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Successful Partnerships

Surety Bond Assistance Fuels Growth

Brokerages help small business take on public works projects that would otherwise be out of reach.
By: | March 3, 2014 • 7 min read
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Federal and state laws mandate that a certain portion of most public works projects be given to small, minority-owned or female-owned contractors. There is little argument that such rules have a great benefit, both in supporting bootstrap businesses, and also in bringing increased talent and competition to contract bidding.

Federal and local laws also mandate that contractors post surety bonds, often to the full value of the contract. The intention is to protect taxpayer dollars and public infrastructure against shoddy work. Often, the two mandates conflict with each other, because even healthy small firms have cash flow constrictions that make posting a bond prohibitive.

While legislative solutions are sought, the interim solution is bond assistance, or subsidy. A few local brokerages around the country, notably one on each coast, have specialized in this field. Most recently, the San Francisco regional Bay Area Rapid Transit (BART) retained Merriwether & Williams, a pioneer in this niche market, to assist in a new round of contracts and bonding.

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A completely separate firm, Surety Bond Associates of Bala Cynwyd, Pa., is active on the East Coast, and has been working with the Philadelphia Industrial Development Corp. for more than a year on an emerging-business capital assistance program.

“We are making final adjustments to the program, and hope to launch it in the second quarter,” said Ellen Neylan, president of Surety Bond Associates.

The national brokerages are not active in the business because it involves a lot of time and effort for a relatively modest return. The big firms laud the efforts, and are content to leave the business to the dedicated regional brokers.

“The bonding requirement is a huge hurdle for small and minority businesses,” said James E. Bridgeman, department manager of insurance for BART. He said that while the heavy burden on bidders’ cash flow and capital is the biggest challenge for them, there are others. “There is a formal bonding statement, accounting standards, and other requirements,” he said. Government entities and large contractors have the personnel and expertise to handle those on their own, but small businesses do not.

Bridgeman added that in meeting the inclusion goals of the contractor distribution laws, BART and other authorities also gain community involvement in local and regional public works. “Merriwether & Williams have held roundtables where prime contractors and subcontractors can sit down, get to know each other and the projects.”

“In these programs, our default is 0.2 percent, which is one-hundredth of the surety industry average of 20 percent.”

– Ingrid Merriwether, president and CEO, Merriwether & Williams

Question of Default

One major concern, especially with a bond assistance or subsidy program, could be default. But he noted the default percentage for contractors in such programs is quite small. “There is a real engagement by the brokerage, a real passion for this underwriting and assistance. They try to make default very difficult. Beyond underwriting guidance, they provide third-party fund administration and other support as part of their process, even beyond our contractor supervision,” said Bridgeman.

Ingrid Merriwether President and CEO Merriwether & Williams

Ingrid Merriwether
President and CEO
Merriwether & Williams

The BART commission comes 17 years after the first effort in bond assistance by Merriwether & Williams, said President and CEO Ingrid Merriwether. “We were handling OCIP for the San Francisco Airport Authority [SFO] when they asked us to help them with a $3 billion capital expansion project. They were having trouble meeting their Miller Act obligations. That is the federal law requiring a portion of the work be done by small, female- and minority-owned contractors. California and most states have similar laws.”

She said that SFO realized it would have to approach the problem in a new way, because this was a systemic challenge. The authority was willing to provide bonding subsidies to help otherwise capable contractors to qualify, but the process was complex. “Bonding is often an artificial barrier,” said Merriwether. “What is commonly called a subsidy or assistance is actually an investment. There are direct and quantifiable cost savings from having more bidders on a job, especially smaller contactors with less overhead.”

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There is a symmetry to the concept. The idea of the bond is that the contractor puts capital at risk but once the job is done, that capital is returned and the contract paid. Similarly, in the surety assistance, the authority provides a subsidy, and gets it back when the bond is returned. The net gain is the lower cost of the project.

“We never arrange for more than 40 percent assistance,” said Merriwether, “that means the contractor is still responsible for 60 percent. The surety is enduring.” For the Miller Act, the federal threshold is $100,000, so that covers just about any public work. “After the SFO project,” she said, “the mayor of San Francisco realized bonding was a major issue throughout the city and county, and within two years there was a citywide bond assistance program.”

