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NWCDC Preview

NWCDC Legal/Regulatory Solutions Track Preview

Breakout sessions for the Legal/Regulatory Solutions track of the 2014 National Workers’ Compensation and Disability Conference® cover temps, ethics, and exclusive remedy.
By: | August 18, 2014 • 4 min read
Topics: NWC&DC | Workers' Comp

The 23rd annual National Workers’ Compensation and Disability Conference® & Expo takes place Nov. 19-21 at the Mandalay Bay Resort and Casino in Las Vegas. The confer­ence is produced by LRP Publications, which also publishes Risk & Insurance®.

ConferenceHere’s a preview of the breakout sessions for the Legal/Regulatory Solutions track of the 2014 National Workers’ Compensation and Disability Conference®.

Turning the Workers’ Comp Settlement Into a Global Settlement: Tackling the General Release and Resignation


  • Jeffrey A. Kadis, partner, Hedrick Gardner Kincheloe & Garofalo LLP
  • Bill Wainscott, manager, Workers’ Compensation and Occupational Health, International Paper

Employers may face federal and state lawsuits if they apply the wrong approach when discussing employment separation with an injured employee whose workers’ comp claim is being litigated. Charges of wrongful termination, discrimination, and violations of the Americans with Disabilities Act can be leveled against them. The speakers will discuss ways employers and their insurers or claims service providers can coordinate to properly broach the worker’s separation and how to conduct a global settlement to avoid litigation.


They will offer ways to assess the circumstances that may allow a successful general release/resignation, discuss how to select the appropriate strategy for releasing contentious workers’ comp claimants, and address potential litigation problems when dealing with injured workers.

Top 10 Ways to Reduce Your Legal Expenses NOW


  • Jill Dulich, senior director, Marriott claims services
  • Richard Lenkov, partner, Bryce Downey & Lenkov LLC

Legal expenses in the workers’ comp system can be astronomical, especially in states such as California and Illinois that have high litigation expenses. It is incumbent on employers and payers to reduce and eliminate legal expenses immediately, suggest the speakers. The two will discuss ways employers can eradicate waste, cut through legal jargon, and get to the bottom line quickly.

Workers’ Compensation and Its Secondary Payers: Medicare and Medicaid.


  • Vernon Sumwalt, partner, The Sumwalt Law Firm
  • Tim Nay, founding principal, Law Offices of Nay & Friedenberg


  • Jennifer C. Jordan, general counsel, MEDVAL LLC

While the SMART Act has improved access to Medicare conditional payment information and streamlined MSP reimbursements, a new law strengthens Medicaid’s reimbursement rights, making them very similar to Medicare’s. Some experts question whether this may be the start of another trend to further enhance Medicaid’s secondary payer rights and address its future medical expenses. With the new law set to take effect October 2016, practitioners need to know if they will face long-term care expenses on top of Medicare set-asides and significant delays in settlements.


The attorney panelists will offer all the facts and discuss the adjustments employers can make to be in the best position.

Direct and Peripheral Attacks on the Exclusive Remedy Doctrine


  • Deborah G. Kohl, managing partner, The Law Offices of Deborah G. Kohl
  • Lex K. Larson, president, Employment Law Research Inc.


  • Thomas A. Robinson, J.D.,

The exclusive remedy doctrine serves as the foundation of the great “bargain” between employees and employers. But now, the lure of the large verdict has spawned both direct and peripheral attacks on the employer’s exclusivity defense. Questions have arisen as to whether federal RICO can be used as an end run around the exclusivity defense. If an employer denies a claim as nonwork-related, can it subsequently defend a civil suit with an exclusivity argument? Has the definition of “intentional injury” been so watered down that it is no longer a meaningful defense? The expert panelists will also discuss whether exclusivity is still a powerful tool for the employer. They will also evaluate the dangers of taking a legal position on a small claim that can be later used against the employer in a much larger tort action and discuss ways to recognize the types of employer/carrier activity that undermine the defense.

