OBJECTIVE ANALYSIS NEEDED
Peter Rousmaniere's articles on state funds, "An Analysis of Arrogance," (Risk & Insurance®, April 1, 2005, page 28) do not display objective analysis. It appears that the writer had a conclusion in mind and then selectively advanced arguments to support his criticisms of the California State Fund.
An objective analysis would have included an examination of three key facts.
Open rating led to cutthroat competition by private carriers. Ultimately, approximately 30 of these carriers, who did not display the judgment and discipline espoused by Rousmaniere, failed.That placed a huge burden on the California Insurance Guarantee Association, and it produced the growth experienced by SCIF.
Rates did go up, and as Rousmaniere must know, there are many factors in play. Benefit increases, medical inflation, the rate of utilization and the attitude of courts, to name a few, had more to do with increased rates than did insurance company pricing decisions.
To say that SCIF could have acted with greater restraint in pricing is to wholly ignore the pressure exerted by the Insurance Commissioner's office. His directives were draconian and left SCIF no choice other than to increase prices dramatically.
Rousmaniere has raised some questions that are worthy of examination, but if he wants to encourage a meaningful debate, he needs to present all the facts.
Lynn Armstrong, ARM
Vice President, Workers' Compensation
Anchor Insurance & Surety Inc.
OPINION LACKING BALANCE
While your concerns about the efficacy and implications of drug therapy in pain management are well placed (Risk & Insurance®, July 2005, page 14), you appear to dismiss the need for an appropriate prescription of pain medication over the long term.
I can attest to the fact that it is possible that such a medication regimen may permit an individual to continue to be a productive member of society. I suggest a more balanced consideration of this subject shouldrecognizecontinuing pain medication as an appropriate option.
Here is a case study. A 60-year-old female in good health twisted her back. A two-month bed rest was prescribed by her internist. Conservative treatment failed to produce relief. She was operatedat Massachusetts General Hospitalby anorthopedic surgeon to remove disc material. Pain persisted and she was referred to the MGH Pain Clinic where varioustechniques failed to yield relief. She was given a heavy dosage of Neurontin and Oxycontin four times a day. Although under the care of her internist, she has had follow-up evaluations by the MGH Pain Clinic over the past 10 yearsreceiving theirconcurrence to maintain the level of medication. At age 70 she continues to operate a successful retail enterprise although with some limitation as far as standing and walking is concerned. Her dosage has been maintained at a constant level during this 10-year period.
While this may not be seen as a prototypical treatment, it should be recognized as one successfulstrategy for return to work where further surgical intervention does not appear to be an option.
Cornelius N. Bakker Jr.
Independent Schools Compensation Corporation
September 1, 2005
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