Tag: Workers Comp

More than half of the complaints filed with the Texas Division of Workers’ Compensation stem from alleged failures of insurance companies, according to an agency official who commented on compliance efforts regulated by law.

During a recent DWC quarterly insurer meeting, Nikki Karr, director of DWC enforcement, reported that as of Aug. 31, the agency had received 1,322 complaints this year.

Of the complaints, 840 concerned insurance company actions or failures to act. Another 264 related to health care providers, while 131 were filed against employers. The remaining complaints were filed against attorneys and injured workers. 

Ms. Karr said top complaints against insurers included failure to timely respond to an injured employee’s request under a claim, failure to notify the DWC or employee within 10 days of taking action on a claim, failure to contact an employer within seven days of receiving notice of a claim, and failure to timely pay temporary income benefits.

Failure to pay medical bills in a timely manner was another top complaint, accounting for about a quarter of the complaints against insurers, she said.

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

The U.S. Department of Labor said impact inspections at 14 mines in 10 states throughout August uncovered a total of 246 workplace safety violations.

The inspections, completed by the department’s Mine Safety and Health Administration, found 94 significant and substantial violations and 17 violations found to have unwarrantable failure findings, the DOL said.

Significant and substantial violations are those likely to cause a reasonably serious injury or illness, and violations deemed unwarrantable failures occur when there is aggravated conduct rising above the negligence level.

The August inspections were carried out at mines in Alabama, Alaska, Indiana, Kentucky, Michigan, New Mexico, Ohio, Pennsylvania, West Virginia and Wyoming.

Monthly impact inspections are done at mines requiring increased regulatory attention and enforcement due to poor compliance history, a history of previous accidents and injuries, and due to other workplace safety concerns, according to the DOL.

 

 

The Utah Court of Appeals ruled that a former BASF Corp. employee’s ailments were directly caused by years of chemical exposure while working for the manufacturer of automotive finishes and other industrial products.

For nearly 30 years, Bradley West was exposed to chemicals that several doctors linked to his medical conditions, according to the ruling in BASF Corp. v. Labor Commission, filed Sept. 21.

In the months following an incident in 2015 in which Mr. West accidentally spilled a can of resin on himself, he began complaining of worsening symptoms — difficulty breathing, coughing, congestion, sinus pain and clogged ears — that he initially thought were related to seasonal allergies. The following year he began coughing while giving a product demonstration and coughed for two hours, losing consciousness twice, according to the ruling.

A biopsy in 2016 revealed he was suffering from a condition consistent with chronic eosinophilic pneumonia, likely linked to occupational exposures, several experts concluded.

A medical panel, following the instructions of an administrative law judge, determined that Mr. West’s conditions were “due to exposures at his work, specifically isocyanates … a known immunologic cause of occupational asthma,” according to the ruling.

The judge ordered BASF to pay Mr. West compensation for past and future medical expenses and total disability compensation. BASF appealed, and a second medical panel concurred that Mr. West’s “occupational disease is largely, if not all, attributable to industrial causes.”

The Utah Court of Appeals affirmed the administrative law judge’s ruling, writing that the evidence presented by two medical panels supported the conclusion that repeated exposure to industrial chemicals caused Mr. West’s medical conditions.

 

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Researchers say they may have found some biomarkers for long COVID, a debilitating condition that the medical community has struggled to identify via diagnoses, according to a study published Monday in the journal Nature.

Examining blood samples among 273 individuals, researchers were able to identify blood conditions that correlated with long COVID symptoms, which the study said included “fatigue, post-exertional malaise, and a variety of cognitive and autonomic dysfunctions” of which, prior to the study, “the biological processes associated with the development and persistence of these symptoms are unclear.”

The blood markers included “exaggerated “immune responses against the virus that causing COVID-19, “higher antibody responses” against non-COVID viral pathogens, and lower cortisol levels.

A recent workers compensation study indicated that 6% of claims have long COVID symptoms, which the industry has described as mysterious with regards to diagnoses.

 

 

 

 

An Oklahoma construction company has agreed to pay $370,680 in criminal and civil penalties in order to avoid being criminally charged over the October 2019 death of a worker who fell 50 feet while working atop a soybean storage tank, the U.S. Occupational Safety and Health Administration announced Wednesday.

OSHA said Yale-based Skinner Tank Co., which builds welded steel storage tanks nationwide, was initially issued civil citations for willful violations for failing to require the use of fall protection.

The company had also faced $415,204 in fines.