Ethics for HR Specialists, Risk Managers, and Claims Adjusters


  • Eugene F. Keefe, partner, Keefe, Campbell, Biery & Associates

The role of ethics in claims handling cannot be underestimated. For example, an employer may end up bearing responsibility for a vendor who acts in bad faith. Situations such as setting up Medicare set-aside accounts, dealing with HIPAA concerns, and addressing fraud should not lead to a company’s downfall. Veteran attorney Eugene Keefe will outline the risks and solutions to ethically challenging workers’ comp scenarios.

He will describe the genesis and development of ethics in the industry, review best practices for ethical handling of claims, and offer ways to recognize the risks involved when confronted with unethical decisions by others.

Temp Nation: Risks, Red Flags, and Injury Rates


  • Corey Berghoefer, senior vice president, Risk Management and Insurance, Randstad
  • Richard M. Jacobsmeyer, partner, Shaw, Jacobsmeyer, Crain & Claffey PC


  • Brad Bleakney, managing partner, Bleakney & Troiani
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The unprecedented growth of temporary workers since 2000 has picked up speed in recent years and continues to be a major trend in a stutter step economy. The speakers will examine a variety of resulting issues from temp workers’ high injury rates to underwriting workers’ comp coverage for employers using a large number of temps.

They will offer insight to interpret how employers can limit exposure when dealing with temp agencies and subcontractor contracts, manage any potential third-party liability concerns from using temp or borrowed employees, and examine case law involving the exclusive remedy doctrine when using temp or borrowed employees.

Nancy Grover is co-Chair of the National Workers’ Compensation and Disability Conference and Editor of Workers' Compensation Report, a publication of our parent company, LRP Publications. She can be reached at
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NWCDC Preview

Medical Management Track Addresses Costs, Reforms, and Outcomes

The NWCDC Medical Management track will offer sessions to help attendees with strategies fro improving outcomes while reining in costs.
By: | August 1, 2014 • 4 min read

The 23rd annual National Workers’ Compensation and Disability Conference® & Expo takes place Nov. 19-21 at the Mandalay Bay Resort and Casino in Las Vegas. The confer­ence is produced by LRP Publications, which also publishes Risk & Insurance®.

ConferenceWith medical overtaking indemnity as the main cost of workers’ comp claims in most jurisdictions, managing the medical component has become vitally important to the workers’ comp system. The Medical Management track addresses a variety of relevant issues. Sessions will include:

Improving Claim Outcomes Using Outcomes Based Networks


  • David Deitz, M.D., vice president, national medical director, CI claims, Liberty Mutual Insurance
  • Stephanie Perilli, senior director, medical health management, The Home Depot

Many workers’ comp practitioners are starting to believe that certain medical providers can make a difference in achieving the best outcomes. Effective partnerships among employers and payors can help engage providers who deliver the best care for injured workers.


Provider measurement strategies to assemble physician panels in multiple jurisdictions is another influencing factor, according to the speakers. They will share how to develop top quality medical networks and will explain how reviewing provider performance metrics has led to reduced workers’ comp and disability costs at The Home Depot. They will also demonstrate how employer engagement in the selection of provider panels may result in better outcomes and analyze various techniques and tools to measure physician quality.

Managing the Costs of Medical Containment and Cost Control Services


  • Charles F. Martin, managing director, casualty operations consulting leader, Marsh USA Inc.
  • Joe Picone, claim consulting practice leader, risk control and claim advocacy practice, Willis

Services to manage ever-increasing medical expenses are essential to help eliminate unnecessary care and inflated billing. But the very cost-control measures and services themselves can become part of the problem and generate unwarranted expenses, if not effectively overseen.

Martin and Picone will discuss analytics and options they believe can help improve return on investment from medical management services. They will demonstrate where unwarranted costs can creep into a workers’ comp program, how to apply strategies for eliminating such expenses, and evaluate medical management spend for optimal outcomes.

Medical Case Management: How to Position Your Program for Best Outcomes


  • Kim Weaver, regional manager, MHayes
  • Anita Weir, director, medical and disability management, corporate risk department, Safeway Inc.

Effective case management does not happen in a vacuum, say Weaver and Weir. Companywide planning that focuses on all aspects of the claim cycle is the best way to ensure the best outcomes.

