Items To Consider When Valuing Catastrophic Work Comp Claims

March 24, 2016 by Michael B. Stack

photo of paramedics from patient's point of viewCatastrophic injury claims make up less than 1% of all workers compensation claims, but different studies show they entail approximately 20% of all workers comp costs.

For the small employer, one catastrophic injury claim can distort the severity factor in the workers comp premium calculations and have a major impact on the workers compensation premiums for years into the future.

 Catastrophic Injuries Significantly Alter Employee’s Life

Catastrophic injuries are injuries that disable the employee to the extent the employee can never return to work and significantly alters the employee’s life in general. Common examples of catastrophic injuries are:

• Brain/brain stem injuries.
• Severe burns over 50 % or more of the body.
• Spinal cord injuries.
• Multiple amputations.
• Multiple trauma.
• Total vision loss.
• Occupational lung diseases.

The eventual cost of a catastrophic injury is very difficult to establish early in the life of the claim. Even the experienced adjuster does not have a crystal ball to determine if the overall cost of the claim is going to be $500,000 or $5 million when establishing the initial reserves on the claim. With catastrophic claims, as additional medical and rehabilitation information becomes available, the reserves are often adjusted by large amounts (6 figures or more) several years into the claim. Continue reading Items To Consider When Valuing Catastrophic Work Comp Claims

Red Cross Hits Home Run With FREE Gamification App for Children

Iltifat Husain, MD | March 16, 2016

graphic for American Red Cross app for children, The Monster GuardThe American Red Cross has been building a great collection of medical and health apps over the past few years. Their collection of apps is similar to the CDCs — the CDC has a number of medical apps aimed at physicians and patients.

Notable medical apps by the American Red Cross have been their blood transfusion guidelines, disaster response and emergency preparedness apps, and their blood donor app (the health app tells you where your donated blood goes and how many lives you helped save). One of the American Red Cross’ most recent apps is Monster Guard, a free gamification app focused on helping prepare children for emergencies.

The Monster Guard app uses games to teach children how to prepare and stay safe during various emergencies — such as home fires, hurricanes, floods, and other disasters.

The app is set in “Monster Guard Academy” and uses a variety of characters to do the teaching, and children get points and medals for completing tasks. The goal is to complete enough tasks and collect enough points to “graduate” from Monster Guard Academy.

The emergency preparedness app is sponsored by Disney and is free to download. I was extremely impressed with the Red Cross app and it has garnered a 4.5 out of 5 star rating on iTunes.


Are the Winds Shifting in Workers’ Compensation?

By Bob Burke 03/14/2016

burlap workers' compo money bagFor the past decade or more, the dominant storyline in workers’ compensation has been the states reducing benefits, limiting the very definition of a compensable injury, and shifting much of the cost of workplace injuries to workers and the federal and state governments.

Then, on March 1, the Oklahoma Supreme Court released a 50-page unanimous opinion that may be the most important state Supreme Court workers’ compensation decision in many years. In Torres v. Seaboard Foods, the Court declared as unconstitutional one section of Oklahoma’s 2013 reform law that required 180 days of continuous employment for a cumulative trauma injury to be compensable. But, the Supreme Court did much more than toss out one arbitrary limitation.

Torres stands for the principle that an injured worker’s federal and state due process rights are violated by a law that limits benefits UNLESS the legislation is rationally related to a legitimate government interest of preventing workers’ comp fraud or decreasing employers’ costs.

Torres holds that a court’s constitutional analysis must be based on what the legislation “actually” accomplishes, not by what the legislature says it accomplishes. The Supreme Court recognizes the legislature’s broad authority to regulate workers’ compensation, but that such police power must be exerted with scrupulous regard for private rights guaranteed by the Oklahoma Constitution. Justice James Edmondson wrote, “It is clear that a state’s legitimate interest in regulating business practices are not exempt from the requirements of substantive due process.” Continue reading Are the Winds Shifting in Workers’ Compensation?

Free App Helps Reduce Alcohol Intoxication

An innovative health app from U of Michigan

Iltifat Husain, MD |March 14, 2016

U of Michigan’s innovative health app helps reduce alcohol intoxicationStay in the Blue is a health app from the University of Michigan with the goal of keeping your blood alcohol content at 0.06 or below. The Michigan app refers to this zone as “Staying in the Blue”. The Stay in the Blue app feels 0.06 or below blood alcohol content (BAC) helps students keep their drinking at lower risk levels.

The Stay in the Blue health app is packed full of interesting features — the main one being the blood alcohol content calculator. The BAC calculator uses your gender and weight, combined with the type of alcoholic drink you are consuming, to estimate your blood alcohol level. Your blood alcohol level changes over time as your body processes the alcohol in your system and the Stay in the Blue app emphasizes this in the app by keeping track of this.

