This week in comp, August 26, 2016

This week in comp is a weekly digest of workers’ compensation news from around the country.

Safety

Beware of OSHA phishing scam email
PhishingIf you receive an email that appears to be from OSHA and advises you to download a guidance document titled “Safety & Health at U.S.: Protecting Workers and Employers” to avoid being fined, do not click on any of the links in the email. OSHA advises you to delete the email immediately and run a virus scan…MORE

DOL announces start date for federal contractor disclosure requirements
Beginning in late October, employers bidding for a federal contract worth at least $500,000 must disclose any of 14 workplace protection violations, including safety and health, cited during the previous three years…MORE

Product recalls
RecallHoneywell Safety Products has issued a voluntary recall of approximately 9,700 bottles of Eyesaline emergency eyewash solution. In other recall news, Carhartt voluntarily recalled nine styles of flame-resistant sweatshirts manufactured from 2014 to 2016.

 

Fraud

Former corrections officer charged with felony in $100,000 workers’ comp scam
A former corrections officer stands accused of holding three security jobs while claiming his on-the-job injury was so serious he couldn’t work…MORE

Scheme results in $1.8 million in unpaid claims
Handcuff FraudA California man misappropriated $7.3 million from his insurance business into his personal accounts. The scheme left approximately 117 injured workers with $1.8 million in unpaid claims…MORE

Opioid epidemic

Could this new drug ease America’s opioid crisis?
Researchers have developed a pain-relieving opioid alternative. Unlike opioids, the compound does not interfere with the user’s breathing or fuel dopamine-driven addiction…MORE

Claims

Drug formularies reduce costs, improve care
Drug formularies built on evidence-based medicine can help control medical costs and improve care for injured workers, according to an American College of Occupational and Environmental Medicine (ACOEM) position paper. The ACOEM recommends states establish pharmacy and therapeutics committees to oversee the content of workers’ compensation formularies prior to implementation…MORE

Copies of designated doctor request now provided with division order
On Sept. 1, 2016, the Texas Department of Insurance, Division of Workers’ Compensation will begin sending all parties a copy of the Request For Designated Doctor (DWC Form-032) along with the commissioner’s order for a designated doctor exam…MORE

The best of the rest

66% of insurers plan increased hiring over next year: Study
hiring
More than 66 percent of insurance companies intend to increase staff during the next 12 months, according to a midyear labor study. That’s the highest percentage since the survey was launched in 2009. The study attributes the increase to demand for technology, claims and underwriter roles…MORE

State of the workers’ comp market: Takeaways for agents
Rate changes, the Affordable Care Act and the upcoming election are just a few issues facing the workers’ compensation system. The 2016 WCI keynote session featured a detailed look at the state of the market and what it means to agents…MORE

 

This Week in Comp, August 22, 2016

This week in comp is a weekly digest of workers’ compensation news from around the country.

Safety

yoga class (2)One hour of daily activity could offset risks of desk-job lifestyle: study
Long hours spent sitting at a desk can contribute to heart disease, stroke, Type 2 diabetes, high blood pressure and other chronic health problems. A new study suggests 60 minutes of physical activity each day can help control the risk…MORE

Texas becomes first state to issue standing order for mosquito repellent to fight Zika
As part of its Zika response plan, Texas Medicaid issued a standing order for mosquito repellent prescriptions for women who are between the ages of 10 and 45 or pregnant. Eligible Texas women on Medicaid can go straight to their pharmacist to pick up mosquito repellent…MORE

Veterinarian, nursing assistant crack list of most dangerous jobs
They don’t fight crime or deadly fires, but they do contend with cantankerous animals and patients. That’s why veterinarians and nurse aids have the dubious distinction of cracking the list of most dangerous jobs, along with police officers and fire fighters…MORE

Texas Mutual News

Gold, Silver, Bronze Medals on ribbons

It takes a team to win with safety
Whether you’re working to win gold or send your workers home safely at the end of the day, teamwork is critical…MORE

Protect yourself against health care fraud

There are many types of health care fraud, from overbilling on the part of care providers to outright theft of medical information by cyber criminals. Here’s how you can protect yourself…MORE