The speakers, highly successful industry veterans, will share case management program strategies they say will help drive clinical quality, improve return to work, and reduce claim costs.


They will explain the elements included in a successful case management program, identify strategies to prevent or limit costly tail claims, and critique what they say are best practices in case management.

Modeling Managed Care for Program Impact


  • Barry Bloom, principal, The bdb Group
  • John Riggs, manager, workers’ compensation, Disneyland Resort
  • John Smolk, principal manager, workers’ compensation, Southern California Edison

Many practitioners find the wide range of managed care services expensive, complex, and difficult to measure. The speakers believe it is important to understand what to look for to determine which ones will deliver the best outcomes for the injured worker and greatest cost savings for a company. The speakers, representing two large self-insured employers and a national workers’ comp consultant, specifically will define the available managed care services; distinguish the most appropriate services, depending on program needs; illustrate how to get better clinical results for injured workers; and assess ways to construct managed care services that are most appropriate for a particular organization.

Health Care Reform: Strategies You Can Apply Now


  • Denise Zoe Gillen-Algire, director, managed care and disability corporate risk, Safeway Inc.
  • William Wilt, president, Assured Research

The speakers say the workers’ comp industry needs to stop theorizing on the potential impact of the Affordable Care Act and start acting in order to be prepared. Wilt, an industry leading actuary, and Gillen-Algire, an occupational health executive, will share data reflecting some of the ACA’s current impact on the industry as well as strategies to help organizations be better positioned for the future.

The two will define the ACA and discuss how it is impacting the workers’ comp system, interpret data showing the direct effects of health care reform, appraise a variety of future changes to the system resulting from the ACA, and discuss design strategies to prepare for health care changes.

How to Reduce Costs With a Wellness Program


  • Karen Curran, director, health risk management, Pinnacol Assurance

Wellness programs can do much more than many employers and payers think, says Curran. She says overwhelming evidence shows that a well-orchestrated program targeting employee health risks can have a significant impact on workers’ comp claims and costs. Curran, an expert on the subject, will outline the undocumented findings of an ongoing study and discuss ways companies can help improve employees’ health and reduce claims frequency, leading to better health and financial outcomes.


She will discuss the preliminary results of a groundbreaking program; show how workers’ comp fits into the overall spectrum of health promotion relative to the more traditional players such as health plans and wellness vendors; analyze documented data showing how health behavior and risk factors impact claims; and compare engagement strategies for small versus larger companies.

Nancy Grover is co-Chair of the National Workers’ Compensation and Disability Conference and Editor of Workers' Compensation Report, a publication of our parent company, LRP Publications. She can be reached at
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Sponsored Content by Helios

Medication Monitoring Achieves Better Outcomes

Having the right medication monitoring tools is increasingly beneficial.
By: | September 2, 2014 • 5 min read

There are approximately three million workplace injuries in any given year. Many, if not the majority, involve the use of prescription medications and a significant portion of these medications is for pain. In fact, prescription medications are so prevalent in workers’ compensation that they account for 70% of total medical spend, with roughly one third being Schedule II opioids (Helios; NCCI; WCRI; et al.). According to the U.S. Drug Enforcement Administration (DEA), between the years of 1997 and 2007, the daily milligram per person use of prescription opioids in the United States rose 402%, increasing from an average of 74 mg to 369 mg. The Centers for Disease Control and Prevention (CDC) reports that, in 2012, health care providers wrote 259 million prescriptions—enough for every American adult to have a bottle of pills—and 46 people die every day from an overdose of prescription painkillers in the US. Suffice to say, the appropriate use of opioid analgesics continues to be a serious issue in the United States.

Stakeholders throughout the workers’ compensation industry are seeking solutions to bend the curve away from misuse and abuse and these concerning statistics. Change is happening: The American College of Occupational and Environmental Medicine (ACOEM) and the Work Loss Data Institute have published updated guidelines to promote more clinically appropriate use of opioids in the treatment of occupational injuries. State legislatures are implementing and enhancing prescription drug monitoring programs (PDMPs). The Food and Drug Association (FDA) is rescheduling medications. Pharmaceutical manufacturers are creating abuse-deterrent formulations. Meanwhile payers, generally in concert with their pharmacy benefit manager (PBM), are expending considerable effort to build global medication management programs that emphasize proactive utilization management to ensure injured workers are receiving the right medication at the right time.


