Tag: 2018 News

The Workers’ Compensation Insurance Rating Bureau (WCIRB) has prepared a new report containing estimated California workers’ compensation costs for 2017 based on insured employer experience. The report also reflects payments made by the California Insurance Guarantee Association (CIGA)

Key findings in the report include:

Total insurer combined losses and expenses incurred in 2017 were $16.2 billion, or 91% of calendar year premium, compared to $16.9 billion (or 94% of calendar year premium) in 2016.

Calendar year 2017 earned premium totaled $17.7 billion (as compared to the $18.0 billion of premium earned in 2016).

Medical losses paid in 2017 were $4.7 billion, or 56% of total loss payments. Of these payments, $1.3 billion were paid for physician services, $1.3 billion were payments made directly to injured workers, $0.7 billion were paid for inpatient or outpatient services, $0.2 billion were paid for pharmaceuticals, and $0.3 billion were paid for medical-legal evaluations.

Beginning with claims incurred on policies incepting on or after July 1, 2010, the cost of medical cost containment programs is required to be reported to the WCIRB as allocated loss adjustment expense rather than as medical loss.The total cost of medical cost containment programs in 2017 was $443 million compared to $468 million in 2016.

Indemnity benefits paid in 2017 were $3.7 billion, or 44% of total loss payments. Of this amount, temporary disability benefits paid totaled $1.8 billion and permanent partial disability benefits paid totaled $1.5 billion.

Medical-legal cost data for 2017 shows that orthopedic evaluations accounted for about 55% of the cost of all medical-legal evaluations. The exhibits also show that the average cost of a medical-legal evaluation was $1,496. Psychiatric evaluations were the most expensive, averaging $3,268.

Incurred loss adjustment expenses (allocated and unallocated) in 2017 were $3.3 billion, or 19% of earned premium. (This includes the full cost to insurers of administering, adjudicating and settling claims.) Incurred loss adjustment expenses include $894 million in defense attorney expenses incurred in 2017. (For comparison purposes, in 2016, incurred loss adjustment expenses were 16% of earned premium, including $827 million in defense expenses.)

In total, California insurers have incurred about $6.7 billion in expenses in 2017, or 38% of 2017 earned premium. (For comparison purposes, in 2016, total incurred expenses were 34% of earned premium.)

Although generally part of incurred indemnity losses rather than expenses, the amount paid in 2017 to applicant attorneys was derived from the WCIRB’s Annual Expense Call. In 2017, applicant attorneys were paid $413 million. (In 2016, applicant attorneys were paid $408 million.)

A survey conducted among the tech workers, including many employees of Silicon Valley’s elite tech companies, has revealed that over 57% of respondents are suffering from job burnout.

The survey was carried out by the team at Blind, an anonymous IM and work conditions review app used by the employees of many top tech firms, such as Microsoft (40K+ users), Amazon (25K+ users), Google (10K+ users), Uber (7K+ users), LinkedIn (5K+ users), and Facebook (5K+ users). Over 11,000 employees at top tech companies responded

From May 12 through May 21, the Blind team asked the app’s users an anonymous question – if they currently suffered from workplace burnout. According to Blind, 11,487 users answered the question, and 57.16% said “Yes” – that they are currently suffering from occupational burnout.

The company with the highest employee burnout rate was Credit Karma, with a whopping 70.73%, followed by Twitch (68.75%), Nvidia (65.38%), Expedia (65.00%), and Oath (63.03% —Oath being the former Yahoo company Verizon bought in July 2017).

On the other end of the spectrum, Netflix ranked with the lowest burnout rate of only 38.89%, followed by PayPal (41.82%), Twitter (43.90%), Facebook (48.97%), and Uber (49.52%).

“The results for Netflix and Credit Karma seem to reflect what users are saying about these companies on Blind,” the Blind team said.

“Netflix is mostly described as a desirable place to work with high compensation, balanced hours, and supportive coworkers – conditions that reduce the risk of burnout. The most negative comment you’ll likely find is that Netflix has a defined culture that can be “cultish” but you’ll rarely find a post that says the company is toxic.

“Credit Karma has more mixed and polarized reviews: Some employees say that Credit Karma is one of the best companies they’ve worked for, with tight-knit teams and a higher than average number of women in leadership roles. Then there are others who accuse the company of discrimination, harassment, and workplace politics – a recipe for a toxic work environment, which can increase the risk of experiencing dissatisfaction and burnout.”

