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Tag: 2016 News

Governor Vetoes Bill Exempting Comp Policy Oversight

Current law authorizes workers’ compensation insurance policies to be either standard, guaranteed premium policies, or deductible policies and requires insurers to file workers’ compensation insurance policies and endorsements with the WCIRB. The WCIRB is the insurance commissioner’s designated statistical agent for workers’ compensation purposes. There are a range of functions the WCIRB performs on behalf of and with the approval of the commissioner.

Insurers are prohibited from the use of the policy or endorsement until 30 days have passed, or the commissioner has approved the filing. It is unlawful for an insurer to use an ancillary agreement if the commissioner notifies the insurer that the agreement does not comply with the law

AB 1922 was introduced this legislative session to modify this requirement. It attempted to establish exceptions from workers’ compensation insurance policy filing requirements for large employers that purchase high deductible policies. It was supported by the American Insurance Association (AIA), the California Chamber of Commerce, Liberty Mutual Insurance, and the National Association of Mutual Insurance Companies (NAMIC).

It was opposed by the California Department of Insurance. It however was approved by both houses of the legislature and sent to Governor Brown for signature. He vetoed the law.

In his veto message he said “I am supportive of efforts to increase the ability of insurance carriers to efficiently conduct their business. This bill, however, reverses Department of Insurance regulations that have been in effect less than six months. These regulations are designed to promote consumer protection and transparency. Let’s allow time for them to work.”

And the Insurance Commissioner was appreciative of his Veto. “I thank Governor Brown for his thoughtful and reasoned veto of AB 1922,” Commissioner Jones said. “I opposed the bill, because it would have created a loophole enabling workers’ compensation insurers to limit or avoid prior review of terms and conditions imposed on businesses. AB 1922 undercut the Department of Insurance’s ability to protect businesses from becoming victimized by some workers’ compensation insurer contracts and it would have resulted in more litigation between businesses and insurers. The bill was bad for employers of all sizes.”

Recent cases highlighted problems when CDI lacks oversight.

Last month, after the department served on them an order to show cause why the insurers should not be barred from selling the policies, two Berkshire Hathaway companies agreed to stop selling certain workers’ compensation policies with provisions not filed with CDI. The policies had serious and unexpected negative consequences for many California employers, including cancellation penalties of $1 million, non-renewal penalties, provisions shifting most if not all of the risk back to the employer, and provisions requiring any disputes with the insurer to be resolved in the British Virgin Islands under Nebraska law. These unfiled policies were successfully challenged by Shasta Linen, a small business in Sacramento.”

A range of business groups joined the Insurance Commissioner in opposing the bill, including the California Hispanic Chambers of Commerce, the California Small Business Association, the Asian Business Association, and the Sacramento Rainbow Chamber of Commerce.

Property/Casualty Association Responds to DOL Critique

A new report from the Labor Department had harsh words for the current condition of various state workers’ compensation systems.

For example, the DOL says “Despite the sizable cost of workers’ compensation, only a small portion of the overall costs of occupational injury and illness is borne by employers. Costs are instead shifted away from employers, often to workers, their families and communities. Other social benefit systems – including Social Security retirement benefits, Social Security Disability Insurance (SSDI), Medicare, and, most recently, health care provided under the Affordable Care Act – have expanded our social safety net, while the workers’ compensation safety net has been shrinking. There is growing evidence that costs of workplace-related disability are being transferred to other benefit programs, placing additional strains on these programs at a time when they are already under considerable stress.

The report calls for “exploration” of “the establishment of standards that would trigger increased federal oversight if workers’ compensation programs fail to meet those standards.”

Not unexpectedly, the report caused a firestorm of controversy, and industry rebuttal.

The Property and Casualty Insurers Association of America is composed of nearly 1,000 member companies, representing the broadest cross section of insurers of any national trade association.

PCI members write more than $183 billion in annual premium, 35 percent of the nation’s property casualty insurance. Member companies write 42 percent of the U.S. automobile insurance market, 27 percent of the homeowners market, 32 percent of the commercial property and liability market and 34 percent of the private workers compensation market. It is one of the major industry organizations that has formulated a response.

