Workers' Comp Options

Fate of Two Comp Alternatives Lies With Courts

In the first two states to wrestle with questions of allowing employers to opt out of the federal workers comp system, uphill battles remain.
By: | March 27, 2015 • 4 min read
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The push to reform state workers’ compensation systems to allow employers to opt out is by no means secure in Oklahoma, the first state to enact such reform. Similar efforts face new challenges in Tennessee, the second state to seek opt-out legislation.

Eight of nine current Oklahoma Supreme Court justices received their appointments from Democratic governors. In April the justices will hear a constitutional challenge to the law allowing employers to leave the Sooner workers’ comp system by implementing an alternative benefits plan.

By contrast, a conservative legislature and Republican governor friendly toward business interests adopted the opt-out legislation in 2013, bringing the opt-out alternative into law beginning in early 2014.

Claimants presenting the constitutional challenge before Oklahoma’s Supreme Court argue the law is unconstitutional because it denies injured workers due process and creates two sets of workers with disparate rights.

The court’s justices may be sympathetic to such an argument.

Past Oklahoma Supreme Court rulings make it apparent the body leans more liberal in judgment than the state’s “very, very conservative legislature,” said Trey Gillespie, senior workers’ comp director at the Property Casualty Insurers Assn. of America.

“I think everybody in Oklahoma will agree the Oklahoma Supreme Court is significantly more liberal in their view of the construction of laws and the application of laws than the Oklahoma Senate and House of Representatives,” Gillespie said. “There have been instances…where it appears the Oklahoma Supreme Court seems to get a lot of joy out of declaring certain acts of the Oklahoma legislature unconstitutional.”

Bill Minick, president of consulting firm PartnerSource and a chief proponent of efforts to allow opting out of state workers’ comp systems, called the Oklahoma Supreme Court’s makeup “a legitimate consideration.”

But Minick argues that the lawsuit’s goal of preventing employer’s from opting out of Oklahoma’s workers’ comp system will fail in the long run. It “is clear that the Oklahoma legislature is committed to do anything necessary to preserve” the law adopted as the Employee Injury Benefit Act, he said.

Gillespie said opt-out backers are already urging Oklahoma legislation that would adjust the law to mitigate the impact should the lawsuit plaintiffs prevail.

Gillespie and Minick will both speak at the National Workers’ Compensation and Disability Conference & Expo to be held November 11-13 in Las Vegas. They will present two divergent viewpoints on opt out.

Meanwhile, on March 25, Tennessee legislators in the House Consumer and Human Relations Subcommittee deferred taking action on opt-out legislation, which could delay further consideration of its passage until next year.

Two days prior, a Tennessee Advisory Council on Workers’ Compensation voted 6-0 against recommending the legislation that would allow employers to leave the state’s workers’ comp system and set up alternative plans.

The advisory council provides research and recommendations to Tennessee’s General Assembly and to state agencies. Mr. Gillespie testified before the council against the opt-out legislation, embedded in Senate Bill 0721 and House Bill 0997.

Tennessee is the first state where proponents for laws allowing employers to opt out of state workers’ comp systems are seeking favorable legislation after winning the right to do so in Oklahoma.

Conditions for Oklahoma’s adoption of an opt-out alternative were ripe at the time of that legislation’s signing into law by Republican Gov. Mary Fallin. Oklahoma employers were frustrated with a dysfunctional workers’ compensation system while neighboring Texas provided an example of advantages employers could gain by opting out.

Texas has allowed employers to opt-out of its workers’ comp system since that system was first created.

The case Oklahoma’s Supreme Court is scheduled to hear on April 14, is Judy Pilkington and Kim Lee V. State of Oklahoma.

Pilkington was injured in 2014, while working for retailer Dillard’s Inc. Lee was also injured in 2014, while an employee of Swift Transportation Co. of Arizona, according to their legal filing.

They claim Oklahoma’s opt-out law strips them of the right to have their workers’ comp cases heard by an unbiased body.

