ND workers' comp agency sues over computer project

Yet another reason for a universal integratable workers' compensation docketing program. Today's post is share from http://www.sacbee.com/. BISMARCK, N.D. -- North Dakota's workers' compensation agency has sued a Chicago company over a failed $17 million computer system overhaul. The Workforce Safety and Insurance agency filed its lawsuit last month in state court against Aon eSolutions Inc. to recoup costs associated with the system that was never delivered. WSI hired Aon eSolutions in 2007 for a software system upgrade. The work was to cost $14 million, but it was plagued by delays and cost overruns and was never finished. The contract with the company expired in 2012, and WSI did not renew it. The state Legislature last year gave WSI $750,000 for potential litigation. WSI, which provides coverage for businesses when employees are hurt or killed on the job, alleges, among other things, negligence, fraud and deceit against the company in court papers. The agency has requested a jury trial. "Aon promised to deliver a state-of-the-art integrated software package that would replace WSI's existing software system and meet all of the agency's business needs," said WSI Director Bryan Klipfel said in a statement. "WSI intends to prove that Aon did not follow through on its promise. We are acting in the best interest of our stakeholders as we try to recover the money that was spent on this desired product." Aon said in a statement that it is "disappointed that WSI chose this course. We delivered substantial value to WSI and we did nothing wrong. We look forward to telling our side of...

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Workers' Compensation Benefits, Employer Costs Rise with Economic Recovery

NASI issued the following press release reflecting that workers' compensation costs are continuing to soar on the back of ever increasing medical expenses. The real question that remains unanswered is whether the Affordable Care Care will rein in costs and capture the workers' compensation delivery system in the process. Increased costs are good for workers' compensation carriers as they increase premiums to reflects those numbers. Looking down the road, a single Universal Medical Benefit program may present the only true alternative to achieve the cost savings employers need and want. Today's post was shared by WCBlog and comes from www.nasi.org

After declining in the wake of the recession, workers’ compensation benefits paid to injured workers and costs borne by employers increased in 2011 as the U.S. economy continued to recover, according to a new report by the National Academy of Social Insurance (NASI).

Total benefits rose by 3.5 percent to $60.2 billion.  The benefits include a 4.5 percent rise in medical care spending to $29.9 billion and a 2.6 percent rise in wage replacement benefits to $30.3 billion. Total costs to employers rose by 7.1 percent to $77.1 billion.

"Workers’ compensation often grows with the growth in employment and earnings,” said Marjorie Baldwin, chair of NASI’s Workers’ Compensation Data Panel and Professor of Economics in the W.P. Carey School of Business at Arizona State University.  When benefits and costs are measured relative to total covered wages, then benefits remained unchanged, and costs to employers rose very modestly (to $1.27 per $100 of wages) after declining in the previous five years.

Workers’ Compensation Benefits, Coverage, and Costs, 2011
Covered workers (in thousands)
Covered wages (in billions)
Workers' compensation benefits (in billions)
Cash benefits	$30.3	2.6%
Employer costs (in billions)	$77.1	7.1%
Amounts per $100 of covered wages
Cash payments to workers
Source: National...

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US EPA Reports: Better Planning, Execution and Communication Could Have Reduced the Delays in Completing a Toxicity Assessment of the Libby, Montana, Superfund Site

The US EPA could have done better in handling the asbestos exposure site in Libby Montana according to a report issued yesterday by the US EPA's Inspector General. 

"U.S. Environmental Protection Agency (EPA) action officials did not complete  planned corrective actions under its Libby Action Plan in a timely manner. This occurred because the scope of the work was larger than originally thought; there was no established charter; and there were contracting delays, competing priorities, unanticipated work, and poor communication with stakeholders. Consequently, the Agency has twice revised its estimates for completing actions in response to our December 2006 report. 

"The toxicity assessment is one of two components (an exposure assessment 

being the other) that makes up the health risk assessment for determining 

cleanup levels in Libby. In December 2011, EPA informed us that the health 

risk assessment would be substantially delayed. As a result, the Agency’s final 

determinations that the completed and ongoing cleanup actions are sufficient to 

address the health risks from site contamination have been delayed from 2 to 6 

years, depending on the studies being performed. This is a significant concern, 

considering that the EPA Administrator declared a public-health emergency at 

the Libby site in 2009 and the Agency has spent over $400 million on cleanup. 

