Dispensing With the Politics: ACA’s Implications for Workers’ Comp

By Jeanette Ward, Senior Vice President of Claims

By Jeanette Ward, Senior Vice President of Claims

No matter what your politics, the Patient Protection and Affordable Care Act (ACA) appears to be here to stay. As workers’ compensation blogger Joe Paduda said in a recent post…“If you spend your work time focused on what you don’t like about health reform, you’re not spending your time thinking about reform’s implications for workers’ comp – how you can mitigate any problems, leverage any advantages, and monitor and measure ways reform affects your business.”

As the head of claims at Texas Mutual, I am heeding his advice by trying to understand the potential impact to workers’ compensation in Texas, as well as to our policyholders and their injured workers.

Workers’ compensation medical costs are estimated to be a little less than 2 percent of total medical spend in the United States. While the ACA did not address workers’ compensation specifically, it is widely believed that there will be unintended impacts.

The overwhelming conclusion right now is that no one really knows what the impact will be, but there will be an impact. There does, however, appear to be several theories regarding the potential effects. Texas Mutual will monitor them and take action if necessary:

  1. Provider shortages/access to care. As more consumers enter the healthcare market, there could be less capacity in the medical community to match the increased demand. The potential downside to workers’ compensation is that if it takes longer for an injured worker to receive medical care, overall claim duration and costs could increase. Additionally, the theory of supply and demand (low doctor supply, high demand) could accelerate medical inflation overall, which would have an impact on workers’ compensation claim costs. Texas is one of the top states projected to have doctor shortages in the coming years.
  2. Medical cost and/or claim shifting. While no one can prove that uninsured workers tend to call an injury work related to have a portion of their health care paid for (i.e. the low back injury from a softball game on Sunday becomes the lifting injury on Monday at work), it is widely suspected in the industry that this does occur. If there is no time lost from work for these injuries, the now-insured worker may be incented to file under healthcare instead of workers’ compensation. However, the high deductibles as part of the ACA could have the opposite effect. Other factors could influence cost or claim shifting between healthcare and workers’ compensation, including reimbursement rates for providers and the complexity of the workers’ compensation system. A recent RAND study shows that in Massachusetts, which implemented an ACA-like reform in 2006, costs shifted from workers’ compensation to healthcare. However, that state’s workers’ compensation reimbursement rates are the lowest in the country. Texas workers’ compensation rates are higher than Medicare, which could favor medical cost shifting to workers’ compensation for some claims. It seems that for every theory I read that would shift costs one way, there is another theory that predicts shifting costs the other way.
  3. Healthier workers. The ACA does not bring all bad news for workers’ compensation. In theory, a healthier workforce could lead to a reduction in claim frequency and acceleration in return-to-work. This could ultimately result in lower workers’ compensation costs overall. While not all theories are proven true, it is worth monitoring for changing claim frequency and severity trends.

Workers’ compensation is not a particularly dynamic industry. Workplace safety, return-to-work and claim management have been best practices for more than 100 years, and they will still be best practices 100 years from now.

Every once in a while, though, something happens to shake up the system. The ACA is undoubtedly one of those issues. Everyone who has a stake in workers’ compensation should understand how the Act could change the landscape we have grown accustomed to.

About the author

As senior vice president of claims, Jeanette Ward is responsible for claim operations, claim quality and compliance, and network and medical operations. Jeanette joined Texas Mutual in 1993 and has since climbed the company’s ranks, serving as operations analyst to the chief operating officer; senior manager of corporate planning, budget and accounting; vice president of claim and information services; and vice president of claim support services. During her diverse career, Jeanette has overseen process and system management efforts, including Texas Mutual’s recent claims system replacement project.

This Week in Comp, April 21 – 25

By David Wylie, Editorial Coordinator

By David Wylie, Editorial Coordinator

This Week in Comp provides an overview of workers’ compensation news from across the country.

Safety

Molding teens into safe workers for life
Remember your first job? Were you nervous? Intimidated? Eager to make a good impression? Probably the last thing you wanted to do was ask your supervisor a “stupid” question. Unfortunately, millions of young workers may not always ask the questions they should about workplace safety.Texas Mutual’s Angela Gardner gives her tips for instilling good habits that will last teens a lifetime…MORE

Take advantage of free distracted driving resources
Before we close the books on Distracted Driving Awareness Month, take advantage of these free resources from the National Safety Council…MORE

As part of its Distracted Driving Awareness Month activities, the National Safety Council called on teens to produce videos that highlighted the dangers of dividing our attention behind the wheel. This 55-second video explains why we cannot safely talk on a cell phone and drive at the same time.

