Tag: Workers Comp

While opioids continue to dip in workers compensation, prescriptions to manage opioid dependency and possible overdose were up 11% in 2022, according to a report released Wednesday by Enlyte LLC.

The percentage of high-dosage opioid claims with naloxone, which can reverse negative effects of an overdose, rose to 7.3%, up from the 5.8% reported in 2021, according to the new data provided by the comp services company.

In 2022, opioid scripts dropped 1.3% and costs decreased 2.5%, in line with a yearslong trend of seeing fewer injured workers prescribed opioids. Overall, 23.8% of injured workers take opioids, according to the report. 

 

 

A recent California Supreme Court ruling that employers aren’t responsible for so-called “take-home COVID” — when workers infect family members — has tossed the issue out of the workers compensation arena, experts say.  

The court ruled July 6 that businesses don’t owe a duty of care to relatives of workers who contract COVID-19 on the job and then pass it along, and that workers comp exclusivity doesn’t prohibit lawsuits.

The ruling, Kuciemba v. Victory Woodworks, means spouses who contract COVID-19 are permitted to sue their spouse’s employer, but recovering damages means a much higher bar for plaintiffs, said Alan Gurvey, a Sherman Oaks, California-based attorney with Rowen, Gurvey & Win, who represents injured workers.

If the employer owes no duty of care to protect workers’ spouses from COVID-19, a plaintiff’s negligence theory would likely be too difficult to prove, Mr. Gurvey said.  

“Historically, it has been very difficult for any kind of condition to involve a spouse in workers comp,” Mr. Gurvey said. “In other words, if someone does not work for the company … they don’t have a claim in workers compensation.”

Litigation remains a possibility.

“As far as the liability aspect goes, it will be difficult for a spouse to successfully sue — although they can, because the decision says they can — because if the employer doesn’t owe a duty of care, then what [legal] theory do you rely on,” Mr. Gurvey said.

Jeff Adelson, a partner with Newport Beach, California-based Adelson McLean P.C., which represents employers, said the California Supreme Court made a “really good public policy decision” but that the decision also means injured plaintiffs might be left without a remedy.

“I would say to employers, I wouldn’t jump up and down and say, ‘Yippee, this is a win,’” Mr. Adelson said. This “benefits us but this in no way gives us a license to be any less vigilant,” he said.

The Washington-based U.S. Chamber of Commerce welcomed the outcome.

“We are grateful the Court recognized that holding employers liable for nonemployees who contracted COVID-19 would be a significant expansion of tort law that would have forced employers to bear the responsibility of subsidizing the health care costs of the pandemic,” said Nicole Wasylkiw, the organization’s corporate counsel.

The California Supreme Court said that sometimes the “consequences of a negligent act must be limited in order to avoid an intolerable burden on society,” and that the “dramatic expansion of liability plaintiffs’ suit envisions has the potential to destroy businesses and curtail, if not outright end, the provision of essential public services.”  

Sara Widener-Brightwell, general counsel for the Oakland, California-based California Workers’ Compensation Institute, said the “court made the correct decision in finding an exception to a duty of care just because of the widespread nature of COVID and the likelihood that every employer in the entire state could have had an action brought against them had the court found that that duty existed,” she said.

Steve Bennett, Washington-based assistant vice president for workers compensation programs and counsel for the American Property Casualty Insurance Association, said he ultimately agrees with the decision but still maintains that comp exclusivity should have been applied.

“We believe that such an injury is derived from the employee’s injury, because, but for the injury, there would have been no injury to the family member,” he said. “The analysis for derivative injuries has always been complicated and remains complicated, and it remains fact specific.”

 

 

Workers compensation insurers’ underwriting results continued to outpace the rest of the U.S. property/casualty commercial sector in 2022, as they benefited from the long-term decline in workplace accidents and a reduction in fraudulent claims, according to an A.M. Best industry segment report released Tuesday.

The report notes that favorable prior-year loss reserve development continued to bolster the insurance industry’s reserve position in 2022, owing to the long-term declines in claims frequency.

The report noted that in 2022 workers comp had a combined ratio of 87.8%, nearly 15 percentage points lower than the overall property/casualty segment’s 102.4.

Trending are rising payroll levels, the report said, noting that workers comp premiums, based on payroll, “benefited from the largest U.S. wage growth in over 25 years, coupled with strong job growth, which has helped increase its overall premium to pre-pandemic levels.”

Medical and indemnity severity increased, but the magnitude of these increases was less than the increase in wages, A.M. Best found, adding that this higher payroll base for workers comp “kept the increase in claim severity manageable.”

The report also notes that workers comp pricing has declined since 2015, except for the post-pandemic period from the second quarter of 2020 through 2021, when modest increases became the norm. The segment is still subject to “a number of factors with longer-term implications on operating performance,” including its being affected by rising inflationary pressures. Higher wages have driven indemnity costs up, resulting in a modest increase in claims severity, according to the report.

 

 

The Minnesota Court of Appeals Monday denied the appeal of a critical care nurse who had sued a psychiatrist for medical malpractice after she filed a workers compensation claim alleging work-related post-traumatic stress disorder.

The court dismissed the suit for failure to state a claim and because the nurse failed to file various court motions in a timely manner.  

The nurse had filed a comp claim in 2017 related to incidents between her and a coworker that she claimed led to her quitting her job as a critical care nurse. A psychiatrist conducted an independent psychological examination in April 2018, finding the nurse didn’t suffer from PTSD.