Communications about delays in completing Libby Action Plan items, and the 

reasons for those delays, were not always timely or clearly communicated to 

stakeholders; and EPA officials failed to update the Agency’s follow-up system 

or notify the Office of Inspector General (OIG) about known delays until 

planned corrective actions under the Libby Action Plan could not be met.

Click here to read the complete report: Better Planning, Execution and Communication Could Have Reduced the Delays in Completing a Toxicity Assessment of the Libby, Montana, Superfund Site

Universal Medical and Workers' Compensation: It's Not "If", It's "When" - California

The Affordable Care Act (ACA) is going to definitely change the landscape of medical delivery over the coming future. Medical care afforded by workers' compensation delivery systems will ultimately be merged into a universal national program, despite all the opposition along the way.

My friend, and cycling inspiration, who keeps me trying to think I can enter the Tour de France while under the influence of Starbucks coffee, David DePaolo, points out that the "fusion" may be coming slowly through legislation of unintended consequences in California.

"The concept of universal care, 24 hour care, single stop shop, etc. has been floating for a couple of decades now with very little progress.

"But the passage of the Affordable Care Act, the signing of HB 1 back in February 2009, and other Federal health related laws and regulations including ERISA, have accelerated the fusion of workers' compensation medicine and general health medicine. Outsourcing MPN [Medical Provider Networks] oversight to a health care related agency is just another step towards this outcome.

David, an expert in analyzing what's around the curve, sees the next wave of change coming to workers' compensation. For so many reasons, including the expansion/reimbursement integration of the Medicare program, the writing is on the wall on this one. 

Every time the lobbyists think that have eliminated the imminent threat of Federal intrusion, ie. Enactment of The SMART Act, the reality of which is that the regulations will eat up the statute, and also their lunch. I plan to write more on The SMART Act in the coming weeks. Maybe that wasn't so smart after all for the cottage industries that supported it.

US Supreme Court, Health Care & Workers' Compensation

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The winds of change have brought a new health care system to the US. The US Supreme Court  will now have an opportunity to express it's opinion on the validity of the legislation. The new system, that provides additional worker protections, and a prototype of a universal medical care system ,"Libby Care," encompassing workers' compensation claims, reflects changes desperately needed.

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Vermont Universal Health Care to Embrace Workers Compensation

A two-stage bill in Vermont is geared to establishing a single-payer medical health care system that would include medical for workers' compensation claims.

The legislation " proposes to set forth a strategic plan for creating a single payer and unified health system. It would establish a board …. ; establish a health benefit exchange for Vermont as required under federal health care reform laws; create a public-private single payer health care system to provide coverage for all Vermonters after receipt of federal waivers.”

The plan proposes covering all workers' compensation claims:

"(3) To the extent allowable under federal law, the Vermont health benefit exchange may offer health benefits to employees for injuries arising out of or in the course of employment in lieu of medical benefits provided pursuant to chapter 9 of Title 21 (workers’ compensation)."

"(c) If the Vermont health benefit exchange is required by the secretary of the U.S. Department of Health and Human Services to contract with more than one health insurer, the Vermont health benefit exchange shall determine the appropriate method to provide a unified, simplified claims administration, benefit management, and billing system for any health insurer offering a qualified health benefit plan. The Vermont health benefit exchange may offer this service to other health insurers, workers’ compensation insurers, employers, or other entities in order to simplify administrative requirements for health benefits."

Nationally, advocates to improve the delivery of medical benefits to injured workers have urged federalization of the medical delivery system into a single payer approach through universal health care. The proposed Vermont single payer system is a unified state approach to the co-ordinated delivery of medical care.

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New 911 Photos Dramatically Illustrate Toxic Cloud

The horrific tragedy of the attack on the World Trade Center on 911 and the toxic cloud of fumes and dust are vividly portrayed in newly released photos. The massive extend of the spread of toxic substances has given rise to resultant disease and illness to emergency first responders and residents of lower Manhattan.

