Tag: Workers Comp

Following four years of efforts to make post-traumatic stress disorder compensable on presumption for first responders, Missouri lawmakers are set to consider another bill that would classify the condition as an occupational illness.

H.B. 164, filed Thursday, would add PTSD for first responders to the list of accepted occupational illnesses under state workers compensation law.

State lawmakers considered similar bills in 2019, 2020, 2021 and earlier this year. Each failed to gain traction, although at least one effort was successful in highlighting mental health struggles among first responders.

In 2021, Missouri Gov. Mike Parson signed S.B. 57 and H.B. 8, which require that law-enforcement officers go through a mental health check-in every three to five years and authorize mental health services and training for officers.

A bill pre-filed with the Texas legislature would give insurers 60 days to contest or deny a workers compensation claim for certain public safety employees or forfeit their right to litigate the claim.

H.B. 790 would apply to claims for “benefits, compensation, or assistance by certain public safety employees and survivors of certain public safety employees.”

The bill states that if a workers comp insurer denies a claim of medical benefits on or before the 60th day after it received “reasonable notice” of a workplace injury, and an administrative judge finds the claim is compensable, the insurer is liable to reimburse the injured worker for all “reasonable and necessary” medical expenses.  

The bill also states that a worker may be represented by an attorney via teleconferencing.

Proposing $363,890 in new penalties for a Middlefield, Ohio, contractor, the Occupational Safety and Health Administration has placed C.R.H. Roofing LLC into its Severe Violator Enforcement Program after more than three years of failed inspections and unpaid fines, the agency announced Wednesday.

Twice in six days in June 2022, federal safety inspectors observed workers exposed to deadly fall hazards at two separate job sites, “continuing a pattern of disregard for workplace safety dating back to 2019,” OSHA said.

The agency identified four willful and two repeat violations during inspections. With these additional penalties, the company now owes more than $414,000 in OSHA fines for its workplace safety failures.

At both worksites, inspectors observed roofing workers at heights greater than 6 feet without fall protection and lacking eye protection while using pneumatic nail guns. The company also allowed ladders to be used improperly. 

After three previous inspections in 2019 and 2021, OSHA assessed C.R.H. more than $51,000 in penalties, which remain unpaid.

“Despite being warned on June 3, 2022, that their failures to protect workers from falls violated federal law, C.R.H. Roofing scoffed at OSHA inspectors, and six days later, we found them committing the same violations,” Ohio-based OSHA Area Director Howard Eberts said in a statement. 

The company has 15 days to contest.

 

 

 

A Texas appellate court on Wednesday ruled that a packaging material manufacturer was entitled to summary judgment on the negligence and gross negligence claims filed by the representative of a temporary worker who had been severely injured on the manufacturer’s premises.

In December 2015, Rigoverto Balderas entered into a client services agreement with Port City Staffing, which stated that the agency would provide temporary employees with certain skills to Houston Foam Plastics Inc., according to Balderas v. Houston Foam Plastics Inc., filed in The Court of Appeals for the 1st District of Texas.

The agreement specified that Mr. Balderas was an employee of Port City, which was a nonsubscriber of workers compensation, and that the agency would perform the duties of “hiring, assigning, reassigning, counseling, disciplining and discharging” Mr. Balderas.

Port City initially assigned Mr. Balderas to work at Houston Foam as a forklift operator, but the company had him work at one of its locations as a grinder operator without providing notice to or obtaining permission from Port City.

Balderas was placing foam pieces on a plastic grinder machine when its interior spokes caught on the handles of a sack that Mr. Balderas was holding, causing grave injuries to his upper torso, head and arms. He currently lives at the rehabilitation facility and requires around-the-clock care.

Mr. Balderas’ representative filed suit against Houston Foam for negligence and gross negligence and later filed a request that the trial court abate his suit against Houston Foam because the company may assert an exclusive remedy defense under the Texas Workers’ Compensation Act, of which Houston Foam later did.

The judge in the negligence suit signed an order of abatement.

Following more proceedings, Houston Foam then filed a motion to discontinue the abatement, requesting that the judge lift the abatement and allow the company to file a motion for summary judgment.

