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A hole is melted in the thin wall of CSST after a lightning-caused fire

Since the 1990s, a product called corrugated stainless steel tubing (CSST) has been used in some home and light commercial construction. CSST is used to deliver fuel gases to gas appliances such as furnaces, water heaters and stoves – a function previously done using rigid black iron pipe. Since CSST is sold on a continuous roll and does not require the labor-intensive cutting and splicing that black iron pipe does, it is more practical, easy and cost-effective to install. According to general contractors, the savings per home can often be as much as $2,000 to use CSST, which led many contractors to choose it over the traditional black iron pipe.

Over a decade ago and not too many years after CSST entered the marketplace, forensic fire investigators started to see fires that resulted when lightning struck a building and a failure of the CSST occurred. The electrical energy from the lightning charged the CSST, and if the CSST was in close proximity to another metal object with a different grounding potential, such as a water pipe or HVAC ductwork, an electrical arc occurred that often melted holes in the thin wall of the CSST. Fuel gas then escaped and was ignited by the electrical arc, resulting in an unintended fire. Since CSST is often installed in walls, below floors and in attic spaces, the fires generally would burn unnoticed until other building components ignited and a much larger fire resulted.

Despite lightning’s categorization as “Act of God,” many successful liability claims have been made against CSST manufacturers and construction contractors who would not always install CSST in a manner compliant with a manufacturer’s installation instructions. The influx of liability claims and the concern for safety caused some CSST manufactures to re-engineer their products and one to discontinue the sale of CSST in its original design completely. Other manufacturers have stopped short of doing the same but have greatly expanded their installation instructions beyond what was initially provided. Nonetheless, CSST is still being used and has been installed in millions of homes in the United States. Many of these homes will never experience a CSST-related fire, but some may, and that could happen soon after construction or many years in the future.

When lightning strikes, incorrectly installed CSST can create a devastating fire hazard

When lightning strikes, incorrectly installed CSST can create a devastating fire hazard

CSST is sold in different sizes depending on the consumption need. CSST in most homes is about the same diameter as an ordinary garden hose and is either wrapped in a yellow plastic material, or in newer designs, a black plastic. CSST is not the same as a similar-looking, shorter (3-5 foot) connection tube, commonly called a “pigtail,” that connects an appliance to a wall connection port or to black iron pipe. CSST may or may not be visible to the homeowner; however, as one step in risk reduction, concerned homeowners can look for it in their homes and simply make sure it is not in contact with any other metals.

For additional information about CSST and lightning-caused fires, contact any of Unified Investigations & Sciences’ offices nationwide. We have experts with specialized knowledge in these areas who are ready and willing to assist you.

Michael Reynolds, IAAI-CFI, FCLS, National Corporate Audit Services Manager
Unified Investigations & Sciences | a Sedgwick company

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Carter-logoRecently I was honored with an invitation from Former First Lady Rosalynn Carter to attend her 30th Annual Symposium on Mental Health Policy at the Carter Center. The two-day event was a celebration of past accomplishments and brought together health industry thought leaders and experts within the national mental health community.

During the time President and Mrs. Carter were in the White House, she served as the Honorary Chairperson of the President’s Commission on Mental Health. She also helped bring about passage of the Mental Health Systems Act of 1980. At the Carter Center, Mrs. Carter is chair of the Carter Center Mental Health Task Force which is recognized for worldwide program initiatives to sustain momentum of the annual symposia and for bringing together mental health leaders and organizations nationwide to focus and coordinate efforts on key mental health issues and policy.

The symposium’s agenda was richly filled with celebrations of the past three decades and went quite deep into current challenges and opportunities, along with speculations about the next 30 years facing patients, providers, communities, policymakers and employers. Highlights included presentations on stigma against mental illness, access to mental health care and resources, coordinated care and recovery, technology-enabled mental health solutions and social justice.

From an employer perspective, one of the sessions which resonated with me was the presentation by Ray Fabius, MD, on cultures of health. Dr. Fabius is currently with HealthNEXT and a well-known author, global physician executive, entrepreneur and expert in the development of cultures of health. The cultures of health model is one that I am hopeful more organizations will embrace. When we think about stigma, access to mental health care, delays in treatment and compliance impacting health costs, disability days and overall productivity, would we not be better served by encouraging health? The model is designed for total health and well-being of the employee and organization, which in turn improves financial returns for the company and job satisfaction for the employees resulting in decreased absences and lower turnover.

Another fascinating mental health trend is the emergence of social media and peer advocacy in the mix of treatment. April Foreman is a psychologist who provided an inspiring and thoughtful presentation on how social media can – and is – being used ethically and effectively in mental health leadership. Through Twitter and chat sessions, mental health and substance abuse providers, patients and peer advocates come together addressing issues from suicide prevention to avoiding needless disability. I was moved by the level of success seen in a patient’s health and well-being with appropriate peer advocacy and support; the advocates are brave and smart about their care and crisis intervention.