“There is no due process protection in allowing an Oklahoma employer to OPT OUT of the statutory workers’ compensation system, set up its own benefit plan, make all the decisions regarding benefits, determine who and how a plan can be reviewed, and have total control of the development of the record for appeal,” the plaintiffs’ Supreme Court filing states. “Nowhere along the way is there an agency or court or unbiased tribunal to look at the merits of an injured worker’s case. OPT OUT employers are allowed to replace a judge with a committee chosen by the employer.”

They also argue that the Oklahoma Injury Benefit Act creates disparate rights for accessing benefits. For example, injured employees working for employers that do not opt out generally have one year to file a claim while an employer that opts out may allow only a 24-hour statute of limitation, they claim.

Oklahoma’s constitution prohibits separate treatment of members of the same class of people, said Bob Burke, an attorney representing the plaintiffs.

Asked whether the Supreme Court justices about to hear his case are likely to be influenced by the fact that 8 of them were appointed by Democratic governors, Burke said that “the court has a tradition of maintaining  access to justice for injured workers and anyone harmed.”

Roberto Ceniceros is senior editor at Risk & Insurance® and chair of the National Workers' Compensation and Disability Conference® & Expo. He can be reached at rceniceros@lrp.com. Read more of his columns and features.
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Drug-Free Workplace

Solid Substance Abuse Program Can Combat Legal, Safety Issues

Organizations need to develop and implement clear and defensible substance abuse programs to keep abusers from putting themselves and others at risk.
By: | March 23, 2015 • 4 min read
pot smoking

More than one-third of workers’ comp claims involve issues surrounding substance abuse, says a risk manager who specializes in workplace substance abuse prevention.  Alcohol and drugs are also major contributors to work-related motor vehicle accidents.

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Employers spend an estimated $7,000 per year per substance abuser in direct operational costs. With some estimates suggesting up to 20 percent of workers are substance abusers, organizations need to develop and implement clear and defensible programs.

“It’s not a moral or ethical issue, it’s a business decision,” said Christine Clearwater, president of Drug-Free Solutions Group, “and a very important one to decide where you want to position your company and communicate that to your organization.”

Failing to address the issue can not only land an organization in a legal quagmire but also puts the safety of the entire company at risk. In a recent webinar produced by the National Safety Council, Clearwater outlined the risks employers face and provided solutions.

Marijuana

In addition to states that allow recreational use of marijuana, 23 allow the drug for medicinal purposes. Clearwater said the effects of the drug can create safety risks in the workplace even two days after use.

While the person may feel “high” for several hours after smoking marijuana, THC, the active ingredient in marijuana, reduces pressure on the optic nerve and can alter depth perception for up to 48 hours.

“So a person works with machines and doesn’t know if something is 5 or 7 inches away,” she said. “If you drive a forklift you don’t know if something is 5 or 10 feet away. … Hundreds of studies show this.”

The fact that federal law still bans the use of marijuana is good news for employers. “In workers’ comp, most states don’t require payment for the injured worker if he is under the influence at the time of an accident,” Clearwater said. “At this point in time, the system is supporting the employer.”

Other Drugs

“Herbs coated with chemicals not designed for human consumption” is how Clearwater defines synthetic drugs. They are one of the fastest growing and readily accessible drugs and are designed to simulate the effects of specific illegal drugs.

“They are fundamentally poisonous with plant fertilizer, etc.,” Clearwater said. “They are 500 times stronger than the actual drug it is simulating.”

Synthetic drugs are illegal in all 50 states, she said. The challenge is that labs making them develop new ones constantly.

“The majority of these simulate marijuana,” Clearwater said, “so you want to be talking to whoever is doing your testing to expand your testing profile.”

Methamphetamine, a synthetic version of cocaine, has grown to epidemic proportions, Clearwater said. It is highly addictive and may be associated with side effects such as paranoia and violent behavior.

Drugs such as Ecstasy and LSD are also prevalent. Clearwater said the LSD on the market today is simply chemicals.

Employer Solutions

Substance abuse issues can be “a hotbed for litigation,” Clearwater said. “The key factor is to have a very comprehensive sound policy that takes into consideration federal law, state law, and case law.”

