Between Correlation and Causation
Employers should not automatically accept a physician’s report that an injury was caused by a work-related event.
And should a claim’s denial be challenged, employers shouldn’t rely on a medical expert who always agrees with them, said Stuart Colburn, an attorney at Downs Stanford, at a session, “How to Use a Medical Expert so You Don’t Get Burned on Causation,” on Thursday at the National Workers’ Compensation and Disability Conference® and Expo.
You are not going to win any cases with those doctors,” he said. “Don’t use them.
“Pick experts that are believable, not that give you the opinion you want.”
It is important that physicians are fully informed about recent research when determining causation of an injury, he said. When necessary, it’s up to the employer to educate physicians.
When analyzing causation, the review should include individual clinical findings, individual workplace exposure, and scientific literature linking or not linking the exposure to the condition.
Don’t just accept prevailing opinion about injury causation, said Dr. Jacob Lazarovic, chief medical officer and SVP, Broadspire. It can be wrong, such as the opinion that carpal tunnel syndrome results from keyboarding.
“Pick experts that are believable, not that give you the opinion you want.” — Stuart Colburn, an attorney at Downs Stanford
Rather, research shows a workplace function would require “significant hand force” to cause carpel tunnel syndrome, he said.
Other research disputes the link between occupational activity and back pain, he said, finding instead that most such injuries have a genetic basis.
Lazarovic also noted there are “significant error rates” in interpreting diagnostic imaging results.
He noted one study found that 33 percent of experienced radiologists disagreed with another physician’s reading of an image. In addition, 25 percent of those physicians disagreed with their own reading, when given the image on another day.
When disputing a claim, Colburn noted that the “exact same wording” about causation will be treated differently, depending on which state the claim is litigated.
Addressing Behavioral and Social Issues
Understanding how an employee feels about their job and their surroundings can hold one of the keys to their recovery, according to a workers’ compensation medical expert.
And using a three-pronged approach to addressing a disabled worker’s recovery helps return employees to the job faster, said Dr. Marcos Iglesias, vice president and medical director at The Hartford.
To improve success, add new approaches to better identify and understand an employee’s behavioral and social issues, Iglesias said during a mega session, “Preventing Prolonged Disability by Assessing and Eliminating Psychosocial Barriers,” at the NWCDC on Thursday morning in New Orleans.
About 10 percent of claims have one or more psycho-social elements, yet they account for 60 percent of costs. The bio-psycho-social model Iglesias presented gives claims managers keys to empower injured employees to return to function.
First, identify the employee’s expectation of recovery by simply asking, “When do you think you’ll return to work?” If the response is more than 14 days, the patient may be at risk of delayed recovery.
Follow up questions can then identify additional issues such as unfounded beliefs about the injury or care, catastrophic thinking and fear of future events, Dr. Iglesias said.
Another barrier could be an employee’s perceived injustice related to the injury and treatment. To identify if an employee is laboring under a possible misconception, ask why they think the injury happened.
Questions about the patient’s condition, he said, should steer away from pain and focus on function: “What are you able to do today that you couldn’t do last week?”
Employees must feel empowered to recover. Passivity, a belief that someone else such as a doctor or spouse, is in control of the injured worker’s return to work could be a red flag, Dr. Iglesias said.
Ask: “What do you like about work; what about your job do you look forward to?”
Disabled workers identified as at risk may benefit from a team of dedicated coaches who offer a functional restoration program that addresses not only medical concerns but also any behavior and social barriers that hamper return to work, he added.
Mind the Gap in Global Logistics
Manufacturers and shippers are going global.
As inventories grow, shippers need sophisticated systems to manage it all, and many companies choose to outsource significant chunks of their supply chain management to contracted providers. A recent survey by market research firm Transport Intelligence reveals that outsourcing outnumbers nearshoring in the logistics industry by 2:1. In addition, only 16.7 percent of respondents stated they are outsourcing fewer logistics processes today than they were three years ago.
Those providers in turn take more responsibilities through each step of the bailment process, from processing, packaging and labeling to transportation and storage. Spending in the U.S. logistics and transportation industry totaled $1.45 trillion in 2014 and represented 8.3 percent of annual gross domestic product, according to the International Trade Administration.
“Traditionally these outside parties provided one phase of the supply chain process, perhaps transportation, or just warehousing. Today many of these companies are extending their services and product offerings to many phases of supply chain management,” said Mike Perrotti, Senior Vice President, Inland Marine, XL Catlin.
Such companies are known as third-party logistics (3PL) providers, or even fourth-party logistics (4PL) providers. They could provide transportation, storage, pick-n-pack, processing or consolidation/deconsolidation.
As the provider’s logistics responsibilities widen, their insurance needs grow.
“In the past, the underwriters would piecemeal together different coverages for these logistics providers. For instance, they might take a motor truck cargo policy, and attach a warehouse form, a bailee’s form, other inland marine products, and an ocean cargo form. You would have most of the exposures covered, but when you start taking different products and bolting them together, you end up with gaps,” said Alexander McGinley, Vice President, US Marine, XL Catlin.
A comprehensive logistics form can close those gaps, and demand for such a product has been on the rise over the past decade as logistics providers search for a better way to manage their range of exposures.
“Traditionally these outside parties provided one phase of the supply chain process, perhaps transportation, or just warehousing. Today many of these companies are extending their services and product offerings to many phases of supply chain management.”