The BART commission represents the eighth such project for M&W in the past 17 years. According to Merriwether, “in that time, we have enabled $699.3 million in transactions, of which $207 million have been successful bidders.” The more important ratio is the default rate. “In these programs, our default is 0.2 percent which is one-hundredth of the surety industry average of 20 percent. That is testimonial proof that bonding is an artificial barrier,” she said.

Another client of M&W is the City of Los Angeles, specifically several of its “proprietary” or autonomous departments. Curtis Kelley is senior risk manager for the city administrator’s office. “The mayor’s office received numerous calls regarding the difficulties that small contractors were having securing surety. I did some research and learned about the program that the City and County of San Francisco had established,” he said. “I called Ingrid and spoke at length with her as well as officials in San Francisco. We decided to establish a similar program here.”

LA started its program under the auspices of the sewer construction and maintenance authority, simply as a good fit with municipal process. Eventually the program grew to include transit and transportation, airports and ports, and central city government.

“For just the City of LA, we have assisted on $156 million in surety or contract value, of which $62 million in contracts were awarded. And we have never had a default.”

– Curtis Kelley, senior risk manager, Los Angeles city administrator’s office

“Merriwether & Williams have great contacts among prime and subcontractors,” said Kelley. “They go through their own underwriting process with the potential bidders on a contract. They determine which surety would be the best fit, then they go to the market with our guarantee. That is the smaller of either 40 percent of the value of the contract, or $250,000.”

Kelley stressed that the bonding underwriters still go through their own underwriting as they would if the contractors had come to them separately. The double underwriting seems to work: “For just the City of LA, we have assisted on $156 million in surety or contract value, of which $62 million in contracts were awarded. And we have never had a default. The savings came to $3 million. This approach has a real payback.”

Growing Program

Kelley expects the program to expand. “We have used the program for a new terminal at LAX, for wastewater projects, but the ports are probably going to be our biggest expansion in the program,” he said. “This is not just piddly little contracts; they have a huge impact for the city and for the people of LA.”

Merriwether also speaks in terms of “the double bottom line,” doing well by doing good. “We are a small, woman-owned firm, so this is our cohort. We can relate,” she said. “This is important work, and as far as I know we are the only firm in the State of California engaged in it. In the past few requests-for-proposal, we were told that we were the only firm to respond.”

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Government officials agreed. “The biggest challenge in our latest program was not getting approvals, it was the lack of competition for the contract,” said BART’s Bridgeman. “We have worked with Merriwether & Williams before as operations broker and also as a team member on construction projects.”

Bridgeman added that the hope of the brokers and of the city is that some of the repeat contractors taking advantage of the bond assistance will be able to build a track record and grow to the point where they no longer need the program.

M&W has several offices around California, and there is plenty of business. Said Merriwether, “We have a big back yard.” She is hopeful about legislative solutions, and M&W has other lines of work, but she expects to be at this for many more years.

“There are constantly efforts around the country to change bonding requirements because this is a real problem for governments at all levels,” said Merriwether. “The availability, or lack, of surety credit has a very big impact on public works everywhere. Surety bonds don’t exist in an abstract public-policy realm. They affect city and county budgets, local and regional economic development and infrastructure.”

Gregory DL Morris is an independent business journalist based in New York with 25 years’ experience in industry, energy, finance and transportation. He can be reached at riskletters@lrp.com.
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Workers' Comp

Making the Grade

Employers make jobs conditional on physical fitness.
By: | March 3, 2014 • 9 min read
Prince William County, VA firefighter Joe Hopper

Taking the time to match a tough job with a worker who can actually do it reduces the potential for costly workplace injuries, employers are now finding.

That concept is leading more employers to study their essential job functions and test the ability of job candidates, particularly when a job requires a new hire to perform functions known to cause injuries.

Increased nationwide hiring, the rising cost of treating workplace injuries and a less physically fit job applicant pool are driving more employers to employ the practice known as post-offer employment testing.

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Post-offer employment testing, or POET, involves simulating the lifting, pushing, pulling and other physical activities that make up a job’s essential functions. Employers are increasingly making employment offers conditional upon a job applicant’s physical ability to perform those activities.