TRIA extension

TRIA: A real need, and the time Is now!
The bombings at last year’s Boston Marathon highlight that the U.S. still faces a very real threat of terrorist attacks. Workers’ compensation coverage is statutory and cannot exclude terrorism as a cause, so carriers in this market are responding to TRIA’s pending expiration by declining coverage to employers in certain geographic areas beyond the end of 2014…MORE

Legislative issues

TDI-DWC: Positive trends in TX workers’ comp system include lower costs for employers
A 27 percent decrease in workplace injuries since 2004, along with a 22 percent decrease in claims, is contributing to lower costs for employers, Commissioner of Workers’ Compensation Rod Bordelon said during recent invited testimony before the House Business & Industry Committee…MORE

OOOOOOOOklahoma, where reforms are causing so much pain
Oklahoma’s landmark bill SB1062 converts the state’s judicial comp system to an administrative one. But the Supreme Court has issued an opinion that the state must continue to operate the Workers’ Compensation Court until all open claims are settled. With more than 100,000 cases in the queue, that likely means operations will continue there for many years. Bob Wilson of WorkCompCentral.com speculates this is going to be a minor nightmare for people managing comp claims in Oklahoma…MORE

Workers’ comp reform bill passes first test
Colorado lawmakers are considering a bill that would expand from two to four the number of doctors that employers must let workers choose from for treatment of on-the-job injuries…MORE

Return-to-work

How do you value a return-to-work program?
The return on investment of brining an injured worker back to the team, even at 50 percent, far outweighs the benefits of letting them sit at home…MORE

Opioid epidemic

Reviewing California’s draft opioid guidelines
Joe Paduda of Managed Care Matters summarizes California’s new 320-page opioid guidelines. Joe notes that the guidelines discourage the use of opioids in minor injuries and encourage alternative therapy. He adds, however, that guidelines as to when to discontinue opioids are absolute in some places, but very flexible in others…MORE

Medical costs

Drugs, testing, and incentives
The California Workers’ Compensation Institute is preparing to release a report documenting that drug testing is one of the top cost drivers in the state’s workers’ compensation system. Treatment guidelines include drug testing as part and parcel of opioid prescription to monitor use. David DePaolo notes that the sad part of the story is that much of this testing is likely unnecessary if physicians followed guidelines…MORE

Fraud

Long way down
David DePaolo highlights workers’ comp fraud cases from the week. One case involved a police officer who claimed a work-related injury when he was, in fact, injured while trying out for another police department…MORE

About the author
David Wylie is the editorial coordinator at Texas Mutual Insurance Company. He works closely with Texas Mutual’s safety professionals to teach employers and their employees how to prevent workplace accidents and their associated costs. David holds the OSHA 10-hour general safety certification and a degree in journalism from Southwest Texas State University.

Links to and from this blog do not reflect any affiliation between Texas Mutual Insurance Company and third parties, and are not an endorsement by Texas Mutual Insurance Company of the linked sites (or their owners or operators) or of any content located there. Texas Mutual Insurance Company does not vouch for the availability or accuracy of any information contained on linked sites. Read more of this post

On the Road with Texas Mutual Recruiting

By Stephanie Schumacher, Recruiting Consultant

By Stephanie Schumacher, Recruiting Consultant

Recent visits to the University of Texas and Texas State Technical College wrapped up a busy first season of college recruiting. I’ve packed everything away until this fall, when our recruiting efforts will continue. The overall result? New relationships, building our brand at universities and a pipeline of talent that will serve Texas Mutual for years to come.   Now, we’ve set our sights on filling a new class of underwriter trainees that will start June 2.

Recruiting for a new class of underwriters made me curious about underwriting. I got a chance to find out more from underwriter and Baylor grad Scott Bonds in our Dallas office.   So Scott, what does a day in your life look like?

Scott says:

I’d say for an underwriter in Texas, my day is pretty darn good.

6:15 a.m. – 6:50 a.m. Wake up, shower, grab a quick glass of orange juice and head to a local networking meeting.

7 a.m. – 8:30 a.m. Network with a group of business people from all industries (Baylor Business Network of Dallas) and listen to an interesting presentation given by a Baylor Alum. I talk with a few alumni and meet a few who are agents in Dallas. They know about Texas Mutual, and I tell them the latest news on our success and which industries I see growing in my book of business. They like the update and talk about the upcoming football season.