The judge granted Houston Foam’s motion to discontinue abatement, and the company moved for summary judgment, arguing the exclusive remedy barred the lawsuit. The judge granted Houston Foam summary judgment.

The appeals court then found Houston Foam’s pleadings provided sufficient support for its summary judgment motion, and it proved that it was Balderas’ employer and a workers compensation subscriber.

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

 

The Washington State Department of Labor and Industries on Wednesday announced a 4.8% increase in the average workers compensation premium rate for 2023.

The rate increase, prompted by wage inflation and rising medical costs, means employers and workers will jointly pay an additional $61 a year, on average, for each full-time employee, the department said.

Workers will continue to pay on average about a quarter of the premium in 2023, a similar percentage to that paid in 2022, the department said.

While comp rates in many states are set as a percentage of payroll — so that when wages go up, more premium is collected — Washington rates are based on the number of hours employees work. The result is that when wages go up, the state needs to increase the hourly rates employers and workers pay.

L&I also noted that it tapped into its contingency reserves to mitigate the extent of the rate increase.

“We’re adopting this modest increase in the workers compensation rate to boost the long-term health of our state workers’ comp system,” department director Joel Sacks said in a statement. “This move will assure that our contingency reserves, which we’re using to buy down the impacts of the rate increase, will continue to be healthy and viable.”

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

 

Opioid prescribing in workers compensation nosedived to an all-time low last year, a new report finds, but experts say there are concerns with other drugs being used for pain management. 

AmTrust Financial Services Inc. reported in October that only 15.2% of its workers compensation claims for 2021 involved an opioid prescription, down from 60% in 2017 and 25% in 2018. The data represents a reduction of 75% in prescriptions containing an opioid over four years, the insurer said. 

The numbers are in line with other reports. 

Enlyte Group LLC subsidiary Mitchell International Inc. reported in July that in 2021 30.3% of injured workers had opioid prescriptions.

Workers comp opioid spending has declined more than 62% since 2016, according to data collected in 2021 by Maggie Valley, North Carolina-based consulting company CompPharma LLC. 

Concerns are emerging, however, that other drugs are moving in to replace opioids as a pain management go-to in comp. Foremost are nonsteroidal anti-inflammatory drugs; neurological drugs, such as gabapentin, which target nerve pain; topical creams; muscle relaxers; and anti-anxiety drugs in a class known as benzodiazepines, according to experts. 

The latter two are of particular concern, as they are considered sedatives similar to opioids, though not as potentially deadly, experts say.

“While opioids have decreased significantly, it’s kind of become a more diffused problem, and it’s now branched out into other controlled substances,” said Silvia Sacalis, a Tampa, Florida-based licensed pharmacist and vice president of clinical services for Healthesystems LLC. “These are other controlled substances that unfortunately have similar side effect profiles to opioids with the sedation and the impact on cognition, which is what keeps injured workers from returning to work.”

Just as there are guidelines for opioids, guidelines exist for drugs such as benzodiazepines and muscle relaxers, which limit such drugs to short-term use, said Nikki Wilson, Omaha, Nebraska-based senior director of clinical services for Mitchell Pharmacy Solutions, an Enlyte company. 

“There are a lot of caveats for use, as both of them can be associated with dizziness and increased levels of nervous system depression,” she said. “And official disability guidelines support use of muscle relaxants only for specific conditions, and not beyond 21 days of use. It’s acute only. So, this is one of the things we monitor even more for limited use.” 

Benzodiazepines are “one drug class that is important to talk about,” said Dr. Marcos Iglesias, Hartford, Connecticut-based vice president and chief medical director of Travelers Cos. Inc. “That’s because benzodiazepines have been used a lot in the industry with pain management.” The industry, just as it has with opioids, has been trying to reduce benzodiazepine prescriptions, he said, adding that the figures are dropping. Muscle relaxers, however, are “flat” in terms of prescriptions, he said. 

“Every drug has some benefits and many of these drugs have risks, and some of them can be potentially quite severe,” Mr. Iglesias said. 

