• LinkedIn
  • Twitter
  • Facebook
  • Google Plus
  • Digg
  • RSS
  • Email
  • Print

Article2_Circle_Rotation-768x768Most workers’ compensation claims do not start out as complex. They become complex over time due to specific drivers that increase costs and duration. Being able to recognize and resolve these drivers at the right time will help reduce a claim’s likelihood of becoming complex. Read on to learn how to recognize risk factors and pick up some tips on how you can have greater impact in changing the trajectory of potentially complex claims.

Litigation

It is no secret that litigation is a key driver of claim complexity, cost and duration. A California Workers’ Compensation Institute (CWCI) survey shows:

  • Claims with attorney involvement are eight times more expensive
  • Lost time days are three times higher
  • 90% of litigated claims result in permanent impairment

Strategies and tools around litigation avoidance are critical. An injured worker can become anxious about their recovery and the ability to sustain themselves and their family. Being an advocate for the injured employee can make all the difference. Providing excellent customer service, making claim decisions faster, facilitating effective meaningful communication and following through with impactful actions will reduce litigation. Take the time to learn about the person at the heart of the claim and find ways to best address their needs and alleviate concerns. It is important to customize your approach and resources for the individual injured employee.

Opioids

Another well-known cause of complexity is opioid utilization. In an interview with DMEC @Work, Dr. Teresa Bartlett of Sedgwick reported the following data:

  • According to the Centers for Disease Control and Prevention, 78 people die every day from the opioid epidemic
  • Sedgwick’s data shows that 56% of injured workers take opioids and, on average, have a 53-week increase in claim duration when opioids are involved
  • 60% of individuals taking an opioid for 90 days will still be taking them 5 years later

In response to the opioid epidemic, several states have enacted formularies, prospective utilization review, limitations on the first fill and enforcement of tracking systems like CURES and ISTOP. Sedgwick provides an effective approach through our complex pharmacy team in recognizing harmful prescribing trends and working with physicians in weaning injured workers off of opioids. These are all necessary mitigation strategies, but ultimately the best approach is to stop potentially harmful practices at the source. Initial efforts should be focused on utilizing good quality physicians and holding them accountable. Sedgwick’s provider benchmarking and search tool helps in identifying physicians we know will do the right thing by their patients. It also flags physicians that have adverse prescribing habits. We want to line up providers who share the same goal: to help the injured worker receive the best possible care and get them back to being healthy and productive.

Comorbidities

The existence of comorbidities adds another layer of complexity to a claim. A two-year study was recently conducted by Harbor Health on injured workers with obesity, hypertension, history of drug addiction and tobacco use. It found the following:

  • Claim durations increased by 76% for claims involving multiple comorbidities
  • Incurred costs increased by 341%
  • Temporary total disability (TTD) days increased by 285%
  • Litigation rates increased by 147%, and jumped to 224% when addiction-related issues were present
  • Surgical rates increased 123%

An optimal recovery demands early intervention and a holistic approach. Coordination with clinical resources is necessary in understanding and articulating what is related to the injury, what is pre-existing and what is complicating recovery. That is why our team of experts coordinates with all stakeholders and maps out a more holistic treatment plan to secure recovery and achieve our goals.

Psychosocial issues

Much like comorbid conditions, unidentified psychosocial issues will lead to increased costs and delayed recovery. A recent study presented by The Hartford and Optum shows:

  • Duration increases 57% when the injured worker is depressed
  • 10% of claims with psychosocial issues cause 60% of claim costs
  • 97% of depressed patients have a second comorbid condition

We can best support individuals dealing with psychosocial challenges by changing our approach in helping them cope with an injury. As discussed with litigation avoidance, advocacy can have a significant impact in successfully managing their claims. Also, we need to start taking a more holistic approach and focus on the whole person when promoting a return to health. Cognitive behavioral therapy can be a useful tool. For instance, at Sedgwick we utilize the expertise of our team of behavioral health specialists, who play a key role in assisting injured workers with management of psychosocial issues and coping skills during the recovery process.

Understanding the basics of complex claims can help you in accessing the right resources to avoid or mitigate these root causes. If you have questions or comments for our complex claims unit please leave us a comment and we’ll be glad to research.