More often than not, mental health care is provided at a time of crisis. Would we wait to treat cancer at stage IV? As I reflect on the symposium, the standout areas of cultures of health, mental health social media and peer advocacy have stuck with me as opportunities for us to further collaborate and transform mental health care and our support tools and ultimately work towards creation and deployment of a pre-disability model for mental health.

Mrs. Carter has been a strong advocate for mental health initiatives for over 40 years and her vision and leadership are cemented in footprints of the past and the future. I thank Mrs. Carter, the Carter Center and all participants of the symposium for a most enlightening and productive meeting. Please join me in continuing this discussion in my LinkedIn group, Transforming Healthcare for Tomorrow.

Kimberly George, SVP, Corporate Development, M&A, and Healthcare

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fraud-hacker-grinchThe holiday season is a great time for family, friends and fun – but it is also a time for fraud. If we let down our guard, fraudsters can turn happy times to sad. According to the Association of Certified Fraud Examiners, fraud increases by as much as 20% during November and December.

Here’s why; as we purchase gifts for loved ones and give our hard-earned money to charities, we should understand that the Grinch has developed thousands of ways to steal from us. The alert consumer will practice these five tips to protect themselves this holiday season from “the mean one!”

1) If it is too good to be true… We have heard this saying time and again, so be cautious. Through numerous news accounts, we know that 2014 has been the year of the computer breach. Many, many retailers have been hacked and our email addresses have been stolen by fraudsters. Be cautious about big brand stores offering dirt-cheap deals. They may well not be the sender. Do not click on hyperlinks in emails; they often take consumers to phantom websites, where fraudsters capture your personal information. Instead, go directly to the merchant’s website for shopping.

Mobile devices make shopping easier than ever, but smartphones and tablets really open the door to online theft. As you browse, tap and buy online, be cautious. Only obtain official apps from the App Store or Google Play, as malicious apps may steal your information and then use the details to commit larger frauds.

2) Credit & debit card fraud  While we should be cautious with our credit cards and debit cards year-round, during the holidays we should heighten our awareness even more. Do not let your credit cards out of your sight. Be cautions of merchants who run your credit card twice (claiming the first time it did not process). Shoppers who make online purchases should be careful to use trustworthy merchants. Never conduct e-commerce using an unsecure WiFi connection. Always check your credit card statement for unauthorized purchases before making the payment. When performing PIN transactions, ensure others are not capturing the number; cover the keypad with your hand. Credit cards are a safer means to make purchases as fraud loss exposure is usually $50 or less. Consider using pre-paid cards for purchases; this method really limits your exposure in stores or online.

3) Fake charities  If you are considering giving to a charity, conduct some research before you give. Sites like Charity Navigator or Forbes.com collect and share independent, objective evaluations of many major charities and are good sources for information. By learning as much as you can about the charity, you can avoid those who try to take advantage of your generosity.

4) Purses, wallets or cards  Malls and department stores have a heavy volume of customers. Never leave these items unattended. Ladies, consider leaving your big purse with shoulder strap at home; instead consider using a cross-body bag that can’t be easily slipped off your shoulder or place important items in your pockets to free up your hands for holding purchases. Gentlemen, consider moving your wallet to your front pocket to protect yourself from pickpockets.

5) Review your credit report  Now is a great time of the year to review your credit report to check accuracy. Look for unfamiliar addresses and unknown accounts; this can help determine if someone has hijacked your account. Credit reports are free and should be obtained from annualcreditreport.com. Be mindful that the Grinch has also set up fake credit report sites to capture your personal information.

R. A. (Andy) Wilson, CFE, CPP, Vice President, Fraud & Compliance

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change-management-blogChange is part of everything we do and the way we go about implementing change can have a tremendous impact on how change is received and accepted by those directly and indirectly affected. At Sedgwick, one of our core values is to embrace change. This does not mean change or managing change is easy, but we have a great Implementation Project Management team who works with new clients and stakeholders to make the process run smoothly.

No matter where you are in your change process, these three things, when done well, will ensure change is developed and implemented successfully:

  1. Stakeholder identification
  2. Impact assessment
  3. Communication

Not surprisingly, these three things all feed into each other and are facilitated by project management.

It is important to understand that these three components are not one size fits all. The Sedgwick teams know each client is unique. Sedgwick’s Implementation Project Management team is empowered to leverage best-in-practice processes and documents in a manner that addresses the uniqueness of each of our clients ensuring a positive perception and outcome of the transition. Recently I worked with a new client where it would have been easy to pull out the project management text book and get the job done.