PCI says that “while the Department of Labor report highlights some of the challenges state workers compensation systems are facing, in many sections it provides an inaccurate assessment of how the system really works for the vast majority of injured workers.”

“Overall, today’s work environment is safer which means fewer workplace accidents. When workers are injured, on average they are receiving higher benefits than in the past, and health outcomes for injured workers have improved. This means workers are able to return to work sooner and resume productive employment. These improvements to the state workers compensation system have all been achieved without federal involvement.”

“While no system is perfect, the state-based system has significantly evolved and will continue to evolve. For over a century, state workers compensation laws have successfully sought to strike a balance between the interests of employers and their employees while promoting safe workplaces. State workers compensation systems guarantee that injured workers receive medical treatment at no cost to the worker and compensation for lost wages and permanent injury, while avoiding cost shifting to families and public assistance programs.”

“Employers and insurers are dedicated to supporting reforms that will improve the effectiveness of the state workers compensation system for all stakeholders. PCI and its members will continue to support reforms at the state level that are targeted to maintain an effective and balanced system for all stakeholders.”

Labor Contractor Gets 9 Months Sentence in Payroll Fraud Case

A Corcoran labor contractor who cheated a workers’ compensation insurer out of millions of dollars in premiums has been sentenced to nine months in jail,

Michael Harold Kreger, 63, of Visalia, owner of Michael Kreger Contracting, was sentenced in California Superior Court in Kings County after his conviction on three felony counts of insurance fraud with a white collar crime enhancement charge for cheating his workers’ compensation insurer out of more than $5.4 million in premiums.

After receiving a referral from Kreger’s workers’ compensation insurer, detectives from the California Department of Insurance launched an investigation into Kreger’s business practices.

The investigation included an audit of Kreger’s payroll records provided to his insurer and what he provided to the Employment Development Department, which revealed that for over four years Kreger intentionally underreported his payroll in order to mislead his workers’ compensation insurer and obtain artificially low workers’ compensation insurance premiums.

Kreger pleaded no contest to three felony counts of insurance fraud with a white collar crime enhancement.

He was released on house arrest and electronic monitoring after two days in jail, according to jail records.

“This case is a clear example of Kings County’s prosecution team standing up for every business owner and employee who is affected by fraudulent business practices that manipulate the system and seek financial gain at the expense of injured employees and upstanding business owner. I am proud of the contribution and work done by all the investigation teams, especially Deputy District Attorney Michael Casaus, Senior Investigator Nicole Lucero, and Legal Secretary Lynn Rikard on behalf of our office.” said Kings County District Attorney Keith Fagundes.

The Kings County District Attorney successfully prosecuted this case, leading to Kreger’s conviction and sentencing of 270 days (9 months) in jail, five years probation, 1500 hours of community service, and ordered restitution exceeding $5.4 million.

Feds May Consider State Workers’ Compensation Oversight

An article on the ProPublica/NPR website proudly announces that a “race to the bottom” in state workers’ compensation laws has the Labor Department calling for “exploration” of federal oversight and federal minimum benefits.

This announcement is the culmination of many ProPublica/NPR stories that featured injured workers who lost their homes, were denied surgeries or were even denied prosthetic devices recommended by their doctors.

The ProPublica/NPR series prompted a letter last fall from 10 prominent Democratic lawmakers, who urged Labor Department action to protect injured workers in the wake of a ProPublica/NPR series on changes in workers’ comp laws in 33 states. The ten ranking Democrats on key Senate and House committees claimed there was a “pattern of detrimental changes in state workers’ compensation laws” that have reduced protections and benefits for injured workers over the past decade.

The response to this letter was a report from the Labor Department that calls for “exploration” of “the establishment of standards that would trigger increased federal oversight if workers’ compensation programs fail to meet those standards.”