And in another recent trend, employers are expanding the strategy to help determine when to return an established employee to their duties following a workplace injury or a non-occupational disability leave.

“Pre-work screens are not a good strategy if your injuries are coming three years into employment.”

–Drew Bossen, founder, Atlas Ergonomics

At Cooper Standard, the Novi, Mich.-based automobile parts manufacturer, for example, workers desiring a strenuous job first participate in “simulated work.” That helps determine whether they are physically capable of performing the real job, said Patricia Hostine, the company’s global manager of workers’ compensation.

A job requiring continual force to press rubber hose into a mold that forms radiator hoses is desirable because it is one of the better paying tasks the auto parts manufacturer offers, Hostine added.

But it’s also one of the company’s most physically demanding roles.

“It’s very hard work,” Hostine said. “That is where a lot of our injuries are found.”

After performing the simulated work, more applicants decide against taking the job than the company disqualifies. That’s because the testing showed them they couldn’t do the job anyway.

Cooper Standard also requires a functional evaluation, conducted by physical therapists, for any worker who has been away from work either because of a workplace injury or a non-occupational disability.

That requires employees who normally form radiator hoses to show that they are once again physically capable of performing the work after returning from an absence.

Employers that have benefited from conducting POET evaluations for newly hired employees are increasingly adopting a similar worker evaluation as part of their return-to-work programs, several experts said.

“Historically, these [physical evaluations] have been used at the point of offer, at the point of employment,” said Drew Bossen, a physical therapist and founder of Atlas Ergonomics. “But in the last 12 months, we have clients formulating methodologies to use them for return to work as well.”

Data from an initial POET exam can also provide a measured baseline of an employee’s abilities that can be reviewed post injury to help determine when the worker has regained their ability to return to their original job, or whether they should take up other duties.

Using data that way can reduce return-to-work durations by providing support for a doctor’s determination to release their patient.

Most employers using a POET system, however, still use it only to test newly hired workers.

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Evaluating whether potential new hires have the physical ability to perform certain tasks can substantially reduce a company’s injury rate because newer workers typically account for a greater number of injuries than their more-experienced counterparts, POET advocates said.

Data compiled by the National Council on Compensation Insurance Inc. showed that workers on the job less than a year in 2007 accounted for nearly 34 percent of injuries although they made up only 23 percent of the labor force.

“Pre-work screens are not a good strategy if your injuries are coming three years into employment,” Bossen said.

Now, as the U.S. Labor Department reports increased hiring across the country, vendors that provide physical ability testing programs said they are seeing increased demand, which had dropped off during the recession.

“We have seen a big uptick in companies interested in doing this across all industries,” including transportation, mining and health care, said Connie Vaughn-Miller, vice president of business development for BTE Technologies.

The testing may be more beneficial for the most strenuous types of work.

Hostine at Cooper Standard said, for example, that she does not see a cost/benefit advantage for testing workers engaged in light production jobs.

Most employers adopting a POET strategy do so for certain positions and many start with a pilot program, experts said. It’s best to decide which job categories to include in a pilot program by reviewing the company’s claims history to pinpoint where injury frequency and severity are problems. Or, they recommend starting with the company’s most physically demanding jobs, then add others if the pilot results warrant doing so.

“We can’t be a better place to work if we’re hiring people that are not able to perform the job. That’s bad for the company and the associate.”

–Libby Christman, vice president of risk management, Ahold USA.

Making Work Safer

“One of our company promises is to be a better place to work,” said Libby Christman, vice president of risk management at Ahold USA.

“We can’t be a better place to work if we’re hiring people that are not able to perform the job. That’s bad for the company and the associate.”

Ahold is a retailer with about 120,000 employees operating stores under the names of Stop & Shop, Giant Food Stores, Martin’s Food Markets, and Peapod, an online grocery ordering unit.

Late last year, Ahold launched a pilot program for Peapod delivery drivers and for certain strenuous jobs in two warehouses, Christman said. The warehouse jobs require pushing, pulling, bending and lifting.

Since September, Christman has found that about 25 percent of job applicants could not pass its physical demands test. Screening for an employee capable of doing the job, though, not only reduces injuries, but improves productivity.

