A tour of the twin river cities down the highway from my farm (New Hope, PA, and Lambertville, NJ) indicates that skeletons and ghosts remain popular, with giant spiders and their webs coming in as a strong third in terms of yard decorations. One good thing about skeletons and ghosts - no soft tissue injuries. Giant spiders, on the other hand, pose a serious AOE/COE puzzle, not to mention coding questions, should they be injured on the job scaring people. So what is an upper body injury anyway?
The folks at R&I recently ran a list of the top ten possibly scary comp disruptors for the coming year, so, this might be a good time to review the selections as we gear up for whatever happens after 2020:
2. Mental/Behavioral Health
3. Psychosocial Factors
4. Artificial Intelligence
6. Mobile Technology
7. Access to Care
8. Interoperability Between Disparate Systems/Processes
10. New and/or Expensive Medical Treatments
Does this match with your worry list? The COVID entry is clearly top of the list for obvious reasons. Dealing with a novel disease instead of an injury is always more complex and disruptive in terms of claims processing, even if, as we reported in our last edition, the impact on costs has thus far not been excessive. More annoying than scary.
Items 2 and 3 have been growing in importance for some time as we in the comp management community build a better understanding of how anxiety, depression, and other related mental and emotional conditions impact the process of recovery and RTW. As a long-time observer of the medical-mental interplay in claims, we see this development as more helpful than disruptive. Indeed, getting appropriate psychological help for struggling claimants is a development to be cheered, not feared.
We have tracked item 5 for some years and watched as the comp claims industry has become much more adept at preventing pain-killer addiction and identifying and treating claimants already in the grips of addiction. While opioids are still ruining lives wholesale in our society, we have done a remarkable job of materially reducing their impact inside the comp world. Still dangerous, but not really as scary now as a couple of years ago.
Items 4, 6, 8, and 9 are all manifestations of the tech spectre. Are these burgeoning technologies seriously disruptive or are they really more like long-needed enhancements in getting basics done - things like getting claimants in front of the right providers, enriching claimant-adjuster communications, and eliminating those annoying points where systems don't talk to each other? That doesn't seem scary at all. On the other hand, if a trick-or-treater turns up at your porch dressed as an Artificial Intelligence algorithm, give the kid the best candy you have. He/she has earned it.
Item 7 seems to be fading like spirits at the first hint of dawn (barring a major resurgence of COVID), but number 10 - well, friends, that's the really scary one. Visualize a kid dressed as a hospital CFO with his hand out. Gives you the shivers, right?
The moral? Assuming that 2020 has already given us its best/worst shot, the worry catalog for 2021 looks pretty tame. How do you scare a risk manager after 2020? Gosh, I can't think of anything either.
Lights, Camera, PPE - Take One!
Love scenes? Fights? Co-conspirators hunched together over the corner table in the back of a dingy diner? All staples of film and TV drama - except in the time of COVID. Think you have problems with social distancing in your operations? Try filming a TV series. One gratifying aspect of coping with COVID has been the myriad of ways we are all finding/inventing to carry on in spite of the pandemic. Even if your own movie-making never gets beyond recording your kids' backyard birthday parties, you'll find a recent article from that other journal (the Wall Street one) about how the TV program S.W.A.T. is being filmed nowadays fascinating. The ingenuity involved in keeping all parties safe while still getting the job done should be inspirational.
The article is a quick read and we recommend it. Indeed, figuring out how to cope with COVID is very much like solving a major crime - fact-finding, getting the right equipment, writing the show to avoid possible production problem areas, consulting experts, etc. Consider just a few of the challenges: the workplace can change every day, in configuration and location. On a typical set there are scores of people with vastly different responsibilities and importance working close to one another - a megastar getting paid millions of dollars is alongside a boom mic holder or makeup artist. Treating everyone safely while taking special care of the performers, who can't work with masks on, is no small effort.
At the same time, a film set is not that much different from a construction site. They have a COVID compliance officer with a six foot long stick who also monitors the set to make sure that everyone not actively in front of a camera is masked up. The lunch buffets have been replaced by boxed lunches eaten in shifts. Special cameras and set ups can make actors appear close together when they are, in fact, over six feet apart.
Your humble scribe worked as an executive producer once upon a time for a series of insurance TV commercials (what else?). The complexity involved in filming simple 60-second spots - without a pandemic getting underfoot - was daunting. As the WSJ article makes clear, producing a S.W.A.T. episode while working around COVID has a dazzling array of moving parts and extra costs - but it can be done. The show must go on. So, what's your show? Any ideas here you might expropriate?
Not opening soon at a theater near you.
Quick Take 1:
What You Lose on the Roundabouts, You Make Up on the Straightaways
That, at least, is the proverbial wisdom from the north of Old England where most of the roads are paved versions of paths made by the Anglo-Saxons, or more likely, their cows. We may be seeing an odd, modern version of the same idea when we look at what COVID is doing to hospitals and the indirect way in which this comes back to bite workers' comp claim payers.