It’s one reason managed care in comp is moving away from drugs — when possible, said Melissa Burke, Southington, Connecticut-

based vice president and head of managed care and clinical for AmTrust Financial Services Inc.

“There are many other ways to treat pain than with opioids, and that’s where the industry has gone,” she said. “We’re very vigilant about ensuring (workers) have what they need. 

“If it’s post op, if they have an immediate need for a pain medication, they’re getting it; we are certainly not getting in the way of that. But we’re ensuring that step two and phase two of their injury recovery process is finding something that’s addressing their needs for pain management and addressing what’s causing the pain.” 

Sometimes, the answer is drugs other than opioids, she said. This involves “identifying whether it is truly an anti-inflammatory need, or do we need something for neuropathy? Do we need a non-pharmacologic treatment like acupuncture therapy? Do they just need cognitive behavior therapy to address what’s internally driving them to focus on their pain?” she said.

Doctors are also getting better at looking at alternatives and proceeding with caution, said Dr. Adam Seidner, Hartford, Connecticut-based chief medical officer for Hartford Financial Services Group Inc.

“The doctors are making sure that they’re doing a proper assessment and that they have the proper management and that they feel comfortable taking care of these patients, both in the acute and chronic pain situations,” he said. “The proper management of acute pain is … important because if it’s not done correctly, it can lead to long-term, chronic pain.” 

And while opioids have gone down “drastically” in comp, it doesn’t mean the industry’s work is done, said Joe Paduda, Skaneateles, New York-based president of CompPharma LLC. 

“While the actual prescription reporting for workers compensation claimants, for drugs paid for by workers comp, has gone down, it does not mean that all those patients who were taking opioids that were paid for by workers comp are not still taking opioids.” 

There are reasons to suspect injured workers are tapping into group health policies, or paying cash for opioids, and still going to work, he said. 

Ms. Sacalis, who has spoken out against issues with “polypharmacy” among injured workers who may be on other medications unrelated to their work injury, warns “it’s now important to be more vigilant than ever” in managing prescriptions.

 

 

 

 

 

The U.S. Centers for Disease Control and Prevention in November released revised guidelines for opioid prescribing with new recommendations for providers that emphasize greater communication with patients and state that opioids should not be on the front line for managing pain. 

The last time the CDC released opioid guidelines was in 2016, which triggered what many considered harsh reductions in pain medication prescribing and a host of laws and other regulations that left pain undertreated and often unmanaged, according to experts. 

“What the guidelines say is that opioids have a place; however, there still needs to be a very thoughtful approach to using opioids, and, whenever possible, the way out of pain is still non-drug and non-opioid,” said Dr. Marcos Iglesias, Hartford, Connecticut-based vice president and chief medical director of Travelers Cos. Inc. “I think it balanced some of the message that some in society took after the 2016 guidelines, which was that opioids are only bad.”

The CDC acknowledged in its new guidelines that some of its previous recommendations resulted in “misapplication” of strategies for limiting opioid prescribing and, in some cases, abrupt discontinuation of opioids that jeopardized patients’ health. 

In what some experts have pegged as a more empathetic approach, the new guidelines stress that doctors should explore non-opioid therapies for chronic pain, and that if a person needs to be weaned off opioids that the process be gradual. 

Nikki Wilson, Omaha, Nebraska-based senior director of clinical services for Mitchell Pharmacy Solutions, said the new approach is a good one, especially for the workers compensation industry, which has grappled with limiting opioids for “legacy” claimants who have been on the drugs for years.

Experts have said that taking a person off opioids once they are chemically dependent on them can be a dangerous balancing act. 

The new guidelines will likely push more doctors to learn and develop weaning strategies, something that hasn’t been addressed in traditional medical training, Ms. Wilson said. 

“The concern has been that there has to be some sort of experience around weaning,” she said. “It’s almost critical to engage a clinician who has experience in it, and not all prescribers do. It’s not their fault, it’s just something that is typically not addressed.” 