Eddy Canavan, VP, Workers’ Compensation Practice & Compliance

Read additional Sedgwick thought leader articles on complex claims in our edge magazine:

  • LinkedIn
  • Twitter
  • Facebook
  • Google Plus
  • Digg
  • RSS
  • Email
  • Print

The Internet of Things (IoT) is a rapidly emerging field of technological devices poised to affect virtually everyone, every day. Smart homes and industry are moving with expediency into your neighborhood and your business. Are you prepared? Do you know what to look for within your specialized field? In this article, we hope to provide a few examples of IoT to help you effectively navigate your loss.

It’s a similar narrative, one we have all been a part of during an investigation of a clIoT-communication-1927706_1920aim in which the security of the structure was important – you observed a security alarm panel and proceed to ask a few questions. Was the system active? Was it armed at the time of the fire? Did you receive any notifications from your alarm company?

Let’s assume in this investigation, the system was not armed at the time of the incident and the occupant reported that he was not and had not been there for several hours. The investigator documenting the scene, notices an innocent looking, non-descript white box on the wall in the utility room. Do you know what it is, how it works, and if it could provide any useful data?

The image (right) is a cellular alarm communicator that also serves as a smartalarm.jpg hub. It records all activity associated with the structure’s alarm system (and a host of other devices connected to it such as lights, door locks, outlets, thermostats, etc.). For example, right now, the owner can pull up the alarm.com app on their cell phone, tap the history button and see EVERY sensor, whether or not the system is armed. They can see when the front door was open and closed, the back door, a window – in other words, every sensor provides a data point to the system when that particular sensor was opened or closed. This presents you with the knowledge and opportunity to request to see the alarm.com sensor history and see time stamped activity to build a timeline, and remember – this particular system operates on battery backup, so even after power is lost, it is still recording data.

There are other, similar, smart hub systems available such as the popular Samsung Smart Home device. As part of your investigation routine, it is time to include looking for smart hub systems and recognizing the possibility of other smart devices connected to the hub.

smoke alarmThe Smart Smoke Detector

Speaking of other smart devices, there are also smart smoke/CO detectors with wireless communication. They communicate with the other detectors in the structure as traditional detectors; however, with the WiFi connected capabilities they transmit a detection signal to the end user via a dedicated app. The app provides the end user with what was detected and which detector signaled.

While it is unlikely this technology will be encountered with regularity, it is becoming more commonplace and more affordable. Awareness of the technology and its capabilities is the first step to incorporating recognition and utility of this technology on all forensic investigations.

Watch for future posts on the emerging technology of IoT and forensic investigations. If you have any questions or great ideas to share, please leave us a comment.

Michael Hoffman, IAAI-CFI, District Manager
Unified Investigations & Sciences, Inc., a Sedgwick company

  • LinkedIn
  • Twitter
  • Facebook
  • Google Plus
  • Digg
  • RSS
  • Email
  • Print

IMG_1147I can honestly say I don’t recall a time I didn’t have a book in my hand as a child. I once got in trouble in fourth grade for reading a book during math. I am pretty sure it made Mrs. Park’s heart happy that I loved to read so much and, let’s be honest, the math gene in my family skipped me, so it all worked out. Reading has shaped my life, as I am sure is the same for many of you reading this post.

Just as we did last year in San Diego, the Sedgwick team attending RIMS 2017 in Philadelphia wanted to leave a lasting mark on the local community. Once again, it was my honor to represent Sedgwick in meeting and learning about the charity we would support this year.

We knew that donating both dollars and books to the Children’s Literacy Initiative (CLI) was the right choice. I hope you will be moved to also find a way to support CLI after reading the statistics and hearing their story. If you visit their website, you will see that the cost of two cups of high-end coffee is enough to provide a high-quality children’s book to a classroom – one step toward improving literacy and combating the numbers they share, shown below.

It’s hard to believe that in 2017:

  • Nearly two-thirds of children in low-income schools are not reading at grade level by the end of third grade.
  • 44 million adults are unable to read a simple story to their children.
  • 1 in 4 children grow up not knowing how to read.
  • 85% of juvenile offenders have problems reading.
  • 60% of all prison inmates are functionally illiterate.