A company’s substance abuse program should include several defensible elements, said Clearwater. The following five elements are program objectives to reach:

  • Policy and procedures.
  • Education for employees, which is mandatory in some states. “Educated employees are three times less likely to produce a positive test result,” Clearwater said. “They understand what you are trying to accomplish, and they don’t want to lose their jobs.”
  • Training for managers, which may also be mandatory. Trained managers are much more likely to use the policy.
  • Drug and alcohol testing. “Look at how you communicate your program,” she said. “Many companies say they have a program. But look at it as a substance abuse prevention program rather than a testing program.”
  • Access to support. This may range from a formal employee assistance program to just a listing of local resources.

 

The substance abuse policy needs to be clear as to when and how much alcohol can be consumed, she added. Retirement or holiday parties, or when employees are traveling and entertaining may be occasions when alcohol is allowed.

“If it’s not written down, it is not a rule and is difficult to take action on,” Clearwater said. “Alcohol is a big hotbed for being exposed to litigation.”

Clearwater also suggests workplace substance abuse policies define the level of “under the influence.”

For prescription medications, employers are advised to clarify employees who must report a specific prescription. “Often I see companies say, ‘all employees need to report prescriptions.’ We can’t do that today,” she said. “We can ask employees in safety-sensitive positions to report a prescription drug that may affect their ability to do their jobs.”

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The policy should specify what should be reported and in what form, whom to report it to, and who decides whether reasonable accommodation is warranted.

If drug and alcohol screening is included in the program, employers need to determine which drugs they are including in the drug panel. Many test for five drugs following the Department of Transportation’s drug testing protocol.

“I’d highly recommend moving that to nine or 10,” Clearwater said. “The additional four or five are generally your prescription drugs. Otherwise, you are not capturing potential problems of prescription drugs.”

Nancy Grover is the president of NMG Consulting and the 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: Liberty Mutual Insurance

2015 General Liability Renewal Outlook

As the GL insurance cycle flattens, risk managers, brokers and insurers dig deeper to manage program costs.
By: | March 2, 2015 • 5 min read
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There was a time, not too long ago, when prices for general liability (GL) insurance would fluctuate significantly.

Prices would decrease as new markets offered additional capacity and wanted to gain a foothold by winning business with attractive rates. Conversely, prices could be driven higher by decreases in capacity — caused by either significant losses or departing markets.

This “insurance cycle” was driven mostly by market forces of supply and demand instead of the underlying cost of the risk. The result was unstable markets — challenging buyers, brokers and carriers.

However, as risk managers and their brokers work on 2015 renewals, they’ll undoubtedly recognize that prices are relatively stable. In fact, prices have been stable for the last several years in spite of many events and developments that might have caused fluctuations in the past.

Mark Moitoso discusses general liability pricing and the flattening of the insurance cycle.

Flattening the GL insurance cycle

Any discussion of today’s stable GL market has to start with data and analytics.

These powerful new capabilities offer deeper insight into trends and uncover new information about risks. As a result, buyers, brokers and insurers are increasingly mining data, monitoring trends and building in-house analytical staff.

“The increased focus on analytics is what’s kept pricing fairly stable in the casualty world,” said Mark Moitoso, executive vice president and general manager, National Accounts Casualty at Liberty Mutual Insurance.

With the increased use of analytics, all parties have a better understanding of trends and cost drivers. It’s made buyers, brokers and carriers much more sophisticated and helped pricing reflect actual risk and costs, rather than market cycle.

The stability of the GL market also reflects many new sources of capital that have entered the market over the past few years. In fact, today, there are roughly three times as many insurers competing for a GL risk than three years ago.

Unlike past fluctuations in capacity, this appears to be a fundamental shift in the competitive landscape.

SponsoredContent_LM“The current risk environment underscores the value of the insurer, broker and buyer getting together to figure out the exposures they have, and the best ways to manage them, through risk control, claims management and a strategic risk management program.”
— David Perez, executive vice president and general manager, Commercial Insurance Specialty, Liberty Mutual

Dynamic risks lurking

The proliferation of new insurance companies has not been matched by an influx of new underwriting talent.

