Column: Workers' Comp

Integration Ramps Up

By: | May 6, 2015 • 2 min read
Roberto Ceniceros is senior editor at Risk & Insurance® and chair of the National Workers' Compensation and Disability Conference® & Expo. He can be reached at [email protected] Read more of his columns and features.

Employer interest in grouping the management of workers’ compensation, nonoccupational disability and employee absence is spreading. The Affordable Care Act, amendments to the Americans with Disabilities Act, employee leave mandates and employer cost-reduction measures are all factors driving the trend.

Some larger employers with more ample risk management resources realized years ago the value of viewing employee health and wellness, disability management and claims administration through one lens.

These trendsetters understood that they faced productivity losses and increased health care costs when employees are ill or absent, regardless of whether the cause is a work-related injury, a nonoccupational disability or the need to care for family members.

They were also quicker to garner synergies by collaboratively administering some programs traditionally handled by human resources or risk management departments.

Now we’re seeing brokers that traditionally provided property/casualty services competing with benefits service consultants to advise clients looking to improve employee health and wellness.

But now a trend to comprehensively evaluate the management of short- and long-term disability offerings, workers’ comp, Family and Medical Leave Act, and ADA compliance is spreading among middle-market employers as well.

They are growing increasingly interested in managing employee absences and medical costs — no matter if the cause is rooted in workers’ comp claims, nonoccupational disabilities, or leave laws like the FMLA.

Recognizing the trend, brokers, third-party administrators and insurers are now offering products and services to middle market employers that want to link management of these areas.

Advertisement




Now we’re seeing brokers that traditionally provided property/casualty services competing with benefits service consultants to advise clients looking to improve employee health and wellness.

As those employers move forward to further health and wellness goals they are asking how they might incorporate their workers’ comp program and claims management strategies.

Overall, though, many employers still manage occupational and nonoccupational disabilities in silos.

Thus, they miss opportunities to identify employees at risk for future lost work time.

It’s common for some claimants to cross over, utilizing both occupational and nonoccupational disability systems, according to a February 2015 report from the Integrated Benefits Institute.

IBI President Thomas Parry said he sees more employers now sharing information across the silos, rather than creating a single organizational unit to manage everything.

Broad-based and well-publicized federal regulatory change is spurring the practice of shared management or shared information.

The Affordable Care Act is designed to promote opportunities to gain from wellness and prevention initiatives that impact injury and illness, whether the cause is occupational or not.

Similarly, increased ADA, FMLA and other leave and accommodation law mandates cut across both areas.

And during the recession, many employers cut their risk or disability staffs and now need practices for efficiently managing claims using less human resources.

Those that underwrite their risks and consult on them have taken notice.

 

Share this article:

RIMS 2015

Changing Third Party Administrators Requires Careful Navigation

One company’s changing of TPAs provided valuable and unexpected risk management lessons for others to glean from.
By: | April 13, 2015 • 3 min read
Changing TPAS Ceniceros

Changing third party administrators provides an opportune time for employers to improve their vendor service instructions and request additional workers’ compensation claims data for satisfying needs not addressed by their legacy TPA.

Advertisement




“With the new TPA you are the golden child,” Linda Hoenshel, senior claims manager risk management for HD Supply told the Risk and Insurance Management Society Inc.’s annual conference held April 26-29 in New Orleans.

TPAs will work to meet a new customer’s requests if it is within their means to do so, she added.

“You don’t just one day think you are going to change TPAs and everything falls in line,” Paulette Harris-Rogers, director risk management for HD Supply

But there are also many transition timeline and budgetary issues for employers wanting to change TPAs to address.

“You don’t just one day think you are going to change TPAs and everything falls in line,” said Paulette Harris-Rogers, director, risk management for HD Supply, a company with 15,000 employees and 700 locations.

HD Supply changed TPAs in 2012 and took advantage of the transition to ask its new vendor for information it didn’t previously receive, such as litigated claims data. It plans to use the information to evaluate the performance of defense firms it contracts with as well as the plaintiffs’ attorneys it faces.

One of the biggest considerations for employers is whether to change TPAs at renewal time for their workers’ comp insurance policy or during an “off cycle,” Harris-Rogers said. Factors such as insurer involvement, workers’ comp program size and complexity, and claims frequency, will impact that decision.

For HD Supply, it didn’t make sense to change TPAs during renewal time.