The report claims that there “have seen significant changes to the workers’ compensation laws, procedures, and policies in numerous states, which have limited benefits, reduced the likelihood of successful application for workers’ compensation, and/or discouraged injured workers from applying for benefits. These include changes that have resulted in the denial of claims that were previously compensated, a decrease in the adequacy of cash benefits to those awarded compensation, imposition of restrictions regarding the medical care provided to injured workers, and the institution of new procedural and evidentiary rules that create barriers for injured workers who file claims. In addition, the elimination by several state legislatures of Second Injury Funds – that is, state-administered funds that provide compensation for injuries not otherwise covered – creates additional holes in the fabric of insurance and coverage.

The agency also suggests a fresh look at reestablishing a 1972 Nixon administration commission that recommended minimum benefits and urged Congress to act if states failed to comply.

To clearly understand the implications of this recommendation, it is important to know the history of the financial waste triggered by the Nixon Commission report after it was published in 1972. In essence, the report was critical of just about every aspect of the various state workers’ compensation systems, and recommended improvements or enhancements to every specie of benefits. If states did not improve their programs in conformity to these recommendations, there was a threat of a federal takeover of all state systems.

For example, the Nixon Commission concluded in 1972 that “Many disabled workers fail to receive vocational services partly because they are not aware of their rights, partly because they lack motivation because of a fear they will lose compensation benefits if rehabilitated, and partly because they cannot afford the out-of-pocket costs of maintenance during instruction.”  Thus the report went on to “recommend that the medical-rehabilitation division within each State’s workmen’s compensation agency be given the specific responsibility of assuring that every worker who could benefit from vocational rehabilitation services be offered those services”.

A few years later, California, as well as many other states, appeased the federal government by adopting some of the Nixon Commission mandates. For example California adopted mandatory vocational rehabilitation. The history of that financial disaster is well documented. Rehabilitation programs easily cost more than $100,000 per claim and rarely produced a return to work outcome. A whole cottage industry of vendors grew around the program. The futility of the program became apparent about 20 years later when a $16,000 cap was placed on the costs of a rehabilitation program. That “reform” was subsequently ineffective, so vocational rehabilitation as a program was scrapped, and instead there have been various forms of training vouchers that pay for training, but no financial benefit to the worker directly. The voucher program is largely unused.

If someone were to add up the industry costs of vocational rehabilitation alone from its birth to its death, it would be a staggering amount of wasted money, spent mostly to appease the federal wonks who thought they knew what they are doing.

With this history in mind, the big question is “is the industry about to face another costly Nixon Commission redux?”

Another Major Hospital Chain Resolves Fraud Charges for $.5 Billion

A major U.S. hospital chain, Tenet Healthcare Corporation, and two of its subsidiaries will pay over $513 million to resolve criminal charges and civil claims relating to a scheme to defraud the United States and to pay kickbacks in exchange for patient referrals.

In addition, two Tenet subsidiaries have agreed to plead guilty to conspiracy to defraud the United States and to pay health care kickbacks and bribes in violation of the Anti-Kickback Statute (AKS). The plea agreements remain subject to acceptance by the court. Up until April 2016, Tenet subsidiaries Atlanta Medical Center Inc. and North Fulton Medical Center Inc. owned and operated acute-care hospitals located in the greater Atlanta metropolitan area.

These subsidiaries were charged in a criminal information filed in federal court in Atlanta with conspiracy to defraud the United States by obstructing the lawful government functions of HHS and to violate the AKS, which, among other things, prohibits payments to induce the referral of patients for services paid for by federal health care programs. The two Tenet subsidiaries have agreed to plead guilty to the charges alleged in the criminal information and will forfeit over $145 million to the United States – which represents the amount paid to Atlanta Medical Center Inc. and North Fulton Medical Center Inc. by the Medicare and Georgia Medicaid programs for services provided to patients referred as part of the scheme.

And this is not the first offense! The criminal information also charges the subsidiaries with conspiring to defraud HHS in its administration and oversight of the Medicare and Medicaid Programs, including HHS-OIG’s enforcement of Tenet’s September 2006 corporate integrity agreement (the CIA). The criminal information and the civil complaint allege that many of the unlawful payments happened while Tenet was under the CIA. The criminal information further alleges that certain executives of Atlanta Medical Center Inc., North Fulton Medical Center Inc. and others concealed these unlawful payments from HHS-OIG during the pendency of the CIA by, among other things, falsely certifying compliance with the requirements of the CIA and failing to disclose reportable events relating to the unlawful relationship under the CIA.

