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

doctor-patient-evaluationA Sedgwick liability nurse was asked to analyze the records of a claim involving a 52-year-old man whose car was struck when our client’s truck driver fell asleep at the wheel, overturning his rig and causing damage to several cars.  Liability was not in question, but there was substantial dispute over the damages. The initial plaintiff demand of $750,000, included $140,000 in medical specials and defense counsel assessed the verdict value of $350,000-700,000 based on the severity of the accident and claimed injuries.

The plaintiff alleged that when the air bag in his car deployed, he lost consciousness and sustained traumatic brain injury, accelerating a pre-existing hearing loss and causing vestibular damage requiring surgical intervention with cochlear implants. A treating physician found that the plaintiff had a congenital disorder that caused his underlying hearing problem and suggested that his type of disorder might have placed him at greater risk for worsening in the presence of head trauma. In addition:

  • The liability nurse reviewer found nothing in the medical records to support either loss of consciousness or evidence of head trauma at the time of the accident.
  • Several months after the accident, the plaintiff reported that he was losing his balance as a result of pain in his legs. The nurse identified that the plaintiff’s orthopedic problems were pre-existing, stemming from a prior injury and pointed out that four of his pain medications were associated with dizziness, gait instability, lack of sensation in the feet, and diminished coordination. The records also contained a statement from the plaintiff to his physician indicating that he had lost his job as a result of falling asleep at work due to sedation.  Once he reduced his use of pain medications his balance improved.
  • The primary cost of the plaintiff’s claim was related to the accelerated hearing loss, but the nurse found that prior to the accident he had a lifetime of hearing loss and was already relying on lip reading and a hearing aid for communication.
  • The liability nurse was able to assist the adjuster in disputing the medical specials, citing the lack of medical indicators for the cochlear implants for his balance problems.
  • The liability nurse identified records not previously identified by the plaintiff attorney and made recommendations for types of experts that might be required should the case proceed.

By the time of mediation, the demand was in excess of one million dollars. The adjuster saved the cost of outside referral and used the nurse’s information about lack of causal links between the treatment provided and the claimed neurological, auditory and vestibular injuries to negotiate a favorable settlement.

The case settled at mediation for $285,000.  Cost to the claim file for the liability nurse review was only $440.

Liability nurse consultants are highly experienced clinicians and consultants with experience in a variety of specialty areas.  Additionally, the nurses are also licensed claims adjusters who provide great value in understanding the needs of other claims adjusters in providing details for the claim file.  Needless to say, their services are highly cost competitive especially compared to the very expensive demands of liability claims.

While we know that the liability nurse consultant may not  have  a dramatic impact on every case, their approach provides claims adjusters with a medically trained resource to assist in the analysis and evaluation of injuries allegedly sustained by injured parties—creating good outcomes and cost savings.

Please feel free to share your thoughts and questions with us; the Sedgwick liability nurse consultant team is available to help meet the needs of your organization.

April Clemens, Business Relationship Manager, Specialty Operations, Sedgwick

Diana Shick, RN Consultant Team Lead, Liability Nurse Program, Sedgwick

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

According to 2015 U.S. Coast Guard statistics, May through September is  the peak period for recreational boating accidents.  Florida, Minnesota, Michigan, and California lead the nation in the number of registered boats while Florida regularly leads the nation in damage claims of over $2000—far outpacing California at a distant second. bwalburnboat

While boat and watercraft insurance is an important line for many insurers, the nature of boating can lead to large property, casualty and liability claims.  There are several areas where marine safety and vessel maintenance can significantly reduce both the incidence of claims and the dollar value of payouts.  This blog post will focus on sailboats, powerboats and personal watercraft.

Risks to boats include:

  • Sinking
  • Collision with other vessels
  • Collision with fixed and submerged objects
  • Grounding; fire and explosion
  • Wind and weather
  • Hurricanes
  • Lightning strikes
  • Theft
  • Injuries
  • Damage to vessels being stored or trailered

Here are a few operation and maintenance strategies designed to reduce boating claims:

  1. The most important rules for safe boating are training and vigilance.  Many states do not require any certification to operate a boat, and some don’t even have age restrictions. All boat owners and passengers should take a boating safety course covering safe practices, safety equipment, navigation rulesand accident prevention. A list of boating safety courses and other information can be found at www.uscgboating.org
  2. Boats can sink at sea as the result of collisions and heavy weather, but they can also be done in by a lack of proper maintenance.  The two most critical areas overlooked are the hull and the engine/electrical systems, which can lead to sinking or fire and often the total loss of the boat.
  3. Boat owners should pay close attention to marina maintenance issues that may pose a risk to their boats, including overheated shore power systems, stored combustibles, unsafe welding operations or corroded fuel lines.  These issues should be reported immediately to marina management.