In a recent article carried on Workerscompensation.com, F.J. Thomas takes a look at how the lockdowns and general strangulation of normal business driven by COVID and official responses to it are putting a major squeeze on hospitals. Further, the extraordinary COVID related medical expenses incurred by hospitals are, at best, slow to be reimbursed by the Feds. "The result is that several of the top states listed in a recent CDC report, such as Tennessee, Georgia, Texas, and Florida, have experienced a rash of hospital closures due to lack of funding and mismanagement."
Obviously, that's bad in a number of ways, but the aspect that we have to look out for is this insidious backlash: "hospitals especially are looking to Workers Compensation to carry the burden of already lost revenue, the question is posed whether the workers compensation industry will be expected to carry even more of that weight. Given the employment environment with the loss of jobs and closures of some organizations, this could potentially be the perfect storm for workers compensation and healthcare as we know it..."
What can you do? For starters, work with your claims manager to direct care to the extent possible to facilities with which they have strong cost of care contracts and work with the providers you know to be straight shooters. Also, monitor cost of care indices for all facility-based care, not just for COVID-related claims. The moral of the story is that, even if you have few and minor claims with a COVID cause of claim code, your comp costs could still be heading up thanks to the knock-on effects of the pandemic and rampant cost shifting.
If you take a tour of a US Navy nuclear submarine, you will probably see a little brass plaque affixed to a bulkhead in the Command and Control compartment which says, "There are two types of ships at sea: submarines and targets." When it comes to medical cost shifting, you are a shiftee or a shifter. Your choice.
Quick Take 2:
What are COVID Impacts by LOC?
The effects of COVID vary greatly across the risk landscape. As that talkative Frenchman, La Rochefoucauld, noted, wind extinguishes candles but fans fires. Philipp Cremer in a recent ITL column provided a nice overview of what fires are being fanned, or not, according to Allianz Global Corporate & Specialty's (AGCS) new report, "COVID-19 - Changing Claim Patterns." As of now, we see that claims are up for entertainment insurance lines (think of all the empty stadia, theaters, and meeting venues) but down for most lines of traditional P&C.
In short, "Claims notifications from motor accidents, slips and falls or workplace injuries slowed as more people stayed at home, and with the temporary closure of many shops, airports and businesses during lockdowns across the world." Slip and fall claims, for example, are the biggest cause of aviation related claims - not what you might expect, eh? - and those are way down, as a look at any airport lobby will attest. Given the customary long tail for filing D&O claims, it's too early to hazard a guess on those LOCs, although preliminary indications are for lower new arisings there as well.
On the other hand, a new report from LexisNexis shows some unusual development in auto Bodily Injury claims. Volumes are down but claims are settling faster than similar 2019 claims and at higher values, showing a distinct severity bias. Collision and Property Damage claims seem to be moving in the opposite direction, settling faster and showing a muted growth in severity. From the report - "July figures represent the lowest severity growth in Collision claims the insurance industry has seen since early 2018."
One very large unknown is what may happen when all of that idle machinery in currently underused factories and warehouses gets turned back on. Does everything start up, or do we see unexpected and expensive delays and breakdowns? Indeed, we are on a voyage into the unknown with COVID. We have been spoiled by long periods where risk consisted of minor variations of well-known parameters, like driving to the local supermarket. Maybe the traffic is a little heavier or a little lighter, but it's still the same trip. Not so in 2020. The route is no longer clear, nor, perhaps the destination as well. We have little choice but to boldly go where no risk managers have gone before.
Navigation in the time of COVID
Say It Isn't So...
Drug testing is one of those necessary precautions that falls square between HR and risk management. But how do we even do drug testing under current conditions? Is it still useful? Check out a recent feature in HR Magazine, "COVID-19 Complicates Companies' Concerns About Workplace Drug Testing", for a review of drug testing in, around, and with COVID compliance.
Words to Remember
November 2 is All Soul's Day, known as Allerseelen in German, the one day in the year when the dead may visit their loved ones - and the occasion of a beautiful lieder* by Richard Strauss (1885):
Die letzten roten Astern trag herbei,
Und laß uns wieder von der Liebe reden,
Wie einst im Mai.
Gib mir die Hand, daß ich sie heimlich drücke
Und wenn man's sieht, mir ist es einerlei,
Gib mir nur einen deiner süßen Blicke,
Wie einst im Mai.
Es blüht und duftet heut auf jedem Grabe,
Ein Tag im Jahre ist ja den Toten frei,
Komm an mein Herz, daß ich dich wieder habe,
Wie einst im Mai.
Bring in the last red asters**,
and let us talk of love again,
as once we did in May.
Give me your hand, so that I may secretly press it;
and if someone sees, it's all one to me.
Just give me one of your sweet glances,
as once you did in May.
Flowers bloom and spread their fragrance today on every grave;
one day in the year is free to the dead.
Come close to my heart, so that I can hold you again,
as once I did in May.
*You can hear a wonderful, if old, recording here.
If this does not make you think of someone you miss terribly to this day, well, you are made of very stern stuff indeed.
** In France, the aster is traditionally laid on the graves of young soldiers.