“We know that obtaining an accurate assessment of an applicant’s physical abilities can help us place him or her in a suitable job, potentially eliminate injuries and ensure efficiency and performance on the job,” Christman said.

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Stepped-up hiring is not the only factor driving employer demand for POET services, observers said.

Employers — continually pushing for more sophisticated safety measures in the face of an aging, more obese, and less physically fit U.S. workforce — are also driving the demand, BTE Technologies’ Vaughn-Miller said.

The Discrimination Question

Employers cannot discriminate when hiring, but they can legally ask a worker to demonstrate that they can meet the physical demands of a job’s essential functions, experts said.

That requires careful analysis, however, to clearly understand a job’s essential functions, so the designed test measures just those functions and does not go beyond evaluating a worker’s ability to perform those specific tasks.

Employers have run afoul of the Equal Employment Opportunity Commission when implementing POET programs that evaluated for abilities beyond those required by the job.

If employees must lift 75 pounds only once a year, and can use a mechanical lift assist to help them when they do so, then testing to see whether a worker can lift 75 pounds is not a fair test, advised Colleen M. Britz, managing director and ergonomics practice leader for Marsh Risk Consulting.

Colleen M. Britz, managing director and ergonomics practice leader for Marsh Risk Consulting

Colleen M. Britz, managing director and ergonomics practice leader, Marsh Risk Consulting

Employers may also face discrimination complaints if they do not require a POET evaluation of everyone seeking a specific job, experts warned.

The tests themselves, however, vary substantially, depending on the vendor or employer providing them.

Some resemble gym equipment with electronic systems for measuring a worker’s strength and agility. Those results can then be compared to computerized measurements of a task. Other tests may be as simple as requiring a worker to lift bags of sand.

“I do consider it a best practice to have a well-designed post-offer employment test that truly is measuring an employee’s capacity to meet physical demands,” Britz said. “It’s a matter, from my perspective, of whether some of the methodologies are truly testing that.”

The wide variation in testing methodology has hampered the collection of data on POET’s impact on overall employee injury rates across industries or multiple employers, experts said.

But individual employers have experienced success, Britz said.

“I don’t know of any company that has stopped doing POET after starting — because they are seeing a positive return on investment,” she added.

A physical abilities test helped Prince William County in Virginia mitigate a double loss driven by candidates seeking to become firefighters.

The county was losing tens of thousands of dollars on hiring and training costs each time a  job candidate washed out of a 26-week training course simply because they could not perform the physical challenges firefighters face in the line of duty, said Tim Keen, assistant chief for the county’s Department of Fire and Rescue.

Because firefighting is a tough job, a lack of physical capability also contributed to recruit training injuries.

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“Not only is it a hard job, but when you add all the gear they wear, their air packs, as well as the functional movements that it takes to accomplish certain tasks, it puts  strains on the body,” Keen said.

Those strains became costly workers’ compensation claims when recruits could not return to an existing job as would occur after an established firefighter suffered an injury, added Lori Gray, the county’s risk management division chief. That forced the county to continue paying workers’ compensation benefits to recruits who did not have a job to return to.

So in 2003, the risk management and fire department helped the county establish its own facility where applicants wanting to become firefighters must first participate in a standardized Candidate Physical Ability Test.

The International Association of Fire Fighters and the International Association of Fire Chiefs developed the CPAT test the county licenses.

The test used by fire departments across the country requires candidates to climb stairs while wearing weight vests, drag hoses and simulated bodies, simulate forcing their way into a building, and conduct other physical feats within a certain time period.

“There are a variety of firefighting tasks they must go through in this course,” Keen said. The course tests their aerobic capabilities, their flexibility, core strength, and upper and lower body fitness.

The test’s standardization ensures it is true to the firefighter’s actual work role and that is legal and fair to all candidates, he added.

“Regardless of age or gender the course is the same for everybody,” he said.

“The test is appropriate so you are not losing people due to injuries, especially early in their careers, Keen said. “It’s the right thing to do, making sure they are physically capable of doing the job.”

The screenings have resulted in fewer recruits lost due to a lack of physical ability.

