Tag: Workers Comp

CHICAGO – Insurance company leaders need to support, participate in and fund diversity programs to attract and maintain diverse workforces, a leading insurance industry diversity officer said.

Creating inclusive work environments requires investments in data analytics and a willingness to take a nuanced approach to increasing diversity, said Ivy Kusinga, Philadelphia-based senior vice president and chief culture officer at Chubb Ltd.

She was speaking at the Business Insurance Diversity and Inclusion Institute’s leadership conference in Chicago on Wednesday.

To be successful, diversity programs require senior leadership that has courage and is willing to provide necessary resources, Ms. Kusinga said during her keynote address.

In the insurance industry, for example, women make up the majority of workers, but they are generally clustered in lower-level jobs; the situation is exacerbated for people of color, she said.

“This is why it’s a business issue, not a social issue,” she said. But “the courage to look at systemic issues is limited.”

For example, to address pay inequity among a workforce, senior managers must be willing to pay the accompanying price tag, Ms. Kusinga said.

In addition, companies must be prepared to appropriately staff diversity efforts and bring in expertise to provide the necessary metrics. “You need to hire someone who does deep analytics and put them in HR,” Ms. Kusinga said.

And while seeking to create a more equitable workplace, leaders need to recognize that aspirations to establish so-called meritocracies face complex challenges, she said, adding, “In reality meritocracy is a science and an art.” 

People feel affinity to certain groups, and they are nice to people they know, which gives them an advantage in climbing the company ranks, Ms. Kusinga said. As a result, it’s important for diverse employees to have some powerful people in their networks, she said.

Leaders should also be interested in current events, how they affect staff and customers, and be willing to say something about them, Ms. Kusinga said. “Leaders need to be more socially attuned,” she said.

In addition, leaders should signal their commitment to diversity and pay attention to data about diversity in their organizations, Ms. Kusinga said. And they should set the tone for zero tolerance and tackle casual racism.

“Be the kind of leader that doesn’t allow casual commentary to go unchecked,” Ms. Kusinga said.

 

 

 

Dollar General Corp. and Dolgencorp LLC, which own more than 18,000 Dollar General discount stores in 47 states, are facing $1.6 million in new Occupational Safety and Health Administration fines after the agency claims the discount chain and its operator “again ignored federal workplace safety standards.”

OSHA on Monday said the newest fines, stemming from inspections at four locations in Alabama, Florida and Georgia, brings to $9.6 million the total of fines issued to the chain since 2017.

In the latest round, inspectors cited the stores for four willful and 10 repeat violations for failing to keep receiving and storage areas clean and orderly, and stacking materials in an unsafe manner. These violations exposed workers to hazards associated with slips, trips and being struck by objects.

OSHA citations also included those for exposing workers to fire and entrapment hazards by failing to keep exit routes and electrical panels clear and unobstructed. Finally, the company received citations for failing to mount and label fire extinguishers and having a locked exit door that required a key to open.  

OSHA says it has conducted 182 inspections at Dollar General locations nationwide, where agency inspectors often find unsafe conditions that put workers’ safety at risk if they need to exit quickly in an emergency.

 

 

 

 

 

Workers compensation insurers have generated solid profits in recent years but face an uncertain future, credit rating agency A.M. Best said in a market segment report released Tuesday.

Annual underwriting profit in the comp line of business averaged $4.8 billion over the last five years, “a level of profitability unmatched by any of the other major property/casualty lines,” A.M. Best said.

The net loss ratio has ranged from 45.4% to 49% over the last five years, reflecting the benefits of better workplace safety as well as legislative changes that reined in claim costs. The combined ratio over the same period was between 86.2% and 92.2%, and was 87.9% in 2021.

A.M. Best also cited strong favorable loss reserve developments and low unemployment rates as pointing to a continued rise in comp premiums through the end of 2022. That forecast, however, will depend on other economic factors.

“Inflation could disrupt this stable environment. If inflation causes loss costs to increase, particularly on the medical side, without a commensurate increase in employee wages, rate increases may be necessary to cover the gap,” Christopher Graham, a senior industry analyst for A.M. Best, said in a statement. “Inflation could also necessitate companies’ further sharpening their risk management and loss control efforts to limit claims frequency.”

A.M. Best also said that while net income for comp insurers is strong, it has not been growing at the same rate as policyholders’ surpluses. This resulted in a drop in after-tax return on equity over the past two years.

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

 

The New Mexico Court of Appeals said an injured worker wasn’t entitled to full reimbursement for his out-of-pocket medical cannabis costs because they exceeded the maximum payment allowed under the state’s medical fee schedule.

