services to insurers and employers, launched a fraud detection product that it says can leverage the company’s AI platform and large workers compensation datasets “to increase visibility into suspicious claims.” 

Mubbin Rabbani, Clara’s Medford, Massachusetts-based chief products officer, said the new capabilities are a natural progression from what Clara and many similar companies already do: provide data to help organizations manage claims. 

“Throughout our engagement with our customers we have built a very large data set of performance data around providers, doctors, hospitals, etc., as well as attorneys, both defense counsel and plaintiff attorneys, on these claims,” he said. “Using that allows us to now start to build on additional capabilities to what we currently offer, all in the spirit of deriving optimal claim outcomes, specifically now in fraud.” 

Tyler Kennedy, Boston-based lead developer for Gain Life Inc., which also provides AI services in the comp industry, said the capabilities show promise. “You’ve got this data and you’re trying to search for anomalies, or you’re trying to search for patterns, which is kind of what fraud is,” he said. 

Both Mr. Rabbani and Mr. Kennedy say the endeavor requires caution (see related story below) and that a good AI fraud program won’t investigate fraud — it just points out the possibility of fraud, given certain claim characteristics. 

“It’s not in our role to say (whether) it’s fraud or not,” Mr. Rabbani said. “What we are trying to do is refer (the information to a client), which will do that deeper investigation and take the corrective actions that may be needed if it is indeed fraud.” 

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False positives, burden of proof slow AI adoption among insurers

Companies looking at artificial intelligence as an avenue for uncovering workers compensation fraud should tread carefully, experts say. 

AI is imperfect and can misrepresent findings and conclusions, finding coincidences instead of fraud and leading investigators astray, they say.

“This technology is not without its challenges,” a spokesman for the Coalition Against Insurance Fraud wrote in an email. “It can produce false positives, leading to unnecessary investigations and customer dissatisfaction.” 

Jeff Gurtcheff, chief claims officer at CorVel Corp., said the challenge is not “the ability to identify lots of red flags through the use of AI” but whether insurers can “truly prove fraud or intent (to commit fraud) or persuade an administrative body.” 

Mr. Gurtcheff gave the example of a malingering workers comp claimant video-recorded on a golf course while attesting he still had a bad back. “You take that video in front of an administrative body, which then says maybe he was just having a good day. Therein lie some of the challenges in this space.” 

Brad Young, Chesterfield, Missouri-based member at Harris Dowell Fisher & Young LC, which represents employers, said workers comp fraud is “very difficult to prove” to begin with. 

“The insurance carrier is going to have the burden of proof to demonstrate fraud,” he said. Investigations often raise privacy concerns, and the process for prosecuting takes on “a general bias in favor of claimants.” 

“I’ve had numerous cases over the years where I’ve had clear and convincing evidence of claimant fraud,” he said. “I had one where the claimant looked to his left, looked to his right, made sure no one was watching, laid down on the ground, and then started screaming. And I submitted that to the (state) fraud unit, and the fraud unit said that was insufficient evidence to demonstrate fraud.” 

Jeff Adelson, a partner with Irvine, California-based Bober, Peterson & Koby LLP, is also skeptical of what AI can do when it comes to fraud convictions. 

In California, where regulators and researchers contend the Los Angeles area is a hotbed for suspicious workers comp claimant activity, it wouldn’t be “fair” to investigate every claim as possibly fraudulent if it shares the same characteristics of another claim found to be fraudulent, Mr. Adelson said. His opinion aside, he said, the state limits the scope of some investigations. 

California law requires that surveillance be supported by an “articulable suspicion of a fraudulent insurance claim” before an investigation is triggered, he said, adding that forgoing that burden could lead to civil liability.

 

 

 

Jay Krueger was named CEO of One Call Care Management in 2022, after a one-year stint as president of the company, which provides workers compensation services. He first joined the company as a board director in 2019. He began his career in health care and branched into workers compensation in 2008, including serving in leadership roles at pharmacy benefits manager OptumRx Inc. His pharmacy benefits background led him to One Call at a time when the industry was seeking alternatives to opioids for pain management. He spoke with Business Insurance Assistant Editor Louise Esola about those changes and other industry trends. Edited excerpts follow. 