Technology

Uber, Volvo team up on driverless trucks

In a few years, that freight truck in the next lane could be autonomous. Uber purchased the self-driving truck startup Otto and announced a $300 million deal with Volvo for self-driving technology…MORE

 

Handcuff Fraud

Fraud

False accident claim leads to ouster of city councilman

A Pennsylvania city councilman reported to police that his car had been damaged in a hit and run, but authorities were suspicious because a utility pole near his car was also damaged…MORE

Opioid epidemic

New pain reliever could lower risks of fatal opioid overdose

American and German scientists are testing  a new pain-relieving drug that does not interfere with breathing, which is the leading cause of death associated with opioid overdose…MORE

Claims

Costs are down thanks to Texas’ closed pharmacy formulary

Researchers at the Texas Department of Insurance have found that, since a pharmacy closed formulary was instituted in 2011, drug costs are down 15 percent in the comp system. A closed formulary requires prior approval for the prescription of certain drugs…MORE

 

Protect yourself against health care fraud

Identity theft and Social Security card

About 2.3 million Americans spent an average of 200 hours and $13,500 to resolve medical ID theft cases in 2014.

Imagine someone offering you the chance to get cutting-edge genetic tests for cancer and other serious diseases at no cost to you. For just a few hours of your time, you walk away with peace of mind and a $50 Walmart gift card.

If you’re thinking it sounds too good to be true, you’re probably right.

A large group of unsuspecting Central Texans recently fell victim to this scam. When reporters began investigating the scam, they found the “clinics” boarded up and the saliva samples discarded in a shed.

Like workers’ comp fraud, health care fraud comes in many forms. In some cases, perpetrators bill for services they never provided. In other cases, they overbill for services or provide services patients don’t need. In all cases, the costs trickle down to consumers in the form of higher premiums.

You can protect yourself from health care fraud by following these simple tips:

  • Guard your health insurance information. More than 2 million Americans fall victim to health care identity theft every year. Protect yourself by guarding your health care information the same way you guard your Social Security number, your credit card numbers and your internet passwords. Never give your medical ID card information to a stranger on the phone, in an email or on a website.
  • Review your statements. Review your bills and explanation of benefits to make sure you and your health plan were only charged for services you received. If you see errors, contact you plan’s customer service center or the provider.
  • Ask questions. Ask questions to make sure the treatment your doctor recommends is necessary. Be skeptical if a doctor recommends a new, unusual or experimental procedure.
  • Remember that nothing is free. Don’t accept offers of money or gifts in exchange for your medical ID or other personal information. While many research studies are legitimate, they should never ask for your medical ID or submit claims to your health plan.
  • Report your suspicions. If you suspect someone is trying to lure you into a health care scam, contact your plan’s customer service center, your employer’s human resources department or the Texas Department of Insurance fraud line at (800) 252-3439.

For more information on medical ID theft, visit the Texas Department of Insurance fraud unit online.

It Takes a Team to Win at Safety

Gold, Silver, Bronze Medals on ribbonsThroughout time, many of us have looked to athletes for lessons on reaching goals and achieving success, and this year’s Olympics are giving us plenty of opportunities to do so. All eyes may be on Rio during primetime, but when you go back into work the next morning after watching Michael Phelps or Simone Biles break world records, there’s one important lesson you can carry with you: it takes a team to win – whether in Rio or when it comes to workplace safety.

During these Olympic Games we’ve all seen the entourages that trail behind Team USA and help them prepare to compete. From trainers to coaches to specialists who are there on game day, to sponsors and supportive fans who cheer them on to success, they don’t win on their own. In the workplace, it takes a support system to win at safety as well. It starts with buy-in from company leadership and trickles down to nearly every area of the business. Each individual plays a part in making safety a priority, from those purchasing PPE to safety trainers to the employees on the floor.

