WCRI Roundup
Mar 14, 2019

Two weeks ago saw the first Workers' Compensation Research Institute meeting in Phoenix instead of the traditional Boston in late February venue (aka the Ice Palace). A few highlights for those who missed the mid-70s under bright blue skies affair:

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The Latest on Opioids: first, the bad news. Opioid related overdoses continue to grow as a major category of cause of death for Americans. We've all heard that story multiple times. Thankfully, there is also good news. For example, Arizona has developed a comprehensive suite of new laws and regulations aimed precisely at curbing over-prescription by medical providers. Arizona joins Washington (the state, not the asylum) which has long been in the forefront of opioid control, so we know it can be done. Nancy Grover's masterful summary provides a quick overview of the good stuff.

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Why medical direction counts: here's a bit of first rate research from the National Bureau of Economic Research - doctors trained at the lowest-ranked medical schools write more opioid prescriptions than those trained at the highest-ranked schools. What more obvious value proposition can you ask for? Don't buy discount networks. Buy quality - unless you prefer claims that trail on forever as your former employee struggles with addiction.

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Unions, management, and workers' comp: another good idea - how management and labor can get together and develop a successful RTW program that meets everyone's goals. The details are probably unique to the parties involved (and Canada, eh?) but the basic ideas for finding common ground and intelligent compromise can work for anyone.

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Telemedicine: the distinguished panel agreed that (a) telemedicine is taking off in general health care, especially for certain categories of covered persons and specific geographies but (b) while it is seeing good acceptance in workers' comp, the areas of application are narrower and solid data on actual claim outcomes are still thin.

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Erosion? The final presentation asked whether there has been an erosion in comp benefits in recent decades. This is an important question. The data presented certainly show that the costs of comp - indemnity and medical - have gone down as a function of total payroll costs but the inquiry remains open concerning how well comp plays its role in supporting injured workers and their families today compared to, say, a generation ago. Bob Wilson's post from WCRI provides further insight into this matter. We have all been very focused on wringing unnecessary costs out of comp. Is it possible that we have forgotten that certain costs are both necessary and morally imperative?

 

What's this about CBT and CPSP?

Workers' comp claim managers who've been on the job for a while have all heard the battle cry, "don't buy a psych claim!" Everyone knew that once you touched a psych component in a comp claim, you owned it for life because psych problems are never cured. So went the myth and so for, lo, these many years we have routinely ignored psych problems which were frustrating RTW and keeping claims open well beyond their natural sell-by date.

One such common problem is chronic post-surgical pain (CPSP). CPSP often follows many of the orthopedic surgeries used to repair severe joint and lower back injuries. While the etiology of CPSP is not clear, it often follows less than optimal management of the acute pain normally associated with slice and dice procedures and it can delay expected RTW by months, even years. A recent article in Workerscompensation.com looks at the use of cognitive behavioral therapy (CBT) in resolving cases of CPSP.

A meta-study of research done in the US, Italy, Sweden, and Denmark showed that: "The impact of CPSP is pervasive, causing significant suffering, global distress, and physical disability, which only add to the growing health care burden... Evidence from the initial randomized controlled trials supports the clinical utility of psychological interventions [like CBT] in the perioperative period to reduce the risk of long-term pain outcomes." In other words, using CBT to help claimants deal with CPSP resulted in better outcomes. CBT is a short series (six or fewer) of psychological counseling interventions aimed specifically at helping the claimant cope with the issues surrounding the chronic pain.

Unlike, say, blood and other bodily tissues, pain has no objective existence. It is what we perceive, which is why pain tolerance varies so dramatically from one person to the next. CBT teaches the claimant how to deal with these perceptions without opioids or other potentially addictive drugs. Many studies in recent years have shown CBT to be an important tool in helping claimants cope. Your faithful correspondent had a life-altering comp claim involving major surgery in 1989. You can't know how challenging that is unless you've been there. CBT is a wonderful example of how we help our injured workers to help themselves.

 

Quick Take 1:
How Do I Hack Thee? Let Me Count the Ways...

Oh no! Say it isn't so. Experian has released its latest report on burgeoning cyber threats. According to a summary in Risk & Insurance by Katie Dwyer, three new species of cyber-attack have been discovered in the high-tech jungle in the past year. They are:

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Biometric hacking: it turns out that at least some biometric security apps are not that hard to fool. Some smartphone face recognition systems respond quite nicely to a picture of the owner's face. Feeling more secure?

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Gaming: massive, multi-player online gaming can provide a new - and possibly entertaining - route into systems to steal credit card info and other PII.

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Multi-vector dark web attacks: our favorite. In this case, a botnet uses a drive-by download or a Trojan horse to slide an app into your system that turns it into another node in the botnet for collecting PII - a computer version of the Invasion of the Body Snatchers.

 
There are remediation steps, of course, and Experian is happy to help, but the larger point is that the parade of hack attacks seems to stretch out to the crack of doom. This means that (a) whatever you're investing in cyber security probably isn't enough and (b) keep reviewing and updating your cyber insurance to make certain that the policy language is adequate to cover new types of attacks.

Wonder why every new show on Netflix looks just like all the others? Looks like all the really creative types have given up screenplays and are creating new hacks instead. That's our theory.

 

Quick Take 2:
Were You Thinking About Work When You Fell Off the Ladder While Taking Down Your Christmas Lights?

Anyone who knows what AOE/COE stands for has always wondered about how many ambiguous soft tissue injuries are filed under comp to avoid the ever-increasing deductibles and copays under group health plans. Our friends at the Workers' Compensation Research Institute have been doing some of their typically thorough research on exactly this topic and their report was published just this past month (membership required).

The headline answer is... yes, sort of. WCRI found some evidence of venue shopping for soft tissue claims specifically when the employee had a large deductible yet to meet on his/her health plan. But the difference was not great. Injured workers are about 1.4 percentage points more likely to file a workers' compensation claim when they have a remaining deductible of $550 (the average) compared with a zero deductible at the time of injury, amounting to a 5.3 percent increase in the workers' compensation claim volume.

Clearly there is still merit to a good investigation of causation and compensability, but, as we reported a few weeks ago (GB Journal Vol 4, #2), there is also a ripe potential for wasting money on claim denials that can't be sustained. The WCRI research confirms what many of us in the claims business have long suspected: we walk a fine line. Push back on cost shifting - but not too hard.

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