Tag: Workers Comp

The Minnesota Supreme Court ruled that a sheriff’s deputy is entitled to a presumption that his post-traumatic stress disorder is an occupational disease since he presented a diagnosis of PTSD, even though his employer offered a competing diagnosis.

The Carlton County deputy witnessed several deadly incidents in his career and following the suicide of his partner he began seeing a clinical counselor and took almost two years off for treatment, according to No. A22-0090.

In 2019 he was diagnosed with post-traumatic stress disorder, major depressive disorder and anxiety disorder. A psychologist said he was not fit for duty as a law-enforcement officer and was incapable of work in any capacity.

Upon telling his supervisors about his diagnosis the deputy was placed on leave, and the county filed a report of injury with the Minnesota Department of Labor and Industry. The department denied liability and arranged for a second psychological evaluation, which led to a diagnosis of a major depressive disorder unrelated to his employment, according to records.

A workers compensation judge denied benefits, finding the second physician’s report “more persuasive” because the deputy’s symptoms “best fit a diagnosis of major depressive disorder,” rather than PTSD.

The Workers’ Compensation Court of Appeals reversed and remanded, ruling that the insurer MCIT failed to rebut the presumption that the deputy’s diagnosis was a compensable occupational disease.

The Minnesota Supreme Court agreed, stating in its Dec. 21 ruling that the statutory requirement of “a diagnosis” requires that an employee satisfies their burden by presenting exactly that — a diagnosis by a licensed psychiatrist or psychologist identifying their disease as PTSD.

“Nothing in the statute suggests that a compensation judge needs to specifically determine that an employee’s PTSD diagnosis is more credible than any competing diagnoses before the presumption applies,” the court said.

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

Business Insurance 2022 Data & Rankings

In this special data and rankings issue of Business Insurance, we bring you our proprietary rankings from the past year plus other industry data to present a numerical overview of the commercial insurance market, from retail brokers to reinsurers and cyber insurers to captive managers.

Alex Sun took the helm as CEO of San Diego-based Enlyte LLC in 2021, when it was formed through the merger of three companies in the workers compensation sector: Coventry Workers Comp Services, Genex Services LLC and Mitchell International Inc. Mr. Sun was formerly CEO of Mitchell, which he joined in 2001. Prior to that, he spent a decade in the banking and financial services industry. He spoke with Assistant Editor Louise Esola about the benefits of combining the operations and challenges in the workers compensation arena. Edited excerpts follow.

Q: Enlyte is a company formed from three companies. What is the vision now?

A: Our principal mission is to assist our clients and help them restore the lives of their customers after a challenging event. We’ve defined that as trying to have the greatest impact on claims outcomes. So, part of that was making sure that we had leading capabilities across all solutions that help address the medical claims cost side of the equation, as well as services that focus on the injured worker and getting them back to work. We’re about having maximum medical improvement. So really the vision for the parent company of Mitchell, Genex, and Coventry was bringing the leading providers of technology, clinical and network solutions all together in one organization where if we do our jobs we will leverage the intersections to create better outcomes for our clients.

Q: How do mergers such as this help clients best? 

A: As we look out into the future, it is important to be a skilled provider. So, it’s making sure that you have all the right infrastructure, the information security investments, and product and service quality. A deep focus on the customer and a strong analytics platform are part and parcel of being an excellent provider. What we were also trying to do on top of that is identify where there’s connectivity between software solutions, clinical solutions and network solutions, and take advantage of those connections to try to deliver better outcomes to our customers, be it greater efficiency or claims handling. We want a better ability to serve the injured worker efficiently with high levels of communication quality, and to also optimize the process. 

Q: What are some of the challenges facing the industry? 

A: Probably one that almost seems to be universally discussed in the last year has been the challenging labor environment. P&C insurance has always had some challenges with respect to making sure that we have a vibrant workforce, but I think that given the pandemic and the Great Resignation, that the challenges increased, be it on clinical staff, claims adjusting teams, or certainly anything involving technology. I think there are a lot of ways that we’ve all learned to address the challenges. First, we learned during the first period of the COVID pandemic, when everybody went into remote work environments, that a transition to a remote workforce ultimately became a capability that we all became pretty comfortable with. And as we continue to all strive to be employers of choice, I think we are now adjusting our workplace strategies to be more accommodated to the needs of employees so that we can remain that employer of choice. So, many of us are trying to be more flexible just to save on commutes, or to improve work-life balance, because this is an industry that demands a lot from people.