Here are three workplace safety lessons we can learn from the success we’ve seen in Rio:

Players will follow their coach’s lead

A good team starts with a good leader. When it comes to safety, employees will follow the lead of their supervisor. If that individual makes safety a priority and requires that employees follow safe practices, workers are likely to comply and possibly even go the extra mile to ensure safety. But if a leader puts productivity or convenience before safety, workers will follow suit. This also extends to leaders who tell employees to work safely but don’t work safely themselves. Employees are watching and will adopt those habits.

Having the right people on the team is essential  

While a good team starts with a good leader, the individuals on the team are the ones who have to choose to work safely day in and day out, which means it’s important to carefully consider the workers you hire. They should be safety-minded, care about the safety of the entire team and be bold enough to speak up when they identify a dangerous situation. Following best practices during the hiring process, such as checking references and requiring drug testing, will help ensure these are the types of people that end up on your team.

No one steps on the court until they’re ready to win

Across the world, there are a lot of athletes who didn’t make it to the Olympics this time around because they weren’t quite ready. In the workplace, this call isn’t made as often as it should be. All too often workers step on the floor or head out in the field before they’re ready to do the job safely. Whether it’s an employee who is new to the industry or a worker who has years under their belt but is new to the company, every individual should be trained, evaluated and qualified before they start work.

Athletes never stop training

The more than 11,000 athletes competing in Rio have spent their entire lives getting ready to perform on the global stage. But they didn’t stop training once they qualified for the Games earlier this summer, or even once they got to Rio. For them, and for your workers, training is not a one-and-done, temporary activity. Safety training for all employees should be ongoing and consistent. Scheduling training sessions ahead of time and informing everyone of when they’ll be held can help keep you on track. Our monthly Policyholder Safety Alerts found in CompNews can also be a monthly tool to help start safety conversations with your team.

For more resources to keep your team safe, login to our Safety Resource Center on our website or visit worksafetexas.com.

 

This week in comp, August 15, 2016

This week in comp is a weekly digest of workers’ compensation news from around the country.

Texas Mutual news

Producers rate Texas Mutual among their top carriers
In a recent Buiness Insurance America (BIA) survey, producers rated Texas Mutual among their top carriers based on a range of factors, including competitive rates, automation capabilities and claims processing efficiency…MORE

Ward Group recognizes Texas Mutual’s financial strength
Texas Mutual was named among the 2016 Ward’s 50 P&C Top Performers. The award recognizes Texas Mutual’s financial strength and ability to keep its promises to Texas employers and their employees…MORE

Safety

5 tips for guarding against workplace violence

Texas Mutual safety expert Woody Hill advises employers to train employees on the warning signs of workplace violence and train them to respond appropriately in emergencies.

Texas Mutual safety expert Woody Hill advises employers to teach employees the warning signs of workplace violence and train them to respond appropriately in emergencies.

Most active shooter situations end in two minutes or less. That doesn’t leave much time for law enforcement to arrive or victims to protect themselves. This week, Texas Mutual safety expert Woody Hill appeared on an Austin news station and shared five tips for guarding against workplace violence…MORE

Infant death in Texas linked to Zika
Harris County recorded Texas’ first case of Zika-related infant death. The mother and baby are classified as travel-related cases, and there is no additional associated risk in Texas…MORE

When is Pokemon Go a no-go?
More than 75 percent of the population plays Pokemon Go. If you’re among them, remember that besides the cybersecurity risks associated with gaming apps, there are old-fashioned risks, including distracted walking and driving…MORE

Fraud

Fraud: To the moon and back…17 times

Employers can reduce stress by giving employees more control over their schedules. Click here for a short podcast on stress management.

Click here for a podcast on how to protect yourself from common insurance scams.

