Incremental Progress and Real Research
Jul 8, 2021

Here at GB Journal World Headquarters our extensive staff scours myriads of publications to find those gems that we think our busy readers may find useful or gratifying. Here are two recent items which address two of our favorite topics in workers' comp - back injuries and pharmaceuticals.

Just what we thought all along has now been demonstrated in black and white. A new study by scientists at the University of Utah School of Health shows us how people with certain back injuries fare better when well-known medical treatment guidelines are followed. Shocking, right?

As obvious as this proposition should be, how often does it get lost in the sauce through error and/or willful misdirection? "The closer people's care follows evidence-based guidelines, the faster their back pain resolves, by quite a bit," says the study's senior author Kurt Hegmann, M.D., director of the University of Utah Rocky Mountain Center for Occupational and Environmental Health. Seems elementary but some 65% of the cases studied included some increments, often material, of what the study politely calls "non-recommended treatments." In fact, the study provides a breakout of the actual treatments:


14% received non-recommended treatments only,


51% received a mix of non-recommended and recommended treatments,


14% received recommended treatments only,


and 21% did not receive any medical intervention.

People with lower back pain injury miss 11 more days of work in a year when they only receive treatments for lower back pain that are not recommended by medical guidelines compared to people treated according to guidelines. Patients who get both miss a little less work than the folks in the non-recommended group.

In short, the evidence based guidelines work, despite the mutterings you may have heard about "cookbook medicine." Question - what are you doing to avoid the docs who don't follow guidelines? How many of those additional days are you paying for in your comp claims?

Meanwhile, our friends at the Workers' Compensation Research Institute have been busy looking at the changing patterns of pharmaceutical expense in comp claims. The full report is available from the WCRI at no charge for members. The report is full of fascinating insights, but two findings stood out for us. First, the cost/frequency of opioid prescriptions is way down. This is good news for everyone, but especially for injured employees who are no longer in as much danger of painkiller addiction.

On the other hand - there is always something else, right? The cost and frequency of topical medications has taken off - see "dermatological agents" in the slide below. These are primarily creams that address local pain. Some docs are dispensing these from their offices. Some are, of course, legit, but you want to be certain that your claims people are birddogging this issue for potential misuse. The increase in topicals begs extra attention.



So What Time's the Next Swan?

The great operatic tenor, Leo Slezak, was singing the role of Lohengrin in Wagner's opera of that name. At the end of the last act, Lohengrin (the Knight of the Swan) steps into a boat pulled by a swan and exits. But, alas, the stagehand got his cues mixed up and pulled the swan offstage before Slezak finished his last aria. The jolly Austrian tenor was unfazed. He turned to the audience and sang, "what time's the next swan?" We might all try to imitate Slezak's sang-froid in the face of adversity the next time we have yet another internet failure.

The rate of what we will lump under the technically fuzzy term "internet failures" seems to be inching up. Good, wide gauge stats are hard to find, but we see articles about various outages popping up all the time nowadays. For example, CNN reported a couple of weeks ago on a typical incident: "London (CNN Business) Airlines, banks, stock exchanges and trading platforms suffered brief website outages early Thursday after a key piece of internet infrastructure failed, sparking the second major interruption of the past 10 days." Note that these outages are not related to hacking - so far as anyone can tell - rather they are caused by various types of failures occurring in the bowels of various internet service providers. One major downtime event stemmed from a failure at the global content delivery network, while another seems to have resulted from a failure at a cloud services provider.

So what's going on and what does it mean to you? The incidents we've seen analyzed in the trade press don't seem to have a great deal in common beyond the obvious facts that (a) everyone's architecture is getting exponentially more complex with more vendors providing more critical components*, (b) overall traffic has been increasing beyond all expectations and plans**, (c) the pandemic-induced rush to place ever more functionality on-line is straining resources and interoperability designs, and (d) IT staffs are stretched gossamer thin.

So what are the associated risks? Well, a major bank, slammed by a serious failure, said "we are seeing services return following a tech outage which had widespread impacts across businesses." The bank further stated that the outage affected its app and internet banking platform, but services had eventually been restored. A couple of major airlines had a similar experience but somehow they managed to avoid cancelling flights.

Yeah, each case is different, but all are disruptive and expensive. The sharp pencil folks at Gartner Associates figure that the average outage costs about $5600 per minute or $336,000 per hour. That will put a dent in the company picnic. What to do? We suggest keeping in close touch with your internet service vendors, with IT, of course, and monitoring failure rates both for their operations and for similar operations in your industry. Failure rate data are not always easy to come by, but the information is out there, and any responsible vendor will be keeping close tabs on what's happening. Have a Plan B in place with every vendor. If you don't know how much redundancy might cost, find out.