ABC secured the release of the photos by a Freedom of Information Act Request to the New York Police Department (NYPD). The photos were taken  from an NYPD helicopter immediately following the attack when two large jet liners, loaded with fuel and passenger, were seized by terrorists and crashed into the buildings.

The fight to secure adequate medical care for medical conditions flowing from the exposures has been very problematic. While several local agencies have attempted to provide medical care, the lack of funds and a unified program has left many without appropriate medical care.

Click here to read more about 911 and medical care programs.

Good Medicine for an Ailing Compensation System

An historic shift in the delivery of medical care for those injured by occupational exposures has been signaled by the US Senate. Following decades of debate, the proposed emerging health care legislation, amended at the last minute by the Majority Leader's manager amendments, shifts Libby, Montana's asbestos disease claims to Medicare as a primary payor.

The stage was set last June 17th, when the US Environmental Protection Agency (EPA) declared Libby, Montana, a Public Health  Emergency, because of asbestos present at the site. The geographical location was the site of a W.R. Grace vermiculite mine.

The legislative provision was "buried" deep in the legislation at the last moment, reported Robert Pear of the NY Times. The amendment was made Senator Max Baucus of Montana, who lead the Senate legislative committee crafting the legislation. The convoluted political bartering over the last few days reflects a sentinel change in how injured workers may be receiving medical care in the years ahead. It is anticipated that major changes will be offered over the years ahead to modify and expand the coverage.

Occupational diseases have always been problematic to the State workers' compensation systems. They have been subject to serious and costly proof issues. They were "tag along" claims for a compensation system that initially was enacted in 1911 to cover only traumatic claims. The proposed legislation is a first major step to move occupationally induced illnesses into a universal health medical care system and will provide a pilot project for addressing the long awaited need to furnish medical care without serious and costly delays.

By allowing Medicare to become the primary payor and furnish medical care, those without a collateral safety net of insurance will be able to obtain medical care effectively and expeditiously. While cost shifting from workers' compensation to Medicare has been an historically systemic problem in the compensation arena, this legislation maybe a first major step to legitimatize the process. The legislation may allow for great accountability and expansion of the Medicare Secondary Payment Act (MSP) to end cost shifting that has become epidemic in proportion. It is good medicine for an ailing workers' compensation system.


Click here to read more about workers' compensation and universal health care.

California Comp is OK, But Just Don't Get Sick

The RAND Corporation published yet another report evaluating the troubled California workers' compensation system. The report, in its esoteric evaluation, reflects on the poor financial judgment of the industry to meet the needs of the injured workers.

The study misses the focus and humanization of what workers' compensation is all about. The concept of providing a remedial and expeditious remedy to injured workers seems to have been left outside in the company parking lot.

The California problems are not isolated, they are nationally systemic. The system fails to deliver and fails to encourage a safer worker environment. More of the same old thing, as RAND recommends, ie. more business should be covered, and more premiums should be collected, just isn't going to cut it any longer.

Workers' compensation is fine, as long as a worker doesn't get sick. Dormant and latent conditions for the most part remain untreated by the present system. Preventive medical care is non-existent. Medical monitoring is a major struggle to secure.

Occupational disease cases have perpetually lingered through delay and denial tactics, and now the condition needs critical care that a bandaid will not cure. As the NY Times reports in results of a recent poll, the safety net has failed.

Nationally the system needs to re-worked. Injured workers need to receive medical care through an effective and efficient process and not left out in the streets to suffer. Congress needs to act to provide coverage through an expansion of the proposed national health care agenda.

Click here to read more about medical benefits and workers' compensation.

Congress, Health Care & Unintended Consequences

This past week some very dramatic things happened in the workers’ compensation world. The US Senate moved forward on initiating a floor debate on health care. At the same time, a group of workers’ compensation scholars met in Washington DC to discuss the future of workers’ compensation and the interplay with social security disability.