Q: The workers compensation industry has lauded the insurance segment’s stability over the past few years. What does that mean for injured workers? 

A: I have the opportunity to talk to our new hires every two weeks. What I tell them is no one goes to work expecting to get hurt, and when they do get hurt, it can be life-altering. What I love about this industry is that companies help these individuals at a critical point in their lives. Stability in workers compensation is a good thing. It means that fewer people are getting hurt at work, and when they do get hurt they recover more quickly than they used to. I’ve been in this industry almost two decades now, and we as an industry have gotten much better at getting people back to work faster, in ways that are much less costly. Medical management across the industry has seen so many improvements with concepts such as early intervention, thinking about individuals holistically, and making sure individuals see the highest-quality providers.

Q: How does your business fit in the advocacy approach to treating injured workers? 

A: Looking at the word advocacy in the dictionary, you see words like “serve” and “support.” In our industry, we’re in the business of serving. What we do, in honor of our clients’ trust, is take care of injured workers. We’re a service organization; our business approach is very focused on our purpose, which we describe as getting injured workers back to work and back to life. Oftentimes, we are one of the first points of contact in the workers compensation system for an injured worker. While points of entry for an injured worker vary, it’s very common for physical therapy and diagnostic imaging to be among if not the very first services that an injured worker needs. PT and diagnostics together is the largest player in the industry; that really creates a unique opportunity for us to be an advocate very early on in the injury life cycle.

Q: One of the biggest changes we’ve seen in the industry is the move away from opioids, which you have been witness to. Where does physical therapy fit in as an avenue to treat pain? 

A: I started in this industry on the pharmacy benefit management side, so something I know a lot about is the decline in opioid utilization. It’s a very, very good thing and something we all should be very proud of as an industry. We have worked very hard to achieve these declines in opioid utilization. Of course, there are other effective ways to alleviate pain, physical therapy being one of them. Musculoskeletal injuries, such as ligament or muscle sprains, carpal tunnel, herniated discs, all of those very clearly respond very well to physical therapy. PT also provides a safe, drug-free method of treatment that allows us all as people to heal naturally and for individuals to learn self-management techniques to mitigate future painful episodes. 

Q: What are some effective ways to get workers involved in taking on physical therapy, which can be painful at first? 

A: Having the right provider is essential. We’re very focused on trying to connect with injured workers quickly, and one of the nice things that we’ve done as an organization is develop a variety of different ways to interact with and communicate with injured workers. Some injured workers prefer phone calls or prefer texts. We’ve really tried to develop the communication mechanisms to meet people where they are and to interact with them in the ways that best connect with them. 

Q: What are some other challenges in the industry?

A: Labor and labor market pressures. All of our clients are very focused on return to work. The quality of our provider network, as well as the investments we’ve made in our customer service platform, allow us to get injured workers the care they need, very quickly. Those two things are the biggest drivers in my mind of how quickly someone returns to work. 

Q: Where do artificial intelligence or similar technologies fit in? 

A: Carefully. We all recognize there is vast potential in next-generation technologies such as artificial intelligence, but we all also recognize the significant concerns and potential pitfalls. We’re spending a lot of time on this area at One Call, and we’re focused on two things: improving the efficiency and consistency of our customer service experience. We’re in the process of automating part of the experience. It allows our colleagues to focus on the more important parts of the customer service experience. One example is appointment confirmation. How many times have you forgotten when an appointment is scheduled? By the end of this year we’re offering that ability. Another example is on the consistency side, as it will allow us to measure the effectiveness of each of our phone calls through something called sentiment scoring. Sentiment scoring measures empathy and emotion during a customer service interaction, and each interaction is given a score. Now, depending on the score, steps are taken to help ensure a better customer experience in the future, such as care coordinator coaching or changes to underlying processes, or direct follow-up with a specific injured worker.

 

 

Work-related injuries or illnesses can be devastating for the employees involved and their families and may in some cases prevent injured workers from returning to their job or working altogether. For employers, a workers compensation claim can have significant financial and operational consequences. 

Many organizations carry out claim reviews to help identify potentially problematic claims, allowing them to focus on managing them effectively. However, the practice of reviewing all open claims, especially for large organizations, often means they spend time discussing claims that ultimately result in minimal, if any, impact. This may be because the path and the overall cost of the claim will not change significantly, which could be due to the permanent status of the injured worker’s medical condition and treatment, along with findings made by a specific state’s workers compensation board. 

Today, more organizations recognize the importance of focusing on claims where they can make a difference and reduce their workers compensation total cost of risk while helping injured employees recover and return to work, whether to their original jobs or modified or light-duty positions. 

Early intervention can be instrumental in reducing the risk of problematic claims becoming even more challenging. However, organizations, especially those with many open claims, sometimes struggle to identify the specific claims that would most benefit from being addressed promptly. 

Organizations seeking to resolve claims and help their people recover and return to work should consider the following actions to streamline the process and improve outcomes.

1. Take a data-focused approach

Analytic tools can help identify those claims that would most benefit from early intervention, providing organizations and their third-party administrators with a more targeted list of claims for resolution. Artificial intelligence and predictive modeling are already used to parse data and identify these claims more quickly and effectively. Programs that use AI can help with the early identification of potentially problematic claims in between claim reviews, allowing an organization to intervene more quickly than it typically would. Analytics-based platforms can alert employers and their TPAs when new information could make a claim more costly. Analytic tools can also help identify claims that have the potential of being settled, allowing organizations to focus their efforts there. 

Take the example of a large retailer that was concerned it was not discussing the claims that required the most attention at claim review meetings. The organization’s claims team focused on claims with high total incurred values, leading to the same cases being discussed during consecutive meetings with minimal results. The retailer decided to change its selection process and work to identify the most complex claims at different points in the claim life cycle. Using an AI-driven program, they could select cases whose outcomes could be significantly improved through early intervention and ensure that there was a well-defined action plan to resolve the issue as quickly as possible and improve the outcome for the injured workers.

2. Extract the relevant insights

Analytic tools can provide significant amounts of information about claims. To use this data effectively and drive positive claim results, though, organizations should extract relevant insights that can help them identify the claims that require intervention. For example, the claim outcome may be affected if an employee is out of work for a prolonged period or has retained legal representation. Critical information is often raised during claim reviews, underscoring the importance that key participants — including the policyholder, the claim provider, and the broker’s claim advocate — are present to discuss the claims. 

This process can also help uncover any areas of opportunity that might impact claim-related costs and identify actions that can address these issues. It is also important that claims are not reviewed in isolation and to consider any possible issues that could keep an injured individual from returning to work, such as related comorbidities or psychosocial barriers. 

In another example, a logistics company was experiencing a rise in workers compensation cases that took longer to process and were more expensive to resolve. The organization reviewed its data through a dashboard that enabled risk managers to determine that several open lost-time cases involved representation by an attorney and that these cases typically took longer to resolve and involved increased costs. Based on these insights, the risk management team decided to increase the focus on injured workers soon after an incident, setting up a process of open communication, providing them with needed education and ensuring transparency about their cases and the process. This program led to expedited claim resolution and a corresponding reduction in cases involving legal representation. 

3. Make actionable decisions

The most effective claim reviews identify problematic claims and internal processes and procedures that may negatively affect their resolution and determine opportunities for improvements that can benefit both the organization and its workers. It is also essential to decide on the next steps required to help resolve them — for example, assigning a nurse to oversee a worker’s recovery or pricing a claim for settlement. Having a plan and assigning individuals to take ownership of each action is critical. Advanced tools can create checklists that allow organizations and their TPAs to keep track of actions required and flag the need for follow-ups. 

As organizations take action to improve their claims outcomes, they should also consider how their response and communication might affect open claims. For example, is there a company-wide- policy on communications with injured employees before and after they have filed a claim? 