The Blind team warns that if these companies ignored this survey, the presence of work burnout could lead to health issues among its employees, such as insomnia, depression, substance abuse, and coronary heart disease, which could incur additional healthcare-related expenses and diminish the workforce’s productivity.

Furthermore, burnout cannot be ignored by HR departments and is often a first sign that employees might soon decide on another career path and leave the company.

A Kronos study from January 2017 revealed that 46% of HR departments blamed work burnout as responsible for up to half of their annual workforce turnover.

The U.S. health regulator approved GW Pharmaceuticals Plc’s epilepsy treatment on Monday, making it the first cannabis-based drug to win approval in the country and opening floodgates for more research into the medicinal properties of cannabis.

The drug’s approval permits its use in patients aged two years and older with Dravet Syndrome (DS) and Lennox-Gastaut Syndrome (LGS), rare childhood-onset forms of epilepsy that are among the most resistant to treatment.

“This approval serves as a reminder that advancing sound development programs that properly evaluate active ingredients contained in marijuana can lead to important medical therapies,” said Food and Drug Administration Commissioner Scott Gottlieb.

According to the report in Reuters Health, the drug, Epidiolex, is made up of cannabidiol (CBD), one of the hundreds of molecules found in the marijuana plant, and contains less than 0.1 percent of tetrahydrocannabinol (THC), the psychoactive component that makes people high.

GW Pharma grows its own supply of cannabis in specialized glass houses in the United Kingdom to ensure uniformity in the genetic composition of the plants, which are then processed into a liquid solution of CBD.

Although THC can induce paranoia, anxiety and hallucinations, CBD has the opposite effect and has been cited by scientists as a potential treatment for mental health issues.

While supporters of legalizing marijuana say the decision is a step in the right direction, businesses reliant on the plant must contend with the federal government’s ban on its use.

Based on the potential for abuse, the Drug Enforcement Administration (DEA) categorizes chemicals into five schedules, with Schedule 1 substances – like marijuana and heroin – considered the most deadly and deemed to have no medical benefits.

As a result, Epidiolex’s launch remains at the discretion of the DEA, which must now evaluate the drug and consider reclassifying it as a substance that has medical properties, so as to allow GW to begin selling it.

GW said it expects the reclassification to occur within 90 days. The company has not yet set a price for the drug and said it would work with insurance providers to ensure the medicine would be covered under health plans.

Most patients with LGS and DS require multiple seizure medications and the majority are resistant to currently approved anti-epileptic drugs.

The two epilepsy forms are severe and associated with high rates of mortality. Some LGS patients have to wear helmets to avoid brain injuries from “drop seizures”, where muscles suddenly become limp and cause standing patients to collapse.

Epidiolex would also be the first approved therapy for DS, treatments for which are currently limited to a combination of seizure medication and drugs to prevent emergencies.

Treatments available for both disorders are far from perfect and some patients resort to buying “self-prescribed” CBD online or from unregulated vendor sites, Dr. Pavel Klein, founder of the Mid-Atlantic Epilepsy and Sleep Center, said.

At the 2018 NCCI Annual Issues Symposium, Paul Meeusen, from Swiss Re and B3i discussed a new technology concept for workers’ compensation – how blockchain can impact the insurance industry. So what exactly is blockchain?

Blockchain is defined as a digital data structure for identifying and tracking information across a network of computers. Blockchain provides a transparent and secure way to track and distribute the information. In insurance, we are talking about the information chain between the risk (policyholder) to the insurer, to the reinsurer and then to the capital markets.

A blockchain,is a continuously growing list of records, called blocks, which are linked and secured using cryptography. Each block typically contains a cryptographic hash of the previous block,a timestamp, and transaction data. By design, a blockchain is resistant to modification of the data. It is “an open, distributed ledger that can record transactions between two parties efficiently and in a verifiable and permanent way.”.

Blockchain was invented by Satoshi Nakamoto in 2008 to serve as the public transaction ledger of the cryptocurrency bitcoin. The invention of the blockchain for bitcoin made it the first digital currency to solve the double-spending problem without the need of a trusted authority or central server.

The bitcoin design has inspired other applications. While the blockchain has been subject to extreme hype, its true killer applications are likely to be in some of the most antiquated fields out there. And it has the capability to be a transformative force for industries like insurance, which requires the coordination and cooperation of many different intermediaries with different incentives.