Tenet HealthSystem Medical Inc. and its subsidiaries (collectively THSM) entered into a non-prosecution agreement (NPA) with the Criminal Division’s Fraud Section and the U.S. Attorney’s Office of the Northern District of Georgia related to the charges in the criminal information. THSM is the parent company of Atlanta Medical Center Inc., North Fulton Medical Center Inc., Spalding Regional Medical Center Inc. and Hilton Head Hospital, and employed their executives. THSM is a subsidiary of Tenet Healthcare Corporation. Under the terms of the NPA, THSM and Tenet will avoid prosecution if they, among other requirements, cooperate with the government’s ongoing investigation and enhance their compliance and ethics program and internal controls. Tenet has also agreed to retain an independent compliance monitor to address and reduce the risk of any recurrence of violations of the AKS by any entity owned in whole, or in part, by Tenet. The term of THSM’s and Tenet’s obligations under the NPA is three years, but the NPA may be extended for up to one year.

In the civil settlement, Tenet agreed to pay $368 million to the federal government, the state of Georgia and the state of South Carolina to resolve claims asserted in United States ex rel. Williams v. Health Mgmt. Assocs., Tenet Healthcare, et al., a lawsuit filed by Ralph D. Williams, a Georgia resident, in the Middle District of Georgia, under the federal and Georgia False Claims Acts. The acts permit whistleblowers to file suit for false claims against the government entities and to share in any recovery. The federal share of the civil settlement is $244,227,535.30, the state of Georgia will recover $122,880,339.70 and the state of South Carolina will recover $892,125. Mr. Williams’ share of the combined civil settlement amount is approximately $84.43 million.

As alleged in the criminal information as well as civil complaints filed by the department and the state of Georgia in 2014 and 2013, Atlanta Medical Center Inc., North Fulton Medical Center Inc., Spalding Regional Medical Center Inc. and Hilton Head Hospital paid bribes and kickbacks to the owners and operators of prenatal care clinics serving primarily undocumented Hispanic women in return for the referral of those patients for labor and delivery medical services at Tenet hospitals. These kickbacks and bribes allegedly helped Tenet obtain more than $145 million in Medicaid and Medicare funds based on the resulting patient referrals.

There seems to be no end in sight to corruption and fraud perpetrated by major national providers.

New Law Clarifies RFA Filing Requirements

Governor Brown signed AB 2503 into law. The new law will require a physician providing treatment to an injured worker to send any requests for authorization for medical treatment, with supporting documentation, to the claims administrator for the employer, insurer, or other entity according to rules adopted by the administrative director. The bill would also make technical changes to existing law. This new law would incorporate changes to Section 4610 of the Labor Code provided by this bill and the companion sweeping overhaul to the UR process specified in SB 1160 which has also been signed by the Governor.  They were in effect companion bills.

According to the author of this law, “it is often difficult for health care providers in the workers’ compensation system to obtain timely approval for treatment of injured workers because it is difficult to know where to send RFAs”.

“Whether it is intentionally complex systems, or bureaucratic inefficiency, physicians report that upon sending RFAs to what appears to be the correct recipient, they are frequently advised that the RFA and attendant medical materials must be sent elsewhere.”

Further, the timeframes within which responses from the UR entity must be provided do not begin to run until the RFA is sent to the “correct” location. The bill is intended to clarify where the RFA and related materials must be sent, so that the time frames specified in statute will be more effective.

According to the author and sponsor, the silence in existing law on where a physician should send a RFA is creating difficulty for healthcare providers and is creating delays in the provision of medical treatment.

Specifically, AB 2503 would require that a RFA is submitted directly to a claims administrator, rather than a UR vendor or some other third party. In doing so, AB 2503 will make precisely clear where a RFA should be submitted so that a request for medical treatment can be timely assessed, avoiding unnecessary delays.

The sponsor of this bill, the California Orthopaedic Association (COA), argued that existing law’s silence on where a physician should submit a request for authorization of medical treatment has the potential to create great mischief.