A variety of factors can still influence the outcome of a workers’ compensation claim. Some are long-recognized for their affect on a claim; for example, body part, nature of injury, state of jurisdiction, and regulatory policy. In contrast, prescribing practices and physician demographics are perhaps a bit unexpected given the more contemporary data analysis showing their influence on outcomes. Such is the case for medication monitoring. Medication monitoring tools promote patient safety, confirm adherence, and identify potential high-risk, high-cost claims. Three of the more common medication monitoring tools include:

  • Urine Drug Testing (UDT) is an analysis of the injured worker’s urine that detects the presence or absence of a specified drug. Although it is not a diagnosis, UDT results are generally a reliable indicator of what is present (and what is not) in the injured body worker’s system. The knowledge gained through the testing helps to minimize risks for undesired consequences including misuse, abuse, and diversion of opioids. With this information in hand, adjustments to the medication therapy regimen or other intervention activities can occur. UDT can also be an agent of positive change, as monitoring often leads to behavior modification, whether in direct response to an unexpected testing result or from the sentinel effect of knowing that medication use is being monitored.
  • Medication Agreements or “Pain Contracts” signed by the injured worker and their prescribing doctor serve as a detailed and well-documented informed consent describing the risks and benefits associated with the use of prescription pain medications. Medication agreements help the prescribing doctor set expectations regarding the patient’s adherence to the prescribed medication therapy regimen. They serve as a means to facilitate care and provide for a way to document mutual understanding by clearly delineating the roles, responsibilities, and expectations of each party. Research also suggests that medication agreements promote safety and education as injured workers learn more about their therapy regimen, its risks, and benefits.
  • Pill Counts quantify adherence by comparing the number of doses remaining in a pill bottle with the number of doses that should remain based on prescription instructions. Most often, physicians request pill counts at random intervals or the physician may ask the injured worker to bring their medication to all appointments. As a monitoring tool, pill counts can be useful in confirming proper use, or conversely, diversion activities.

On a stand-alone basis, these tools rank high on individual merit. When used together as part of a consolidated medication management approach, their impact escalates quite favorably. The collective use of UDT, Medication Agreements, and pill counts enhance decision-making, eliminating gaps in understanding. Their use raises awareness of potential high-risk, high-cost situations. Moreover, when used in concert with a collaborative effort on the part of the payer, PBM, physician, and injured worker, they can improve communication and align objectives to mitigate misuse or abuse situations throughout the life of a claim.


Medication monitoring can achieve better outcomes

The vast majority of injured workers use medications as directed. Unfortunately, situations of misuse and abuse are far too common. Studies show a growing trend of discrepancies between the medication prescription and actual medication-regimen adherence when it comes to claimants on opioid therapy (Health Trends: Prescription Drug Monitoring Report, 2012). In response, payers, working alongside with their PBM and other stakeholders, are deploying medication monitoring tools with greater frequency to verify the injured worker is appropriately using their medications, particularly opioid analgesics. The good news is these efforts are working. Forty-five percent of patients with previously demonstrated aberrant drug-related behaviors were able to adhere to their medication regimens after management with drug testing or in combination with signed treatment agreements and multispecialty care (Laffer Associates and Millennium Research Institute, October 2011).

In our own studies, we have similarly found that clinical interventions performed in conjunction with medication monitoring tools such as UDT reduces utilization of high-risk medications in injured workers on chronic opioid therapy. Results showed there was a decrease in all measures of utilization, driven primarily by opioids (32% decrease) and benzodiazepines (51% decrease), as well as a 26% reduction in total utilization of all medications, regardless of drug class. This is proof positive that medication monitoring can be useful in achieving better outcomes.

This article was produced by Helios and not the Risk & Insurance® editorial team.

Helios, the new name for the powerful combination of Progressive Medical and PMSI, is bringing the focus of workers’ compensation and auto-no fault pharmacy benefit management, ancillary services, and settlement solutions back to where it belongs—the injured party.
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