Founded in 1988 in Philadelphia, CLI provides professional development to pre-K through third-grade educators. CLI offers a dynamic approach that provides teachers with training in a wide range of best practices in early literacy instruction that all lead to cultivating a love of reading in their students. During the 2015–2016 school year, CLI services reached more than 40,000 students in 1,666 classrooms across the country.

Frank Grossman of CLI talks in the video below about LEARN, to which Sedgwick’s $10,000 donation will be directed, and about the lasting impact it will have on the lives of thousands of students. LEARN stands for Literacy Education and Resource Network and is a free, online knowledge management system that provides early-grade educators and district partners with modules offering lesson plans, checklists and video demonstrations, fully supporting early literacy professional development. Since its launch late last year, LEARN has already reached 7,673 teachers.

When we asked our colleagues, clients and other friends at RIMS 2017 if they were willing to do something tangible to support this great cause, the overwhelming response was, “Count us IN.” So through additional donations, we were able to purchase more than 100 new books from a recommended reading list provided by CLI – and we were able to deliver and put them in the hands of local students immediately to help spark their love for reading.

After wrapping up another successful business week at RIMS 2017, we left Philadelphia knowing that Sedgwick’s colleagues and partners will be a part of the long-term dividends our partnership with CLI will create. Materials provided by the LEARN modules will make an impact for children who will gain better reading skills now and help open up new opportunities for them far into the future.

“Any book that helps a child to form a habit of reading, to make reading one of his deep and continuing needs, is good for him.”

–Maya Angelou

Jonathan Mast, Director of Social Media

 

  • LinkedIn
  • Twitter
  • Facebook
  • Google Plus
  • Digg
  • RSS
  • Email
  • Print

dispense-as-writtenThe 2017 National Prescription Drug Take-Back Day is Saturday, April 29 from 10:00 a.m. – 2:00 p.m. The day was established in 2010 by the U.S. Drug Enforcement Administration (DEA) to help reduce prescription drug risks and promote safety.

According to the DEA, most prescription drug abusers report that they get their drugs from friends and family. Cleaning out old prescription drugs around the home or workplace reduces accidents, thefts, misuse and abuse of the drugs. Drug overdose is the leading cause of accidental death in the United States, with 52,404 lethal drug overdoses in 2015.  Opioid painkillers were involved in 33,091 overdoses, which come to 90 deaths per day. Eight out of 10 new heroin users began by abusing opioids and moved to heroin after they could no longer obtain the prescription drugs, according to a DEA report.

In the past decade, improper disposal of fentanyl patches has caused 24 hospitalizations of children under 2 years old. Of those hospitalizations, 12 were deadly. Participate in the take-back day and you could save a life. The DEA reported that the 2016 National Prescription Drug Take-Back Day was a record-breaking success, resulting in the collection of 447 tons of unwanted medicines across all 50 states. Sedgwick encouraged participation last year and we are again encouraging our colleagues and clients to participate and to spread the words of encouragement for others. In addition, most local police stations now have disposal bins for medications. Pharmacies such as Walgreens have added disposal centers and others have mail-away kits for purchase. Everyone must be accountable for the medications they are prescribed.

On April 29, various local sites will be set up to collect unused, unwanted or expired medications. The collection facilities have the ability to dispose of the drugs in a manner that is safe and environmentally sound.

We encourage you to help increase awareness of this program and take the opportunity to clean up your own medicine cabinet.

To find a collection site near you, use the search tool on the DEA website. You can also contact the DEA’s call center at 800.882.9539 or your local law enforcement agency.

Andrew Newhouse, Sedgwick pharmacist

  • LinkedIn
  • Twitter
  • Facebook
  • Google Plus
  • Digg
  • RSS
  • Email
  • Print

Wellness-ZENter-blog-graphicOn Wednesday in the Wellness ZENter, RIMS attendees had the opportunity to hear about a recent study on the work/health relationship. Darrell Brown, Chief Claims Officer at Sedgwick, and Brian Gifford, Director of Research and Measurement at Integrated Benefits Institute, explored the results of this study and what the findings mean for the risk management industry.

They discussed how illness does more to an employer’s workforce than run up healthcare spending. Brian noted that it actually impacts the way a company does business. It is important for employers to recognize that helping employees get healthier is a way to improve business performance. A key finding in our recent survey showed that about 13% of all of the occupational claims that we saw had been in the non-occupational system before. These are people who have had some kind of non-work-related injury that took them off the job. The findings from several studies on this topic show that when you’re dealing with occupational injuries, you’re dealing with people that have a high risk because they have other health issues.