The Stay in the Blue app gives you real time blood alcohol levels but emphasizes that these are estimations, and not absolute. You would obviously need a blood draw or breathalyzer to get exact amounts.

There are other key features included in the health app:
• Call a Cab: Using your GPS location the Stay in the Blue app will call a cab (gives you an option to Uber as well)
• Detailed tracking — you can keep track of “sessions”. For example, you can trend how often you have been able to keep yourself “In the Blue”.
• Resources: A list of key resources for U of M students.
• Events: A list of calendar events happening at U of M.


CA & NH Look to Help Consumers Get Healthcare Pricing Information

March 11, 2016 | Jordan Rao – Kaiser Health News

California healthcare cost comparisonTwo states are making inroads into revealing some of the biggest secrets of health care by publishing price information to help consumers comparison shop for doctors, dentists and prescription drugs.

New Hampshire, which already had the nation’s most advanced website allowing people to compare the cost of specific medical procedures, last week added prices for 16 dental procedures and 65 prescription drugs. The website,, is run by the state insurance department and lets consumers see how much they would have to pay based on the price their insurer negotiated with each provider, rather than the sticker price that is charged. The site also shows the price uninsured people must pay.

California on Wednesday released an expanded version of its quality report cards on 154 large physician groups. Those cards, which already assess clinical quality and patient experiences, take a different tack than New Hampshire. Instead of drilling down on specific procedures, the report cards summarize the total cost of medical services run up by the average patient of each group. The medical groups care in total for more than 9 million people.

Elizabeth Abbott, the director of California’s patient advocate office, which put together the report cards, said that by coupling the cost rating with similar star ratings for quality, consumers and those who decide which medical groups to include in insurance networks will see that the most expensive medical groups may not be the ones that provide the best care.

“We want to have human resources departments and executives for health providers look at this to guide their decisions,” Abbott said.


Text Messaging Benefits Medication Adherence

Brian Chau, MD |March 11, 2016

Doctor texting on tablet ipadIt’s easy to miss a few doses of medications, even when you’re taking just one or two. Imagine the complexity involved with a whole litany of daily medications, all at varying times and in different regimens throughout the day.

The World Health Organizations has estimated roughly 50% of all medication is not taken as prescribed. It’s no surprise that medication adherence is a real barrier to when it comes to improving health. With the growth of digital health, there has been a lot of interest in using technology like apps & text messaging in medication adherence programs.

A recent meta-analysis published in JAMA Internal Medicine investigated the role of using text messaging for medication adherence.
This meta-analysis reviewed 16 randomized controlled trials with over 3000 total patients. 2-way communication (between provider and patient), and daily messages were seen in the majority of trials. They performed a pooled analysis of The authors found that text messaging significantly improved adherence with an odds ratio of 2.11 (95% CI, 1.52-2.93; P < .001). Interestingly, text-messaging characteristics did not appear to alter the behavior (i.e. personalized, 2-way communication, etc).


Long Work Hours Linked to Higher Cardiovascular Disease Risk

By 03/10/2016

long work hours iconWorking long hours — particularly 46 hours per week or more — may increase the long-term risk of cardiovascular disease (CVD) events such as heart attack, reports a study in the March Journal of Occupational and Environmental Medicine, official publication of the American College of Occupational and Environmental Medicine (ACOEM).

“In general, we found that the risk of CVD increased as the average weekly working hours increased,” write Sadie H. Conway, PhD, of University of Texas Health Sciences Center, Houston, and colleagues. They note that among full-time workers, CVD risk appears lowest between 40 and 45 hours per week.

The researchers analyzed the relationship between work hours and CVD using data on more than 1,900 participants from a long-term follow-up study of work and health. All participants had been employed for at least 10 years. During the study, a physician-diagnosed CVD event — angina, coronary heart disease or heart failure, heart attack, high blood pressure, or stroke — occurred in about 43 percent of participants.

Risk of CVD events increased by one percent for each additional hour worked per week over at least 10 years, after adjustment for age, sex, racial/ethnic group, and pay status. The difference was significant only for full-time workers, not part-timers. Among those who worked more than 30 hours per week, risk increased as weekly hours approached 40, but then decreased again between 40 and 45 hours per week.


Third of Consumers Are Using Health Apps – More Would If Doctor Recommended

Satish Misra, MD |March 3, 2016

iHealth app iconA  new health app survey by Accenture suggests that the number of consumers using health apps has doubled in the past two years, with 33% using health apps & 20% using health wearables.
These findings come from a health app survey commissioned by Accenture and performed by Nielsen of 8,000 people in seven countries including 2,225 in the United States. Responses were collected using an online survey between November, 2015 and January, 2016.