“We have also seen a huge reduction in the number of injuries that were occurring because recruits are coming in more physically fit to do the job,” Keen said.

POET advocates said the screening results have other applications as well.

In some cases, post-offer physical test results provide employers with a defense in permanent disability cases, Britz said.

In states allowing employers to apportion responsibility for permanent disability claims, for example, the baseline results from the initial post-offer exam can limit an employer’s liability by showing that a worker lost only a certain portion of their functional ability during their employment tenure.

Britz added that she expects to see more large, sophisticated employers counter rising claims severity driven by factors such as aging and obesity by integrating their ergonomics, wellness intervention and physical ability testing programs.

For example, an employee returning from a leave might undergo a fitness for duty exam to evaluate their ability to perform the job without injuring themselves.

Simultaneously, the employee could be referred to the employer’s wellness program to address health-related issues such as high body mass index or to learn exercises that would strengthen certain body parts, such as their shoulders, if frequently used in their daily work routines.

“That is the evolution of post-offer employment testing into fitness-for-duty programs,” she said.

“Not so they lose the job, but to recognize that this person needs to work on shoulder strength. So we create an opportunity to increase shoulder strength. I think that is going to be the wave of the future.”

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Roberto Ceniceros is senior editor at Risk & Insurance® and co-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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Sponsored: Healthesystems

Changing the WC Medical Care Mindset

Having a holistic, comprehensive strategy is critical in the ongoing battle to control medical care costs.
By: | November 3, 2014 • 6 min read
SponsoredContent_HES

Controlling overall workers’ compensation medical costs has been an elusive target.

Yet, according to medical experts from Healthesystems, the Tampa, Fla.-based specialty provider of innovative medical cost management solutions for the workers’ compensation industry, payers today have more powerful options for both offering the highest quality medical care and controlling costs, but they must be more thoroughly and strategically executed.

Specifically as it relates to optimizing patient outcomes and controlling pharmacy costs, the key, say those experts, is to look beyond the typical clinical pharmacy history review and to incorporate a more holistic picture of the entire medical treatment plan. This means when performing clinical reviews, taking into account more comprehensive information such as lab results, physician notes and other critical medical history data which often identifies significant treatment plan concerns but frequently aren’t effectively monitored in total.

Healthesystems’ Dr. Robert Goldberg, chief medical officer, and Dr. Silvia Sacalis, vice president of clinical services, recently weighed in on how using a more holistic, comprehensive strategy can make the critical difference in the ongoing medical care cost control battle.

Fragmentation, Complexity Obscure the Patient Picture

According to Dr. Goldberg, fragmentation remains one of the biggest obstacles to controlling overall healthcare costs and ensuring the most successful treatment in workers’ compensation.

Robert Goldberg, MD, discusses obstacles to controlling overall medical costs and ensuring the best treatment in workers’ compensation.

“There are several hurdles, but they all relate to the fact that healthcare in workers’ comp is just not very well coordinated,” he said. “For the most part, there is poor communication between all parties involved, but especially between the payer and the provider. Unfortunately, it’s rare that all the stakeholders have a clear, complete picture of what’s happening with the patient.”

Dr. Goldberg explains that health care generally has become a more complex landscape, and workers’ comp adds another level of complexity. Physicians have less time to spend with patients due to work loads and other economic factors, and frequently there isn’t adequate time to develop a patient specific treatment strategy.

“Often we don’t have physicians properly incentivized to do a complete job with patients” he said, adding that extra paperwork and similar hurdles limit communication among payers, nurse case managers and other players.

In fact, Dr. Sacalis emphasized that it’s not only the payer, but often the healthcare provider who is not getting a complete picture. For example, a treating doctor may not be the primary care physician and therefore they may not have access to the total healthcare picture for the injured worker.

SponsoredContent_HES“Most of all, payers need to adopt a more collaborative approach in their relationships with physicians, employers and patients, as well as networks involved. It will result in getting people back to work through appropriate medical care and moving the case along to a prompt closure.”
– Robert Goldberg, MD, FACOEM, Chief Medical Officer, Healthesystems

“It’s often difficult for multiple physicians to communicate and collaborate about what’s happening because they may not be aware of each-others involvement in that patient’s care,” she said. “Data sharing is lacking, even in integrated healthcare systems where doctors are in the same group.”