Brian explained that if there is more communication and coordination within an organization, you can start to triage some of the cases and you can almost spot the employees who are at a high risk for a later claim. By the time you’re dealing with a short-term disability claim, you’re likely to see it showing up later on because you’re dealing with a person with health challenges. Brian also pointed out that people who were actually touching both systems had the highest costs in terms of lost productivity and it was higher than those who had multiple short-term disability claims.

They discussed how treating the person no matter how they sustain an injury or illness, and taking a holistic look at them, can improve outcomes. Darrell pointed out the importance of figuring out the best way to treat the person in terms of communication and transferring them from one benefit system to another. If you don’t do those things, friction and litigation can occur and when there is litigation, the costs rise exponentially.

Brian noted that risk managers have a stake in this because of all of the ways in which poor health can impact a person’s performance on the job – their ability to show up day in and day out, their ability to produce high quality work and their ability to avoid disabilities – all of that down the road is going to have an impact on the workers’ compensation field.

Be in the know about everything Sedgwick is involved with at RIMS 2017 by visiting our special website.

  • LinkedIn
  • Twitter
  • Facebook
  • Google Plus
  • Digg
  • RSS
  • Email
  • Print

Wellness-ZENter-blog-graphic

The first topic in the spotlight on Tuesday in the Wellness ZENter at RIMS was employee resilience. Kimberly George, SVP, Corporate Development, M&A, and Healthcare at Sedgwick, talked with Molly Doyle, Chief Product Officer at meQuilibrium, about the importance of resilience. Resilience is about the ability to handle the natural challenges and opportunities that come your way in order to respond in the most productive and positive way, and achieve the best outcome. Molly explained that the human body is not designed to accommodate 24/7 stress. The symptoms of stress can be seen in how we respond to difficult situations. Companies are deploying resilience training across their organizations to improve employees’ ability to bounce back after a rough day, negative feedback or a challenging assignment. Resilience can also impact recovery after an injury or illness. The more resilient an organization’s employees are, the healthier the company. meQuilibrium has found that more resilient employees tend to be sick less often, have fewer days out of the office, stay with companies longer, be more productive, and have less hospitalization and less disability. The company’s data-driven solution leverages cognitive behavioral techniques and focuses on taking small incremental steps to create lasting behavioral change. It includes being aware of your thoughts and then using the tools to respond differently.

Consumer engagement was also on today’s agenda. Dr. Teresa Bartlett, SVP of Medical Quality at Sedgwick, discussed the importance of consumer engagement and the impact it can have on outcomes. She described the huge burden of chronic health that we have in our country and how diseases like diabetes, high blood pressure and obesity are often caused by lifestyle problems, and noted that 93% of all diseases are preventable by changing your eating habits, changing your lifestyle and moving more. She also highlighted the importance of engaging each other and our employees to be healthier and more active. Health education and health literacy are also important. When consumers understand a diagnosis, it can help them take the steps they need to get better. Will Smith, Chief Product Officer at One Call Care Management, discussed how providing transportation can also help drive engagement by ensuring patients get to their appointments. They are a part of their own recovery process. The group also discussed pain management. Shaun Rahimi, CEO at Enso, pointed out that physical and emotional baggage that comes with chronic pain, which is a very complex problem. With the opioid epidemic in our country, it is important to look for creative solutions for managing pain.

Be in the know about everything Sedgwick is involved with at RIMS 2017 by visiting our special website.

  • LinkedIn
  • Twitter
  • Facebook
  • Google Plus
  • Digg
  • RSS
  • Email
  • Print

Wellness-ZENter-blog-graphicEmployee health took center stage during Monday’s Wellness ZENter presentations at RIMS. Dave North, President and CEO at Sedgwick, kicked off the day with a corporate wellness discussion with Shawn Leavitt, Senior Vice President of Global Benefits at Comcast. They highlighted the importance of wellness for individuals and populations, and how health and productivity impact business performance.