And now technology leaders, such as IBM boast of bockchain implementations for the insurance industry. IBM claims that “technological disruption has come to insurance – and the smart risk management strategy is to embrace it. IBM Blockchain is radically transforming insurance operations with faster verifiable data exchanges, visibility for all parties, and transactions underpinned with pervasive security and trust.”

“IBM Blockchain records transactions on a provable, permanent ledger, so multiple parties can exchange data with increased transparency and security. This is particularly important for insurers dealing with sensitive financial and personal information, often with multiple parties involved.”

Insurance experts say today, we have a “man in the middle” problem. The person controlling the central ledger (often a broker) knows every detail on every transaction, but all the parties in the transaction are dependent entirely on that person for information. Under blockchain, all the information is in a shared online platform where all parties have access to it. This reduces the friction associated with risk transfer. There is no dispute over whether a premium was paid, a contract signed, an endorsement added, or a claim reported. All of that is updated real-time in the shared ledger.

And now the Insurance Journal reports that the Workers’ Compensation Insurance Rating Bureau in California is looking into using blockchain technology as a better, safer, way to get the workers’ comp carriers and agents and brokers access to the massive amount of data the WCIRB collects.

The organization isn’t stopping there. It’s funding efforts to look into using behavioral science, machine learning and other digital and technological innovations under an ongoing modernization effort.

Bill Mudge, president and CEO of the WCIRB, the provider of actuarial-based information and research and advisory rates for a state that comprises roughly one-fifth of all the nation’s workers’ comp premiums, talked about these changes with Insurance Journal.

Erwin Raul Mejia, 42, of Van Nuys, was sentenced to 10 years in state prison following his conviction on 10 felony counts of insurance fraud for his role in a staged auto collision ring that bilked insurers out of more than $700,000. Mejia was also ordered to pay $699,784 in restitution to six auto insurers, including over $420,000 to Nationwide Mutual Insurance Company.

Mejia, who was previously convicted of insurance fraud in 2005, pleaded guilty to 10 felony counts of insurance fraud in two separate cases, according to the Los Angeles County District Attorney’s Office.

Erwin Mejia played an integral role in a staged auto collision ring involving hundreds of suspects. Since October 2017, 25 additional arrests were made in connection with this organized ring, which in total has resulted in $1.7 million in losses to insurers.

Nine of those defendants have pleaded guilty to insurance fraud and gotten sentences of up to two years in county jail along with being ordered to pay a combined restitution of hundreds of thousands of dollars, according to the District Attorney’s Office.

The other defendants – who are awaiting a hearing to determine if there is enough evidence to require them to stand trial – include Melvin Galang Dungca, 47, whom prosecutors allege was the so-called “capper” who recruited businesses and individuals to take part in the alleged ring; and Edgar Omar Estrada Romero, a 39-year-old auto body shop owner charged with 35 felony counts of insurance fraud, according to the District Attorney’s Office.

The remaining defendants’ next court date is a preliminary hearing setting Aug. 10 in Department 103 of the Foltz Criminal Justice Center.

Mejia worked as a Material Damage Appraiser for Nationwide where he inspected damaged vehicles, prepared repair estimates, and issued checks to claimants for their damaged cars.

An investigation by the California Department of Insurance, which led to Mejia’s arrest in October 2017, revealed Mejia and additional suspects orchestrated an elaborate scheme to defraud insurers with paper collisions that never occurred or by intentionally damaging vehicles to submit fraudulent claims.

Mejia often inflated the damages to the cars in his estimates and even wrote estimates for cars that were not actually damaged. He and a capper recruited people to insure vehicles and make fraudulent claims resulting in 70 fraudulent claims.

After leaving Nationwide, Mejia worked as a claims adjuster at MetLife Insurance in Nevada where he continued his scheme adjusting known fraudulent claims. Mejia issued settlement checks to the claimants that were redirected to a friend in Los Angeles who was cashing the checks.

After leaving MetLife, Mejia went to Fred Loya Insurance and then on to Kemper Insurance. Additional victim insurers include State Farm, Wawanesa, and Mercury who were affected by the fraudulent claims generally as the second party involved, for example the claimant party.

The Los Angeles County District Attorney’s Office prosecuted this case. The same office convicted Mejia on a prior insurance fraud charge in January 2005.