However, the answer was not 1, 2, 3 and move on to the next project. As outlined below all three areas are important but, depending on the need, one may be more important than the other two. In the case of this client, Sedgwick’s experience helped us identify that we really needed to focus the client on communication. We created an effective communication plan with attention to the other two areas for an excellent outcome.

So let’s dive in and look at each of these in more depth.

Stakeholder identification
Projects are defined as temporary and having a beginning and an end. Throughout the project, the project team should ensure they are identifying the complete scope of work. At Sedgwick, that means including what the client and/or sponsor defines as quality. First priority in the project management process is to identify a list of typical stakeholders. Although stakeholder identification occurs throughout the project’s lifecycle, identifying stakeholders during the beginning of the project will increase the likelihood of the project being successful. By taking the appropriate time to identify all stakeholders, the team can refine scope, define quality and determine appropriate communications needed early on in a project.

A stakeholders list can be documented by using team directories and sub-team directories that define responsibilities and approximate time needed so the client understands how to procure their project team resources. Our clients, across all industries, also typically consider who should be included in a project from not just internal departments, but also vendors, brokers and/or insurers.

Impact assessment
Impact assessment is necessary to understand and confirm a project’s impact within an organization’s risk and project portfolios and identify changes that could have a positive or negative impact. For example, we implemented a client that had recently purchased several large organizations on multiple technology platforms. The goal of the project was to integrate the various absence management programs into one total absence management program, while maintaining the multiple technology platforms for the recently purchased companies. The team engaged in this project spent time conducting a thorough review of the overall strategy for the client in regards to their newly acquired organizations and what that meant to the current structure of their absence program. It helped us determine what would need to be done and communicated in order to ensure the future state was in line with the client’s vision and strategy. To do this, we used the following Sedgwick tools and processes with the client to complete our assessment:

  • Stakeholder list
  • Communication plan
  • Identification and documentation of standard functions typically implemented as part of change
  • Creation of templates to ensure a consistent approach for analyzing the change
  • Development of processes to maintain the integrity and appropriate application of the tools used to define/refine scope and define quality

Communication
Finally, one of the most critical and more difficult challenges we see for our clients is communicating change to their employee population. By taking the time to identify all groups that have some sort of stake in the project/product, combined with the completed impact assessment and the organization’s risk/project portfolio, the project team can determine the types and frequency of communication to ensure there are no midnight hour surprises or poor perception of the change that is being implemented. Here are some of the most common methods we find useful for clients:

  • Sample communication schedules
  • PowerPoint training presentations for HR managers
  • System guides
  • Sample FAQs
  • Communication vehicles
    • Posting communications on internal portal sites
    • Panel card notifications
    • Tri-fold brochures with perforated wallet cards
    • Process templates

With effective communications, you can ensure change is received more positively and that employees, HR personnel, risk managers, supervisors and management staff know how to interact and use the new products/services. Management support is gained for overall objectives.

Change is difficult so if you can identify who should be involved, how it impacts the overall organization and what and when to communicate, you can ensure the success and positive perception of the change you are implementing. How do you manage change? Share your successful strategies in the comments below.

Daniel Gerke, Project Manager, Implementations | PMP

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CDC_Ebola-in-US_lrThe possible spread of the Ebola virus to persons in the United States has raised concerns regarding the handling of insurance claims that might result from this disease.

As the leading North American provider of claims management services, Sedgwick offers many resources to assist our clients during times of uncertainty. From the initial report of the claim, each line of business has best practices in place to manage claims related to threats to public health, such as the Ebola virus. We have developed these best practices with flexibility enterprise-wide to meet the needs of our clients and ensure we are prepared to handle these potential claims. Please be assured that if Sedgwick receives an Ebola claim, we will not only notify our clients and carrier partners immediately, but also follow any special handling instructions and our own established best practices.

To ensure we are prepared to assist our clients during this time of uncertainty, we have educated Sedgwick colleagues regarding Ebola, its transmission and proper medical treatment. Additionally, we have established an internal Ebola information site for our colleagues who handle claims. Continue reading to learn some of the Ebola facts we’ve shared with our colleagues and clients.

What is Ebola?
Ebola virus disease (EVD) is a severe, often fatal illness in humans caused by infection with one of the Ebola virus strains. There are five known strains of the Ebola virus, four of which are known to cause disease in humans. The Zaire strain is the source of the current outbreak.

Ebola was first discovered in 1976 near the Ebola River in what is now the Democratic Republic of the Congo. Since then, outbreaks have appeared sporadically in Africa. The 2014 Ebola epidemic is the largest in history, affecting multiple countries in West Africa.