Q: What are top trends to watch?

A: A dynamic legislative and regulatory environment. Inflation is also something that we have to contend with — medical inflation or the inflation associated with repairing a vehicle. Lastly, there continues to be a challenging liability environment and nuclear verdicts. 

Q: A trend we have been following is the advocacy model for treating injured workers. How has this evolved in recent years? 

A: We’re focused on trying to help an injured party navigate this system through a focus on the whole person. I think that’s what we’ve seen. Particularly in the last year, there’s been a focus on mental health and other things that may not be directly related to the physical expression of an injury but something that may be in the background. It could be everything, including diet and medical conditions related to where you live, and whether you have ready access to basic medical services. All of that becomes part of helping someone navigate their treatments and getting back to work as quickly as possible.

Q: How does the company best balance its objectives along with caring for injured workers?

A: Caring for injured workers is central to our mission. We focus both on the injured worker through clinical services as well as trying to drive greater efficiency and accuracy in the claims-handling process, so that there is a focus on total cost of claims. Obviously, there’s a very deep focus on the injured worker and making sure that they get back to work because that’s an important aspect of controlling claims costs, including the medical claims cost side of the equation. 

Q: What do you like about what you do? 

A: I’ve always wanted to be part of something special — a community of people with a shared purpose. And I wanted that purpose to be meaningful. And so we take our mission very seriously, which is to provide support to our customers as they try to restore the lives of their clients after a challenging event. To me that is very, very important work. Insurance is woven deep into the fabric of society, and so we in our small way can help deliver on the promise of the insurance industry. It’s a very personal thing for myself and the nearly 6,000 associates that we have here at Enlyte. And I think it’s a very important part of our culture.

 

 

 

 

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Changes among the insurance sector’s executive leaders drew plenty of interest throughout the year, but a story about senior management changes at Chubb Ltd.’s third-party administrator unit ESIS Inc. generated particular attention.

In June, the insurer announced that Suresh Krishna would be chief operating officer of ESIS, moving over from Chubb’s North America accident and health business, which he previously headed. He was replaced as A&H head by Lauren Gillette, who was previously chief operating officer of the division.

The story about Mr. Krishna’s and Ms. Gillette’s moves was the most read workers compensation-related story on Business Insurance’s website in 2022.

Earlier in the year, Chubb named Jim Shevlin president of ESIS, succeeding Leigh Anne Sherman, who was named specialty officer for North America middle market.

Ms. Sherman had headed ESIS since February 2021.

No. 2 most read story

Legal disputes over whether workers injured while traveling were due workers compensation benefits led to several significant rulings in the past year.

In May, a Florida appeals court heard the case of a worker who was injured in an accident with a drunk driver while driving to work. The appeals court ruled that while the injured driver was a “field employee” his job did not start until he arrived at the first job of the day.

In overturning a lower court in DSK Group Inc. and Zurich American Insurance Co. v. Hernandez, the appeals court ruled that the worker was “a typical commuting employee” and therefore was ineligible for comp.

The story about the ruling was the second-most-read workers compensation-related story on Business Insurance’s website in 2022.

Other rulings on traveling employees this year included an Ohio appellate court ruling that a traveling worker did not suffer a compensable injury when he fell in a restaurant parking lot while having lunch with a colleague.

A tree company employee in New Hampshire, though, did win workers comp benefits after he was severely injured in an accident after being released early from his shift because of an approaching storm.

The state high court ruled that the “special errand” exception to the “coming and going” rule applied.

And in Kentucky, the state’s highest court ruled in favor of a worker who was injured in an accident that occurred as he was traveling back to his employer’s property from a job site.

In its ruling, the Kentucky Supreme Court noted two exceptions from the general rule that commuting accidents are not covered under workers comp applied in the case.

No. 3 most read story

In most states injuries suffered by employees in parking lots almost always call into question employer premises, coming and going rules, and whether a worker was in the course and scope of their job at the time.

New Jersey Gov. Phil Murphy aimed to clarify matters on Jan. 10 by signing legislation that puts an employee on the clock upon arriving on property operated by the employer. An article analyzing the issue was the third most read workers compensation-related article of the year on Business Insurance’s website.

