Risk Scenarios Live: Lessons in Managing Chronic Pain
When a patient is in pain and in fear of pain, physicians face a dilemma. How to manage that pain in the best way without creating a dependency on pain medications?
When an injured worker is already floundering in a haze of prescription medications and denial, how best to intervene in a way that respects the worker’s rights, preserves the bottom line and most importantly, keeps that person productive?
These and other questions were on the table in the fourth installment of the Risk Scenarios Live presentation at the Ernest N. Morial Convention Center in New Orleans on Wednesday.
“Forget the money. Focus on the outcome.” — Michael Paladino, director, insurance services and claims, VCU Health System
As they watched filmed enactments of fictitious workers’ compensation claim scenarios, a veteran panel of workers’ compensation professionals had plenty to share.
“Forget the money. Focus on the outcome,” said Michael Paladino, director, insurance services and claims, VCU Health System.
The award-winning risk manager went on to say that an organization pays for an injured worker whether it is on the group health side or under workers’ compensation.
So, focusing on where that payment is coming from is less important than bringing the worker back to health, he said.
“We do have to treat the patient as a whole,” said Jill Leonard, assistant vice president of claims operations, Louisiana Workers’ Compensation Corp.
In three vignettes, the panel examined a chronic pain case, a case where a worker was ingesting a wide range of pharmaceuticals, and a scenario where a worker with an injured back failed to understand or comply with his return to work options.
Too often, according Dr. Robert Goldberg, chief medical officer, Healthesystems, there is a rush to surgery or a failure to fully educate an injured worker on their treatment and recovery options.
Rehab Rx: Return to Work
“Injured workers are a rewarding group to take care of, but a challenging group,” said Robert Hall, corporate medical director, Helios.
He and Dr. Marcos Iglesias, vice president and medical director, The Hartford, outlined the barriers to returning injured workers to full functionality and how to overcome them at a Wednesday morning session at the National Workers’ Compensation and Disability Conference, titled “Medical Director’s Perspective: Restoring Function and Returning to Work.”
Comorbid conditions – both physical and psychosocial – present the greatest obstacle.
They not only set people up for injury but also delay recovery. If an injured worker has a physical condition like obesity, diabetes or older age, recovery time usually doubles, Iglesias said.
If that condition is coupled with a psychosocial factor like catastrophic thinking or perceived injustice, the recovery time quadruples. Add in a mental health issue like depression or anxiety, and that time increases by a factor of eight.
Psychosocial risk factors are increasingly gaining awareness from the workers’ comp provider and payer community.
“Self-predictions about return to work are often self-fulfilling prophecies,” Iglesias said. He said that claims managers can identify patients as high or low risk by asking them when they believe they can return to work.
“Any answer beyond 10 to 14 days means they are at high risk for delayed recovery,” he said.
The best way to manage comorbid conditions and speed up return to work is through open and frequent communication between patient, provider, payer and employer, Hall said.
Physicians should use simple language to address patients’ fears and provide reassurance, and payers should follow up with doctors to verify that their treatment plan follows evidence-based guidelines.
Non-pharmacological treatments like exercise and socialization should also pay a big role. As Hall said, “Opioids alone don’t bring about recovery.”
Because time away from work only increases the likelihood of developing depression and exacerbating existing comorbids, returning to work should also be considered part of the rehab process, Iglesias said, and not just the end goal.
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.