Compared to a similar health app survey two years ago, they found that 33% of respondents said they were using a health app and 21% were using a health wearable. That’s up from 16% and 9% respectively in 2014. Most of the apps being used were fitness and diet/nutrition apps though 25% reported using a health tracker app, 12% a medication tracker app, and 10% a chronic disease management app. Not surprisingly, younger people (between 18 – 34 years old) were the most likely to use a health app or wearable.
Perhaps most interesting though were the findings related to doctor recommendations to use an app or wearable. Nearly 20% of participants were asked by their doctors to use an app or wearable to track fitness or a vital sign. Among those individuals, more than 75% followed through. Nearly 80% of respondents said they were either already using these tools or would if their doctor asked them to. And a majority also said they’d be comfortable talking to their doctor about these tools & sharing data.


Traffic Crashes Cost Employers $47.4 Billion In 2013

Will Self-Driving Vehicles Save Billions?


TrafficCrashCostsWashington, DC  – Protecting employees from motor vehicles crashes could be a profitable investment for U.S. businesses, according to a new report released today by the Network of Employers for Traffic Safety (NETS).

In 2013, U.S. traffic crashes cost employers $47.4 billion in direct crash-related expenses, which includes medical care, liability, lost productivity and property damage. The study showed that employers could control costs by promoting safe driving habits, including seat belt usage and the elimination of speeding, drunk driving and distracted driving, whether or not employees are on the clock.

The study was funded by the U.S. DOT’s National Highway Traffic Safety Administration and updates a 2002 study, titled the Economic Burden of Traffic Crashes on Employers.

“The consequences of traffic crashes are far reaching. It’s a domino effect that negatively impacts individuals, families, communities and businesses,” said Dr. Mark Rosekind, NHTSA Administrator. “It is critical that individuals make safe choices. Driving behavior change in traffic safety is something NHTSA is exploring through a series of regional summits. We hope employers will join us and look at this report as a motivator to help save lives and prevent injuries on our roads.”

The report shows that more than 1.6 million work days were lost due to traffic crashes, with nearly 90 percent of those days attributed to crashes that occurred off the job, involving employees and/or their dependents. The report details the costs to employers of traffic crashes occurring on and off the job associated with driver behavior.

Speeding resulted in $8.4 billion in crash-related expenses, with distracted driving close behind, at $8.2 billion. Driving under the influence of alcohol resulted in $6.0 billion in losses and not wearing a seat belt added $4.9 billion to the total. In addition, the report finds that medical costs paid by employers per employee injured in a crash were nearly double in on-the-job crashes where the employee was not wearing a seat belt and increased by a third for off-the-job crashes. Click here for an Infographic of the findings.

1 in 2 Americans Musculoskeletal Condition Costs $213 Billion /Year!

Estimated $213 Billion Each Year in Treatment and Lost Wages Attributed to Musculoskeletal Condition


Crystal ball of arthritis symptomsRosemont, IL – An estimated 126.6 million Americans (one in two adults) are affected by a musculoskeletal condition—comparable to the total percentage of Americans living with a chronic lung or heart condition—costing an estimated $213 billion in annual treatment, care and lost wages, according to a new report issued today by the United States Bone and Joint Initiative (USBJI).

Musculoskeletal disorders—conditions and injuries affecting the bones, joints and muscles—can be painful and debilitating, affecting daily quality of life, activity and productivity.

The Impact of Musculoskeletal Disorders on Americans: Opportunities for Action” outlines the prevalence and projected growth of musculoskeletal disorders in the U.S., and recommends strategies for improving patient outcomes while decreasing rising health and societal costs.

“This report provides the critical data needed to understand the magnitude of the problem, and the burden, of musculoskeletal disease in our country,” said David Pisetsky, MD, USBJI president, and professor of medicine and immunology at Duke University Medical School.

“The number of visits to physicians for these disorders, the cost of treating them, and the indirect costs associated with pain and loss of mobility, are proportionately much higher than the resources currently being allocated to combat these conditions and injuries.”

“As a nation, we need to establish greater funding for musculoskeletal research, improve our understanding and strategies for prevention and treatment of these injuries and conditions, and ensure that more adults and children receive appropriate treatment sooner, and on an ongoing basis, to ensure quality of life and productivity,” said Stuart L. Weinstein, MD, co-chair of the report’s Steering Committee and a professor of orthopaedics and rehabilitation at the University of Iowa Hospitals and Clinics.