In a final example, a financial institution was concerned that action items discussed during claim review meetings were not being followed up on since the status of the files remained the same from one review to the next. Notes were taken, but there was no consistent process to ensure the agreed-upon actions were being taken to resolve open cases. The organization implemented a digital claim review process that automatically generates action items and notes following each claim review meeting. This information was shared with the TPA, which worked with the risk manager to establish time frames for each action item. This allowed the team to ensure the agreed-upon tasks were completed and communicated to the relevant stakeholders as needed. The more streamlined process created by the digital tool helps ensure that needed follow-ups occur within the approved timeline to advance or fully resolve open cases, leading to more positive outcomes for both the organization and impacted workers. 

Adopting an analytics-driven approach to managing open workers compensation claims can help organizations improve claim outcomes. Prioritizing early intervention, leveraging data-driven insights, and implementing innovative solutions can help optimize workers compensation processes and reduce the total cost of risk.

Dennis Tierney is a managing director and national director of workers compensation claims at Marsh Advisory’s Workers Compensation Center of Excellence. He can be reached at dennis.p.tierney@marsh.com.

 

 

Whether you were in the Midwest, the South or even the Northeast, you probably felt the effects as a climate change-fueled heat wave spread across large parts of the U.S. last month, bringing record-high and high-low temperatures. Forecasters pointed to a weather phenomenon called a “heat dome,” where a stalled high-pressure system in the upper atmosphere trapped warm air beneath.

The arrival of intense heat so early in the summer was a surprise to some, but forecasters have said that July is likely to bring more of the same and that such heat waves are part of a “new normal” as climate change brings more extreme weather events. In New Jersey, where I live, train lines ground to a halt as a brush fire and strained infrastructure combined to disrupt service, leaving commuters stranded. Meanwhile, heat-related visits to emergency rooms spiked. 

The U.S. wasn’t the only country affected, as parts of Canada, Mexico, India and Saudi Arabia were also hit by heatwaves, leading to many reports of heat-related illnesses and fatalities. In Paris, athletes have been warned to expect intense heat at the Summer Olympics, which begin in a few weeks. Risks range from sunburn and heat cramps to heat exhaustion and even collapse from heatstroke, which is life-threatening.

High temperatures kill hundreds of people every year, according to the Centers for Disease Control and Prevention. More than 2,300 people in the U.S. died of heat-related illnesses last year — the highest number in 45 years of recordkeeping, an Associated Press analysis of CDC data found. That was up from about 1,700 heat-related fatalities in 2022 and 1,600 in 2021. Older adults, young people, and those with pre-existing health conditions are particularly vulnerable. Heat-related illnesses such as heat exhaustion or heatstroke happen when the body cannot properly cool. 

For employers and insurers, the effects of rising heat-related illnesses and claims are a growing concern. California’s insurance department reports that in the past decade, extreme heat waves have cost the state at least $7.7 billion in lost labor productivity, costs related to power outages, infrastructure repairs and premature deaths. In the workplace, the probability of work-related accidents increases by 5% to 6% when the temperature rises above 90 degrees compared with 65 to 70 degrees, according to the Workers Compensation Research Institute. The effect of workplace heat is stronger in the southern U.S. and on workers in the construction industry, WCRI found.

As regulators intensify their focus on workplace heat safety practices, and the Occupational Safety and Health Administration works toward a standard to protect workers in outdoor and indoor settings from the risk of heat illnesses, employers need to be prepared. Though workers can adapt or acclimatize to excessive heat, and many employers take precautions in summer months to provide hydration stations, modify shifts and monitor employees, heat protections for workers are all over the map; clearly, more needs to be done. With a changing climate, hot temperatures aren’t about to let up, and more safeguards will be needed. While the proposed OSHA regulation will face opposition, preventing work-related deaths, injuries and illnesses caused by excessive heat exposure is critical. Insurers and risk managers have a key role in promoting heat safety.

 

 

 

 

Jay Krueger was named CEO of One Call Corp. in 2022, after a one-year stint as president of the company, which provides workers compensation services. He first joined the company as a board director in 2019. He began his career in health care and branched into workers compensation in 2008, including serving in leadership roles at pharmacy benefits manager OptumRx Inc. His pharmacy benefits background led him to One Call at a time when the industry was seeking alternatives to opioids for pain management. He spoke with Business Insurance Assistant Editor Louise Esola about those changes and other industry trends. Edited excerpts follow. 