 Highlights of the NASI (National Academy of Social Insurance) conference convened in Washington were findings presented by eminent leaders in the field. Professor John Burton, Rutgers University, pointed out that newly created barriers to workers’ compensation were pushing more injured workers to the Social Security disability system for benefits. This reflects a phenomenon that occurred in the late 1970’s when a study commissioned by the US Department of Labor and conducted by Mt. Sinai Hospitals’ Environmental Sciences Laboratory, revealed that the inadequate benefit delivery system of workers’ compensation for asbestos related illness, was forcing injured workers and their families into the civil justice arena for adequate compensation.

The problems have not changed in decades; they have only gotten worse, maturing into a system that is in critical condition and on life support. In 1980 Irving J. Selikoff, M.D. reported, “There has been widespread acknowledgement of significant problems with disability compensation for workers in the United States. One major area of concern has been the shortcomings with regard to occupational disease. Whatever the suitability of current workers’ compensation systems in the 50 states for injuries and work accidents, there has been little disagreement about the inadequacies of such systems for workers who become disabled by illness or, if they die, for their surviving dependents.”

Complex questions continue to exist between the scientific and legal communities as to the path to be taken. Barriers placed into the path of recovery, including pre-existing and co-existing conditions, which result in limited or delayed recovery and major shifting of the economic responsibility upon the public/private benefit systems need to be removed. The unspoken social consequences continue as a silent epidemic as families and survivors struggle in silence.

Looking backward over the noble experiment in California which turned sour, Tom Rankin, former President of the California Labor Federation, AFL-CIO, expressed his regret of the reform. The former Labor leader theorized that the results were “unintended consequences.” Indeed he is looking forward to solutions springing forth in a “public option” embedded into the national health care legislation.

Some participants at the NASI conference alleged a major shortcoming of the California workers’ compensation legislative reform effort. Doug Kim, a lobbyist for the claimant’s attorneys, disclosed that the injured workers’ advocates were not invited to partake in the discussion that lead up to crafting the initial drafts of the 2004 California reform legislation SB 899.

History reveals, that when the theoretical reforms were practically applied, the injured workers suffered serious setbacks. If these were in fact “unintended consequences,” then one must consider the active involvement of all stakeholders when looking forward to solutions. The courts in California have consistently upheld challenges to the inequitable results, pointing to the legislative intent to reduce costs. Absent from the discussions of the presenters were practical systemic applications to improve the present system. The “blood and guts” of the traumatic, delay and denial, struggles of navigating in a crippled workers’ compensation system, in California and elsewhere, is verification that change is mandated.

As North Carolina attorney, Valerie A. Johnson, so eloquently remarked, “workers’ compensation is supposed to be a simple system.” The process has now been obstructed by encroaching elements of fault, contributory negligence, apportionment of pre-existing conditions and difficulties of the element of time, manifested by latent diseases unknown to the fathers of the system a century ago. The advance of medical science has brought forth new and innovated modalities that have contributed to soaring medical costs. The convergence of these issues has generated higher administrative costs.

Pecuniary Industry motives have worked adversely to improving safety in the workplace. The need for workers’ compensation would be minimized by adopting a safer occupational environment. Under reporting of workplace accidents continue as the Government Accountability Office announced. Nebraska Appleseed reveals that workers feel intimidated and are apprehensive to report injuries and unsafe work conditions. This is scenario is compounded by the fact that undocumented workers, who have even less job security, work in jobs with higher risk. The Bush Administration did not make efforts to allow OSHA to heighten enforcement efforts. All of these ingredients combine to create a recipe that just doesn’t work.

The US Senate advanced the health care legislation to a floor debate in an unusual late Saturday night session. This action may indeed provide an opportunity for the stakeholders in workers’ compensation to all join in the debate and look for solutions to the delivery of appropriate medical care in an efficient and timely fashion. To avoid “unintended consequences” yet again, injured workers and their advocates will need to be active participants and engage in the debate now.

.......

To read more about workers’ compensation and universal health care solutions click here.

Integration of Benefits Anticipated to Save Money

A recent report indicates substantial economic savings if health insurance (a date based system) was merged with workers’ compensation (an event based system) coverage. The report, authored by a study group headed by Frank Neuhauser, and funded by the California Healthcare Foundation, predicts substantial money savings as well as system efficiency would occur upon integration of benefits.