Many TPAs will need 90 days to get a new program running, Harris-Rogers said. Meanwhile, a legacy TPA contract may require the employer to provide a 60-day termination notice. But a transition timeline of 60 days likely won’t provide the legacy TPA sufficient time to fulfill its duties.

The legacy TPA will need time to manage its arrangements with the employer’s insurer, which will have its own timeline and needs for practices like system mapping and claim test runs.

“It’s true, the new TPA can take 90 days to work a program and get you started, Harris-Rogers said. “However, the legacy TPA needs considerably more time. Sixty days is not enough. So if you are thinking you are going to serve a notice of cancellation to your TPA in 60 days, that is fine, but there is a lot of work that needs to be done before that time.”

Other considerations include a review of medical-provider arrangements to help ensure employees’ existing providers will not be cut off mid-treatment, notification of the employers’ payroll and financial departments, and a need to hold claims reviews with two TPAs.

There are also costs to consider such as expenses paid simultaneously to two TPAs, including fees for continuing to access data maintained by the legacy TPA and charges for the legacy organization to run off existing claims.

Changing TPAs other than at renewal time may cause the insurer to conduct a collateral review or charge a fee for a mid-term change. The claims closure rate may also drop at first, because the new TPA’s adjusters are not familiar with the employer’s claims.

Advertisement




But when transitioning to a new service provider, employers can benefit from the resources some TPAs have invested in technology and risk systems that provide report reviews and claims trend analysis.

It’s a great time to fill existing claims information gaps or address requests for information demanded by upper management, the speakers said.

“If there is anything out there that you think you want, now is the time to ask,” Hoenshel said. “If the answer is no, ask again. You never know what can open up.”

Roberto Ceniceros is senior editor at Risk & Insurance® and chair of the National Workers' Compensation and Disability Conference® & Expo. He can be reached at [email protected] Read more of his columns and features.
Share this article:

Sponsored: Lexington Insurance

Pathogens, Allergens and Globalization – Oh My!

Allergens and global supply chain increases risk to food manufacturers. But new analytical approaches help quantify potential contamination exposure.
By: | June 1, 2015 • 6 min read
Lex_BrandedContent

In 2014, a particular brand of cumin was used by dozens of food manufacturers to produce everything from spice mixes, hummus and bread crumbs to seasoned beef, poultry and pork products.

Yet, unbeknownst to these manufacturers, a potentially deadly contaminant was lurking…

Peanuts.

What followed was the largest allergy-related recall since the U.S. Food Allergen Labeling and Consumer Protection Act became law in 2006. Retailers pulled 600,000 pounds of meat off the market, as well as hundreds of other products. As of May 2015, reports of peanut contaminated cumin were still being posted by FDA.

Food manufacturing executives have long known that a product contamination event is a looming risk to their business. While pathogens remain a threat, the dramatic increase in food allergen recalls coupled with distant, global supply chains creates an even more unpredictable and perilous exposure.

Recently peanut, an allergen in cumin, has joined the increasing list of unlikely contaminants, taking its place among a growing list that includes melamine, mineral oil, Sudan red and others.

Lex_BrandedContent“I have seen bacterial contaminations that are more damaging to a company’s finances than if a fire burnt down the entire plant.”

— Nicky Alexandru, global head of Crisis Management at AIG

“An event such as the cumin contamination has a domino effect in the supply chain,” said Nicky Alexandru, global head of Crisis Management at AIG, which was the first company to provide contaminated product coverage almost 30 years ago. “With an ingredient like the cumin being used in hundreds of products, the third party damages add up quickly and may bankrupt the supplier. This leaves manufacturers with no ability to recoup their losses.”

“The result is that a single contaminated ingredient may cause damage on a global scale,” added Robert Nevin, vice president at Lexington Insurance Company, an AIG company.

Quality and food safety professionals are able to drive product safety in their own manufacturing operations utilizing processes like kill steps and foreign material detection. But such measures are ineffective against an unexpected contaminant. “Food and beverage manufacturers are constantly challenged to anticipate and foresee unlikely sources of potential contamination leading to product recall,” said Alexandru. “They understandably have more control over their own manufacturing environment but can’t always predict a distant supply chain failure.”

And while companies of various sizes are impacted by a contamination, small to medium size manufacturers are at particular risk. With less of a capital cushion, many of these companies could be forced out of business.

