What Kind of Day Was It?
Dec 19, 2019

An ordinary hot summer weekday in Fresno, California, in 1979. Our claims office was in a rehabbed building in the center of downtown, a block from our major bank, next to the Hilton. No one knew why, but two local high school gangs collided with knives and guns literally on our doorstep a little after lunch. Fatalities ensued - kids killing kids. That evening, our adjusters had to walk around the chalk body outlines, the yellow tape, and the bloodstains on the sidewalk. Two resigned by phone that evening, two more in the following weeks. That was your faithful correspondent's sudden introduction to "incident management" and its impact on our claims processing center, as well as the employee perception of risk and its consequences.

A scan of any recent group of headlines will remind all of us that such incidents, rare in 1979, are commonplace today. That's why US Bank's National Workers' Compensation and Disability Conference presentation, "After a Traumatic Workplace Incident, How Do You Address Behavioral Health?", is so important now. Banks get held up often enough that employee impact is an important part of risk and HR attention. Risk&Insurance offers a neat summary of the conference presentation for another look at the matter, check out a guide provided by, of all outfits, Canada Life. Yes, these things happen in Canada as well. They're just more polite.

In general, risk management has been slow to recognize the importance of mental health programs in dealing with RTW and related comp claims issues, but serious trauma in the workplace, and the crippling stress it can engender, is real. When a robber sticks a great big gun in a teller's face and demands money, an injury occurs. When an employee sees a colleague or a customer fatally injured, an injury occurs. As the assistant claims manager for US Bank puts it, "These are the types of claims that develop into really large claims. Robberies are triple what our other claims typically cost us."

You don't need to be a bank. In a previous life I dealt with a large retailer which happened to have a store full of employees at a mall where a terrorist incident occurred on an ordinary afternoon. People were shot dead in front of their shoe racks. We had an incident response team in place within hours. The point is that it's not just the employees in the immediate line of fire who are traumatized; it's their colleagues, even the folks who had the day off and just missed the event. Now they don't know if they can go back to work where such a tragedy just occurred. Do you and your colleagues in HR have a joint incident response plan in place with service vendors who can have nurses and counsellors on site within twenty four hours or less? Let's hope you never need one, but let's also hope that you have one if you do.

We don't like to think of these things at this time of year, but there's a reason we call your attention to these dismal facts even in the midst of celebration. Pause with us to remember the terror attack on the Christmas village in Berlin on December 19, 2016, that shocked the civilized world. Decorated trees, carols, and eggnog are seasonal. Risk is not.

a christmas village, devastated

Berlin, 12.19.2016, courtesy Wikipedia

We offer this reminder in the memory of the twelve innocent holiday makers who died that evening at the Breitscheidplatz.


Who Are Those Guys, Second Time Around?

How many low-down conniving medical providers does it take to seriously screw up a workers' comp system? Two recent reports from California indicate that a relative handful will do the job quite nicely. By the numbers:

The Workers Compensation Insurance Rating Bureau (WCRIB) has just published a report which analyzes the treatment patterns of medical providers who have been indicted for fraud recently. This is a small subset of all the providers in the Golden State, but a look inside their practices shows that:


The average total medical paid per indicted provider was 10 times higher than other, non-indicted providers between 2013 and 2018. These folks "treated" large numbers of injured workers, but more to the point, they rendered/inflicted more services per claimant.


The shares of medical payments for medical-legal and medical liens of indicted providers were 2.5 times higher than for other providers. (See below for another view of this feature.)


Indicted providers in the Los Angeles Basin accounted for about half of indicted providers linked to WCIRB data, but they received more than 90 percent of the medical payments made to these indicted providers. Have claims in SoCal? Surprised?

Meanwhile, my fellow blogger extraordinaire, Joe Paduda, has provided an excellent overview of a new California Workers' Compensation Institute (CWCI) report on IMR disputes in the same California state of mind. The CWCI analysis shows us that only 122 docs in all of California file some 44% of all IMR requests and a mere ten account for 9.5%. Even more astonishing, the rate of IMR requests keeps going up. What's happening here? Well, one clue may be the fact that most of these requests are being filed not by the docs themselves but by the applicant attorneys working with those few docs.