How is Ebola transmitted?
According to the Centers for Disease Control and Prevention (CDC), the Ebola virus can be spread through direct contact of broken skin due to an open cut, wound or abrasion or mucous membranes in, for example, the eyes, nose, or mouth with:

  • Blood or body fluids including but not limited to urine, saliva, sweat, feces, vomit, breast milk and semen of a person who is sick with Ebola
  • Objects such as needles, syringes and medical equipment that have been contaminated with the virus
  • Infected animals

Ebola is not spread through the air or by water, or, in general, by food. However, in Africa, Ebola may be spread as a result of handling bushmeat (wild animals hunted for food) and contact with infected bats. There is no evidence that mosquitos or other insects can transmit Ebola virus.
Only mammals (e.g., humans, bats, monkeys and apes) have shown the ability to become infected with and spread Ebola virus.

How long can Ebola live outside the body?
In a perfect environment, Ebola can live for up to six days outside the body. In most cases, it is believed that it lives for only a few hours. UV light, heat and exposure to oxygen deactivate the virus over time. Ebola can be killed on surfaces by using bleach, any EPA approved disinfectants,
or household cleaning products like Clorox or Lysol. The virus depends on a human or an animal host to survive. It does not survive long in water, and contamination of our water system is unlikely.

What are the signs and symptoms of Ebola?
Symptoms may appear from two to 21 days after exposure to Ebola, but the average is eight to 10 days. A person infected with Ebola is not contagious until symptoms appear. Signs and symptoms of Ebola typically include:

  • Fever greater than 101.5 degrees Fahrenheit
  • Severe headaches
  • Muscle pain
  • Vomiting
  • Diarrhea
  • Stomach pain
  • Unexplained bleeding or bruising

Diagnosis and treatment of Ebola
There are several laboratory tests used to confirm the diagnosis of Ebola. Although experimental medications and vaccines for Ebola are under development, there is currently no cure and no vaccine for this virus. The patient is isolated to prevent the spread, and then symptoms are
treated as they manifest with interventions such as:

  • Providing intravenous fluids (IV) and balancing electrolytes (body salts)
  • Maintaining oxygen status and blood pressure
  • Treating other infections if they occur

Recovery from Ebola depends on the patient’s immune response. Once someone recovers from Ebola, they can no longer spread the virus. However, Ebola virus has been found in semen for up to three months. People who recover from Ebola develop antibodies that last for at least
10 years or longer.

More information
Helpful Ebola information resources include:

How you are preparing for the possibility of Ebola claims? You can contact Sedgwick’s medical director, Dr. Teresa Bartlett, for more information on Ebola as a workplace health issue. For additional perspective on how potential Ebola claims may impact the U.S., post your questions for me in the comment section below.

Download a printable copy of this Ebola fact sheet or pick one up and discuss with our experts at this week’s National Workers’ Compensation and Disability Conference – booth #1617. 

Desiree Tolbert, National Technical Compliance Manager

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This blog article has been republished as originally run in Human Resource Executive magazine’s November 2014 issue

As an employer, you’ve most likely heard about the multimillion-dollar lawsuits and settlements related to the Americans with Disabilities Act and the ADA Amendments Act. These acts are designed to protect qualified individuals from job discrimination, but without a consistent management process, employers leave themselves open to costly legal fees and penalties for non-compliance.

Sedgwick recently hosted a webinar discussing ADA/ADAAA compliance, presented by Human Resource Executive. There was a high level of interest and employers asked many thought-provoking questions –reminiscent of the days when companies were adopting Family and Medical Leave Act policies and procedures. Organizations are dealing with overlapping complex employment issues, and as we look ahead to 2015, ADA/ADAAA compliance continues to be among the top concerns for human resource and risk professionals, particularly when considered alongside other disability and absence issues, including FMLA, or workers’ compensation requirements.

How can employers ensure compliance in these areas? Through consistency and integration. The keys to success include adopting consistent management practices to address all types of employee absences, along with an integrated claims system that brings all of the information together.

Developing a consistent process
For ADA/ADAAA accommodations, employers should make every effort to meet the employee’s request unless it truly has a significant impact on their business. The process typically begins when an employee requests a change in the way his or her job is performed or he or she exhausts all job-protected leave while remaining absent from work. For each request, your disability management team should follow a consistent process that includes:

  • Capturing the request. Make sure standard procedures regarding leave or accommodation are up to date, clearly communicated to the employee and trigger an interactive process review.
  • Working with the physicians to certify the impairment. Set expectations with employees, and request reasonable documentation to determine if they are disabled and if they can perform their jobs with an accommodation. A job accommodation specialist certified in vocational rehabilitation can be very beneficial at this point.
  • Navigating through the interactive process. Once the healthcare provider has established that the employee has an impairment but is able to perform job functions with an accommodation, the team will engage in an interactive discussion with the employee, set expectations up front and help them gain an understanding of possible accommodations.
  • Working together to determine the appropriate accommodation. Choose the accommodation (if there are more than one) that will allow the disabled person to do his or her job most effectively, such as modifying lifting tasks for a warehouse employee who injured his or her back. This may involve researching technical solutions and adaptive equipment.
  • Implementing the accommodation. Discuss the status and next steps with the employee along with a designated contact. The accommodation should be implemented as soon as possible. In some cases, a reasonable accommodation may be unpaid leave.