Specifically, COA notes that different employers/insurers have different policies for where a RFA should be submitted, which can lead to confusion for physicians. COA argues that, by specifically stating where a RFA must be submitted, AB 2503 will minimize confusion and delays, leading to better medical treatment for injured workers.

There was no opposition to this law noted in the legislative record.

Governor Brown Vetoes Proposed Extension of Police/Firefighter Benefits

Governor Brown vetoed SB 897. The proposed law would have extended an additional year of injury leave for city police officers, city, county, or district firefighters, and sheriffs if: 1) The injured worker is employed on a regular, full-time basis regardless of their period of service; 2) The injured worker suffers a “catastrophic injury at the hands of another” during active duty through the actions of another or through active firefighting operations without respect to the cause of the fire.

Proponents of the bill noted that California’s firefighters, police officers, and sheriffs face significant risks on the job, including a higher likelihood of injury. Proponents argue that the existing leave provisions reflect that, as the Governor and Legislature wanted to ensure that a peace officer facing those risks would not face financial devastation. Proponents argue that AB 897 continues this tradition by granting California’s firefighters, police officers, and sheriffs an additional year of leave in order to return to active duty after a catastrophic injury. Proponents note that this extra year will allow firefighters, police officers, and sheriffs to heal from their injuries and return to work when they can, rather than rush back to work still injured and possibly hurt themselves and others.

Opponents of the bill noted that, under current law, police officers, sheriffs, and firefighters have access to a year of paid leave under Labor Code Section 4850, as well as a year of 2/3 wage replacement through TD benefits, both of which are tax-free benefits. Opponents argue that these benefits are significant, and are paid out by self-insured cities and counties on a pay-as-you-go basis. Opponents argue that requiring additional disability benefits will require cities and counties to remove funding from existing services, without necessarily resulting in the injured police officer, sheriff, or fire fighter returning to work.

In Governor Browns veto message he said “This bill doubles from one to two years special leave benefits for police officers, firefighters, or sheriffs who are disabled by a qualifying catastrophic injury. This leave is required to be provided at full salary and tax-free, resulting in take home pay that is higher than pre-injury wages.”

“I was concerned when told this bill was prompted by a City of Riverside police officer who nearly lost his health benefits while on temporary disability. In that case, the City chose to extend the officer’s benefits. Upon closer review, I have not found any other city which terminates the health benefits of police officers while they are on temporary disability.”

“As noted in my veto of AB 1451 last year, this disability leave benefit drives up costs significantly. Many local agencies are under significant financial stress. They must consider employee benefit increases in light of competing demands for critical services and long term pension and health care debts. In light of all this, I believe the decision on how to handle cases such as this is best left to the local jurisdiction.”

Governor Approves Major Changes to UR Process

Governor Brown signed SB 1160 into law on the last day of the legislative session. This bill makes a series of significant, wide-ranging changes to the operation and UR processes, approval of UR processes, and lien filing and collection. This bill expedites medical care at the beginning of an injured worker’s claim, modernizes data collection in the workers’ compensation system, and implements anti-fraud measures in the filing and collection of liens.

Specifically, with respect to UR operation, this bill:

1) Provides that, with respect to medical treatment that is provided through a medical provider network (MPN), a health care organization (HCO), other employer-directed provider, or a pre-designated physician, no prospective UR may be undertaken for the first 30 days of treatment.
2) Provides several exceptions to the “no UR” rule, including surgery, medications not covered by the formulary, psychological treatment, non x-ray imaging, durable medical equipment (DME) if total costs for all DME exceeds $250, and home health care services.
3) Requires any treatment provided within the first 30 days to be reported to the employer or claims administrator – failure by the provider to properly report treatment can lead to revocation of the “no UR” rule.
4) Authorizes an employer to conduct retrospective UR to ensure compliance with evidence-based medicine standards, and if a pattern of non-compliance is discovered, the “no UR” rule could be revoked or the provider removed from the MPN.