Historically, manufacturing executives were hindered in their risk mitigation efforts by a perceived inability to quantify the exposure. After all, one can’t manage what one can’t measure. But AIG has developed a new approach to calculate the monetary exposure for the individual analysis of the three major elements of a product contamination event: product recall and replacement, restoring a safe manufacturing environment and loss of market. With this more precise cost calculation in hand, risk managers and brokers can pursue more successful risk mitigation and management strategies.


Product Recall and Replacement

Lex_BrandedContentWhether the contamination is a microorganism or an allergen, the immediate steps are always the same. The affected products are identified, recalled and destroyed. New product has to be manufactured and shipped to fill the void created by the recall.

The recall and replacement element can be estimated using company data or models, such as NOVI. Most companies can estimate the maximum amount of product available in the stream of commerce at any point in time. NOVI, a free online tool provided by AIG, estimates the recall exposures associated with a contamination event.


Restore a Safe Manufacturing Environment

Once the recall is underway, concurrent resources are focused on removing the contamination from the manufacturing process, and restarting production.

“Unfortunately, this phase often results in shell-shocked managers,” said Nevin. “Most contingency planning focuses on the costs associated with the recall but fail to adequately plan for cleanup and downtime.”

“The losses associated with this phase can be similar to a fire or other property loss that causes the operation to shut down. The consequential financial loss is the same whether the plant is shut down due to a fire or a pathogen contamination.” added Alexandru. “And then you have to factor in the clean-up costs.”

Lex_BrandedContentLocating the source of pathogen contamination can make disinfecting a plant after a contamination event more difficult. A single microorganism living in a pipe or in a crevice can create an ongoing contamination.

“I have seen microbial contaminations that are more damaging to a company’s finances than if a fire burnt down the entire plant,” observed Alexandru.

Handling an allergen contamination can be more straightforward because it may be restricted to a single batch. That is, unless there is ingredient used across multiple batches and products that contains an unknown allergen, like peanut residual in cumin.

Supply chain investigation and testing associated with identifying a cross-contaminated ingredient is complicated, costly and time consuming. Again, the supplier can be rendered bankrupt leaving them unable to provide financial reimbursement to client manufacturers.

Lex_BrandedContent“Until companies recognize the true magnitude of the financial risk and account for each of three components of a contamination, they can’t effectively protect their balance sheet. Businesses can end up buying too little or no coverage at all, and before they know it, their business is gone.”

— Robert Nevin, vice president at Lexington Insurance, an AIG company


Loss of Market

Lex_BrandedContent

While the manufacturer is focused on recall and cleanup, the world of commerce continues without them. Customers shift to new suppliers or brands, often resulting in permanent damage to the manufacturer’s market share.

For manufacturers providing private label products to large retailers or grocers, the loss of a single client can be catastrophic.

“Often the customer will deem continuing the relationship as too risky and will switch to another supplier, or redistribute the business to existing suppliers” said Alexandru. “The manufacturer simply cannot find a replacement client; after all, there are a limited number of national retailers.”

On the consumer front, buyers may decide to switch brands based on the negative publicity or simply shift allegiance to another product. Given the competitiveness of the food business, it’s very difficult and costly to get consumers to come back.

“It’s a sad fact that by the time a manufacturer completes a recall, cleans up the plant and gets the product back on the shelf, some people may be hesitant to buy it.” said Nevin.

A complicating factor not always planned for by small and mid-sized companies, is publicity.

The recent incident surrounding a serious ice cream contamination forced both regulatory agencies and the manufacturer to be aggressive in remedial actions. The details of this incident and other contamination events were swiftly and highly publicized. This can be as damaging as the contamination itself and may exacerbate any or all of the three elements discussed above.


Estimating the Financial Risk May Save Your Company

“In our experience, most companies retain product contamination losses within their own balance sheet.” Nevin said. “But in reality, they rarely do a thorough evaluation of the financial risk and sometimes the company simply cannot absorb the financial consequences of a contamination. Potential for loss is much greater when factoring in all three components of a contamination event.”

This brief video provides a concise overview of the three elements of the product contamination event and the NOVI tool and benefits:

Lex_BrandedContent

“Until companies recognize the true magnitude of the financial risk and account for each of three components of a contamination, they can’t effectively protect their balance sheet,” he said. “Businesses can end up buying too little or no coverage at all, and before they know it, their business is gone.”

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




Lexington Insurance Company, an AIG Company, is the leading U.S.-based surplus lines insurer.
Share this article: