The best articles from around the web and R&I, handpicked by R&I editors.
Workers' Comp news and insights as well as columns and features from R&I.
Update on new scenarios as well as upcoming Risk Scenarios Live! events.

2014 Risk All Star: Elizabeth Ruff

Simply Peerless

Not long out of college, Elizabeth Ruff arrived at Peerless Industrial Group in June of 2011, tasked with taking control of workers’ compensation for the company. She soon discovered that the company had a culture of lost time and that really bothered her.

“She said, ‘We’ve got to put a stop to this hemorrhaging,’ ” recalled her boss, Vice President of Human Resources Barbara Breza.

Elizabeth Ruff, human resources generalist, Peerless Industrial Group

2014 ri, human resources generalist, Peerless Industrial Group

Ruff was intent on getting employees back to work, in some capacity, as soon as possible.

“One of the first things I initiated is that whenever somebody was injured on the job and they required immediate medical attention, either myself or Barb would actually go with the employee to the health care provider’s office and sit with them,” said Ruff.

“The reason that was really key was because we were able to talk to the doctor about the fact that Peerless accommodates almost every type of light duty or transitional option,” Ruff added.

Before Ruff began her new approach, Peerless had 40 lost-time claims, multiple years in a row.


“In 2012-2013, with a total of 386 employees in the company, we had it down to less than 25 claims,” said Ruff.

At the company’s main plant in Winona, Minn., which has 287 employees, Peerless has gone 700 days without a lost-time claim.

“It’s a pretty heavy-duty industrial manufacturing plant, so that’s a huge accomplishment, which we’re extremely proud of,” said Ruff.

“The head of underwriting at a major insurance company recently said that he has never seen anyone like Elizabeth at a company, big or small. She is truly one of a kind and a major difference-maker in our industry.” — Josh Warren, senior vice president of Equity Risk Partners

Josh Warren, senior vice president of Equity Risk Partners, Peerless’ broker, said, “They do have some additional lifting machines that make it easier on the employees, but the main difference is that Elizabeth and her colleagues in the HR department pay attention to their employees, learn from workplace injuries in order to avoid repeat situations and get people back to work.”

Warren added: “The head of underwriting at a major insurance company recently said that he has never seen anyone like Elizabeth at a company, big or small. She is truly one of a kind and a major difference-maker in our industry.”

Other accomplishments Ruff has initiated at Peerless include bolstering the company’s safety program. Safety is particularly important at Peerless because it is the largest manufacturer and distributor in North America for industrial and consumer chain and tractor products.

“One of the things I created was regular training programs,” Ruff said. “Each month, there is some type of training program project I am organizing, whether it is bringing in an external expert or coordinating with an internal supervisor.”


Another thing Peerless has done is to spend more money on capital each year to be proactive rather than reactive.

“Each year since 2011, we’ve been adding $20,000 per year just in capital for hoists,” she said.

Under Ruff’s direction, Peerless has also been aggressive in implementing ergonomic improvements, Breza said.

Ruff still works 20 hours a week at Peerless, while also working at BIC Graphic, which she joined in June.

“What I value most about Elizabeth is her knowledge and expertise and professionalism in the field of HR and how broad-based she is and that she came in that way to Peerless when she was so young,” said Breza. “She is just so intelligent.”


350px_allstarRisk All Stars stand out from their peers by overcoming challenges through exceptional problem solving, creativity, perseverance and/or passion.

See the complete list of 2014 Risk All Stars.

Share this article:

NWCDC Preview

Disability Track Focuses on Saving Money, Managing Absences

NWCDC's Disability Management track includes breakout sessions on integrated disability management, managing workplace absences, and making the most of workplace diversity.
By: | September 10, 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®.

ConferenceThis Disability Management track of the 23rd annual National Workers’ Compensation and Disability Conference® & Expo includes breakout sessions on integrated disability management programs that are saving employers money, managing workplace absences, and making the most of workplace diversity.

The Productivity Challenge: Engaging Injured, Absent and Disconnected Workers


  • Teresa Bartlett, M.D., senior vice president of medical quality, Sedgwick
  • Kevin Confetti, employment practices and workers’ compensation, University of California

Managing workplace absences is as much an art as a science. Whether due to injury or disability, occupational or nonoccupational problems, or personal challenges that render employees unproductive, the results are the same: Less than optimal output for the employer.