Rodolfo Barrozo Jr. injured his wrists and elbows while working for grocery chain Albertsons Inc. and qualified for medical cannabis under the state’s compassionate use laws, according to Rodolfo Barrozo Jr. v. Albertsons Inc. and Ace American Insurance Co.

Mr. Barrozo requested that Albertsons and its insurer Ace American Insurance Co. reimburse the full $453.05 he paid for medical cannabis. He was reimbursed $108.18 under the state’s medical fee schedule.

A workers compensation judge denied Mr. Barrozo’s appeal and agreed that the reimbursement was properly calculated in accordance with fee schedule rates.

In dismissing his appeal, the New Mexico Court of Appeals rejected Mr. Barrozo’s arguments that the requirement that employers provide injured workers with health care services entitled him to full reimbursement and that the cap on reimbursement in the fee schedule conflicted with a statutory requirement that employers cover the full cost of medical treatment for injured workers.

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

A new report shows that medical inflation in workers compensation over the past decade has been modest, but one area to watch is costs paid to facilities, which make up the lion’s share of increases, according to experts.

Between 2012 and 2021, workers comp medical costs increased nationally at an average of 2% a year, according to the Boca Raton, Florida-based National Council on Compensation Insurance, which this month released its report on medical inflation. The report showed an average annual 1.2% rise in facilities costs, while costs for drugs dropped 0.2% and physicians costs increased 0.6%. The final category — “other” — rose 0.4%.

Raji Chadarevian, director of medical regulation and informatics at NCCI, said states with fee schedules for hospital services fared better in cost containment, but the issue is difficult to address with little competition in some areas.

Costs for “hospitals are difficult to control because you don’t have a lot of control over the marketplace,” he said.

Bill Yaeger, Charlotte, North Carolina-based southeast regional director, health care practice, for Gallagher Risk Management Services, a division of Arthur J. Gallagher & Co., noted that facilities costs increased during the pandemic due to staffing shortages in hospitals, which continues to be an issue.

“If you don’t have enough employees, the hospitals have had to hire temporary workers or go through staffing agencies,” he said. “The facilities costs went through the roof on account of that.”

Increases in medical malpractice insurance premiums are also driving up costs, he said.

The drop in fees paid for drugs in comp is attributed to declining opioid prescriptions, which has been well documented in other industry reports, according to Mr. Chadarevian.

States, insurers and their third-party administrators, and pharmacy benefits managers implemented over the past decade a number of changes — including formularies and prescription monitoring programs — that made the prescribing of addictive opioids more challenging, thus decreasing costs. The increased availability of generic drugs is also helping to decrease costs, Mr. Chadarevian said.

Can regulation of medical procedures in comp help keep facilities costs from rising? It’s not likely, said Brian Allen, Salt Lake City-based vice president of government affairs, pharmacy solutions, for Mitchell International Inc., a subsidiary of Enlyte Group, who said regulators have little appetite for intervening on the question of medical necessity. States can and have used fee schedules to control costs, however, and the results have been mixed, he said.

States with a fee schedule based on another entity, such as those based on the Medicare fee schedule, fare better, Mr. Allen said. States with percentage of bill fee schedules — which are based on a percentage of the actual cost for services — aren’t as successful, as hospitals tend to simply raise their fees to increase that percentage, he said.

To reduce facilities spending, insurers and employers can look at the medical necessity for some procedures, as some costly surgeries performed in the comp sector have not always led to optimal results, experts say.

“One of the reasons facility costs are going up is that there’s been an increase in surgeries … in outpatient and ambulatory surgical centers,” said Steve Bennett, Washington-based assistant vice president for workers compensation programs and counsel for the American Property Casualty Insurance Association. “We certainly support all reasonable and necessary care, but we have to make sure that surgeries are necessary, reasonable and efficient.”

Twenty-four percent of COVID-19 workers compensation claimants have or had long COVID, according to a report released Monday by the National Council on Compensation Insurance.

Overall, 20% of non-hospitalized and 47% of hospitalized workers with admitted COVID-19 claims developed long COVID, according to the Boca Raton, Florida-based ratings agency.

NCCI relied on claims data extending through the first quarter of this year, for claims with accident dates between March 2020 and June 2021. The data “does not fully reflect the potentially longer-term impacts of long COVID,” NCCI said.

The average temporary disability indemnity benefit duration for long COVID patients was about 160 days for hospitalized patients and 95 days for non-hospitalized patients. Breaking out the demographics, most long COVID claims — 34.9% for hospitalized patients and 30.4% for non-hospitalized patients — were in the 51-60 age group, and females were more likely to have long COVID, accounting for 79% of hospitalized claimants and 61.8% of non-hospitalized claimants.