Fraud steals $80 billion across all insurance lines each year, according to the Coalition Against Insurance Fraud. If you put 80 billion $1 bills end-to-end, they would stretch to the moon and back about 17 times. Ultimately, everyone pays the price, even honest consumers…MORE

McAllen medical clinic operator pleads guilty in pill mill case
Muhammad Faridi, former owner of the McAllen Medical Clinic, faces a maximum statutory penalty of 20 years in federal prison and a fine not to exceed $500,000 for his role in a prescription drug distribution conspiracy. According to court documents, Faridi and his co-conspirators distributed and caused to be distributed at least 150,000 30mg oxycodone pills for no legitimate medical purpose…MORE

Underwriting

As active shooter incidents increase, industry addresses coverage ‘gray area’
Approximately 70 percent of active shooter incidents occur in a business, according to an FBI study. The insurance market is responding with programs that provide coverage for pre- and post-active shooter incident services…MORE

Opioid epidemic

Injured workers with comorbidities may be ripe for ‘gene’ testing
Pharmacogenetic testing can help clinicians improve outcomes for injured workers and reduce costs for payers. One growing area of interest is in genetic tests that can identify injured workers most at risk for addiction and abuse…MORE

Technology

Going digital? Here’s how to keep a personal connection with clients

Insurance industry trends include increasing use of automation to eliminate cumbersome paperwork.

Insurance industry trends include increasing use of automation to eliminate cumbersome paperwork.

Thanks to electronic signatures, digital forms and automated workflows, clients don’t need to drive to their agent’s office anymore to slog over cumbersome paperwork. Still, technology can’t be the exclusive tool for client interaction, or relationships will suffer…MORE

Texas Department of Insurance

TDI-DWC finalizes designated doctor certification application form
The Texas Department of Insurance has revised DWC Form-067, Designated Doctor Certification Application. The revised form is effective Sept. 1, 2016. Designated doctors may continue to use the existing form for 60 days after the effective date…MORE

The best of the rest

Changing employee demographics push insurers to focus on strategic recruitment

By 2020, the Millennial generation will make up nearly half of America's workforce.

By 2020, the Millennial generation will make up nearly half of America’s workforce.

Nearly 400,000 insurance industry workers are expected to retire in the next year. The impending talent shortage, coupled with recent studies suggesting the insurance industry isn’t widely appealing to young workers, is forcing insurers to rethink their recruiting strategies…MORE

Business Insurance stops the presses after 49 years
Structural changes and consolidation in the insurance industry forced Business Insurance (BI) to close for business this week after nearly 50 years. Uncompleted BI awards programs “40 under 40” and “Women to Watch” also ended abruptly…MORE

 

 

 

 

This week in comp, August 8, 2016

This week in comp is a weekly digest of workers’ compensation news from around the country.

Safety

Texas on alert for local Zika, urges precautions

mosquito

Zika virus symptoms are typically mild and include fever, rash, joint pain, muscle pain, red eyes and headaches.

With local Zika cases detected in Florida and increased travel to Brazil for the Summer Olympics, Texas is on high alert for local Zika transmission during the height of mosquito season. As part of the state’s Zika response plan, Texas Medicaid will cover the cost of mosquito repellent for eligible women who are between the ages of 10 and 45 or pregnant…MORE

OSHA not the only agency increasing penalties
Effective Aug. 1, 2016, OSHA increased its maximum penalties 80 percent. The Environmental Protection Agency is one of many agencies following suit under a recent law that requires federal agencies to evaluate their penalty structures and adjust for inflation…MORE

FAA rejected advice for hot air balloon safety rules 2 years ago
Last weekend, a Texas hot air balloon crash claimed 16 lives. In the wake of the accident, the National Transportation Safety Board says the FAA rejected its cautions to increase oversight of the industry two years ago…MORE

The opioid epidemic claims 78 American lives every day, according to the Centers for Disease Control and Prevention.

The opioid epidemic claims 78 American lives every day, according to the Centers for Disease Control and Prevention.