The speakers will offer insight to help employers integrate their health, wellness, safety, and quality care programs. Bartlett and Confetti will share a comprehensive employee-centric model they say has been shown to engage injured, absent, and disconnected workers and produce dividends for employers. They will identify ways to lessen the drain on workplace productivity, demonstrate the direct linkage between health, safety and wellness, quality care, employee engagement, and productivity, and compare traditional programs with those being integrated and expanded to improve performance.

Harley-Davidson Saves $3.5 Million Through Injury Prevention, Management Program


  • Sue Gartner, corporate health services HR manager, Harley-Davidson Motor Company
  • Beth Mrozinsky, corporate safety and health HR director, Harley-Davidson Motor Company

A 68 percent reduction in workers’ comp claims, a 63 percent drop in costs, and bottom line savings of $3.5 million are the achievements at Harley Davidson since 2009. Gartner and Mrozinsky will outline the challenges that led to their integrated approach focusing on occupational and nonoccupational injuries, and will share their strategies and successes to help other employers build a similar program.

They will provide strategies for employers to integrate absence management programs and build on the strengths of the employer’s partners, demonstrate how to manage an aging workforce from hire to retire, evaluate metrics to gauge progress and determine the need for modifications to continue ensuring successful results, and show how to use outside-the-box thinking to incorporate progressive solutions to issues previously considered just a part of doing business.

Overcoming Psychosocial Barriers to Recovery: It’s Not Just a Theory Anymore


  • Sherri Burrell, head of operations, Briotix Inc.
  • Ruth Estrich, chief strategy officer, MedRisk
  • Carrie Freeland, manager of the Integrated Leave Department, Costco Wholesale

Despite advances in medical care, many rehabilitation programs fall short of the main goal: returning injured workers to preinjury functional outcomes. According to the speakers, these programs typically are symptom-based and lack effective elements to address the psychosocial issues that stall recovery in the claims responsible for 80 percent of the workers’ comp spend.


They will address how cutting-edge behavioral modification programs that effectively address these psychosocial barriers can help practitioners identify at-risk injured workers, facilitate faster return to work, and promote reintegration into life-role activities. The three will explain how psychosocial risk factors impact disability and drive costs; differentiate cost-effective rehabilitation programs designed to improve return-to-work, health, and socioeconomic outcomes; and illustrate how the integration of physical therapy and a behavioral modification program can result in reduced medical and disability costs for occupational and nonoccupational injuries.

Making Integrated Disability Management Work for You


  • Loyd Hudson, integrated disability management manager, American Electric Power
  • Terri Rhodes, executive director, Disability Management Employer Coalition
  • Sarah von Schrader, assistant director of research of the Employment and Disability Institute, Cornell University

Reduced lost time, lower costs, and simpler processes are some of the benefits of a well-run integrated disability management program. But making the business case for IDM can be a challenge.

The speakers will offer advice to lay the groundwork for workplace policies and climate in conjunction with best practices in regulatory compliance with best practices in ADA compliance using IDM. They will offer a variety of tools, steps, and resources for an effective program and describe how American Electric Power achieved a regulatory compliant and fiscally successful IDM program. The speakers will outline the building blocks of integrated disability management, demonstrate how to build a successful IDM program, and review research on RTW and ADA and the aging workplace and how they impact IDM.

How Diversity Impacts Workers’ Compensation and Disability Strategies


    • Jennifer De La Torre, executive director of workforce diversity, AT&T
    • Elizabeth Demaret, executive vice president, chief customer relationship officer, Sedgwick

The increasing diversity in today’s workforce is impacting the way companies conduct business. Workers today exhibit a range of differences in age, race, religion, gender, and physical abilities with each individual providing a unique contribution to the products and services delivered. The speakers will address some of the diversity shifts in the workforce and offer strategies for employers to manage these differences. Additionally, they will examine the impact diversity has on workers’ comp and disability programs. Finally, the two will outline ways employers can capitalize on diversity and improve productivity.

For more information, visit NWCDC’s website. To post your thoughts on the conference, join LinkedIn’s National Workers Compensation and Disability Conference & Expo.

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
Share this article:

Sponsored Content by Helios

Medication Monitoring Achieves Better Outcomes

Having the right patient 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.
Share this article: