This Just In - A New Disease!
Nov 16, 2017

NASH (Non-Alcoholic Steato-Hepatitis) isn't really new, but it's gaining rapidly in visibility - and its potential impact on workers' comp and other health related exposures. NASH is one more insidious co-morbid complication of obesity with its own special talents for inhibiting RTW and turning simple claims into complex creeping cats.

NASH is worth your consideration because it is exploding on the American health scene, according to a recent CNBC report. Dr. Rohit Loomba, Chairman of the American Liver Foundation's National Medical Advisory Committee, estimates that about 30 million Americans already have NASH. Including closely related fatty liver conditions under the umbrella term non-alcoholic fatty liver disease (NAFLD) brings the total of compromised Americans to about 80 to 100 million, almost one third of the population. Considering that this is a condition usually found only in adults, one in every three of your employees probably has some degree of fatty liver disease in progress. The number of deaths from chronic liver disease and cirrhosis has risen every year since 2007, according to the Centers for Disease Control and Prevention. It is now among the top 15 causes of death for Americans.

NASH, and other forms of NAFLD, attack the liver in much the same way that alcohol does - degrading the functions of this key organ until actual cirrhosis or liver cancer sets in. As the CNBC report notes, "perhaps the most alarming aspect of NAFLD, say researchers, is that in its mildest form it typically causes no signs or symptoms, isn't readily picked up in a routine physical, and currently there are no drugs on the market to treat it..."

In other words, NASH and other fatty liver diseases are classic sleepers - you don't see them coming. How many of your overweight employees think they're still on the sunny side of God's waiting room because their cholesterol and cardiac metrics are OK? We all may be looking at an incomplete set of numbers when we do our now standard health tests and reviews. Fatty liver is not hard to detect - but someone has to be looking for it. Is it on your company's HR radar?

Like other chronic lifestyle diseases - diabetes, COPD, several types of cardiac conditions - fatty liver can turn a routine comp injury into a horror story for all parties. Costly for you but far worse for the employee who probably had no idea this killer was stalking him or her. The bottom line for risk managers and benefits managers is the same - fat kills and when it doesn't kill, it disables.

Employee obesity isn't someone else's problem.

Is "Workampers" Really a Word? 

The Washington Post thinks it is in their excellent article, "The New Reality of Old Age in America" and it may be a word you need to learn more about if workers' comp falls under your purview. We all read the articles or see the news items about how Americans are failing to save for their old age in this brave new pensionless era where retirement sounds more and more like a sour joke and a distant memory. "Workampers" is the new reality - Americans over age 65 who still need to work and who have become the new class of itinerant laborers.

From the Post:

"There is no part of the country where the majority of middle-class older workers have adequate retirement savings to maintain their standard of living in their retirement," said Teresa Ghilarducci, a labor economist who specializes in retirement security. "People are coming into retirement with a lot more anxiety and a lot less buying power."

One solution? Many older workers are hitting the road as work campers - also called "workampers" - those who shed costly lifestyles, like houses, purchase RVs and travel the nation picking up seasonal jobs that typically offer hourly wages and few or no benefits.

So where do these folks work? Amazon hires droves of them about this time every year to help with the Christmas rush. Many migrate to vacation areas to work as "in season" help, filling every job from campground maintenance to retail clerking. In short, they are everywhere that seasonal jobs can be found, hence their use of RVs.

This is a very new aspect of the aging workforce and it brings new concerns for workers' comp management. For example, these folks have limited health benefits. They are on Medicare, meaning an MSA comes with every serious on the job injury. They are itinerant workers, so they come with all the pre-existing injury and apportionment baggage you can imagine, plus their comorbid conditions and all the claim complications that entails. Home care becomes an issue for people living in RVs with changing locations.

Might be a good idea to have a frank talk with your TPA if you think any parts of your company are employing these folks to any extent. The potential for "special" claims is high. Are you prepared to deal with this new challenge of the 21st Century? Oh, yes - "workampers" is a word now. Remember that next time you play Scrabble.

The Frog in the Pot 

You know the story. The frog jumps out if you try to plunk him in boiling water but if you put him in a pot of cold water and gradually turn up the fire, he'll cook without realizing it. We all may well be that frog right now when it comes to cyber exposures. A recent report from the Risk Institute at The Fisher College of Business at Ohio State explores this question - how hot is the water?

"Cyber-attacks continue to pose an extreme threat to the U.S. - major security breaches in private industry and government are on the rise," says Dr. Zhenhua Chen, a research fellow of The Risk Institute and assistant professor at The Ohio State University. "These attacks haven't yet caused major cross-sectorial damage, but the potential is there."

While Dr. Chen's work is focused primarily on questions concerning the potential for cyber attacks at the national or regional level, like the one that shut down Kiev last year, the same questions apply to every corporation, assuming that you're not still using the telegraph and carrier pigeons.

  • What are the economic consequences of a possible cyber-attack (denial of service, theft of confidential data, ops systems hacks) measured in terms of both annual top line and bottom line numbers for your company - and what might this do to your employees as well in terms of layoffs or even business component shutdowns?
  • How do the consequences vary when the attacks are targeted among different critical infrastructure sectors of your organization, such as manufacturing or finance or retail customer operations?
  • What is the potential of various cyber-resilience tactics to reduce losses? What have you implemented thus far and what remains to be done?

Dr. Chen's work also looks at what happens when the hacker is Mother Nature in terms of a major earthquake or, say, a hurricane. Not all hackers are shady figures hunched over laptops in some obscure corner. The Journal has looked at hack prevention techniques in recent issues, but the real question may well be what level of mitigation and resiliency is your organization developing to jump out of that pot if the water gets too hot? Are you asking the right questions often enough?

The one question you don't want to ask? Are we cooked yet?

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