With respect to UR Process Approval:

5) Prohibits explicitly an employer or claims administrator from providing a UR organization with financial incentives to deny or modify treatment.
6) Requires financial interest disclosure of UR entities be shared with DWC.
7) Requires any UR organization to be accredited by an entity specified by the DWC, subject to exceptions for certain public entities that have internal systems approved by the DWC. The entity must be independent and non-profit. Until the rules are approved by the AD, the entity will be URAC.
8) Provides authority to the DWC to approve UR processes.

With respect to UR and Medical Guideline Modernization:

9) Requires, through the URAC accreditation process, the availability of peer-to-peer communication in the event of a UR modification or denial.
10)Requires the AD to develop a mandatory electronic system for sharing documents necessary to conduct UR.
11)Adopts new procedures designed to better facilitate delivery of information for purposes of IMR.
12)Establishes an expedited five-day time frame for IMR decisions related to medications on the formulary.
13)Provides that MTUS may be updated with evidence-based medicine standards by an expedited process.

With respect to Anti-Fraud Measures:

14)Requires, for liens filed on or after January 1, 2017, a lien filer to specify in the lien filing the basis upon which the lien is authorized.
15)Requires these same data elements to be added to pre-existing liens, but allows until July 1, 2017, for lien filers to comply.
16)Provides that the failure to comply with the requirements noted above results in a dismissal of the lien with prejudice.
17)Provides that in the event a lien filer is charged with workers’ compensation fraud, Medi-Cal fraud, or Medicare fraud, all liens are stayed pending resolution of the charges.
18)Prohibits, for liens on or after January 1, 2017, any assignment of liens unless the person has ceased doing business in the capacity held at the time the expenses were incurred and has assigned all rights, title, and interest in the remaining accounts receivable to the assignee. The assignment of a lien, in violation of this paragraph is invalid by operation of law.
19)Clarifies existing law on liens assigned between 2013 and 2016 by codifying Chorn v. WCAB (Workers’ Compensation Appeals Board) (2016), 2016 Cal. App. LEXIS 232 and states these amendments to be declaratory of existing law.

Governor Vetos CAAA Sponsored Limits on Apportionment

Governor Brown vetoed Assembly Bill 1643. This bill would have prohibited apportionment in cases of physical injury based on pregnancy, menopause, osteoporosis, and carpal tunnel syndrome and requires that breast cancer not be less than the comparable impairment rating for prostate cancer.

The sponsor of this bill, the California Applicants’ Attorneys Association (CAAA), argues that AB 1643 will eliminate gender bias from apportionment when determining permanent disability ratings. CAAA argues that factors such as pregnancy and menopause are used as factors to lower permanent disability. CAAA also cites several cases where apportionment is purported to have occurred due to risk factors and immutable characteristics, rather than proven conditions. CAAA also notes that AB 1643 will make breast cancer eligible for the same disability rating as prostate cancer. Finally, CAAA argues that the workers’ compensation system treats being a woman as a pre-existing condition, and that AB 1643 will ensure that women receive the level of permanent disability they deserve.

In his veto message the Governor said “I am vetoing this bill for many of the same reasons that I returned a similar measure, AB305, last year. This bill is poorly drafted and reflects a seriously flawed understanding of both the workers’ compensation system and the nature of physical disability that may result from a workrelated injury. The bill would, among other provisions, mandate that impairment ratings for breast cancer be no less than the ratings for prostate cancer. It would also create broad genderbased exceptions to the core principle of apportionment: that employers are liable only for the permanent disability directly caused by their employee’s work-related injury.”

“This measure seeks to draw a false comparison between disability ratings resulting from prostate and breast cancers, notwithstanding that these organs neither perform analogous physiological functions nor do their treatments result in similar physical limitations. There is a wide disparity in impairment levels that may result among individual women diagnosed with breast cancer and individual men diagnosed with prostate cancer, and individuals of all genders diagnosed with any form of cancer, depending on the stage at which the cancer was diagnosed, the nature of the treatment, and the degree and process of recovery. The suggestion that these two very different conditions should be rated equivalently in all cases has no basis in medical fact and upends the goals of ensuring consistency, uniformity and objectivity in ratings supported by substantial medical evidence.”