 

 

LAS VEGAS — While claim frequency in workers compensation has been flat for a decade, claim severity is increasing, and no industry is seeing it more than construction, according to a panel of experts. 

“This is driven by medical advances,” said Mark Walls, vice president, communications & strategic analysis, for Safety National Casualty Corp. “They’re getting better treatment; they’re getting a medevac helicopter to a level one trauma center.” 

Accidents that previously resulted in fatalities are now leading to prolonged medical treatment and rehabilitation, he said during a session at the 42nd International Risk Management Institute Inc. Construction Risk Conference.

“We have seen in our data set a 30% increase over the last three years of claims worth over $10 million,” said Chicago-based Mr. Walls. 

He joined other panelists discussing workers comp issues facing the construction industry, including claims severity, labor force challenges and marijuana legalization. 

While some challenges are ongoing, and difficult to quantify, injury severity in construction — where worker accidents are often more catastrophic than in other industries — is leading to a rise in high-dollar claims. 

As an example, amputations — comparatively common in the construction industry — used to cost much less when a $5,000 prosthetic was commonplace, Mr. Walls said. Now, with technological advances that provide more function for an amputee, costs can rise to $40,000 for a device that is not as durable as a traditional prosthetic.

Another example common in the construction industry involves those who are paralyzed as a result of accidents, he said. The traditional life expectancy for such injured workers had been a decade and can now be three times that long, he said.

“The medical science here is amazing,” he said. “But there are costs. These big claims are getting much, much bigger, and unfortunately these are the types of claims that you often see in your industry.”

Meanwhile, claims frequency in construction has remained flat over the past decade, with the exception of the COVID-19 pandemic, which saw a sudden drop and subsequent increase in frequency, according to panelist Donna Glenn, chief actuary for the National Council on Compensation Insurance in Boca Raton, Florida. 

The generally flat trend helps offset rising costs related to severity, and it’s why the construction industry should continually focus on workplace safety, she said.

Safety “is the fuel behind the long-term frequency decline,” she said, when questioned about technological advances making workplaces safer, such as wearables that alert workers of hazards. 

Panelists also addressed the challenge of finding qualified, experienced workers and what it means in terms of injury risks.

“Data shows that there tends to be a higher accident frequency rate for the newer workers,” Mr. Walls said. “The other concern becomes if you don’t have enough workers, your people are having to do more with less; they’re working longer hours. That can lead to overexertion and chances of injuries occurring.” 

The aging workforce is another challenge, as such workers tend to take longer to heal and can have comorbidities that complicate their recovery, Ms. Glenn said.

The potential effect of marijuana legalization is another issue facing the construction industry and its ability to prevent accidents. There is limited adequate drug testing in this area,  and some jurisdictions bar drug testing in some cases.

Mr. Walls noted that legislative efforts are underway regarding the legalization of other drugs. Colorado, for example, just legalized hallucinogenic mushrooms. 

“This is a huge challenge for employers because your drug testing policies vary,” he said. 

Another issue, he said, is that the Occupational Safety and Health Administration does not allow employers to have a blanket post-accident drug-testing program for fear that workers will not report accidents and injuries out of fear.

 

 

 

 

LAS VEGAS — Ergonomics generally hasn’t received the attention it needs in the construction industry, but that may be changing. 

That’s according to presenters at the International Risk Management Institute Inc. Construction Risk Conference, who said the rising costs of musculoskeletal and soft-tissue injuries, particularly in an industry in which materials are heavy and the work can be repetitive, are helping make the case for improving ergonomics. 

“Soft-tissue injuries are complicated,” said Allison Seijo, senior risk control consultant with Travelers Cos. Inc.’s construction practice. “They can happen from an acute injury. They can happen from repetitive motion. 

“They can happen over years, over months, and they’re hard to diagnose and treat. It keeps workers off the job for longer periods of time.” 

Ms. Seijo cited National Council on Compensation Insurance Inc. data that found in 2018 and 2019 that the average cost for a muscle strain or sprain was $34,000, equally split between indemnity and medical costs. Travelers released its own data showing that injuries caused by exertion represent 25% of comp claims. 

