LBP and Thee
Nov 15, 2018

Lower Back Pain - the phrase just rolls off your tongue if you're a comp claims adjuster or an orthopod. You deal with it every day. Once upon a time, doctors prescribed bed rest for LBP (a few still do). Nowadays, the idea is to get the claimant/patient up and moving, but there has not been a great deal of good clinical data to support this concept. Now there is and the new study profiled below tells us a great deal about how to handle LBP, the most common cause of comp claims.

The October issue of the Journal of Occupational and Environmental Medicine (JOEM) (, subscription required) includes a report with a title almost as long as the text: "Early Return to Work Has Benefits for Relief of Back Pain and Functional Recovery After Controlling for Multiple Confounds." Whew. The team of researchers from several important medical schools, related organizations, and Liberty Mutual looked at a good sized sample of LBP claims and charted the outcomes as some claimants were returned to work quite soon after their FNOL and others were treated in a more traditional way. What happened?

The researchers note that, in addition to avoiding deconditioning and promoting speedier recovery from pain, rapid RTW has other benefits for the injured worker. They note, in part, that "there is also an emerging body of literature showing coworker, supervisor, and general organizational support lead to improved back disability outcomes." In other words, being back in the social context of normal work aids in timely recovery. The actual outcomes are recorded across a number of variables of worker age, sex, tenure, type of job, etc., so there is no one magic number, er, index of improvement, but all of the views show that early RTW across similar injuries was highly successful in reducing time off work with few relapses or other problems.

Two items are worth special attention. First, the results were tested across 11 "confounding factors" such as co-morbid conditions. While some confounders were associated with slightly less impressive improvements, early RTW got better results in spite of all the co-morbids examined. Second, the researchers note that modified duty provisions by the employers "had a pronounced effect on RTW." The reports also says, "These data support the value of offering routine job modifications, especially given our results that an early RTW speeds the pain recovery process."

For those craving more granularity, the report has a number of detailed tables right down to the R-squared values, but the most important outcome shows plainly: getting injured workers with LBP back to work promptly (with modifications as needed) is not only less expensive, it's actually better for the injured workers in terms of recovery from pain and resumption of normal function. This is a win-win we should put up in lights.


The Phones May Be Smart, but What about the Drivers?

Writing in, Peter Rousmaniere assembles a compelling view of the true costs of the smartphone as a major cause of motor vehicle accidents (MVAs). We have not seen a study of the topic as complete as Peter's and it is eye-opening. How much does that smartphone in the cab of a company truck or car really cost? Any idea?

Working with data supplied by the National Council on Compensation Insurance (NCCI), Peter estimates that "on a fully developed ('ultimate') valuation of MVA-related claims incurred in 2016, total MVA-related lost time claims costs were about $6.5 billion." He also notes that "at least one third of workers' comp claims that have a total cost of at least one million dollars ... are MVA-related."

Note these two factors: (1) MVA related comp indemnity claims have risen by 5% while all other claims have decreased by 17% during the same period when smartphone ownership went from 27% to 81% and (2) auto insurance carriers estimate that fully 10% of fatal car crashes are now caused by distracted driving. Now you begin to get an idea of how much of that $6.5 billion is due to distracted driving from the driver glomming over a smartphone instead of paying attention to the road.

And that's just comp costs. The liability and property damage costs are, of course, collected on separate ledgers. Current statistics do not allow us to estimate the total cost of smartphones and distracted driving for employers, folding comp and A/L together, but just this first look tells us it's huge. Peter looks at the potential of usage based, performance monitoring devices like Zendrive to provide a possible model for fleet operators to rein in the cost of distracted driving - a cost measured in lives and broken bodies as well as dollars.

As Peter points out with Zendrive, the solution may reside in the cause - a driving performance app on the driver's smartphone which monitors speed, braking, cornering, phone use, etc. for far less cost than some of the new truck mounted devices. How absurdly appropriate. As the Mikado sings in the Gilbert & Sullivan operetta of the same name:

My object all sublime,
I shall achieve in time,
To make the punishment fit the crime,
The punishment fit the crime.