The report also highlighted the number of medical specialties involved in caring for a patient with long COVID, which comprise more than 150 medical codes associated with the diagnosis and are grouped into eight symptom groups. The most common, in order, are, pulmonary or cardiovascular,  followed by neurological, systemic, endocrine, autoimmune, mood disorders and sleep disorders.

Hospitalized patients sought more physical medical services in the 30- to 270-day post-acute infection period of COVID-19 than non-hospitalized patients. Home health care services performed in that time frame were among the top three medical services provided for patients who had been hospitalized.

Prescriptions for pulmonary inhalers dominated both the hospitalized and non-hospitalized cohorts of patients.

(Reuters) – Amazon.com Inc. must face a claim that it failed to protect New York City warehouse workers and their families from COVID-19, a U.S. appeals court ruled on Tuesday while dismissing the bulk of a 2020 lawsuit.

The 2nd U.S. Circuit Court of Appeals in New York reversed a federal judge’s ruling that said only the U.S. Occupational Safety and Health Administration had the power to review complaints about Amazon’s workplace safety practices.

The court, however, upheld the dismissal of other claims, including that Amazon created a “public nuisance” by failing to stop the spread of COVID-19 and did not properly provide payments for sick leave.

The case involves workers at an Amazon warehouse in Staten Island that earlier this year became the company’s first unionized facility.

The Court of Appeal for the 1st District of Florida ruled that a worker’s claim for benefits for an alleged injury to his neck and back was not timely filed and that there were “serious gaps regarding causation in the hospital records.”

In 2019 Eddy Bonhomme was employed by Staff Team Hotels Corp., a hotel staffing company, when he was asked to work with another employee and help carry mattresses.

 Mr. Bonhomme testified that he made six trips carrying mattresses. On the fourth trip, he “felt a tingling from head to toe on the right side” as if his right side was being “twisted,” he said. He finished moving the rest of the mattresses and did not tell his employer about the incident, according to Bonhomme v. Staff Team Hotels Corp.

Mr. Bonhomme went to work three days later and worked a full day. That night, he allegedly awoke with “numbness,” “tingling,” “muscle weakness” and “blurred vision.” He called 911 and was transported by ambulance to an emergency room.

There is no indication in the records that he reported at the hospital any complaint of neck or back pain. Emergency room personnel did not diagnose him with any back or neck injury during this visit. Instead, they chalked up his symptoms to heat exhaustion and sent him home.

Over the next few weeks, Mr. Bonhomme made repeated trips to the emergency room. The records from those visits do not indicate any complaint of neck or back pain until an emergency room doctor mentioned to him the possibility of a cervical sprain but without a formal diagnosis.

Mr. Bonhomme did not notify his employer of an injury until nearly two months after carrying the mattresses. He filed a workers compensation claim, which a judge of compensation claims denied.

The Court of Appeal for the 1st District of Florida said “Bonhomme put himself in a difficult spot in connection with his claim,” as “the hospital records from Bonhomme’s multiple emergency room visits tell one story, and his later testimony given in the context of his petition for benefits tells a different story.”

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

The Occupational Safety and Health Administration has fined a Florida seawall and erosion repair company $46,409 following an investigation that found safety lapses after a diver drowned while removing sand with an industrial vacuum to restore an embankment.

The April 4 incident was the result of Margate, Florida-based Erosion Barrier Installations Corp.’s failure to train divers on emergency procedures, OSHA said in a statement released Thursday.

Specifically, OSHA said the company failed to train divers in dive-related physics and physiology and did not train dive teams on equipment use, techniques and emergency procedures required to perform underwater tasks safely.

The company, which is facing two willful and 10 serious violations and was cited in 2011 following another fatal diving incident, has 15 days to contest.

 

 

The Kentucky Department of Insurance approved a recommendation from the National Council on Compensation Insurance to reduce loss costs by an average of 6.8% across all class codes, representing the 17th consecutive loss cost decrease for the state.

“The overall decrease shows the continuing decline in claim severity and frequency,” the department said in a statement. “Wage and medical inflation have the potential to affect historical patterns and were considered, but it is not anticipated to create increased premiums due to the declining claim trend.”

Loss costs are an average compensation for lost wages based on the level of disability and medical benefits and are a direct component of an employer’s work comp rate.

While the department approved an average reduction of 6.8%, not all employers will see a decrease. For example, while the new loss cost for surface coal mining is down 2.2%, the new rate for underground coal mining is up 3.5%.

The new loss costs apply for policies incepting on or after Jan. 1. 2023.

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