“Integrating occupational medical care into the more efficient group health model would reduce administration to approximately 12% to 13%. We extend these findings to the US and estimate that the 10- year (2011- 2020) savings of integrating coverage would be between $490 billion and $560 billion, sufficient to pay for between 26% and 78% of the incremental cost of universal coverage.”

The study also indicates substantial savings in the costs of medical care would occur through integration of benefits.

“The savings would result from the much greater efficiency with which health insurance delivers care compared to workers’ compensation insurance. A minority of health insurance premiums (12%-14%) go to cover administration and profit. Workers’ compensation turns this ratio on its head, spending the majority (50%-60%) of premiums on these same overhead costs.”

“If near universal coverage becomes a reality, the medical portion of several types of property casualty insurance could be delivered in a much more efficient manner. Absent  near universal coverage, we will likely have to continue relying on the more costly, but  important role of other insurance models.”
.......
To read more about workers' compensation and medical benefits click here.

Denial Rates: An Insurance Company Tactic That Compounds the Health Care Delivery Problem

As Congress considers changes in the nation’s health care program, US health insurance companies continue to be scrutinized. The methodologies of how insurance companies deny claims are being investigated.

A certified nurse assistant, Amelia Mendoza, age 52, of West Covina, California, was attacked twice in the same week by a patient while working at Huntington Hospital in Pasadena earlier this year. Amelia suffered injuries that resulted in her suffering a stroke in April, falling into a vegetative state and contracting pneumonia. The hospital insurance carrier cut off medical care for her, forcing her from the hospital, and leaving her family responsible for medical care for Amelia’s work-related injury that is the hospital’s responsibility.

Her husband, Ralph Mendoza, who met with reporters and supporters outside the hospital, commented, “I am shocked and extremely disappointed that Huntington Hospital would treat Amelia this way. Amelia gave her all to her job for more than six years, and she deserves better….Amelia was injured doing her job, and the hospital has avoided its responsibility for months. I watch my wonderful wife, a mother of four children, slip away in a vegetative state and I wonder whether she would be healthy today if the hospital had met its responsibility. I want the medical care that my wife deserves.”

After an attack by a violent patient, Amelia was examined in the hospital’s Emergency Room and told to return to work. After a second attack just two days later, Amelia went to the Emergency Room and was told to go to Huntington Hospital’s in-house workers’ compensation clinic. The hospital was aware that Amelia’s blood pressure was dangerously high after the attack, and that the patient had infectious diseases. The hospital even called Amelia and her husband to warn of the health dangers Amelia faced. Yet the hospital’s clinic turned Amelia away, saying they were too busy to see her. Amelia suffered a stroke less than three hours later. The attacks had caused bleeding in her brain.

“The workers’ compensation carrier, Sedgwick, has denied liability for Amelia’s medical care, claiming that their investigation did not support a claim of injury and no medical evidence supports the claim either,” said Amelia’s attorney, Chelsea Glauber of the Glauber/Berenson Law Firm. “Medical evidence does in fact exist which states in no uncertain terms that Amelia’s condition was caused by these attacks at work. Amelia is trapped in a horrible hell, between two insurance companies trying to avoid responsibility. So Huntington Hospital let Amelia go home, in a vegetative state, to be taken care of by her husband, who no matter how loving and well intentioned, is not qualified to provide the critical care that Amelia needs and deserves. What does it say about these insurance companies and a hospital that they would treat a hard-working human being in this awful manner?”

A recent report on insurance companies denial rates reveals that, “When it comes to claim denials, insurers may be putting profits ahead of patients’ best interests. Most major insurance companies have reassigned their medical directors—the doctors who approve or deny claims for medical reasons—to report to their business managers, whose main responsibility is to boost profits.”


An inefficient system is not helpful to anyone, including injured workers, insurance companies, and employers. Wasteful administration should be curbed. The U.S. healthcare system wastes between $505 billion and $850 billion every year, recently reported Robert Kelley, vice president of healthcare analytics at Thomson Reuters.

Lawmakers must concentrate the U.S. health debate on how the delivery of medical care can be more efficient and effective. Delays and denials presently occurring in the workers’ compensation system continue to highlight the fact that injured workers need a universal health care system.

To read more about "health care" and "workers' compensation" click here.