Done Right, Technology Can Bridge the Treatment Strategy Gap

Dr. Sacalis explained the role technology advancements can play in creating a more holistic picture of not only an injured workers’ post-accident state or pace of recovery, but also their overall health history. However, the workers’ comp industry by and large is not there yet.

“Today’s technology can be very useful in providing transparency, but to date the data is still very fragmented,” she said. “With technology advancements, we can get a more holistic patient view. However, it is important that the data is both meaningful and actionable to promote effective clinical decision support.”

Silvia Sacalis, PharmD, explains the role that technology advancements can play in creating a more holistic picture of an injured worker’s overall health.

Healthesystems, for example, offers an advanced clinical solution that incorporates a comprehensive analysis of all relevant data sources including pharmacy, medical and lab data as part of a drug therapy analysis. So, for example, the process could uncover co-morbidities – such as diabetes – that may be unrelated to a workplace injury but should be considered in the overall treatment strategy.

“Healthcare professionals must ensure there are no interactions with any
co-morbidities that may limit or affect the treatment plan,” Dr. Sacalis said.

In the majority of cases where Healthesystems has performed advanced clinical analysis, information gathered from the various sources has uncovered critical information that significantly impacted the overall treatment recommendations. Technology and analytics enable the implementation of best practices.

She cites another example of how a physician may order a urine drug screen (UDS), yet the results indicating the presence of a non prescribed drug were not reflected in the treatment regimen as evidenced by the lack of modification in therapy.

“Visibility and transparency will help with facilitating a truly effective treatment plan,” she said, “Predictive analytics are necessary tools for proactive monitoring and detection of trends as well as early identification of cases for intervention.”

Speaking of Best Practices …

Dr. Goldberg highlighted that the most important overall best practice needed to secure the optimal outcome is centered around getting the right care to the right patient at the right time. To him, that means identifying patients who need adjustments in care and then determining medical necessity during the entire case trajectory.

“It means using evidence-based medical treatment guidelines that are coordinated,” he said.

“You must look at the whole patient, which means avoiding the typical barriers in the workers’ comp treatment system, issues such as delays in authorizations, lengthy UR processes or similar scenarios that are well intentioned but if not performed effectively they can get in the way of expedited care.”

Dr. Goldberg and Silvia Sacalis provide recommendations for critical steps payers should take to achieve the best outcomes for everyone.

Dr. Goldberg noted that seeking out the most effective doctors available in geographic locations is another critical best practice. That requires collecting data on physician performance, patient satisfaction and medical outcomes, so payers and networks can identify and incentivize them accordingly.

“This way, you are getting an alignment of incentives with all parties,” Dr. Goldberg said, adding that it also means removing outlier physicians, those whose tendencies are to over-treat, dispense drugs from their office or order unnecessary durable medical equipment, for example.

SponsoredContent_HES“Visibility and transparency will help with facilitating a truly effective treatment plan. Predictive analytics are necessary tools for proactive monitoring and detection of trends as well as early identification of cases for intervention.”
– Silvia Sacalis, PharmD, Vice President of Clinical Services, Healthesystems

“Most of all, payers need to adopt a more collaborative approach in their relationships with physicians, employers and patients, as well as networks involved,” he said. “It will result in getting people back to work through appropriate medical care and moving the case along to a prompt closure.”

Dr. Sacalis added that from a pharmacy perspective, another best practice is becoming more patient-centric, using a customized and flexible approach to help payers optimize outcomes for each patient.

“Focus on patient safety first, and that will naturally drive cost containment,” she said. “Focusing on cost alone can actually drive results in the wrong direction.”

Additional Insights 

Dr. Goldberg explains how consolidation in the health care and WC markets can impact the landscape and quality of care.

Dr. Goldberg and Silvia Sacalis discuss if injured workers today are getting better treatment than they were twenty years ago.

SponsoredContent

BrandStudioLogo

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


Healthesystems is a leading provider of Pharmacy Benefit Management (PBM) & Ancillary Benefits Management programs for the workers' compensation industry.
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