8:30 a.m. – 9 a.m. Travel into work and fight traffic. I dream about the day road construction will be finished and anticipate how much better the drive will be.

9 a.m. – 11 a.m. Pull up my email and queue to see what the day has in store. I have two voicemails from agents. The first is a question on how to classify a risk.   The second wants to discuss pricing on a new business account we quoted last week. His presentation to the client is Friday, so he needs a quick response.

I return the phone calls and respond to a few emails. The agent who wanted to discuss the submission thinks his account deserves better pricing. I ask about the safety procedures the account has in place and what the insured has done to prevent a few larger losses from happening again. He says he will find out and get back to me later in the day.

I process a few endorsements and review renewal accounts. I’m able to release them fairly quickly. Now it’s time to head to lunch.

11 a.m. – noon Grab lunch with a co-worker down the street at a local Italian restaurant. We talk about a few of the accounts we are working on and how the Dallas sports teams are doing.

Noon – 2:30 p.m. I get back to my desk. I have a voicemail from the agent who needs additional pricing. He has the answers I need. I review how the losses will develop in our pricing tool and document why I’m able to reduce the pricing. He is excited and thinks we will get the business.

I review a more complex account and discuss some of the exposures with my supervisor. We agree that we need a slight increase due to the losses being higher than expected.

I send a few emails, process three more endorsements and pack up for my agency visit later at 3 p.m.

2:30 p.m. – 3 p.m. Our marketing representative and I drive over to meet with one of my agents. Their office is actually near my house, so I take my own car to head home afterward.

3 p.m. – 4:30 p.m. Our marketing representative and I meet with the agency owners to discuss accounts and check their outlook for the year. The agency projects they will grow approximately 10 percent with us in the coming year.

We finish up our meeting around 3:45 p.m., and I walk around the office talking with some of the account managers and producers. I visit with an account manager and learn about her commute. Then, I speak with a few producers who are Baylor alumni about my meeting that morning and talk football. The owner of the agency drops by and gives us a hard time about it, as he went to a different school. We discuss a few more accounts the agency is targeting that may be a good fit for Texas Mutual. I make a few notes in my notebook and tell the producer I will be on the lookout for them when they hit my desk. I shake a few more hands as I’m walking out and head home.

4:30 p.m. – 4:45 p.m. I make the short(er) drive home.

As Scott describes his “typical Tuesday,” I notice he is clearly well-versed in analysis, teamwork, negotiating, customer service and relationship building. And football, lots of football.

Join me next time, when I go “On the Road” with Austin regional office senior underwriter Nathan Rudolph and update progress on our underwriting class.

This Week in Comp, April 14 – 18

By David Wylie, Editorial Coordinator

By David Wylie, Editorial Coordinator

This Week in Comp provides an overview of workers’ compensation news from across the country.

Safety

Trains and cars: A true underdog story
The average train weighs 12 million pounds. Even in Texas, where everything’s bigger, the weight ratio of train to car is about 4,000-to-1. When the two collide, the result is similar to a car running over a soda can. Texas Mutual’s John Calvert offers these tips for staying on the safe side of the tracks…MORE

DOT launches distracted driving campaign
The Department of Transportation has launched a campaign to educate drivers about the hazards of texting behind the wheel. Free resources are available at distraction.gov…MORE

Industry pushing back against fertilizer plant safety requirements
The state fire marshal wants 46 facilities that store ammonium nitrate in Texas to make safety improvements following the deadly West fertilizer plant explosion last year. Improvements include installing sprinklers or retrofitting buildings to mitigate the potential for explosions…MORE

Return-to-work

Resume-writing as a return-to-work tool?
Bob Wilson of WorkersCompensation.com was skeptical when an insurance professional recently suggested resume-writing as a return-to-work tool. Bob was wrong, and he explains why in this installment of “From Bob’s Cluttered Desk”…MORE

Opioid epidemic

Maine leads push to limit use of painkillers
Officials of MaineCare, the state’s version of Medicaid, credit new rules for a 17 percent drop in how many patients took opioid painkillers in 2013, compared with 2012…MORE

Industry news

25 key slides on workers’ comp’s future
Workers aged 65 and over miss up to three times more days from work due to injury or illness than their younger counterparts. This short presentation by Insurance Thought Leadership highlights 25 other workers’ comp trends…MORE

Medical costs

Cost increases drive higher drug trend for workers’ comp
Significant increases in cost per prescription drove drug trend for workers’ compensation payers higher in 2013, according to research recently released by Express Scripts. Compounded medications used for injured workers saw the most significant increase, with per-user-per-year costs rising 126 percent from 2012…MORE 