Opioid epidemic

Coventry drug trend analysis shows falling opioid costs
Last year, overall cost per claim rose at half the pace seen in prior years, and opioid cost per claim fell from 2014, according to a Coventry drug trend analysis. The analysis offers an examination of reduced morphine equivalent dosing levels over the last three years as a meaningful sign of change…MORE

DEA report: Counterfeit pills fueling
U.S. fentanyl and opioid crisis

U.S. law enforcement agencies have been seizing a new form of fentanyl—counterfeit prescription opioid pills containing fentanyl or fentanyl-related compounds. The trend contributed to a 79 percent increase in deaths from synthetic opioids between 2013 and 2014…MORE

Claims

News from Texas: Know what you did last summit
Benefit adequacy, regulatory complexity and delayed treatment are the three most-pressing issues facing the workers’ comp system, according to the final 2016 Workers’ Compensation Summit report…MORE

Fraud

Social media exposes comp claimant’s faked injury

One in five employers feel unsure how to identify workers' compensation fraud scams, according to the Coalition Against Insurance Fraud.

One in five employers feel unsure how to identify workers’ compensation fraud scams, according to the Coalition Against Insurance Fraud.

A New York woman falsified injuries and feigned the use of a cane to fraudulently obtain more than $27,000 in workers’ compensation benefits to which she was not entitled. An investigation, which included a review of the woman’s social media activity, found she used a cane only when attending medical exams or a hearing before the State Worker’s Compensation Board…MORE

Underwriting

NCCI issues special economics brief on Brexit implications for workers’ comp
Economists agree that Briton’s exit from the European Union (Brexit) will result in a negligible 0.1 percent reduction in the U.S. gross domestic product over the next year. Brexit’s impact on the workers’ comp industry should also be minor. But a drop in U.S. exports to Briton could affect payrolls in manufacturing, technology, financial services and other select industries…MORE

Getting started: What new insurance brokers need to know
The insurance world is ever-changing, and there is more room than ever for new brokers to be successful. If you focus on your prospect, engage in a business relationship, and keep a big picture perspective of your middle-market prospects, you will gain traction much faster…MORE

 

 

 

Subrogation protects employers’ premium dollars

subrogation

Texas Mutual’s dedicated team of full-time subrogation specialists are celebrating a banner year in 2016.

Remember when you were a kid and adults told you it’s wrong to point fingers? That’s not always true. Take the workers’ comp world, for example.

Workers’ comp is no-fault insurance. That means if a claim is compensable, your insurance carrier will be there to make sure your injured employee gets the benefits they’re entitled to. That’s a promise financially strong carriers make and keep to their customers.

Sometimes, however, third parties contribute to workplace accidents. In those cases, your workers’ comp carrier might recover the costs of benefits from the responsible party through a legal process called subrogation.

What is subrogation?
Subrogation protects you from paying for someone else’s mistake. That’s because subrogation can have a positive impact on claim reserves and experience modifiers, both of which affect your premium.

Many insurance carriers assign subrogation to adjusters, whose primary job is administering benefits to injured workers. Texas Mutual employs a team of dedicated subrogation specialists. They spend the bulk of their time subrogating claims involving vehicles, products and premises.

Regardless of how your workers’ comp carrier handles subrogation, you can facilitate the process by following a few simple tips.

Vehicles
Your employee is making a delivery. Another driver, who is not one of your employees, rear-ends the vehicle your employee is driving. Your carrier may pursue the other driver’s auto insurance carrier to recover the costs of claim-related benefits.

Tip: Document the exact location of the accident, as well as the law enforcement agency that responded. This information will help your workers’ comp carrier locate the accident report.

Products
A ladder breaks and injures your employee. Your accident investigation shows the employee was using the ladder correctly; however, the ladder was faulty. Your carrier may pursue the ladder’s manufacturer to recover the costs of claim-related benefits.

Tip: Documentation is critical to the subrogation process. Keep receipts and thorough maintenance records on ladders, vehicles, equipment and your facility. In addition, secure the ladder in case it is needed as evidence in the case.

Premises
An employee slips on a recently mopped floor at a customer’s workplace. There are no cones or signs warning pedestrians about the hazard. Your carrier may pursue the entity responsible for maintaining the customer’s premises to recover the costs of claim-related benefits.

Tip: Take photos of the area where the employee was injured, noting whether there were warning signs posted around the hazard. Get witness names, note the type of shoes the employee was wearing, and document the time of day and associated lighting conditions.

More information
For more information about subrogation, visit Texas Mutual’s case archives and the National Association of Subrogation Professionals website.