Insights Affecting Risk Management and Self-insurance

Quick reviews of new studies and related insights
affecting risk management and self-insurance.
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The 2017 Forum of the Integrated Benefits Institute and Workers' Compensation

Apr. 27, 2017

The 2017 annual Forum of the Integrated Benefits Institute (IBI) held in San Francisco this March had a couple of presentations which speak to new ideas in workers' comp. As the IBI's name suggests, this organization focuses on new developments at the points where different benefit "silos" touch and where some degree of integration of data resources and claim processes can promote better outcomes, whether in non-occupational disability, leave administration, workers' comp, or group health and its associated programs.

Insurance Program Managers Group (IMPG) and one of their clients, Tazewell County in Illinois, described their program for a large group of Illinois counties which brings together workers' comp with employee benefits and wellness. They use one triage nurse, one case manager, one "health management coordinator", and one risk expert all operating on a single wellbeing and administration system. This concept focuses on the key issue with so many aging workforces - the impediments to RTW often extend well beyond the immediate cause of the workplace injury. IMPG's approach allows a variety of resources and benefits to be focused on returning the injured worker to function while allocating costs appropriately among comp, group health, wellness and other benefits. This is designed to prevent effective RTW from being stymied by the comp adjuster's reluctance to "buy a health claim". While the program is still very new, initial results appear promising.

The University of Pittsburgh Medical Centers (UPMC) presented a unique look at mobilizing big data to get a better grip on the issue of dealing with mental health problems. The essential conceptual breakthrough at UPMC was to combine claim and health data from all of the systems - group health through comp - into a single data resource which could be mined to build highly effective predictive models to identify those claimants most likely to have mental comorbidities as part of a disability claim. While the project was designed to embrace all benefit lines, it has special relevance for highlighting those comp claims where the injured workers' mental health problems may frustrate RTW, thus setting the stage for a timely evaluation and possible clinical intervention well before RTW becomes a forlorn hope.

Both of these sessions demonstrate how effective solutions to sticky workers' comp problems may be found by looking beyond the narrow comp silo to bring in allied resources and data.

I Injured My What?

There is no effective course of treatment for the wrong diagnosis. A new Mayo Clinic based study published in the Journal of Evaluation in Clinical Practice and summarized in Science Daily shows that one in five initial diagnoses by first line providers, such as family practitioners, is incorrect. Earlier studies have indicated that the rate of misdiagnosis may be even higher for some common workers' comp cumulative injuries.

The one in five rate is somewhat overly optimistic when you read the details: "In 21 percent of the cases, the diagnosis was completely changed; and 66 percent of patients received a refined or redefined diagnosis." Two conclusions concerning the implications of this finding for workers' comp:

  • Provider selection can make a huge difference. Providers who see many on the job injuries regularly will be less likely to misdiagnose a wrist problem as carpal tunnel when the presentation suggests something like focal dystonia as the more likely cause.
  • Specialist referrals are often very important to make certain that we have the correct diagnosis both at a high level and in the vital details as well. Only 12% of initial diagnoses in the study were correct in every respect.

One of the most important tasks a claim professional performs in workers' comp is to help make certain that the best procedures are followed in developing a diagnosis. Every further aspect of managing the claim hinges on getting the ICD-10(s) right. Slam dunks happen only in basketball - and not very often even there.

Autonomous Vehicles - You May Have One Already

Attention fleet managers - the era of automated driving is already here and you may well have "level 2" or even "level 3" vehicles on the road today. An almost-crash in Phoenix recently prompted this summary of the current state of the people v self-driving cars in USA Today. The important new concept outlined in this article is the six levels of automation promulgated by the National Highway Traffic Safety Administration (NHTSA) and the Society of Automotive Engineers. If your fleet includes vehicles - even plain old compact sedans - with new driver assist technologies, you are already on the zero to six spectrum.

Zero denotes full human control and five is a fully autonomous vehicle. With the level of automation today at level two or below, it's the driver who is responsible if the car crashes, said Bryant Walker Smith, an assistant law professor at the University of South Carolina. "Anything that's below level three, it's clearly a human that's supposed to be doing part of the driving," Smith said. Clearly, moving from a level 2 to a level 3 is very incremental but it can put you in an interesting legal and risk limbo in that autonomous vehicles come under Federal regulation (NHTSA) while most traffic laws are state and local.


The spectrum concept is going to be ever more critical as you bring new, more advanced vehicles into your fleet. You want the latest safety technology, but be aware that it may place you in a whole new world of risk. Are you a five, or are you a zero?

Whither El Nino?

Colorado State University has issued the first of its annual hurricane forecasts for the 2017 storm season. The season officially starts on June 1, if you are looking for a reason to party. Hurricane forecasting remains a complex and arcane art which combines predictions of regional Pacific and Atlantic water surface temperatures and a number of other factors. The coming season looks to be a little less threatening than average.

The CSU forecast includes 11 tropical storms, 4 hurricanes, and 2 major hurricanes of category 3 or higher. The predictions do not specify how many of these storms will make landfall and how many will spin more or less harmlessly out to sea, but this is a better expectation than the long term average which is 12 tropical storms, 6 hurricanes and 2 major hurricanes. If you have significant operations along the Gulf Coast or the Eastern Seaboard, now is a good time to check your flood, business interruption and fleet coverages. Are they up to date? Are new acquisitions adequately insured?

When daylight savings time arrives, check your smoke and carbon monoxide alarms. When CSU issues its first forecast for the season, think through all of your possible storm related loss exposures, including any recent changes, and check your policies accordingly. Don't get caught with your covers down.

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