This may be about to change, however. I can't improve on Joe's pointed prose, so allow me to quote:


Till now, the top offenders, the docs who don't want to comply with evidence-based treatment guidelines, the ones who slow down the recovery process by continually requesting inappropriate drugs, unnecessary surgeries, unneeded injections and unproven therapies have been able to hide behind a wall of anonymity.

California Senate Bill SB537 changes all this and allows the Department of Workers' Compensation to reach out to these frequent filers on or before 01/01/2024. The days of frivolous IMRs are numbered. If you have comp claims in California, think of this as a long awaited Christmas gift. It's not wrapped, but it still looks great under the tree.


Quick Take 1:
Do Not Go Gentle Into That Good Night

Need a few good people? Employees who need minimal training, already know your business and equipment so they will have a minimum of newbie on the job injuries? OK - don't let them retire. A new study from the Rand Corporation, The American Working Conditions Survey (AWCS), shows that more than half of recent retirees would be happy to return to work. Hmmm. That's quite a labor pool.

What do older workers want? The answers Rand garnered are fascinating:


More meaningful work: now, dig this - older workers (especially men without college degrees) are more likely than prime-age workers to say that they apply their own ideas (87 percent versus 83 percent in prime age) and solve unforeseen problems (84 percent versus 78 percent) in their work. Want some of that?


More flexibility in work hours: Hey - overall, 17 percent of older workers set their own work hours, while this is true for just 14 percent of younger workers. These are people you can trust with their own initiative.


Constructive relationships in the workplace, like supportive supervisors.


Less heavy exertion: But still - older workers are less likely than younger workers to sit all day on the job (39 percent versus 49 percent). In fact, when looking at all of the indicators for physical demands, older workers' jobs are surprisingly strenuous.

For a different view and the low-down on "returnships" for retired employees, see this essay from the folks at Career Partners.

So, my friends, is the labor market tight? Are good, skilled people hard to find? Well, maybe you've been looking in the wrong places.

a photo of santa

This guy ready for retirement?


Quick Take 2:
Deck the Halls with Claims Adjusters

Ah, retail. It's the time of year when children drool, shoppers go berserk and employees have slip, trip and fall injuries, run into stuff, and overexert themselves. Eh? Well, the rate of comp injuries went up last year in the retail industry for the first time since detailed records were started in 2003. Even more special? Retail was the only industrial category to record an increase in time loss injuries in 2018. Too many doorbuster specials? The whole package has been carefully gift wrapped by the BLS just for you, should you be interested in the details.

Maybe you should be interested since retail stands out from the crowd in such an undesirable way. Do you have retail operations in your span of responsibility? If so, it might be time for some more intensive loss analytics. If you do take a closer look, don't forget to check variables such as location of injury (sales floor or stock room?), employee age (more older employees or more newbies?), time of day (any clustering around quitting time?) or store location (does one regional manager have more of the outliers?). Margins are thin in modern retail. All it takes are a few expensive claims and operating margin disappears like Christmas cookies in the employee lounge.


Words to Remember:
Halcyon Days

December 14-18

a colored illustration of a kingfisher aka the halcyon bird

The ancient Greeks called the seven days preceding and the seven days following the WINTER SOLSTICE the "Halcyon Days." According to one legend, the halcyon bird, or kingfisher, nested during this period. Because she built her nest on the water, the gods granted her a respite from storms and high seas so that she could hatch and rear her young. Early Christians saw the halcyon days as a prefiguring of the birth of Christ, a holy time of serenity and reflection. Today, the expression "halcyon days" has come to mean a period of tranquility, often used as a nostalgic reference to times past.

Our holiday wish for our readers: may you find a halcyon day or two even amid the stress of holiday making and time to call to mind all those friends, relatives, and fellow holiday revelers of yore whose voices the years have silenced but who still live on in fond memory.

The GB Journal will resume on January 9, 2020.


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