Fraud

New York cop on workers’ comp gets buffalo wings clipped
The claimant admitted that his tax-free benefits gave him an incentive to feign injury and sit at home. What he didn’t know was that he was speaking with two FBI agents…MORE

Legislative issues

Insurance industry welcomes terrorism bill but not co-pay hike
The Senate has introduced a bill that extends the Terrorism Risk Insurance Act (TRIA) for seven years. Insurance industry lobbying groups expressed concern, however, that some provisions in the bill could boost insurer costs and shrink the market. If Congress does not pass a reauthorization bill by Dec. 31, 2014, TRIA will expire…MORE

About the author
David Wylie is the editorial coordinator at Texas Mutual Insurance Company. He works closely with Texas Mutual’s safety professionals to teach employers and their employees how to prevent workplace accidents and their associated costs. David holds the OSHA 10-hour general safety certification and a degree in journalism from Southwest Texas State University.

Links to and from this blog do not reflect any affiliation between Texas Mutual Insurance Company and third parties, and are not an endorsement by Texas Mutual Insurance Company of the linked sites (or their owners or operators) or of any content located there. Texas Mutual Insurance Company does not vouch for the availability or accuracy of any information contained on linked sites. Read more of this post

Trains and Cars: A True Underdog Story

Everyone loves an underdog. Who can resist the diminutive hero who overcomes impossible odds and emerges victorious against the big, powerful villain?

Unfortunately, when cars and trains square off, the underdog never wins, and the consequences are often fatal.

Since 2010, there have been nearly 350 accidents at railroad crossings. Approximately 30 percent resulted in fatalities.

The average train weighs 12 million pounds. Even in Texas, where everything’s bigger, the weight ratio of train to car is about 4,000-to-1. When the two collide, the result is similar to a car running over a soda can.

Here are some tips you can follow to stay on the safe side of the tracks when driving on personal or company business.

Consider the stats:

  • A train travelling 41 miles per hour covers 660 feet in 11 seconds.
  • Most train/automobile collisions happen when trains are travelling less than 35 mph.
  • A train travelling 55 mph needs a mile, or the length of 18 football fields, to stop.
  • The driver in a train/automobile collision is 40 times more likely to die than in a collision with another automobile.

 Forget what you think you know:

  • Freight trains don’t run on schedules, and passenger trains often change schedules.
  • Trains can move in either direction at any time.
  • Because trains are large, they may look like they are travelling slower than they actually are. They may also appear to be farther away than they actually are. The point: Don’t try to race trains across the tracks.
  • Always assume a train track is active, even if you see weeds growing or it looks unused.
  • Trains are quieter than they used to be. Don’t rely on your ears to tell you whether it’s safe to cross the tracks.
  • Trains always have the right of way, even over emergency vehicles.
  • Trains cannot stop quickly enough to avoid a collision.

Practice safe behaviors:

  • Avoid distractions. You should always avoid distractions behind the wheel, especially near train tracks. Don’t use your cell phone, listen to loud music, reach for things in the back seat or do anything else that might prevent you from observing an oncoming train.
  • Leave plenty of room. A train can extend three feet or more beyond the steel rail, putting the safety zone well beyond the three-foot mark.
  • If the gates are down, stop.More than half of all motor vehicle-train collisions occur at crossings equipped with automatic signals. Some drivers go around the gates or through the flashing red lights because they think they can beat the train. Others assume a stopped train activated the signals, or the signals are malfunctioning.
  • Don’t pass the car in front of you. If you’re within 100 feet of a railroad crossing, do not pass another vehicle.
  • Don’t shift on the tracks.Many crossings are on surfaces higher than the roadway. Shifting gears with a manual transmission may cause the vehicle to stall on the tracks.
  • Take your time. Don’t try to cross immediately after the train passes. Another train might be coming, especially on crossings that have multiple tracks.

Prepare for the worst-case scenario:

  • If the gates close while you are on the track, keep driving, even if you have to break the gates.
  • If your car stalls on the tracks, get yourself and your passengers out of the vehicle and to a safe place.
  • Move toward the approaching train to reduce your risk of being hit by flying debris.
  • Call 9-1-1 and report the stalled vehicle as soon as safely possible.

