Tag: Workers Comp

ORLANDO – The workers compensation system continues to perform very strongly, as private insurers produced their 10th consecutive year of underwriting profitability and the combined ratio sat below 90% for the seventh year in a row, the National Council on Compensation Insurance reported during its Annual Insights Symposium Tuesday.

“Workers compensation continues to have the strongest profitability of all the property/casualty lines,” NCCI Chief Actuary Donna Glenn said during the annual State of the Line report. “It’s pretty stunning results we have here.”

The 2023 calendar year combined ratio was 86% while the accident year combined ratio was 98%, and the workers compensation reserve redundancy grew to $18 billion in 2023, $1 billion more than in 2022, experts said.

Lost-time claim frequency declined by 8% in 2023 and claims severity saw a “moderate” increase of 2% for medical costs and 5% for indemnity benefits, Ms. Glenn said.

Indemnity benefits are tied directly to wages, and indemnity severity typically increases as payroll goes up, experts said.

NCCI researchers said technological advancements and improved data analytics have led to improved claims cost management and processing.

Claims frequency continues its long-term decline and the focus on improving workplace safety through technological advancements and job automation are helping to contribute to fewer workplace injuries, Ms. Glenn said.

The industry also saw a 6% increase in payroll growth in 2023, with wage growth seen in nearly all sectors, she said.

“All in all, this is indicative of a very strong labor market,” Ms. Glenn said.

Payroll growth was about 7% for NCCI states and 5% for non-NCCI states, she said.

“Loss costs have been declining as wages rise and claim frequency improves,” said Nadege Bernard, a practice leader and senior actuary with NCCI.

Medical lost-time claims severity was expected to be about 2% higher in 2023 than in the prior year, experts said.

“The workers compensation system has unique features that have differentiated us from other commercial lines in terms of overall performance during the past several years,” said NCCI President and CEO Bill Donnell.

The industry continues to keep an eye on issues such as claims frequency trends and medical inflation as it looks to the future, Mr. Donnell said.

 

 

Seventy-six percent of physicians treating workers compensation patients in Texas in 2021 continued to do so in 2022, according to a report released by the Texas Department of Insurance that found the dip was due to “normal attrition processes among physicians such as retirement, death, changes in practice type and migration.”

When compared with 2017, when 79% of doctors who had treated injured workers in 2016 continued to do so, the department said the changes reveal a steady medical industry, in which newer doctors have replaced those who left. Retention rates by specialty showed that over five years orthopedic surgeons maintained the highest retention rate at consistently over 87%, according to the report.

Overall, 56% of doctors who treated injured workers in 2017 continued to do so in 2022, yet among the top 20% of treating physicians in 2017, representing 90% of total payments,74% remained in 2022, according to the department. 

Oklahoma Gov. Kevin Stitt on Thursday signed into law a measure that makes line-of-duty mental injuries compensable for first responders.

Beginning in 2025, S.B. 1457 will allow for workers compensation benefits for police officers, professional and volunteer firefighters, and emergency medical technicians diagnosed with post-traumatic stress disorder whose mental injury is connected to “responding to an emergency.”

The bill defines PTSD as that which is connected to witnessing or experiencing near-death or death or a threat to the “physical integrity of others” and that the response involved “fear, helplessness, or horror.” The bill also outlines what symptoms must be present, such as “recurrent and intrusive” thoughts about the event.

The new law limits medical treatment for PTSD to one year and states that for those who despite treatment are unable to perform duties, the law stipulates that the first responder would be eligible for disability benefits not to exceed $50,000.

 

 

A divided Mississippi Court of Appeals on Tuesday upheld an award of permanent disability benefits to a former police officer who was beaten while responding to a call that she believed to have been set up by the chief of police, who was involved in a sexual harassment case filed by the only female officer in the force.

The officer was working for the City of Verona, Mississippi, in 2017 when she was dispatched to handle a domestic dispute at an apartment building, a call that resulted in her being violently attacked for 11 minutes, losing consciousness several times and believing she was going to be killed, according to No. 2022-WC-01050-COA.

Following recovery of several physical injuries, the officer was later diagnosed with post-traumatic stress disorder, depression and anxiety. The officer said she believed the attack had been a setup by the police chief, angry that she had twice filed claims with the Equal Employment Opportunity Commission for sexual harassment, one was still pending when the attack occurred, according to records.

The chief was supposed to be her backup that day, and he had been 30 minutes late arriving. Two women also provided sworn statements that the chief was going to have the female officer killed, according to records.

In 2018, after it was determined that she had reached maximum medical improvement for her physical injuries, a psychiatrist said she was likely suffering from major depressive disorder and somatic symptom disorder but was at MMI for any mental injury, and gave no restrictions nor impairment rating.

Upon appeal, an administrative judge found that she developed PTSD and that she had a 50% loss of wage-earning capacity. The Workers’ Compensation Commission upheld the AJ’s finding of PTSD but increased her lost wage-earning capacity to 80%.

The Mississippi Court of Appeals said there was substantial, credible evidence in the record supporting the commission’s decision.

“The traumatic event that caused (her) PTSD was getting assaulted nearly to death,” the court said. Part of that trauma was her belief she had been set up by the chief, who was supposed to be her backup. The court concluded that this evidence was more than enough to establish a causal connection between the officer’s work and her PTSD.