Insuring Disabled Seniors and The Public Option

Disabled workers over the age of 65 have difficult decisions to make concerning health insurance. Those who rely upon workers’ compensation and Medicare to cover all their medical costs are in for a rude awakening. John D. Podesta and colleagues reported difficulties in the present system that seniors utilize.  “The gaps in coverage, the high cost of insurance, and the quality of care that consumers receive are the most frequently cited problems" in the present medical delivery system. Disabled workers will also have their strife compounded by the fact that Congress anticipates an increase of 15% in basic Medicare premiums next year.

Workers’ compensation insurance usually covers medical conditions that "arise out of and are in the course of employment." Treatment extends to medical care that is reasonable and related to cure the work related condition and relieve the symptoms. Workers’ compensation was not intended to any for conditions that are not work related.

Medicare provides coverage to disabled workers and those who are over 65 years of age. It does not extend coverage to those conditions that are work related. In fact, Medicare, under the Medicare Secondary Payer Act (MSP), will seek reimbursement from the injured employee for those medical conditions related to the employment, but Medicare may have accidentally or conditionally paid for.

The Federal system now keeps a tight rein to avoid duplication of benefits. As of July 1, 2009, the workers’ compensation insurance carriers are now subject to mandatory reporting of those eligible or anticipated to be eligible for workers’ compensation benefits. Medicare seeks to participate in the review of any settlement in workers’ compensation by eligible beneficiaries through an elaborate voluntary scheme of workers’ compensation set aside agreements (WCMSA).

The coverage scenario is complicated further by so called “Medigap policies” sold by private insurance companies that provide supplemental health insurance to those on Medicare for services and benefits not covered by the Federal government.  The Kaiser Family Foundation reports, that “Most Medicare beneficiaries (89%) had some form of supplemental health insurance coverage in 2007. More than a third of all beneficiaries (34%) had coverage from an employer-sponsored plan, 22% were in Medicare Advantage plans, 17% purchased supplemental insurance (Medigap) policies, and 15% were covered by Medicaid (generally those with very low incomes and modest assets). Eleven percent [4.48 million] had no supplemental coverage [emphasis added].”

Those who lack coverage, avoid or forgo, medical care. Underlying medical conditions, even those that are work related, may become aggravated or accelerated. The “gap” in coverage for the some disabled workers, that exists in the system, creates additional risk factors for not only those that fall within the gap, but also as to general community health and well being.

The gap in disability insurance converge will need to be debated as Congress goes forward in the health care debate. As Speaker Nancy Pelosie (D-Calif) surveys Congress in anticipation of her final draft of a "public option," the discussion continues in Washington. A universal approach is warranted to bridge the gap for affordable and meaningful coverage.

To read more about "health care" and "workers' compensation" click here.

Commissioning The Federal Government for a New Workers' Compensation System

Legislation was recently introduced in Congress to re-establish a National Commission on State Workers’ Compensation Laws [Commission]. This attempt to recreate the almost 4 decades ago effort to evaluate uniformity of benefits, was introduced by a sole legislator, Representative Joe Baca [CA-43] and lacks any co-sponsorship or a duplicate effort in the US Senate.

The initial Commission I, 1972 Report of the National Commission on State Workmen's Compensation Laws, chaired by Professor Emeritus John Burton, looked the national patchwork of chaotic programs to provide uniformity of benefit delivery in the program almost 4 decades ago.

The 1972 report concluded: “We have concluded that there is a significant role for a modern workmen's compensation program and that the States' primary responsibility for the program should be conserved. We also agree that the protection furnished by workmen's compensation to American workers presently is, in general, inadequate and inequitable. Significant improvements in workmen's compensation are necessary if the program is to fulfill its potential.”

The bottom line is that the national system is a hodgepodge of state workers’ compensation laws that are not at all functional in today’s economic/medical market. The times changed since the original enactment of multiple state enactments in 1911. The present program has indeed out lived its usefulness. Over the decades many stakeholders have become preoccupied with economic considerations that have far seriously degraded human considerations.

A national review at the Federal level is a welcome sign that The Administration is using a thoughtful approach to change. This path must embrace the workers’ compensation medical delivery system into universal health care.