The risk management industry has built an entire infrastructure around trying to take care of injured employees in an efficient way, but it has become complex for the employee with multiple phone numbers to call and forms to fill out. Accolade offers a way to keep the complexities behind the scenes and put the employee at the forefront. As a part of their program, each employee on an employers’ benefit plan is assigned a trained health assistant who helps them with issues such as finding a doctor, understanding a diagnosis, getting a second opinion, or figuring out which bills are supposed to be paid. Comcast began working with Accolade to help bring all of their employee benefit programs together. The health assistant serves as a single resource for all health-related questions and concerns for the employee and their family members.

The advanced technology combined with the health assistant’s compassionate approach helps personalize and enhance the experience for the employee. Working together, the data that Sedgwick has gathered can be integrated with the information that Accolade has captured. Integrating group health, workers’ compensation and disability offers benefits that can help people get back to work faster. They discussed the importance of having access to all of the same benefits no matter how an employee is injured

Rob Cavanaugh, President of Accolade joined Kimberly George, Senior Vice President of Corporate Development, M&A, and Healthcare at Sedgwick, and Shawn to discuss how the three pillars of health – physical, emotional and financial – play a role in achieving wellness. The health assistant can help the employee with problems that may be uncovered during the call like concerns about paying for prescriptions. With Accolade’s program, the health assistant ensures the employee is never given another phone number or another app; and never has to think about where to go to next. They also inform the employee about all of the benefits and resources available to them based on their situation and medical needs.

Be in the know about everything happening Sedgwick is involved with at RIMS 2017 by visiting our special website.

  • LinkedIn
  • Twitter
  • Facebook
  • Google Plus
  • Digg
  • RSS
  • Email
  • Print

I have been coming to RIMS for over 20 years and it never grows old. I remain as excited this year as I did the first time I attended. Again I can say rapid changes are happening in our industry, especially in the area of technology. At Sedgwick, we also continue to gauge legislation change at the state level and actively keep an eye on what’s happening at the federal level. This year you can count us in as part of something brand new that looks to explore these areas of change and more – the Wellness ZENter, that we are pleased to sponsor with RIMS.

During exclusive exhibit hours at the Wellness ZENter, leading experts will speak on topics related to health and productivity in the workplace. I am personally going to share why wellness and health for individuals and populations translates to wellness of a company and, in turn, adds up to higher business performance. Focusing on wellness and health creates a win-win situation for everyone; it is part of why we at Sedgwick believe that caring counts.℠ While these topics are still outside the norm for many companies and risk managers, I believe the time is now to begin integrating whole health into your vision for a healthy workforce.

Let me expand on what we mean by whole health. The three pillars of a consumer’s health journey include physical, emotional and financial health. When any of these becomes out of balance, it can affect the whole person. Navigation of a person’s overall health is more complex than ever and, while it is easy to say there is “an app for that,” the human element is still very important to whole health.

Another word you are going to hear a lot from us in the Wellness ZENter is resilience. The science of resilience is a powerful tool when considering workforce wellness. Companies are deploying resilience training across their organizations to improve employees’ ability to bounce back after a rough day, feedback or a challenging assignment. Resilience impacts recovery following an injury or illness. The more resilient an organization’s employees are, the healthier the company.

We were pleased to sponsor a very interesting study in the February issue of Health Affairs on the correlation between the work/health relationship; you will want to join in the discussion about this research and take it back to your organization.

There is so much more happening at the Wellness ZENter than what I have highlighted. Take time to view the full list of speakers and times listed here; I think you will agree there is value in attending as many of these exclusive sessions as time allows.

As always, I look forward to meeting and talking with you next week at RIMS. I encourage you to stop by Sedgwick’s booth 2127 and Vericlaim’s booth 2219 and talk to our expert team more in-depth about your specific needs.

Dave North, president and CEO, Sedgwick

  • LinkedIn
  • Twitter
  • Facebook
  • Google Plus
  • Digg
  • RSS
  • Email
  • Print

LinkedIn_inspiredMany industries today share a dilemma: how to bridge the talent gap. As seasoned professionals retire, they take with them institutional knowledge, industry experience, subject matter expertise, and technical and leadership competencies. Recruiting new workers to take their place is a challenge.