The advantages of an integrated claim system
An employee’s request for a job accommodation can arise as part of a claim for short- or long-term disability, FMLA or workers’ compensation. It may also stem from a condition that does not qualify for any of these. A claims management system that brings together the information on all types of employee absences, tracks each step in the process and enables comprehensive documentation helps ensure compliance on multiple fronts. Relying on manual tracking methods may lead to compliance violations and increased risk. A centralized information platform that supports multiple processes can greatly reduce that risk – and give the employer a significant advantage in the current regulatory environment.

Integrating claim systems not only helps streamline the information, it can also help employers reduce costs. In fact, over a three year-period, Sedgwick found employers that implemented integrated disability management programs reduced their internal administration costs by an estimated 10 to 20%.

The bottom line
State and federal regulations for ADA/ADAAA, FMLA and workers’ compensation are becoming increasingly complex. Developing a successful compliance program includes ensuring you have the right resources to provide a consistent process supported by a centralized information system that can easily adapt to regulatory changes.

To learn more, please see the additional resources below:

Darryl Hammann, EVP Disability Operations

 

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doctor-patient-evaluationEmergency Department (ED) staff members have all felt the anxiety of a potential missed diagnosis. For those who have actually witnessed a missed chance, it is not hard to understand how agonizing it would be to realize the missing piece of information was right at your fingertips…had the interview process nailed down the correct information during patient evaluation.

This brings to mind how dependent ED team members are during the interview process on what the patient shares. Patients will sometimes tell us things we really don’t need to know and in other instances will tell us very little. That makes it important to understand that it is our obligation, as healthcare providers, to use interview skills that encourage, evoke and extract information from the patient.

This might seem an easy task but really, in this day and age, we are dealing with so many diverse cultures and languages that asking the right questions in terms that are understood can be very difficult. Not only do we need a concise and accurate history and medication profile, we also need the interview skills to elicit an appropriate response from the patient. Several things come to mind, like asking open ended questions and giving the patient the opportunity to define the conversation. Of course, the most basic interview skill is listening and, if a language barrier exists, the information might not be accurate unless an interpreter is involved.

Maybe now is a good time to re-educate ourselves on the interview process and take ownership of the fact that the first line of defense includes the quality of the interview and the information obtained.

As a takeaway for your ED staff, share the patient-centered interviewing tips that promote two-way conversation – and the best chance at getting the full story – found in: “Five-Step Patient-Centered Interviewing” at http://members.aapa.org/aapaconf2005/syllabus/5024FortinSmithInterview.pdf.

As a check-and-balance, let your ED’s healthcare professionals perform a self-assessment of their interview skills by checking off this list of common problems that trip us up, as published by Peter Lichstein, in Clinical Methods: The History, Physical, and Laboratory Examinations, 3rd edition:

  1. Confusing the traditional, rigid order of the written medical history with the actual process by which information emerges during the medical interview.
  2. Relying too heavily on directed, closed questions. This style discourages the patient’s associations and spontaneous report of symptoms.
  3. Ignoring the patient’s emotional responses and concerns during the interview process.
  4. Narrowing the scope of inquiry too early in the interview.
  5. Failure to clarify the seven dimensions of a symptom in the patient’s own words.
  6. Insisting that the interview must be accomplished in one session (experienced clinicians return to the patient again and again to clarify the history).
  7. Limiting the list of diagnostic hypotheses before adequate data has been collected.
  8. Using questions that are leading, too complex, double-barreled or unclear.
  9. Failure to follow basic courtesies in the interview: lack of clear introductions, ignoring the patient’s comfort, failure to establish an atmosphere of trust and confidentiality.
  10. Failure to elicit the patient’s own ideas about the cause of the problem and the patient’s fantasies about what the doctor will do.
  11. Note-taking that interrupts the flow of the interview.

(More content available at: http://www.ncbi.nlm.nih.gov/books/NBK349/)

Finally, if interpreter services are utilized as part of the interview process, be sure to document the interpreter’s name, what language was being interpreted and any other relevant points around questions asked and answered through this intermediary.

With a renewed focus on interviewing skills, ED team members – and healthcare providers in general – can avoid common problems that could lead to a missed diagnosis. When we ask the right questions and listen to the patient, we can target our response and provide the most appropriate treatment every time.