Screening Insurance Companies

OK, quick now - what do The Good Life Insurance Company, Pacific All Risk Insurance Company, and All Lives Insurance Company have in common? Answer: they exist only in the movies. To be specific and in order - The Gold Diggers of 1937, Double Indemnity, and Gone Girl. On the theory that risk managers need the occasional "day off" more than most folks in management, we suggest taking a look at the list of insurance companies in the movies compiled by Roger Crombie in the October 23 online Risk & Insurance issue.

This exercise in looking backwards tells us certain things. For example, insurance is woven right into the fabric of American life. It figures in small ways and large in comedies, tragedies, murder mysteries, adventure films - every kind of film is mentioned in Roger's list. This includes cartoons, for which, see "Insuricare" in The Incredibles. Once in a while, an insurance pro even gets the spotlight. Who can forget Edward G. Robinson's bulldog claims adjuster who takes down a scheming salesman in Double Indemnity, the all-time classic insurance based film. Of course, the film, just like the insurance business, never quite got the respect it deserved. It was nominated for seven Oscars and won none, zero, butkus. Wouldn't ya know?

Got a stormy weekend and don't feel like going out? Find Steven Soberbergh's cult classic, Kafka. Our hero, Franz Kafka (played by Jeremy Irons, no less), works for The Workers' Accident Insurance Company - when he's not pursuing an underground group of anarchists. Or check out Howard's End, a gorgeously photographed James Ivory film set in fin de siècle Britain which includes scenes in the offices of the Porphyrion Fire Insurance Company Ltd. Don't miss the chance to see how the insurance business used to be conducted, inkwells and all. Oh, your carrier still has inkwells on stand up desks? Er, sorry.

Roger's list is a wonderful resource and a marvelous tribute to the industry. Now you can sit back with your favorite libation, some popcorn, and watch insurance in action - just the ticket for a snowy winter afternoon.


Quick Take 1: Blowin' in the Wind

A new study in the journal Climate and Atmospheric Science tells us that the focus of tornado activity in the US is shifting to the east side of the Mississippi. This is one more in a series of changes in the risk landscape as climate change gets real.

We recently noted how 100 year floods are being reclassified as 25 year floods around Houston, Texas. Now we see that "tornado activity is increasing most in Mississippi, Arkansas, Tennessee, Louisiana, Alabama, Kentucky, Missouri, Illinois, Indiana, Wisconsin, Iowa and parts of Ohio and Michigan." Overall, we are looking at more tornadoes occurring in places where more people live while we have fewer twisters in the Great Plains and parts of Texas.

How does this change impact you and your employees? Your supply chains? Your coverages and limits? As one of the authors of the study pointed out, "More folks are generally at risk because of that eastward shift..." Are you one of them?


Quick Take 2: Pot Meets Stat

A new joint study by the Insurance Institute for Highway Safety and the Highway Loss Data Institute is all over the newswires lately. It is one of the first reasonably rigorous efforts to track the impact of legalized marijuana on traffic safety. The news isn't good. The researchers compared recent crash stats in Colorado, Oregon, Washington, and Nevada, which have legalized recreational marijuana, with similar control states - Idaho, Montana, Utah, and Wyoming - where marijuana is still tightly controlled. Once all of the variables had been corrected for, the crash rate in the "pot states" was 6% higher.

A variance of 6% is material, especially if you have significant fleet operations in those four states. Highway Loss Data Institute President David Harkey made the point unmistakable, "Despite the difficulty of isolating the specific effects of marijuana impairment on crash risk, the evidence is growing that legalizing its use increases crashes." Do everything you can to keep your drivers off the pot (remember, the effects of marijuana linger in ways that alcohol does not), but consider what you may need to rethink in terms of the larger number of impaired drivers sharing the roads in these states with your own vehicle operations.

Stoners are funny in the movies, but there's nothing amusing about stoners behind the wheel.



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