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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

Speakers:

  • 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.

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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

Panelists:

  • 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.

Speakers:

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

Moderator:

  • 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.

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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

Speakers:

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

Moderator:

  • Thomas A. Robinson, J.D., workcompwriter.com

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

Speaker:

  • 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

Panelists:

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

Moderator:

  • 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 riskletters@lrp.com.
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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

Speakers:

  • 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.

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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

Speakers:

  • 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

Speakers:

  • 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.

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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

Speakers:

  • 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

Presenters:

  • 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

Speaker:

  • 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.

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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 riskletters@lrp.com.
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Sponsored: Aspen Insurance

A Modern Claims Philosophy: Proactive and Integrated

Aspen Insurance views the expertise and data of their claims professionals as a valuable asset.
By: | August 3, 2014 • 4 min read
SponsoredContent_Aspen

According to some experts, “The best claim is the one that never happens.”

But is that even remotely realistic?

Experienced risk professionals know that in the real world, claims and losses are inevitable. After all, it’s called Risk Management, not Risk Avoidance.

And while no one likes losses, there are rich lessons to be gleaned from the claims management process. Through careful tracking and analysis of losses, risk professionals spot gaps in their risk control programs and identify new or emerging risks.

Aspen Insurance embraces this philosophy by viewing the data and expertise of their claims operation as a valuable asset. Unlike more traditional carriers, Aspen Insurance integrates their claims professionals into all of their client work – from the initial risk assessment and underwriting process through ongoing risk management consulting and loss control.

This proactive and integrated approach results in meaningful reductions to the frequency and severity of client losses. But when the inevitable does happen, Aspen Insurance claims professionals utilize their established understanding of client risks and operations to produce some truly amazing solutions.

“I worked at several of the most well known and respected insurance companies in my many years as a claims executive. But few of them utilize an approach that is as innovative as Aspen Insurance,” said Stephen Perrella, senior vice president, casualty claims, at Aspen Insurance.

SponsoredContent_Aspen“We do a lot of trending and data analysis to provide as much information as possible to our clients. Our analytics can help clients improve upon their own risk management procedures.”
– Stephen Perrella, Senior Vice President, Casualty Claims, Aspen Insurance

Utilizing claims expertise to improve underwriting

Acting as adviser and advocate, Aspen integrates the entire process under a coverage coordinator who ensures that the underwriters, claims and insureds agree on consistent, clear definitions and protocols. With claims professionals involved in the initial account review and the development of form language, Aspen’s underwriters have a full sense of risks so they can provide more specific and meaningful coverage, and identify risks and exclusions that the underwriter might not consider during a routine underwriting process.

“Most insurers don’t ever want to talk about claims and underwriting in the same sentence,” said Perrella. “That archaic view can potentially hurt the insurance company as well as their business partners.”
SponsoredContent_AspenSponsoredContent_AspenAspen Insurance considered a company working on a large bridge refurbishment project on the West Coast as a potential insured, posing the array of generally anticipated construction-related risks. During underwriting, its claims managers discovered there was a large oil storage facility underneath the bridge. If a worker didn’t properly tether his or her tools, or a piece of steel fell onto a tank and fractured it, the consequences would be severe. Shutting down a widely used waterway channel for an oil cleanup would be devastating. The business interruption claims alone would be astronomical.

“We narrowed the opportunity for possible claims that the underwriter was unaware existed at the outset,” said Perrella.

SponsoredContent_Aspen
Risk management improved

Claims professionals help Aspen Insurance’s clients with their risk management programs. When data analysis reveals high numbers of claims in a particular area, Aspen readily shares that information with the client. The Aspen team then works with the client to determine if there are better ways to handle certain processes.

“We do a lot of trending and data analysis to provide as much information as possible to our clients,” said Perrella. “Our analytics can help clients improve upon their own risk management procedures.”
SponsoredContent_Aspen
SponsoredContent_AspenFor a large restaurant-and-entertainment group with locations in New York and Las Vegas, Aspen’s consultative approach has been critical. After meeting with risk managers and using analytics to study trends in the client’s portfolio, Aspen learned that the sheer size and volume of customers at each location led to disparate profiles of patron injuries.

Specifically, the organization had a high number of glass-related incidents across its multiple venues. So Aspen’s claims and underwriting professionals helped the organization implement new reporting protocols and risk-prevention strategies that led to a significant drop in glass-related claims over the following two years. Where one location would experience a disproportionate level of security assault or slip & fall claims, the possible genesis for those claims was discussed with the insured and corrective steps explored in response. Aspen’s proactive management of the account and working relationship with its principals led the organization to make changes that not only lowered the company’s exposures, but also kept patrons safer.

SponsoredContent_Aspen

World-class claims management

Despite expert planning and careful prevention, losses and claims are inevitable. With Aspen’s claims department involved from the earliest stages of risk assessment, the department has developed world-class claims-processing capability.

“When a claim does arrive, everyone knows exactly how to operate,” said Perrella. “By understanding the perspectives of both the underwriters and the actuaries, our claims folks have grown to be better business people.

“We have dramatically reduced the potential for any problematic communication breakdown between our claims team, broker and the client,” said Perrella.
SponsoredContent_AspenSponsoredContent_AspenA fire ripped through an office building rendering it unusable by its seven tenants. An investigation revealed that an employee of the client intentionally set the fire. The client had not purchased business interruption insurance, and instead only had coverage for the physical damage to the building.

The Aspen claims team researched a way to assist the client in filing a third-party claim through secondary insurance that covered the business interruption portion of the loss. The attention, knowledge and creativity of the claims team saved the client from possible insurmountable losses.

SponsoredContent_Aspen

Modernize your carrier relationship

Aspen Insurance’s claims philosophy is a great example of how this carrier’s innovative perspective is redefining the underwriter-client relationship. Learn more about how Aspen Insurance can benefit your risk management program at http://www.aspen.co/insurance/.

Stephen Perrella, Senior Vice President, Casualty, can be reached at Stephen.perrella@aspen-insurance.com.

This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Aspen Insurance. The editorial staff of Risk & Insurance had no role in its preparation.
This article is provided for news and information purposes only and does not necessarily represent Aspen’s views and does constitute legal advice. This article reflects the opinion of the author at the time it was written taking into account market, regulatory and other conditions at the time of writing which may change over time. Aspen does not undertake a duty to update the article.


Aspen Insurance is a business segment of Aspen Insurance Holdings Limited. It provides insurance for property, casualty, marine, energy and transportation, financial and professional lines, and programs business.
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