There is conflicting research on what millennials actually want and need.  The most recent research shows that it is more aligned to those of previous generations.  However, millennials tend to be more vocal about their expectations and will leave an organization if those expectations aren’t met.  Businesses can struggle to meet the “new expectations” of the next generation. In addition, today’s client increasingly expects our workforce to mirror the diversity of their own organization’s workforce and customer base. Shifting consumer expectations also present a challenge.

The Institutes® Risk and Insurance Knowledge Group has found that only 4 percent of current college graduates are considering the insurance industry as a career option.  That speaks volumes about the image of the industry and the job itself.  Our industry needs to rebrand itself by focusing on purpose—that is, people helping people in times of need, rather than the outworn “deny first” mindset of days gone by. Sedgwick’s caring counts℠ approach focuses on empathy and compassion when working with injured workers and other claimants. Our clients have come to expect this from us.

Leveraging technology to improve business operations is vital to attracting talent. Sedgwick has been at the forefront of our industry in offering leading-edge capabilities. Raising awareness about these assets can be instrumental in recruiting younger workers. And casting a wider net in the emerging talent pool means looking beyond specific college majors and educational backgrounds to identify candidates with attributes and skill sets that match the competencies needed to be successful in the position. For example, when hiring a claims examiner, we would look for personality traits that include empathy and compassion.

To retain talent, we must cater to employees’ changing needs. For example, those who prefer less structured schedules might appreciate the ability to work remotely. Corporate culture plays a major role in meeting expectations of performing rewarding, meaningful work. Feeling aligned with the culture of the company builds corporate loyalty.  Training and professional development help workers grow within their jobs and rise in the organization.

Understanding the unique value each individual brings to achieving the shared mission and goals of the organization encourages colleagues of all ages to deliver excellence every day. Setting clear, realistic expectations from the outset and keeping the lines of communication open show colleagues that they have a voice and the organization is listening.

I look forward to hearing your thoughts as this is such an important topic to all of us. I look forward to seeing you on Tuesday, April 25, starting at 2:30 p.m. to share more and engage in conversation to equip us all for attracting and retaining talent in our industry.

Terri Brown, chief people officer for Sedgwick

  • LinkedIn
  • Twitter
  • Facebook
  • Google Plus
  • Digg
  • RSS
  • Email
  • Print

LinkedIn_indepthOn Wednesday, April 26, from 8:30 am – 9:30 am Gert Cruywagen (Director of Risk Management for Tsogo Sun and author of the book “Jungle Risk Management”) and I will be presenting on a subject many risk professionals struggle with: identifying and exploiting the upside of risk for value creation. Because traditional risk management has been oriented around loss events and their pretty uniformly negative consequences, the positive aspect of risk is hardly recognizable. More significantly, opportunities to create value are overlooked or ignored as risk leaders find themselves in a nearly constant “hair on fire” mode dealing with the losses that can consume their teams and their time.

An opportunity is not merely the upside of a downside risk but those standalone opportunities that define an organization’s core purpose and add value to its strategic planning. This session will take a look at how the King IV Corporate Governance Code, launched in 2016 by the Institute of Directors in Southern Africa, adds this dimension to risk governance. It will enable attendees to explore the broader definition of your role as a risk leader. It will allow attendees to evaluate the suitability of risk management methodologies for opportunity management and the value that can come from this approach to managing risks. It will examine the many stumbling blocks to both organizational and personal success as well as considering the alternate ways to communicate with and report to your C-suite and board.

The value of risk management is often a question about which the C-suite and business unit management often press for better answers. While Total Cost of Risk (TCOR)  is a common and  usually well received measure, risk managers need more ways to prove their value and gain management and board commitments to greater investment in managing risk. Over the last decade, practitioners have found new and innovative ways to gain influence, show value, measure success differently and fuel their own personal success as a result. For some this has been the path from middle management to the C suite. This session will review the various ways successful risk managers tell their story, drive innovation in their function, gain deeper commitment to their strategies and the effect it has on not just their organizations but also their career trajectories.

Some of the many topics we’ll cover in this interactive session include: defining and redefining risk; Identifying both threats and opportunities; passive versus active opportunity identification; the various and alternative roles of risk leaders who take this broader view; useful risk management methodologies; and the potential stumbling blocks of taking this approach.

Chris Mandel, SVP and Director, Sedgwick Institute