Three judges dissented, writing that the officer failed to connect her PTSD to the beating, and instead her mental injury the result of her poor relationship with her boss and her pending EEOC lawsuits.

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

 

 

 

 

A pork processing company was prematurely granted summary judgment in a lawsuit brought by an injured staffing agency employee because of lingering questions over the worker’s employee status, the Iowa Court of Appeals ruled Wednesday.

Emerson Dennis Saul sued Sioux City-based Seaboard Triumph Foods LLC for negligence over injuries he says he sustained in July 2019 after being “slammed” between two pallets that were struck by a forklift operated by a Seaboard Triumph worker.

Mr. Saul filed a workers compensation claim against his employer, a staffing agency that placed him in the role, but he also sued Seaboard Triumph, claiming the company’s forklift driver negligently caused the accident.

Seaboard Triumph argued that the suit was barred by workers comp exclusivity, saying Mr. Saul was considered an employee of the company.

A trial judge agreed with the company and granted summary judgment.

The appeals court said the suit would only be barred if Mr. Saul and Seaboard Triumph had an express contract, which was not the case.

The court also noted that the company’s own human resources manager testified at a deposition that Mr. Saul was not an employee.

The staffing agency stated that Mr. Saul was its employee.

The appeals court reversed and remanded to the trial court, saying that “reasonable minds can differ” on the question of employee status, and that summary judgment should not have been granted at this stage of the litigation.

 

 

The U.S. Occupational Safety and Health Administration said Thursday that it cited the operator of multiple psychiatric and rehabilitation facilities for the third time in five years after workers were killed or seriously injured in violent patient attacks.

OSHA cited Melbourne, Florida-based Circles of Care Inc. for a “repeat” violation and an “other-than-serious” violation for various safety and health failures and issued $101,397 in proposed penalties.

The agency said Circles of Care failed to provide sufficient controls designed to prevent the “escalation of acts of aggression toward professional staff.”

“Circles of Care’s reluctance to protect its employees from the recognized danger of patient assault is shocking,” OSHA Orlando Area Office Director Erin Sanchez said in a statement.

The citation and proposed fines stem from a November 2023 inspection following a worker’s hospitalization. The employee was injured in the head, face, hands and arms after a patient used a metal hole punch to strike the mental health technician at a nurse’s workstation, OSHA said.

The agency said it also investigated the company after two other incidents in 2020 at the Melbourne facility. One of those was a fatal shooting of a counselor by a former patient and the other involved an alleged assault.

Circles of Care, which operates 10 behavioral health and substance abuse facilities, and has about 480 employees in Florida, has 15 business days to contest the citation and proposed penalties. 

 

 

The probability of work-related accidents increases 5% to 6% when temperatures rise above 90 degrees, and the effect of workplace heat is stronger in the southern U.S. and in the construction industry, according to a report released Thursday by the Workers Compensation Research Institute.

The report, “Impact of Excessive Heat on the Frequency of Work-Related Injuries,” used workers compensation claim data from 2016 to 2021 across 24 states.

Researchers looked at work injuries caused by direct and indirect heat exposure. Direct heat exposure involves the effect of heat on a worker’s body leading to heat exhaustion or other issues. Indirect exposure involves cases where workers suffer injuries from accidents such as falling off ladders when heat impairs cognitive or motor functions.

“It is important to note that workers can adapt, or acclimatize, to excessive heat, which could reduce the incidence of heat-related work accidents,” the report states.

Despite acclimatization, researchers still recommend that employers implement greater safety protections for employees who work in hot temperatures.

Excessive workplace heat can also exacerbate health problems such as asthma, kidney failure and heart disease, for those employees who already suffer from such conditions, the report states.

Injured worker claim frequency vary “substantially” between industry and occupation, the report states.

Researchers also examined the connection between heat exposure and traumatic injuries, finding that the risk for traumatic injuries increases in cases of external heat exposure and internal heat generated by physical exertion.   

 

A split West Virginia Supreme Court on Tuesday upheld a denial of workers compensation benefits to a man who claimed he developed Parkinson’s disease after being exposed to industrial chemicals while working as an automotive paint technician.

The court, in a 5-1 decision, ruled that Gregory Gwinn was unable to prove that he developed Parkinson’s disease due to occupational chemical exposure. Mr. Gwinn worked in the industry from 1992 to 2018, the year he filed for workers comp.

He claimed “inhalation and dermal exposure” to paints, solvents, primers and chemicals caused his disease.

His employer, Beckley, West Virginia-based Lewis Chevrolet Co., submitted an independent medical evaluation that cast doubt on whether Mr. Gwinn developed Parkinson’s disease due to work activities.  

Another doctor who examined Mr. Gwinn said it’s rare to develop Parkinson’s disease at a young age and that the industrial exposure could possibly be associated with the diagnosis.

In 2022, the West Virginia Insurance Commissioner’s Office of Judges found that Mr. Gwinn failed to offer enough proof to establish an occupational disease claim. A review board and the state Supreme Court upheld that determination.  

The dissenting Supreme Court justice said the case should have been permitted to proceed because of lingering questions over causation.