The result is the potential dilution of existing talent, creating an opportunity for insurers and brokers with talent and expertise to add even greater value to buyers by helping them understand the new and continuing risks impacting GL.

And today’s business environment presents many of these risks:

  • Mass torts and class-action lawsuits: Understanding complex cases, exhausting subrogation opportunities, and wrangling with multiple plaintiffs to settle a case requires significant expertise and skill.
  • Medical cost inflation: A 2014 PricewaterhouseCoopers report predicts a medical cost inflation rate of 6.8 percent. That’s had an immediate impact in increasing loss costs per commercial auto claim and it will eventually extend to longer-tail casualty businesses like GL.
  • Legal costs: Hourly rates as well as award and settlement costs are all increasing.
  • Industry and geographic factors: A few examples include the energy sector struggling with growing auto losses and construction companies working in New York state contending with the antiquated New York Labor Law

David Perez outlines the risks general liability buyers and brokers currently face.

Managing GL costs in a flat market

While the flattening of the GL insurance cycle removes a key source of expense volatility for risk managers, emerging risks present many challenges.

With the stable market creating general price parity among insurers, it’s more important than ever to select underwriting partners based on their expertise, experience and claims handling record – in short, their ability to help better manage the total cost of GL.

And the key word is indeed “partners.”

“The current risk environment underscores the value of the insurer, broker and buyer getting together to figure out the exposures they have, and the best ways to manage them — through risk control, claims management and a strategic risk management program,” said David Perez, executive vice president and general manager, Commercial Insurance Specialty at Liberty Mutual.

While analytics and data are key drivers to the underwriting process, the complete picture of a company’s risk profile is never fully painted by numbers alone. This perspective is not universally understood and is a key differentiator between an experienced underwriter and a simple analyst.

“We have the ability to influence underwriting decisions based on experience with the customer, knowledge of that customer, and knowledge of how they handle their own risks — things that aren’t necessarily captured in the analytical environment,” said Moitoso.

Mark Moitoso suggests looking at GL spend like one would look at total cost of risk.

Several other factors are critical in choosing an insurance partner that can help manage the total cost of your GL program:

Clear, concise contracts: The policy contract language often determines the outcome of a GL case. Investing time up-front to strategically address risk transfer through contractual language can control GL claim costs.

“A lot of the efficacy we find in claims is driven by the clear intent that’s delivered by the policy,” said Perez.

Legal cost management: Two other key drivers of GL claim outcomes are settlement and trial. The best GL programs include sophisticated legal management approaches that aggressively contain legal costs while also maximizing success factors.

“Buyers and brokers must understand the value an insurer can provide in managing legal outcomes and spending,” noted Perez. “Explore if and how the insurer evaluates potential providers in light of the specific jurisdiction and injury; reviews legal bills; and offers data-driven tools that help negotiations by tracking the range of settlements for similar cases.”

David Perez on managing legal costs.

Specialized claims approach: Resolving claims quickly and fairly is best accomplished by knowledgeable professionals. Working with an insurer whose claims organization is comprised of professionals with deep expertise in specific industries or risk categories is vital.

SponsoredContent_LM“We have the ability to influence underwriting decisions based on experience with the customer, knowledge of that customer, and knowledge of how they handle their own risks, things that aren’t necessarily captured in the analytical environment.”
— Mark Moitoso, executive vice president and general manager, National Accounts Casualty, Liberty Mutual

“When a claim comes in the door, we assess the situation and determine whether it can be handled as a general claim, or whether it’s a complex case,” said Moitoso. “If it’s a complex case, we make sure it goes to the right professional who understands the industry segment and territory. Having that depth and ability to access so many points of expertise and institutional knowledge is a big differentiator for us.”

While the GL insurance market cycle appears to be flattening, basic risk management continues to be essential in managing total GL costs. Close partnership between buyer, broker and insurer is critical to identifying all the GL risks faced by a company and developing a strategic risk management program to effectively mitigate and manage them.

Additional insights



For more information about how Liberty Mutual can help you manage the total cost of your GL program, visit their website or contact your broker.

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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.




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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