Do you have stories of how you overcame communication barriers through interviewing or how potential issues were avoided? Share them with us in the comments.

Cynthia D. Bullard, RN, Senior Professional Liability Claims Specialist

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Fun-Fair-1001290If you have been trying to keep up with the latest Medicare compliance changes, you might feel like you are watching the carnival vendor who used to say, “around and around it goes and where it stops nobody knows.” Fortunately, with these answers you don’t have to guess.

Liability: CMS withdraws proposal for liability MSAs
Sometimes the biggest developments come from the changes that don’t happen; this was the case for Medicare set-asides (MSAs) in liability cases. In 2012, the Centers for Medicare and Medicaid Services (CMS) intimated they were going to issue rules and regulations about Medicare set-asides (MSAs) in liability cases. This raised concern in the industry because the proposed rules made little sense in the context of liability cases. Sedgwick was concerned the proposed rules would unreasonably delay and drive up the costs of resolving liability cases. Last month, we, as a member of the Medicare Advocacy Recovery Coalition (MARC), met with CMS representatives to address many outstanding items related to Medicare compliance. When this issue came up, MARC asked that CMS withdraw the current proposal. We received confirmation that CMS granted the request and has, in fact, withdrawn the proposal concerning liability MSAs.

Despite the recent developments, our best practice regarding liability MSAs remains unchanged, so things are “business as usual” for Sedgwick. We believe our established approach to be reasonable based on the uncertainty involving liability MSAs.  Input from the defense attorney and the client will be necessary to determine if a liability MSA is applicable in any given case.

January 2015 change in reporting of SSNs
What might be one of the best changes to come about – and I think you will agree – is the pending change in Social Security number (SSN) reporting, as it will greatly simplify a burdensome process. CMS recently announced that, beginning Jan. 5, 2015, only the last five digits of a claimant’s SSN will be required for Medicare reporting purposes. This change reduces the burden on our claims handling teams to collect full SSNs from claimants who may not want to provide this information. We anticipate the removal of this obstacle will significantly simplify the Medicare reporting processing for our colleagues. More detail about the new rule can be found in the announcement linked above.

I think both of these changes – or, rather, one non-change and one change – are significant to how you do business. Particularly, the change on Social Security number reporting is a very positive step and one that will reduce administrative time and potential errors. We will continue to keep you updated on important changes in the Medicare compliance space. In the meantime, please feel free to contact us. Our expert team is ready to work with you.

Michael Merlino, VP, Medicare and Medicaid compliance

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ebola-price-blogThe recent appearance of Ebola in the United States has given rise to claims concerns at multiple levels for hospitals and other healthcare providers. The first U.S. case of Ebola came after a traveler from West Africa reportedly arrived without symptoms and sought care in a Dallas emergency department, only to be released home. When symptoms arose, he soon returned to that same hospital, was diagnosed with Ebola, and was treated but succumbed to his disease.

At its core, Ebola is a public health matter with significant similarities to other infectious public health events of the past. However, from a claims perspective, public health claims involve primary and secondary exposures for hospitals like the one at the center of current U.S. Ebola developments.

Primary exposure
Let’s look at the timeline for the patient who traveled from Africa to Dallas. He was infected in Africa and, therefore, the hospital is not responsible for that infection. Next, the issue of liability regarding the primary patient is one of a delay in diagnosis and the potential that his care was too late to be effective as a result of that delay. Recent publicity has cited the lack of timely diagnosis and care in the hospital. Based on known evidence, it seems likely that negligence exists. However, since the current Ebola strain is classified by the World Health Organization (WHO) as having a 70% mortality rate, and assuming a local jurisdictional causation standard of “more likely than not,” it seems reasonable to conclude that the primary patient was more likely than not going to survive.

Press articles report the family contends the patient was denied the therapy used with success on other Ebola-infected patients moved from West Africa to the U.S. for care. Those patients were given an untested anti-viral treatment and lived. News accounts report that anti-viral supply has been exhausted. If it develops that the Dallas hospital had this or other therapies available that were not used, the causation defense is jeopardized.

Secondary exposures
The major exposure in an infectious public health claim: one patient may become many. Those patients may be in a position to claim their infections were the direct result of healthcare negligence (or public health failure).

The secondary exposures thus far who have contracted the virus – two nurses who provided care for the primary patient – are hospital employees. It seems likely “exclusive remedy” under the Labor Code applies, and that a tort remedy is not available from the hospital. It remains to be determined if the involved physicians who did not make the diagnosis on the first emergency department visit have a non-employment exposure to the infected nurses.