Lawmakers said the intention of S.B. 771 is to prevent such rulings as a 2014 New Jersey Supreme Court decision — Hersh v. County of Morris — that found not compensable the injuries suffered by a worker who was struck by a vehicle in an employer’s parking lot. A little more than a week after the bill was signed, the New Jersey Supreme Court found compensable injuries suffered in a similar accident.

In Florida, however, an appellate court on March 10 ruled in Aquino v. American Airlines that an airport worker was not entitled to benefits for an injury that happened while walking through the terminal to a shuttle bus stop.

Facing a similar issue regarding an employee injured in a parking lot, the Oklahoma Supreme Court on June 2 said a worker who was severely injured crossing a busy highway to get to work can sue his employer because the injury did not occur in the scope of employment and “is covered by tort law” if there is just cause.

No. 4 most read story

Fraud has long been a concern for the workers compensation sector but 2022 saw the industry and law enforcement in California fight back against the problem.

One medical provider who felt the sharp end of the anti-fraud efforts was a surgeon in Beverly Hills, California, who received 10 years behind bars for comp fraud.

Dr. Randy Rosen pleaded guilty in August to numerous felony counts in connection with what prosecutors said was a “massive scheme and conspiracy” to fraudulently bill insurers for unnecessary procedures performed on drug-addicted patients.

Dr. Rosen was also charged with having patients undergo unnecessary drug tests that were analyzed by a lab owned by his girlfriend, Liza Visamanos, who ended up pleading guilty to two felony insurance fraud counts and was given one year of home confinement. 

In addition to the 10-year prison sentence, the courts also ordered Dr. Rosen to pay $9.1 million in restitution and to not pursue payment on more than $22.35 million in outstanding workers compensation liens. The story about his sentencing was the fourth most read workers comp-related story on Business Insurance’s website in 2022.

In November, the California Department of Industrial Relations Division of Workers’ Compensation suspended Dr. Rosen from participation in the state workers compensation system because he is a convicted felon.

The suspension was scheduled to begin in late December unless Dr. Rosen requested a hearing. 

Dr. Rosen was one of 178 medical providers suspended by the Division of Workers’ Compensation in 2022 as of late September.

No. 5 most read story

Unpopular among some Americans during the pandemic, mask mandates hit the courts several times and on several fronts over the course of the COVID-19 pandemic.

In a particularly notable case, nine flight attendants representing six airlines sued the U.S. Centers for Disease Control and Prevention on March 24 over its air travel mask mandate, claiming masks are ineffective, cause breathing trouble and that the policy was difficult to enforce.

The lawsuit further claimed the mandate raised constitutional concerns and violated the federal rulemaking process.

The story on the lawsuit was the fifth most-read workers compensation–related article this year on Business Insurance’s website.

The flight attendants’ lawsuit was part of a surge in legal challenges to COVID-19-related mandates, including one filed March 28 by attorneys general in 21 states.

A Florida judge, in a ruling April 17, said the U.S. mask mandate on public transportation was unlawful. The decision overturned the Biden administration’s effort to reduce the spread of COVID-19 by requiring travelers to wear masks on airplanes and trains and in taxis, ride-share vehicles, as well as in transit hubs.

The U.S. Justice Department appealed that ruling days later.

In related news, on Oct. 31 the U.S. Supreme Court let stand a separate ruling that allowed the Transportation Security Administration to require mask-wearing on planes, trains and other forms of transportation.

No. 6 most read story

Vaccine mandates were a pandemic mainstay that made headlines early this year amid widespread efforts to force employees to get vaccinated.  

When California lawmakers on Feb. 9 introduced a bill that would require both public and private employers to enforce a vaccine mandate for employees, the article was the sixth most read workers compensation–related story this year on Business Insurance’s website.

A.B. 1993, which failed to gain traction outside committee, stated that “an employer shall require each employee or independent contractor to provide proof to the employer, or an authorized agent thereof, that the person has been vaccinated against COVID-19.”

By mid-May, the issue appeared to be waning, as indicated in a survey that found employer interest in COVID-19 vaccine mandates had dwindled as federal efforts to institute broader mandates failed.

The survey of 1,275 in-house lawyers, C-suite executives and human resources professionals, conducted by employment law firm Littler Mendelson PC in March, found 56% said their companies would not implement mandates or testing unless required by law.

Late in the year Washington state lawmakers pre-filed for 2023 legislation that would re-hire state workers fired over not getting vaccinated.

No. 7 most read story