The nurse alleged in her suit that the psychiatrist’s actions during the exam retraumatized her. 

The appellate court said the lower court’s dismissal of the case was proper because independent psychological exams in workers comp claims don’t create a patient-physician relationship. The nurse had argued there was a relationship because the psychiatrist gave her treatment recommendations and offered a diagnosis.

 

 

The Occupational Safety and Health Administration on Thursday launched a national emphasis program to prevent workplace hazards in warehouses, processing facilities, distribution centers and other “high-risk retail” establishments.

OSHA says the program is in response to the growth in warehousing and distribution centers, paralleled by increases in workplace accidents, citing Bureau of Labor Statistics data that show injury and illness rates for these establishments are higher than in private industry overall and, in some sectors, more than twice the rate of private industry.

Under this three-year emphasis program, OSHA says it will conduct comprehensive safety inspections focused on hazards related to powered industrial vehicle operations, material handling and storage, walking and working surfaces, means of egress and fire protection. The program will also include inspections of retail establishments with high injury rates with a focus on storage and loading areas; however, OSHA may expand an inspection’s scope when evidence shows that violations may exist in other areas of the establishment. OSHA says it will also assess heat and ergonomic hazards under the emphasis program, and health inspections may be conducted if these hazards are present.

State plans are now required to adopt this emphasis program or establish a different program at least as effective as the federal model, according to the statement. 

 

 

 

The U.S. Occupational Safety and Health Administration has cited a Missouri company for 55 health and safety violations after a sawmill worker was killed after getting pulled into machinery.

OSHA on Thursday announced the citations and $346,954 in proposed penalties against Don Gibson, doing business as Missouri Mats, following the Jan. 11 fatality at a sawmill in Brashear, Missouri.

OSHA said the company failed to notify regulators about the incident in a timely manner, which delayed the workplace safety investigation. Investigators subsequently ordered the company to take steps to protect workers against amputation hazards, but inspectors in March found it had failed to implement proper safety measures, the agency said.

OSHA cited the company for two willful, 53 serious and two other-than-serious safety and health violations and placed it in its Severe Violator Enforcement Program. The company has 15 days to contest the citations.

OSHA said it cited the company in 2012 after a fatality at a Missouri logging site.

 

The U.S. Occupational Safety and Health Administration cited a New Jersey construction contractor for exposing workers to potentially deadly falls of up to 30 feet.

OSHA said Tuesday it cited Newark-based Main Line Contractor Corp. for 17 serious and four willful violations and proposed $333,052 in fines after inspectors visited work sites in Berlin, Cape May, Lakewood, Mount Holly and Mount Laurel beginning in January.

The agency said the framing and sheathing contractor failed to provide or did not require the use of protective equipment designed to prevent falls from elevations greater than six feet.

The company has 15 business days to contest the citations and penalties.

Sedgwick Claims Management Services Inc. on Thursday announced the launch of Sedgwick Government Solutions, a new business to further expand its administrative and managed care offerings to the federal government.

The news follows the company’s 2021 acquisition of Managed Care Advisors Inc., a Bethesda, Maryland-based government contracting firm and provider of workers compensation and specialty health plan products and services to the federal government.

Sedgwick Government Solutions is focused on developing and implementing highly specialized health programs, products and services tailored to the government sector, according to the announcement.

 

 

 

 

 

An examination of workers compensation pharmacy data showed a 1.06% increase in drug prices for injured workers between May 2020 and May 2023, according to a white paper released Thursday by MyMatrixx, a Jacksonville, Florida-based pharmacy benefits manager and subsidiary of Express Scripts Holding Co.

MyMatrixx said the data showed that comp drug price increases are “far below the 5.44% inflation rate reported by the U.S. Bureau of Labor Statistics consumer price index.”

Analysts, using MyMatrixx data only, also found that traditional drugs, such as opioids, nonsteroidal anti-inflammatory drugs, muscle relaxants, anticonvulsants and antidepressants represent 95% of prescription volume but 87% of price, while specialty drugs account for 0.7% of volume but 7% of price.

The paper also said pharmacy benefits management saw 90.97% lower-cost generic drug utilization, which helped drive costs down. That figure climbed steadily from 86.76% reported in 2018.

A U.S. Department of Labor’s Office of Inspector General said in a report issued Wednesday that it had has to cancel one previously contracted audit of the Occupational Safety and Health Administration’s pandemic readiness due to budget issues.

The OIG, which had previously audited OSHA’s response to the COVID-19 pandemic and found issues with enforcement activity and follow–ups, said in its latest report that the reduction of its audit capacity is “particularly of great concern given the detriment” to Department of Labor oversight when it comes to preparedness for future emergencies.

“For example, we have reported deficiencies in (OSHA’s) programs that subjected U.S. workers to greater safety risk despite OSHA’s guidance and actions during the pandemic,” the report said.

“OSHA received an increased number of safety and health complaints during the pandemic, but decreased the number of inspections and most inspections were not conducted onsite,” it said. “We have ongoing and, subject to resource availability, planned audits on OSHA, including to assess the actions OSHA has taken to protect supply chain workers — such as those at online retailers’ warehouses — and the adequacy of OSHA’s plans to prepare for future pandemics,” the report said.

Overall, the OIG says it has had to cancel 10 audits involving the DOL’s response to pandemics.