–Mike Perrotti, Senior Vice President, Inland Marine, XL Catlin
A Complementary Package
XL Catlin’s Logistics Services Coverage Solutions takes a holistic approach to the legal liability that 3PL providers face while a manufacturer’s stock is in their care, custody and control.
“A 3PL’s legal liability for loss or damage from a covered cause of loss to the covered property during storage, packaging, consolidation, shipping and related services would be insured under this comprehensive policy,” McGinley said. “It provides piece of mind to both the owner of the goods and the logistics provider that they are protected if something goes wrong.”
In addition to coverage for physical damage, the logistics solution also provides protection from cyber risks, employee theft and contract penalties, and from emerging exposures created by the FDA Food Modernization Act.
This coverage form, however, only protects 3PL companies’ operations within the U.S., its territories and possessions, and Canada. Many large shippers also have an international arm that needs the same protection.
XL Catlin’s Ocean Cargo Coverage Solutions product rounds out the logistics solution with international coverage.
While Ocean Cargo coverage typically serves the owner of a shipment or their customers, it can also be provided to the internationally exposed logistics provider to cover the cargo of others while in their care, custody, and control.
“This covers a client’s shipment that they’re buying from or selling to another party while it’s in transit, by any type of conveyance, anywhere in the world,” said Andrew D’Alessio, National Ocean Cargo Product Leader, XL Catlin. “When provided to the logistics company, they in turn insure the shipment on behalf of the owner of the cargo.”
The international component provided by ocean cargo coverage can also eliminate clients’ fears over non-compliance if admitted insurance coverage is purchased. Through its global network, XL Catlin is uniquely positioned as a multi-national insurer to offer locally admitted coverages in over 200 countries.
“In the past, the underwriters would piecemeal together different coverages for these logistics providers. For instance, they might take a motor truck cargo policy, and attach a warehouse form, a bailee’s form, other inland marine products, and an ocean cargo form. You would have most of the exposures covered, but when you start taking different products and bolting them together, you end up with gaps.”
–Alexander McGinley, Vice President, US Marine, XL Catlin
A Developing Need
The approaching holiday season demonstrates the need for an insurance product that manages both domestic and international logistics exposures.
In the final months of the year, lots of goods will be shipped to the U.S. from major manufacturing nations in Asia. Transportation providers responsible for importing these goods may require two policies: ocean cargo coverage to address risks to shipments outside North America, and a logistics solution to cover risks once goods arrive in the United States or Canada.
“These transportation providers are expanding globally while also shipping throughout the U.S. That’s how the need for both domestic and international logistics coverage evolved. Until now there have been few solutions to holistically manage their exposures,” D’Alessio said.
In another example, D’Alessio described one major paper provider that expanded its business from manufacturing to include logistics management. In this case, the paper company needed coverage as a primary owner of a product and as the bailee managing the goods their clients own in transit.
“That manufacturer has a significant market share of the world’s paper, producing everything from copy paper to Bible paper, wrapping paper, magazine paper, anything you can think of. Because they were so dominant, their customers started asking them to arrange freight for their products as well,” he said.
“These transportation providers are expanding globally while also shipping throughout the U.S. That’s how the need for both domestic and international logistics coverage evolved. Until now there have been few solutions to holistically manage their exposures.”
–Andrew D’Alessio, National Ocean Cargo Product Leader, XL Catlin
The global, multi-national paper company essentially launched a second business, serving as a transportation and logistics provider for their own customers. As the paper shipments changed ownership through the bailment process, the company required two totally different types of insurance coverage: an ocean cargo policy to cover their interests as the owner and producer of the product, and logistics coverage to address their exposures as a transportation provider while they move the products of others.
“As a bailee, they no longer own the products, but they have the care, custody, and control for another party. They need to make sure that they have the appropriate insurance coverage to address those specific risks,” McGinley said.
“From a coverage standpoint, this is slowly but surely becoming the new standard. A logistics form on the inland marine side, combined with an international component, is becoming something that a sophisticated client as well as a sophisticated broker should really be asking for,” McGinley said.
The old status quo method of bolting on coverage forms or additional coverages as needed won’t suffice as global shipping needs become more complex.
With one underwriting solution, the marine team at XL Catlin can insure 3PL clients’ risks from both a domestic and international standpoint.
“The two products, Ocean Cargo Coverage Solutions and Logistics Service Coverage Solutions, can be provided to the same customer to really round out all of their bailment, shipping, transportation, and storage needs domestically and around the globe,” D’Alessio said.
The information contained herein is intended for informational purposes only. Insurance coverage in any particular case will depend upon the type of policy in effect, the terms, conditions and exclusions in any such policy, and the facts of each unique situation. No representation is made that any specific insurance coverage would apply in the circumstances outlined herein. Please refer to the individual policy forms for specific coverage details. XL Catlin, the XL Catlin logo and Make Your World Go are trademarks of XL Group Ltd companies. XL Catlin is the global brand used by XL Group Ltd’s (re)insurance subsidiaries. In the US, the insurance companies of XL Group Ltd are: Catlin Indemnity Company, Catlin Insurance Company, Inc., Catlin Specialty Insurance Company, Greenwich Insurance Company, Indian Harbor Insurance Company, XL Insurance America, Inc., and XL Specialty Insurance Company. Not all of the insurers do business in all jurisdictions nor is coverage available in all jurisdictions. Information accurate as of December 2016.
This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with XL Catlin. The editorial staff of Risk & Insurance had no role in its preparation.