Risk Insider: Marilyn Rivers

Enforcing Safety Rules in Summer is Challenging

By: | July 22, 2016 • 2 min read
Marilyn Rivers is director of risk and safety for the City of Saratoga Springs. She chairs the PRIMA Institute for the Public Risk Management Association and is chairperson of the RIMS Standards and Practice Council. She was named Public Risk Manager of the Year by PRIMA in 2007. She can be reached at [email protected]

Summer is the “high season” for construction and maintenance. It’s time to pave our roadways, stripe them, install crosswalks, pour sidewalks and take a stringent approach to building and property maintenance.

Inevitably, public risk professionals deal with public works departments who choose to go it alone to “get the job done.” More often than not, risk managers hear the complaints of limited funding and resources, and of a lack of understanding by risk professionals that corners have to be cut wherever possible in order to meet deadlines.

I’m particularly fond of the hot sultry days that are perfect for roof repair. We all get that priceless phone call from the community called “Man on the Roof.”

The phone rings and a lady on the phone commends me for the bare-shirted muscular employee on a city building roof enjoying the sun. “Dear … your employee is in fantastic shape and lovely to look at, but shouldn’t you be out there reminding him to wear his safety gear?”

Risk professionals need to personalize their safety message to a level of understanding that each employee can rationalize, understand and make part of their persona.

“Yes, Madam. Might you tell me the location of my employee?”

As you get to the job site you find your employee shirtless, barefooted, in shorts and sitting on the edge of the roof’s eves … throwing OSHA to the wind and every other safety talk you ever gave.

Patience is a virtue … sometimes.

Paving you ask? Shorts, T-shirts wrapped around heads and not a safety vest in sight … they’re too hot in the summer and interfere with tan lines as a matter of practicality, we are told.

And those “flags and signs” you recently purchased to inform the public to be wary, to keep a distance and to stay out of the construction zone? They are often considered trivial because they are too difficult to remember on a hot summer day.

As safety professionals, we all strive to promote and enforce lifesaving “Rules of the Road” before, during and after our projects. Our law enforcement folks try and intercede when they pass by or receive complaints when we can’t get there fast enough.

A poignant and effective sign promoted by the National Work Zone Safety Information Clearinghouse I often see in roadwork is Slow Down – My Mommy (Daddy) Works Here. It serves a reminder to the general public and more importantly our public works professionals that their lives are important.

You’ll note, I’ve identified folks as “public works professionals.” It’s an argument I often have with employees who are out on the road maintaining highways, fixing buildings and improving infrastructure.

I advocate respect and a recognition that public works is difficult work. It’s often dirty and messy and well, it’s work that requires perseverance in the worst of weather when we need them the most.

Safety is personal because it belongs not only to the employee, but to their partners, spouses, extended families and their dogs and … even their tarantulas.

Risk professionals need to personalize their safety message to a level of understanding that each employee can rationalize, understand and make part of their persona.

Safety needs to be a language unto itself that is universally accepted as the norm.

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Risk Insider: Jason Beans

Compounding and Rampant Care in Workers’ Comp

By: | July 12, 2016 • 2 min read
Jason Beans is the Founder and Chief Executive Officer of Rising Medical Solutions, a medical cost management firm. He has over 20 years of industry experience. He can be reached at [email protected]

Compound prescription growth in workers’ compensation is a striking example of how the lack of consumer involvement can cause treatment to expand from reasonable to rampant care.

Compound drugs join physician dispensing, opioid overprescribing, vocational rehab and chiro overutilization to share a common story — from initial expansion, to industry and regulator response, to some degree of containment.

In each case, the provider is not doing anything necessarily illicit or illegal, and the practices themselves do serve a purpose in some specific situations.

Combining, mixing and altering a drug can make sense for patients with an allergy to a non-essential ingredient, like dyes. Patients who have difficulty swallowing oral medications may find topical, compound alternatives helpful.

But when there is an opportunity for profit — where patients have no financial incentive and/or there is no clear regulation to control costs — some providers will abuse this gap in the marketplace. Three signs of rampant medical care are:

  • Epidemic expansion
  • Questionable positive value and very real risk factors
  • Financial incentives for clinicians, consultants and other parties

California saw compound drugs, medical foods and co-packs grow in share of total medication expenses from 2.3 percent in January 2006, to 12 percent in early 2009. Pricing controls were weak then and remain so.

Seven years after that surge, independent research on efficacy is scarce. Laboratories and consultants are known to share in the profits with the prescribing physicians.

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We have seen the federal Food and Drug Administration (FDA) get involved in improving the hygiene of compounding labs, after 64 meningitis deaths were caused by contamination at a Massachusetts compounding pharmacy. But the FDA does not verify the safety or effectiveness of compounded drugs.

State oversight, not federal, will almost certainly drive the containment effort. The Texas drug formulary caused a 65 percent reduction in problematic use of “N” drugs for pain relief.

When there is an opportunity for profit — where patients have no financial incentive and/or there is no clear regulation to control costs — some providers will abuse this gap in the marketplace.

Researchers recently reported the not surprising, but depressing, finding that Texas physicians did not shift their patients to other drugs or non-pharmaceutical care. This implies that the risky prescriptions weren’t completely necessary in the first place.

Compound containment inroads can also be made at the ground-level practices of claims payer operations and managed care organizations. I have seen some medical management programs virtually eliminate opioid problems and similar progress is possible.

The extent to which pharmacy utilization best practices are currently being used to address compounding is unknown; however, we should have some data soon. The “Workers’ Compensation Benchmarking Study” just recently surveyed claims executives to understand the headway organizations are making to curb this issue as well as other rampant medicine issues.

Looking forward, I expect the industry will have a much better handle on compounding in the next three to five years, like its over-utilized predecessors.

Effectively applying past “lessons learned” will be key to reducing compound drugs’ share of the pharmacy market back to levels consistent with the very small percentage of prescriptions that actually require customization.

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Sponsored: Liberty Mutual Insurance

Buyers Beware: General Liability Outlook May be Shifting

Buyers should focus on building a robust GI program and risk management infrastructure to lessen the impact of emerging GI trends.
By: | July 5, 2016 • 6 min read

The soothing drumbeat of “excess capital” and “soft market” to describe the general liability (GL) market is a familiar sound for brokers and buyers. Emerging GL trends, however, suggest the calm may not last.

Increasing severity of GL claims may hit some sectors like a light rain at first, if they have not already, but they could quickly feel like a pelting thunderstorm in others. A number of factors could contribute to the potential jump in GL prices for certain industry segments or exposures, possibly creating “micro” or niche hard markets in the short-term, and maybe even turning the broader market over the longer-term.

“There are trends we’re seeing that will play out slowly. Industries that carry more general liability exposure will and have been hit first and hardest, but it won’t apply across the board initially,” said David Perez, Senior Vice President and Chief Underwriting Officer, for Liberty Mutual Insurance’s National Insurance Specialty operation. “There is ample capital in the market today, which allows a poor performing account to move its policy frequently from carrier to carrier. Poorer performing classes, however, will likely face increased pricing for GL policies and a reduction in capacity.”

The good news for buyers is that they can take action today to lessen the impact these trends and the evolving market may have on their GL programs.

David Perez on the state of the GL market.

Medical and Litigation Trends Drive Severity

One factor increasing claim severity is the rising cost of health care, driven both by greater demand and by medical inflation that is growing faster than the Consumer Price index.

The impact of rising medical costs on commercial auto is well-known. Businesses with heavy transportation exposures are finding it more difficult to obtain coverage, or are paying more for it.

That same trend will impact general liability, just on a slower and more fragmented basis.

LM_SponsoredContent“In light of these trends, brokers and buyers should seek to understand how effectively their current or potential insurers defend GL claims, particular in using evidence-based medicine to assess and value the medical portion of a claim, and how they can provide necessary care to claimants while still helping clients control their total cost of risk.”

— David Perez, Senior Vice President & Chief Underwriting Officer, National Insurance Specialty, Liberty Mutual Insurance

“It takes longer for medical inflation to register through the tort system in general liability than it does in auto liability (AL) because auto claims are generally resolved more quickly,” Perez said. “But the same factors affecting severity in AL also exist in GL and as a result, it’s foreseeable that we will not only see similar severity trends in GL, but they may in fact be worse than we’ve seen in commercial auto.”

Industries with greater exposure to severity in general liability claims should be the first wave of companies to notice the impact of medical inflation.

“Medical inflation will drive up costs across the board, but sectors like construction and product manufacturing have a higher relative exposure for personal injury lawsuits.”

The impact of medical inflation on the GL market.

Beyond medical inflation, two litigation trends are increasing GL damages. First, plaintiffs’ lawyers are seeking to migrate the use of life care plans—traditionally employed only for truly catastrophic injuries—to more routine claims.  Perez recalled one claimant with a broken thumb and torn ligaments who sought as much as $1 million in care for the injury for the rest of his life.

Second, the number of allegations of traumatic brain injuries (TBI) in GL claims is growing.  It can be difficult to predict TBI outcomes initially and poor outcomes can be expensive and long tailed.

“In light of these trends, brokers and buyers should seek to understand how effectively their current or potential insurers defend GL claims, particular in using evidence-based medicine to assess and value the medical portion of a claim, and how they can provide necessary care to claimants while still helping clients control their total cost of risk,” notes Perez.

Changing Legal Landscape

Medical inflation and litigation trends are not the only issues impacting general liability.

Unanticipated changes in court interpretations of policy language can throw unexpected pressure on GL pricing and capacity.

Courts sometimes issue rulings interpreting policy language in a manner that expands coverage well beyond the underwriter’s original intent. Such opinions may sometimes have a retroactive effect, resulting in an immediate impact on not only open, but also closed cases in some circumstances.

Shifts in the Marketplace

In addition to facing price increases, GL brokers and buyers will be challenged by slightly shrinking capacity due to consolidation and repositioning among carriers in the marketplace. “Some major carriers have scaled back their GL writing, resulting in a migration of experienced senior management. As these executives leave, they take their GL expertise and relationships with them, resulting in fewer market leaders and less innovation,” Perez said.

“Additionally, there are new carriers coming into the business that may not have the historical GL loss data to proactively identify trends or the financial strength and experience to effectively service their GL customers and brokers. Both trends make it important for brokers and buyers to work with an insurer that is committed to the GL market and has the understanding and resources to help better manage risks impacting customers.”

Last year saw a high level of mergers and acquisitions in the insurance industry. Buyers should take advantage of that disruption to re-evaluate their needs and whether their insurers are meeting them.  Or better yet, anticipating them.

What’s a Buyer to Do?

Buyers—and their brokers— should look to partner with insurers that can spot emerging trends and offer creative solutions to address them proactively.

What should buyers and brokers do, given the trends facing the GL market?

“Brokers and buyers should value insurers that have not only durability and a long history in the general liability business, but also a strong risk management infrastructure,” Perez said. “Your insurer should be able to help you mitigate your specific risks, and complement that with coverage that works for you.”

Beyond robust GL claims and legal management, Liberty Mutual also provides access to one of the insurance industry’s largest risk control departments to help improve safety and mitigate both claim frequency and severity.

In addition, notes Perez, “Even if a company has a less than optimal loss history in general liability, there can be options to provide adequate coverage for that company. The key is to partner with an insurer that has the best-in-class expertise, creativity, and flexibility to make it happen.”

By working closely with their insurers to understand trends and their potential impacts, brokers and buyers can better prepare for the possible GL storm on the horizon.

To learn more about Liberty Mutual’s general liability offering, visit https://business.libertymutualgroup.com/business-insurance/coverages/general-liability-insurance-policy.

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This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Liberty Mutual Insurance. The editorial staff of Risk & Insurance had no role in its preparation.

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Liberty Mutual Insurance offers a wide range of insurance products and services, including general liability, property, commercial automobile, excess casualty, workers compensation and group benefits.
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