The matter was referred to the U.S. Justice Department for criminal prosecution after OSHA investigators said the contractor deliberately provided workers with incorrect information, namely that wearing fall protection presented a greater hazard than not wearing it.

The company also failed to provide employees with fall protection training, OSHA stated.

The agreement gives Skinner Tank deferred prosecution protection.    

 

Target Corp. announced Tuesday that it is closing nine stores across four states, effective Oct. 21, due to “theft and organized retail crime … threatening the safety of our team and guests.”

Workplace violence in the retail sector has been an ongoing issue for companies.

The Minneapolis-based company said in a statement that “unsustainable business performance” at the stores helped justify the closures despite investment strategies to prevent retail crime, including adding more security personnel, using third-party guard services, and implementing “theft-deterrent tools.”

Target is closing three stores each in the Portland, Oregon, and San Francisco-Oakland markets; two in Seattle; and one in New York.

Developing “soft skills” such as empathy and active listening is fast becoming vital for those who want to successfully manage workers compensation claims, according to a recent survey of high-performing claims organizations.

Chicago-based Rising Medical Solutions on Sept. 18 released the findings of its 10th annual benchmarking survey in which it gathered the input of 388 claims leaders in 2022, identifying how claims organizations with successful claims experiences for injured workers distinguish themselves.

In addition to using technology to assist with workflows and other tasks — now commonplace as the insurance industry as a whole embraces technology — addressing mental health and applying sensitivity-based approaches to managing claims stood out as must-dos for those handling claims.

Paige McCraney, Rising’s vice president of care management and a nurse practitioner, said the move away from “adjudication of claims” to addressing the biopsychosocial issues in workers compensation has been a slow but necessary shift.

“It’s a change of culture and kind of a change of paradigm,” she said. “Historically (in workers comp) we’re looking for fault. And it’s very easy to say, ‘Oh, well, this person has mental health issues and that is really their fault, or that’s not related to the workers comp issue,’ when it actually is caused by the workers comp injury and certainly impacts (the claim) and needs to be addressed.”

Successful claims managers are “connecting with people in a meaningful way,” said Denise Algire, Pleasanton, California-based director of health for grocery chain Albertsons Cos. Inc., who served on the advisory council for Rising’s study. 

“At the end of the day, we’re working with an injured worker dealing with what could be their worst day. Most people … don’t understand the system, and our system can be quite complicated,” she said.

“Having empathy and understanding critical skills like active listening are just as important as the other strategic and tactical skills that claims professionals need in the daily management of claims.”

Dr. Marcos Iglesias, Hartford, Connecticut-based vice president and chief medical director at Travelers Cos. Inc., said the industry in the past steered clear of managing the mental side of claims out of fear they would cross into the mental-injury space.

That notion has not been proven, he said, adding that there’s a difference between having a diagnosable mental health condition and having stress, depression or anxiety when dealing with a physical injury suffered at work and not being able to work because of it.

“We have lumped all of mental health into one monolith, and mental health isn’t a monolith. … Mental health is really a continuum,” Dr. Iglesias said. “At any one point in time, I might be excelling, thriving, or I might be in a crisis and those are two very different ends of the continuum.

“Likewise, within that continuum, I could have a diagnosable mental health condition like schizophrenia or major depressive disorder, or I could be somewhere in the middle where I have symptoms of depression or anxiety, which isn’t a disease or mental health condition. They’re just the way that I’m feeling right now.”

Addressing “how an injured worker is feeling and acknowledging their concerns is the approach successful claims handlers are applying,” Dr. Iglesias said.

The change is slow, Ms. Algire said. Training claims managers is “not something that can be a one-and-done training session. You can’t just get training on empathy. It has to be the ongoing messaging,” she said.

 

James River Group Holdings Ltd., a Bermuda-based holding company that operates a group of specialty insurers and reinsurers, announced Monday that it has agreed to sell the rights to its Individual Risk Workers’ Compensation business to The Amynta Group, a New York-based insurance company.

Under the terms of the deal, Amynta would obtain the full operations of the comp business, including underwriting, claims and loss control. The deal, financial terms of which were not disclosed, is expected to close at the end of the third quarter.

The business, which generated $53 million in gross written premiums in 2022, would operate under Amynta Work Comp Solutions.

James River CEO Frank D’Orazio said in a statement that the agreement is aligned with the company’s strategy to focus resources on “core businesses where we have meaningful scale.”

Bob Schultz, Amynta’s head of insurance programs, said in a statement that the acquisition would help to expand its workers comp business across targeted industries and establish a strong presence in the southeastern U.S.