Our seat of the pants reckoning suggests that incident rates may be climbing. This is one of those risks where insurance is nice if all else fails, but minimizing or avoiding outages altogether is vastly preferable. Are you and corporate IT on the same page here? Does everyone agree on when the next swan arrives?

*When we were managing a national call center for a very large carrier, we had redundant trunk lines with both major phone companies so we could switch from one to the other in case one system went down - a back-up we got to test repeatedly when four hurricanes hit our operation one summer.

**The world's largest internet exchange, the DE-CIX Frankfurt, hit 9.1 terabytes per second in March, 2020, a year earlier than expected.



Quick Take 1:
Weather or Not...

The following is about as close as you'll get to a movie review in these august pages. We recently viewed an on-line webinar produced by Risk & Insurance and Liberty Mutual. Despite the somewhat clunky title - "Severe Weather and the Interconnectivity of Risks: How Business Can Manage Through the Storm" - the presentation is brisk with a great deal of on point content. We have noted in many previous items in our Journal how the very nature of weather risk is changing, often dramatically. The webinar looks at this and it also offers great insight into how weather based events bleed into other areas of risk more than ever.

Here's a quick, off-beat example: recovery from physical weather damage is becoming more problematic as recontruction and repair resources in the form of speciality contractors and expert personnel are being stretched ever thinner by a variety of causes, especially the increasing frequency of major weather events. Two-month business interruption turnarounds may now be four or five month turnarounds.

The webinar is neatly structured, topic by topic, with a good accompanying slide deck, so you can use the discussion as a kind of checklist in reviewing your own policies and plans. Here's a quick example:


Interconnected Risk #3:

The Environmental Look Storage tank concerns: Lightning strikes, deep freezes, flooding, and other weather events can cause damage to storage tanks.


This damage can result in a release of produced water and other pollutants into the local environment or water supply.


Businesses could be liable for environmental cleanup claims in addition to tank repair or replacement costs.

I found nothing startlingly profound, but the presentation is quite thorough and worth a listen. Popcorn is optional. Perhaps for further insight, you might ask your colleagues in the Pacific Northwest about new dimensions in weather risk and impacts on business as usual. What, after all, could possibly go haywire when the temperature is 108 degrees Fahrenheit in Seattle? Well, both people and equipment may pop gaskets.



Quick Take 2:
A New Angle on Diversity, Equity, and Inclusion (DEI)

Personnel and risk have never been more closely related than nowadays when corporate compliance with not just DEI formal requirements but also the accompanying social expectations - the perceptions of our clients, our employees, and the general public - seems to hit the headlines regularly. One quick and fairly painless way of keeping up with how DEI relates to age in the workforce might be looking in on a new online forum offered by the American Society on Aging* next week.

Never has the American workforce contained such a range of different generations. It's no longer unusual to see in one facility millennials, Xers, boomers, war babies, and a few brand new Gen Z folks. This is a great and good thing, but it also carries potential risks in several dimensions. Are Risk Management and HR on the same pages concerning hiring and retention compliance and PR or social media exposures?

How about your own risk staff? Have you balanced youthful energy with mature judgment? Perhaps risk managers, more than any other kind of corporate executive, need to keep in mind the words of Robert Frost: "The afternoon knows what the morning never suspected."

*Full disclosure: your faithful reporter is a member and sometime contributor of the ASA. On one recent Risk Institute panel on aging in the workforce I was the designated dinosaur to fill out the representation of all the generations now in the workforce.


Say It Isn't So...

From the compnewsnetwork:


June 28 has been designated as National Insurance Awareness Day. Although the origin of this holiday is unknown, it is observed annually on this day to serve as a reminder to small business owners to review their insurance policies and make sure they have the coverage they need.

Well, dang - did you miss the parade too, the fireworks, the picnics, the speeches? Went right past me. Have to mark the calendar for next year, lay in a supply of sparklers.

Yeah, we missed the date (again) - but we can celebrate anyway.


Words to Remember

Now that you've digested the last of your hot dogs and potato salad and gotten the temporary tinnitus from your ears after all those fireworks, let us pause to examine one of those myths Americans are so fond of. Jefferson said a great many things, but he never said "eternal vigilance is the price of freedom." Sounds like old Jeff, but this is a misattribution. The real words were written by another patriot, John Philpot Curran, indeed, an Irish patriot, much the same age as Jeff and quick to defend the rights of his fellow Irishmen. Curran wrote:

"The condition upon which God hath given liberty to man is eternal vigilance, which condition, if he break, servitude is at once the consequence of his crime, and the punishment of his guilt."

Let us take his words to heart, as if they were our own, and keep in mind that liberty is owned by no one; it is held in common by all mankind.


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