It's Always Phishing Season
Aug 3, 2017

I'm a Ruritanian prince trying to smuggle a steamer trunk full of emeralds out of Pontevedrin and I need your help. Just wire $xxxxx.xx to my secret account to cover the UPS charge and I'll send you a large, heavy box of jewels for safekeeping.

Yeah, sure. It's been a long time since those early on-line scams, but phishing has continued to get more and more subtle and sophisticated. The GB Journal has looked at this ever present danger several time in recent issues. Now, what should a risk manager do if you find out you've already been phished? The National Law Review has published a very useful overview of the basic steps to follow once you've determined that someone in your organization has already fallen for a scam and sent company funds or information to the scammers.

The authors, a crackerjack team from the firm Dickinson-Wright, give you a strong, common sense critical path outline to follow once you've stopped hyperventilating. While having strong security measures in place to stop phishing and related attacks in the first place, is paramount, no defense is any better than its weakest link - that one employee with key passcodes and a deficit of good sense.

Implementing appropriate recovery and follow-up procedures in advance can help "reduce the likelihood of data security incidents occurring, decrease the times investigating and responding to an incident, reduce the costs associated with a breach response, and help to identify legal rights and obligations more quickly." Every potential breach needs a powerful response plan.

(If you know where Ruritania and Pontevedrin are, you're seriously older than your driver's license says you are.)


The late, great Danish comedian, Victor Borge (1909-2000), included in his concert performances a wonderful routine about his uncle, the unsuccessful inventor, whose inventions kept backfiring until one day he invented a cure for which there was no disease. Unfortunately, Borge would say in his Danish accented English, his uncle then caught the cure - and died of it.

An excellent and short article, "The Art and Science of Getting Off Opioids", by Dr. Laura Gardner in  looks at how the WC industry is moving ahead in "curing" opioid addiction and how this process is creating its own list of casualties. While new regulations, state formularies, and much greater vigilance by WC carriers and TPAs are all helping to reduce the use of opioids for new claims*, we still have the problem of thousands of injured workers who were put on opioids, often incorrectly, in the past few years - and remain dependent on them today. Most physicians who have prescribed these drugs until recently are not familiar with how to wean injured workers off them, especially injured workers who have been on opioids for many years.

According to Dr. Gardner, "In fact, 80 to 90 percent of physicians in the United States have absolutely no training or education in the use of controlled substances." What does this mean to you about how you work with your claim professionals in handling claims involving opioid addiction? The key is working with clinical professionals who understand the many aspects of tapering. Every person reacts differently - to taking opioids in the first place and to tapering off an opioid dependency later. In most circumstances, "abrupt denial of payment for opioid treatment can lead to medically dangerous withdrawal symptoms and drug-seeking behavior and is not recommended...."

Getting the claimant to the right provider is key. This will be a clinician and a clinic with the following capabilities:

  • Experience with the tapering process
  • A proven track record of not using added opioids to treat flare-ups during the weaning process
  • Ability to offer pain coaching or pain psychology services
  • No pressure placed on recovering workers to have invasive procedures or operations
  • A good weaning success rate among their injured workers. 

Recovery from the overuse of opioids is a long road. Yes, it saves the employer serious money over the long haul, but most of all, helping an injured employee get his or her life back is the right thing to do.

*For an excellent update on the progress being made in combatting new opioid addiction, see Joe Paduda's Managed Care Matters weblog post for 07/11/2017 at: .


Remember our review of Crooked, the book exposing the "back racket" in our last issue? Well, the journal Spine has just published a careful look  at the impact of spinal fusion procedures in Ohio on RTW and the results aren't pretty. has also provided a helpful summary.

The researchers looked at some three hundred sixty-four Ohio WC (BWC) subjects who underwent primary decompression (DC) or primary decompression and fusion (DC + F) for degenerative spinal stenosis (DLS) without deformity or instability associated with on-the-job injury alone between 1993 and 2013. They then looked at the rate for a stable RTW within the two years following the procedure. As readers of Crooked will recall, indications of DLS are common among middle-aged and older Americans and may or may not be job related, but the emphasis of this study was on recovery and RTW when spinal fusion was performed as a remedy for presumed work related injuries.

The tales is soon told. The DC only patients has a RTW rate of 36% while those who had DC plus fusion had a RTW rate of only 25%. The conclusions of the study's authors deserves to be considered in full: "Overall, fusion with decompression had a significantly negative impact on clinical outcomes in WC subjects with DLS. These results demonstrate the high risk of postoperative morbidity associated with fusion procedures and underscore the need to strongly reevaluate the use of fusion for DLS without instability in the WC population."

One other thing - those injured workers who had the fusion procedure would up costing over $45,000 more than those who did not. Pretty little picture?



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