“On the issue of apportionment, this bill creates broad, gender-based exceptions to the rule that employers are liable only for the percentage of permanent disability directly caused by a workrelated injury. As written, the bill would prohibit apportionment to, and thus require emplbyers to pay for, a permanent disability that actually resulted from pregnancy or menopause, or from osteoporosis or carpal _tunnel syndrome where these are preexisting conditions or unrelated to work.”

“As I said last year, there is no place for gender discrimination in the workers’ compensation system. Current law, however, already prohibits apportionment to risk factors, including gender, age, and family history. There is ample opportunity within the workers’ compensation adjudicatory process for workers, their counsel, and others to raise any concerns or allegations of improper and impermissible gender discrimination in the medical evaluation or apportionment process.”

“California’s workers’ compensation system strives to treat all injured workers fairly and to ensure that all workers, regardless of gender, are adequately compensated for any permanent disability directly caused by work-related injuries. Rather than promoting equality, the statutory changes proposed by this measure would create new gender-based classifications and spur additional and costly litigation, undermining the successful reforms enacted in 20 12 and the sustainability of the system.”

“I urge proponents of this bill to support efforts to educate medical evaluators on current laws prohibiting bias and to collaborate with my administration.”

California Health Care Workers’ Claim Severity Treble National Average

Aon Global Risk Consulting, released its biennial Health Care Workers’ Compensation Barometer report, which explores trends in frequency, severity and overall loss rates related to workers’ compensation in the health care industry. The report finds that for the 2017 accident year, health care systems will face a complex environment of emerging risks that will have a direct impact on workers’ compensation.

The report, which analyzed data from approximately 1,600 heath care facilities across the country, found that while the severity of workers’ compensation claims has been increasing at a rate of two percent annually, the frequency of claims is expected to decrease one percent annually. The report also found that the industry should see loss rates increase by a projected one percent.

“As has been the case historically, the health care industry has experienced little volatility in workers’ compensation loss rates and, to augment that, claims frequency continues on a slow and steady decline,” said Martha Bronson, associate director and actuary for Aon Risk Solutions. “However, an aging workforce, safe patient handling issues and workplace violence are all emerging risks that need to be top of mind for the industry.”

Data from Aon’s 2016 Health Care Workers’ Compensation Barometer report finds that workers’ compensation claim costs increase as health care workers age, with the majority of those claims resulting from injuries to the back and shoulders. Fifty three percent of working nurses – a demographic that is the most frequently injured – are over the age of 50. A likely consideration for controlling these types of claims in the future and helping to ensure a healthy and safe workforce is education, specifically mentoring of the younger nursing population. While the report found that 58 percent of respondents have a program that develops younger workers, 61 percent do not have policies or programs that help transition older workers to a different work setting.

Aon’s Health Care Workers’ Compensation Barometer report also provides statistical information on historical frequency, severity, and overall loss rates specific to 11 states. Notably, the report finds that loss rates in California are almost double the countrywide rate and that claims severity is nearly three times that of the countrywide average of $23,950.

While loss prevention was the area of most concern for respondents, safe patient handling policies and controls are also top-of-mind in regards to minimizing risk of injury to health care workers. The report’s findings suggest that focusing on patient handling initiatives and best practices can aid in preventing workers’ compensation claims, thus helping mitigate both concerns. The average cost of a claim for systems that use Safe Patient Handling and Mobility standards is lower versus a facility that does not – $6,000 versus $7,800 – and overall these standards have reduced the incidence of health care worker injuries by up to 95 percent.

An alarming number of survey respondents – 91 percent – have experienced workplace violence in the past three years. However, approximately half of respondents indicate they are prepared for such an incident, with another 27 percent being very prepared. Eighty-one percent of respondents have a formal Workplace Violence Prevention Policy in place.

Dominic Colaizzo, chairman and U.S. Health Care practice leader for Aon Risk Solutions added, “While we recognize these emerging risks that are facing our industry in the year ahead, we also see that health care systems are ahead of the game. They are adhering to standards and utilizing best practices that are no doubt having a direct, positive effect on the number of workers’ compensation claims.”