More resources:

Texas Highway-Rail Grade Crossing Safety Action Plan

Indiana Department of Transportation Railroad Crossing Safety Tips

Texas Department of Insurance Railroad Crossing Safety Fact Sheet

U.S. Department of Transportation Federal Highway Administration

This Week in Comp, April 7 – 11

By David Wylie, Editorial Coordinator

By David Wylie, Editorial Coordinator

This Week in Comp provides an overview of workers’ compensation news from across the country.

Safety

CDC study highlights safety and health issues for working women
Levels of stress-related illness are nearly twice as high for women compared to men, according to a report issued by the Centers for Disease Control and Prevention. The NIOSH Science Blog reviews the most common health and safety risks women face on the job…MORE

1 in 10 small businesses report workers under influence of alcohol, drugs
Small-business owners reported that alcohol, marijuana and prescription painkillers were the most common substances employees used, according to a study by Employers Holdings Inc…MORE

NIOSH follows workers as they age
Older workers tend to be experienced and productive. But chronic conditions can make them more susceptible to workplace injuries. NIOSH recently rolled out a Web page promoting healthy aging among America’s workforce…MORE

Wearable technologies: the next frontier in workplace safety
A North Carolina firefighter has developed an app that that displays incoming emergency dispatches, where incidents are, nearest fire hydrants, and even building plans. His work foreshadows a probable explosion in wearable technology solutions for the safety industry…MORE

OOIDA speaks out against electronic logging device proposal
The Owner-Operator Independent Drivers Association is encouraging truckers to comment on – and address safety issues related to – a recent proposal that would require truck and bus drivers to use electronic logging devices to track their compliance with hours-of-service regulations…MORE

New website helps workers ‘choose hand safety’
The Choose Hand Safety website features information on hand tools and gloves, types of injuries, preventive measures, and training. Resources include toolbox talks, handouts and ergonomics videos…MORE

The illusion of being invulnerable
No matter how many safety training courses emphasis how dangerous it may be to work with electricity, chemicals or cargo unless proper safety protocols are followed, there is always a percentage of employees who believe they aren’t vulnerable to such risks — until it’s too late…MORE

Opioid epidemic DWC commissioner testifies closed formulary helping reduce opioid use, cost
Opioid prescriptions are down 10 percent since Texas implemented its pharmacy closed formulary, according to DWC Commissioner Rob Bordelon. Bordelon testified this week before the Texas House Committee on Public Health that Texas’ closed formulary has also contributed to a 74 percent reduction in drugs with “N” status and an 82 percent drop in costs associated with those drugs…MORE

Washington man gets more than 2 years in jail for defrauding hospital to get painkillers
A Washington State man is accused of making 51 visits to more than two dozen emergency rooms and urgent-care clinics to get prescriptions for Vicodin, Percocet and other painkillers…MORE

Claim management UR Nation, Pt 2: A Tale of Two States Trying to Control High Medical Costs
Lisa Hannusch offers three keys to successful utilization review based on California’s journey…MORE

Legal

Oklahoma’s workers’ comp administrative redesign takes effect
The transition of Oklahoma’s workers’ compensation system from a court-based system to an administrative one became effective Feb. 1, 2014, a change that proponents believe will lower costs and help make the state more competitive in attracting businesses…MORE

Victoria man sues construction companies after malaria outbreak
A Victoria man is suing two construction companies after he said he contracted malaria while working for them in Africa about a year ago. One company carries workers’ compensation insurance. Under Texas law, employees cannot sue their employers over workplace injuries in most cases…MORE

About the author
David Wylie is the editorial coordinator at Texas Mutual Insurance Company. He works closely with Texas Mutual’s safety professionals to teach employers and their employees how to prevent workplace accidents and their associated costs. David holds the OSHA 10-hour general safety certification and a degree in journalism from Southwest Texas State University.

Links to and from this blog do not reflect any affiliation between Texas Mutual Insurance Company and third parties, and are not an endorsement by Texas Mutual Insurance Company of the linked sites (or their owners or operators) or of any content located there. Texas Mutual Insurance Company does not vouch for the availability or accuracy of any information contained on linked sites. Read more of this post

Before You Text Behind the Wheel, Watch this Short Video

Texas Mutual’s workers’ comp experts do their best to share their expertise with you as economically as possible. We know you’re busy, so we keep our posts short and to the point.

Sometimes, a third party reminds us that words aren’t always the best way to make a lasting impression.

This short video by the National Highway Traffic Safety Administration demonstrates, in no uncertain terms, the potentially fatal consequences of texting while driving.

The next time you’re tempted to glance at that cellphone screen, if only for split second, remember this 30-second video. It might save your life.

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