The list of secondary exposures is long. There are the family members of the primary patient, others that he and his family and friends came into contact with prior to his diagnosis (estimated at 80, none of whom are reported as having symptoms thus far despite reaching the 21 day measure), the two infected nurses, both of whom spent at least a couple of weeks out in public prior to their diagnosis, including a commercial flight by one nurse.

It is easy to see that secondary infections may grow rapidly, causing health facilities to be busy with both infected patients and others who are frightened that they are infected.

The measure of communication in viral infections is Ro, the basic reproduction number. This can be thought of as the number of cases one case generates on average over the course of its infectious period, in an otherwise uninfected population. The Ro for Ebola in the United States is presently 2. Any value greater than 1 means that viral spread has occurred and, in the absence of other data or developments, is likely to continue. A list of Ro for a variety of viruses is below.

At this writing, it seems public confidence in the Centers for Disease Control and Prevention (CDC), perhaps public health broadly, and certainly the Dallas hospital at the epicenter, is rapidly waning. Ro is only one aspect. The low Ro for Ebola seems encouraging compared to the vastly higher Ro for measles or pertussis – but for two factors: the lethality of Ebola given the (current) lack of effective therapy and the new and dynamic outbreak. Note that the century-ago Spanish flu had an Ro 2-3, and yet killed 50 million to 100 million worldwide.

The claims issues with secondary exposures will mainly be a concern if the Ebola secondary exposures are relatively low. If, for example, a worst case scenario occurs with a broader exposure, it seems likely that the claims system will lack the funding necessary to handle the claims. And we are already seeing that hospitals linked to Ebola complications are losing other patients. Should an Ebola outbreak reach numbers sufficient to threaten the infrastructure, Federal government relief is likely.

The most important thing this event has shown us is the need for preparedness and education of healthcare operations. We work every day helping our clients prepare for such events. I would be happy to answer your questions or hear your thoughts on where you see our readiness in the U.S. stands today for a major epidemic.

Jerry Frick, Director, Professional Liability Claims

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Sedgwick recently hosted a webinar discussing Americans with Disabilities Act (ADA) and ADA Amendments Act (ADAAA) compliance, in partnership with Human Resource Executive. There was a high level of interest and employers asked many thought-provoking questions – many of which shared common themes, reminiscent of the early days of Family and Medical Leave (FML) adoption and the development of related policies and procedures. Organizations are dealing with overlapping complex employment issues; ADA/ADAAA compliance continues to be among the top concerns for human resource and risk professionals, particularly when considered alongside other disability and absence issues, including FML, or workers’ compensation requirements.

We compiled a list of the most prominent questions we answered in our webinar, as well as many of the frequently asked questions we continue to hear in the marketplace. It’s likely these may be questions you also have asked when considering your own ADA/ADAAA policies and compliance requirements. Read on and please continue the conversation by asking your own questions in the comments below or via our ADA/ADAAA inquiry form.

Q: What are our obligations under ADA/ADAAA?

The law is designed to be very employee friendly. Its goal is to keep people at work. An employer should make every effort possible – unless it truly creates a significant hardship for their business – to meet a disabled employee’s accommodation request and keep them within the work environment. In the past, prevalent thought may have been, “if we can accommodate, great, but if not, it’s no big deal.” Today, this type of thinking goes against the principles of ADA/ADAAA.

What are an employer’s obligations? The employer is entitled to pursue medical substantiation – is the disability certified and an accommodation appropriate? Then what comes next? If given a medically reasonable accommodation request, the employer is required to pursue the interactive process – engage with the employee to clearly understand the accommodation needed, look for potential options and consider parameters, and monitor that the accommodation is being carried out appropriately and consistently.

Q: ­Can you expand on what constitutes a hardship to the employer? ­

Based on communication from the Equal Employment Opportunity Commission (EEOC), an employer must prove that implementing an accommodation would put them in financial hardship. For a very large employer, there are not many modifications that would be officially seen as impactful enough to incur financial risk. For a smaller employer, major modifications may be more likely to be considered a hardship. Buying a piece of equipment, for example, is not usually going to be considered something that would put an employer into financial risk. Having to redesign the workplace or something of similar significance could possibly be seen as a hardship, depending on the size of the employer.

Truly, the buzzword is “significant” – very major, negative impact must be proven to the finances of your organization for a proposed accommodation to be recognized as a hardship. Especially for larger employers, we’ve seen that this is very difficult to prove under most circumstances, but each situation must be evaluated for specific determination.

Q: How can we protect ourselves from lawsuits?