Q: The workers compensation industry has lauded the insurance segment’s stability over the past few years. What does that mean for injured workers? 

A: I have the opportunity to talk to our new hires every two weeks. What I tell them is no one goes to work expecting to get hurt, and when they do get hurt, it can be life-altering. What I love about this industry is that companies help these individuals at a critical point in their lives. Stability in workers compensation is a good thing. It means that fewer people are getting hurt at work, and when they do get hurt they recover more quickly than they used to. I’ve been in this industry almost two decades now, and we as an industry have gotten much better at getting people back to work faster, in ways that are much less costly. Medical management across the industry has seen so many improvements with concepts such as early intervention, thinking about individuals holistically, and making sure individuals see the highest-quality providers.

Q: How does your business fit in the advocacy approach to treating injured workers? 

A: Looking at the word advocacy in the dictionary, you see words like “serve” and “support.” In our industry, we’re in the business of serving. What we do, in honor of our clients’ trust, is take care of injured workers. We’re a service organization; our business approach is very focused on our purpose, which we describe as getting injured workers back to work and back to life. Oftentimes, we are one of the first points of contact in the workers compensation system for an injured worker. While points of entry for an injured worker vary, it’s very common for physical therapy and diagnostic imaging to be among if not the very first services that an injured worker needs. PT and diagnostics together is the largest player in the industry; that really creates a unique opportunity for us to be an advocate very early on in the injury life cycle.

Q: One of the biggest changes we’ve seen in the industry is the move away from opioids, which you have been witness to. Where does physical therapy fit in as an avenue to treat pain? 

A: I started in this industry on the pharmacy benefit management side, so something I know a lot about is the decline in opioid utilization. It’s a very, very good thing and something we all should be very proud of as an industry. We have worked very hard to achieve these declines in opioid utilization. Of course, there are other effective ways to alleviate pain, physical therapy being one of them. Musculoskeletal injuries, such as ligament or muscle sprains, carpal tunnel, herniated discs, all of those very clearly respond very well to physical therapy. PT also provides a safe, drug-free method of treatment that allows us all as people to heal naturally and for individuals to learn self-management techniques to mitigate future painful episodes. 

Q: What are some effective ways to get workers involved in taking on physical therapy, which can be painful at first? 

A: Having the right provider is essential. We’re very focused on trying to connect with injured workers quickly, and one of the nice things that we’ve done as an organization is develop a variety of different ways to interact with and communicate with injured workers. Some injured workers prefer phone calls or prefer texts. We’ve really tried to develop the communication mechanisms to meet people where they are and to interact with them in the ways that best connect with them. 

Q: What are some other challenges in the industry?

A: Labor and labor market pressures. All of our clients are very focused on return to work. The quality of our provider network, as well as the investments we’ve made in our customer service platform, allow us to get injured workers the care they need, very quickly. Those two things are the biggest drivers in my mind of how quickly someone returns to work. 

Q: Where do artificial intelligence or similar technologies fit in? 

A: Carefully. We all recognize there is vast potential in next-generation technologies such as artificial intelligence, but we all also recognize the significant concerns and potential pitfalls. We’re spending a lot of time on this area at One Call, and we’re focused on two things: improving the efficiency and consistency of our customer service experience. We’re in the process of automating part of the experience. It allows our colleagues to focus on the more important parts of the customer service experience. One example is appointment confirmation. How many times have you forgotten when an appointment is scheduled? By the end of this year we’re offering that ability. Another example is on the consistency side, as it will allow us to measure the effectiveness of each of our phone calls through something called sentiment scoring. Sentiment scoring measures empathy and emotion during a customer service interaction, and each interaction is given a score. Now, depending on the score, steps are taken to help ensure a better customer experience in the future, such as care coordinator coaching or changes to underlying processes, or direct follow-up with a specific injured worker.