“Financial impacts are significant,” Ms. Seijo said. “Soft tissue injuries have significant impact on the construction industry as insurance costs increase through elevated experience modification rates.”

One only need spend time on a construction site to see the issues, Ms. Seijo said.

“It could be the tradesmen or women on ladders working overhead, workers carrying materials back and forth across the jobsite, the operator outside working in a heavy piece of machinery, or even the masons outside brushing concrete,” she said. 

“It’s almost the expectation to see these types of actions performed on a jobsite but the fact of the matter is, we need to use modernization to our advantage,” she said. “We are at a turning point in the industry where we need to work smarter, not harder, to help drive an industry that has been so ingrained with the status quo of physical manual labor.”

Michael Gonzales, a senior account consultant at Travelers, said injuries rooted in incorrect ergonomics stem from such factors as posture, frequency, force, pushing or pulling, and duration of work. “We have demands that outweigh capabilities,” he said. 

New technologies are helping employers zero in on and correct issues with movement, he said. 

One technology enables a safety inspector or supervisor to record a worker in motion, and upon analysis of the video, target body parts that are at risk for injury. It’s then up to the employer to provide engineering controls or other mechanisms to correct the issue or eliminate the risk. 

The solution can be as simple as providing a shelf to keep materials off the floor and easier to access without bending, Ms. Seijo said. Using a platform instead of a ladder to work on a ceiling is another example.

Mr. Gonzales said a selling point for making such ergonomic changes is the return on investment as a result of fewer injuries, he said. 

Ms. Seijo added that “sometimes the benefits are intangible.” 

“Think about this aging workforce. The last thing you need are good people out of work or retiring early because they’ve had a soft tissue injury,” she said. “In the long run, if we can keep workers working longer and safer … it’s going to have a significant long-term effect on the construction industry as a whole, especially in certain trades that are very physically labor intensive.”

 

 

 

 

 

 

Finding effective, safe therapies to treat pain and help injured workers return to work remains a major concern for the workers compensation sector.

While advances are being made, there are still limited alternatives to opioids, which were prescribed widely starting in the 1990s, but over the past 10 years were used far less frequently as problems with addiction and dependency were recognized. 

In workers comp, the drugs were a scourge for many injured workers, sedating their bodily systems and impairing their cognition for prolonged periods, preventing them from returning to work. 

As we report here, though, various studies show that opioid scripts in comp have fallen dramatically over the past five years and more, and the notoriety of the drugs, not to mention the multibillion-dollar liability settlements, will likely mean that their use will decrease further.

But like many other substances or materials that were once used widely but are now banned or restricted — the fire-resistant properties of asbestos, for example, made it an extremely useful material in construction and other industries before its lethal toxicity became apparent — the benefits of opioids are real.

One of the reasons why their use became so widespread was because they were very good at what was said on the packet — they relieved pain. And, so far, other options are limited, as chronic pain continues to be an issue in treating injured workers.

Other drugs that are now being used to treat pain come with their own side effects and risks, which is why physicians and pain relief experts are looking to alternatives that do not involve medication.

The results, though, are mixed. For example, in a recent study published by the Journal of the American Medical Association that compared treatment of lower back pain in veterans treated with medication and those treated with cognitive behavioral therapy sessions, the drugs won. The CBT treatment was still determined to be effective in reducing pain but not as effective as the medication.

The study’s authors concluded both pharmacological and behavioral approaches were reasonable options for chronic pain.

While the study had a relatively narrow scope, it illustrates difficulties involved in managing pain — popping a pill is a quick and easy way to get relief, but slower, ostensibly less-effective therapies might be the wisest choice in the long run, especially if they get patients healthy and back to work quicker.

Workers comp insurers and physicians have already made progress moving toward a more nuanced and laborious approach to pain management, but there remains some way to go. Pharmaceuticals, including some powerful drugs, clearly still have a vital role to play, but other treatments such as CBT, physical therapy and massage therapy are being tried and tested. Methodical, clear-eyed analysis of all the options is critical for the industry to avoid another rush to an easy but fatally flawed approach to managing pain.