The documentation proving consistency within the interactive accommodation process is of prime importance. Through the years, loose management and inconsistent accommodation – whether based on personal bias, informal policies, lack of training or other circumstances – has led to legal action for unfair employment actions. Consider an example where an employee is accommodated with generic restrictions. However, if nobody monitors for consistency and then, perhaps after years of working under these conditions, new management comes in and says, “I won’t accommodate that anymore,” the employer would be in compliance trouble. Under the law, if an accommodation has already been made available, it sets a precedent. We see more and more employers paying out large sums of money because, even if they’ve tried to do the right thing, if it’s not well-defined, well-documented and consistency and appropriate action can’t be proven in court, they will still end up in legal trouble.

More lawsuits have brought the compliance requirements under ADA/ADAAA into focus. Litigation is most easily avoided through clear adoption of the interactive process and complete documentation around the steps of this process, from the initial request through conversations taking place, medical records retrieved for substantiation, vocational rehabilitation options investigated, what accommodations have been proposed and/or why accommodations may not be considered reasonable.

While employers should have consistency across their entire organization when it comes to the evaluation process used, this doesn’t mean that every work location will be able to make the same accommodations based on the specifics of their business unit.

Q: ­Does Sedgwick’s platform integrate workers’ comp, FML/leaves of absence, disability and ADA/ADAAA systematically when all elements are overlapping?

One of the keys to reducing risk under ADA/ADAAA is to have standard procedures in place that will trigger the need for an interactive process review. The second key is to use an information management platform to support the accommodation process. Whether or not you utilize Sedgwick’s platform, these keys are critical for ADA/ADAAA compliance.

At Sedgwick, workers’ compensation, disability, absence and ADA/ADAAA are completely integrated so employers can see all of the pieces of the puzzle within one platform. Because of our integrated platform, our clients can look to a centralized source for resources and recordkeeping, and compliance becomes a far easier thing to accomplish.

Q: ­What guidance do you offer regarding prompting conversation with an employee who appears to have a disability but has not approached the employer for an accommodation? ­

Similar to the FML arena, an employee doesn’t have to ask for ADA accommodation. If you know an employee has been impacted by a disabling condition, for example if they have been away under FML or another leave type, we encourage employers to offer language in written communication or a conversation to be sure the employee explores the ADA process. Employers should approach ADA concerns in the spirit of collaboration and think creatively to find ways to accommodate any disability.

Q: ­How long should you extend time after FML has been exhausted?

Once an employer knows there is potential for extended disability-related need upon FML exhaustion, they have a responsibility to educate their employee and explore options under ADA/ADAAA. There’s no official limit on timeframe to allow for conditions that could change; opinions vary on reasonable amount of time – and most often, compliance experts discourage setting hard limits and instead encourage evaluating each situation individually. The employer should be focused on determining whether allowing extra time will ultimately allow their employee to come back into the workplace and return to their job, while also considering whether keeping the position open longer is reasonable.

­Q: How do you suggest we handle situations where we are not able to accommodate an employee in any position after engaging in the interactive process?

If ADA/ADAAA options are explored and the employee can’t remain in the workplace and perform their essential job functions through accommodation, it becomes an employment decision. We often see employers put employees on extended leave – personal leave or another leave type – for a period of time to make sure the condition is not one that can change in the short term. Yet, there may be situations where reasonable accommodation cannot be made and an employee is terminated as the end result. Interpretation is much tighter under ADAAA than was originally intended under ADA, but ADAAA changes did not create an environment where an employee can never be terminated. Collaborate with counsel in any situation where termination of employment is considered.

Q: ­How does an employer accommodate a request for intermittent leave for flare-ups? The employee either exhausted their FML entitlement or is not eligible. ­

Because leave can be a reasonable accommodation, an employee could potentially be eligible beyond their 12 weeks of federal entitlement, and leave as an accommodation could be used on an intermittent basis. It’s important to remember, even under requirements for reasonable accommodation, an employee must still be able to perform essential job functions and productivity levels must be maintained – lowering productivity standards is not a requirement. If someone is constantly away from work and cannot maintain standards, leave as an accommodation is not allowing them to do their job as defined.

The intent of the law is not to change someone’s job duties; for example, moving someone to part-time work/changing their productivity standards is not specifically the intent of ADA/ADAAA rulings but, if available, may be a good solution based on the employer’s circumstances and is not prohibited by ADA/ADAAA.

Q: ­Does Sedgwick’s ADA/ADAAA platform include vocational or ergonomic experts that assist employers in determining potential job modifications? ­

Yes, Sedgwick uses job accommodation specialists who all have vocational rehabilitation backgrounds. When we assist clients with ADA and return-to-work solutions, our job accommodation specialists help with certification, facilitating discussions with physicians to confirm the need for an accommodation, setting expectations with employees and requesting reasonable documentation to evaluate whether they can perform their job with an accommodation. These experts can assist with workplace evaluations to help define the essential tasks of a job and determine which possible accommodations can be made.

Shawn Johnson, SVP Client Services, Disability Administration