Forensic marine professionals are experts in recreational watercraft, yacht, commercial shipping and marina type fires. In addition to fire related incidents, forensic engineers can perform accident reconstructions, ocean engineering and code compliance inspections and reviews.  These professionals also have experience working along with maritime attorneys, marine surveyors, heavy equipment operators and other experts on large joint scene examinations.

While it is impossible to prevent all boat-related accidents and losses, you can rest easier knowing there are experts who can help with loss prevention and recovery.  Please feel free to share your questions and ideas with us. Learn more about Unified  and how we are here to meet the needs of your organization.

Patrick Hudson, PhD, PE, District Manager/Forensic Engineer
Unified Investigations & Sciences, Inc., a Sedgwick company

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


Telemedicine customized for occupational injuries will provide the greatest advantage

“You have to start with the customer experience and work backwards to the technology.”  – Steve Jobs

Telemedicine, primarily audio technology, has been available to  group health providers for care for minor illnesses, follow-up care and e-prescribing for a long time. Many workers’ compensation claims administrators and managed care organizations also provide audio telehealth services in areas such as 24/7 nurse triage and prescription drug reviews.

Nowtech-and-wc video telemedicine services are evolving for group health and they are at the genesis of  production in workers’ compensation. Claims administrators and managed care organizations must thoughtfully connect specific crucial areas in order to successfully deliver quality occupational care via mobile technology and video.

We have seen for years that getting injured employees to the occupational injury care providers proven to achieve the best outcomes in workers’ compensation significantly lowers cost, time away from work and rates of litigation. High-quality healthcare is a MUST for telemedicine.

In order for telemedicine to be successful in workers’ compensation, employers need to be sure their claims administrators and managed care providers are fully prepared to deliver:

  • Technology and logistics: Through the right platform, we can ensure easy access, short wait times, provider availability and correct/efficient billing.
  • Experience and results: One of the keys to improved health and return to work in the workers’ compensation space is having access to the best-performing occupational medicine providers available around the clock. This remains true whether seeing a doctor in person or via telemedicine.
  • Network connectivity: We must ensure that the networks entering into this new approach are organized and trained to meet the needs of occupational injury providers, the employer and injured workers.
  • Fully transparent pricing/fees: Telemedicine is simply a form of healthcare enabled by technology, so the cost of services should be fully transparent.
  • Regulatory compliance: The services should be fully compliant with applicable regulatory requirements, including state reporting, compliance with telemedicine jurisdictional laws and billing for services.

By connecting these critical areas, the claims and medical cost containment services administrator will eliminate travel time, reduce lost productivity and cost associated with occupational injury care, while creating a new model with ease of access to high-quality care. Telemedicine customized for occupational health can offer a convenient avenue to provide initial and follow up occupational medicine and specialist care for injured workers which will promote higher patient satisfaction and reduce cost.

According to an article from Harvard Medical School, the average total visit time for a person seeking care for themselves, a child or another adult was 121 minutes, including 37 minutes of travel time and 84 minutes in the clinic. Yet, only 20 minutes was spent with a physician. The opportunity for great improvement is here.

We see an excellent future for telemedicine to save time and cost and to improve access to specialty care in workers’ compensation. With the logistics to deliver great service, regulatory compliance and connection to the highest-quality providers, the opportunities in this area are phenomenal. But be sure to do your homework and find the right option to make it a win!

Dr. Teresa Bartlett, SVP, Medical Quality

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

Pete Hamann, Sedgwick SVP of business development, Stamford, Connecticut

Fifteen years; how can time have passed so quickly? When I close my eyes, I am immediately transported back to that day and its amazingly crystal-clear blue sky. I am one of the many 9/11 “what if” stories.

On the morning of Sept. 11, 2001, I made my way into the South Tower of the World Trade Center in downtown Manhattan for a meeting at the Aon offices with some colleagues from Marsh on a co-brokered account. Sedgwick was intricately connected to Marsh at that time, so it was not uncommon for me to be in the World Trade Center. Usually, I went to the Marsh offices in the North Tower, but that day, my meeting was in the South Tower.

I arrived early and decided to join a friend from Aon for a cup of coffee before our scheduled meeting. We proceeded to the Sky Lobby on our way down to a coffee shop in the concourse. We heard that something had happened in the North Tower but were told there was no issue in our tower and we could return to our meetings. Because we had some time and we were curious, we headed downstairs, completely unaware of the magnitude of what had occurred just minutes earlier in the North Tower.

The events that followed are well chronicled, and everyone who survived that day lives with their own memories. The things we saw as we exited the building were even more terrible in person than can ever be grasped by what is captured on film.

Thinking about it 15 years later, it was an unbelievably sad day that changed the world for our generation. However, my heart also swelled with pride as a New Yorker and an American when I witnessed tremendous human courage and strength in the immediate aftermath of the attacks. As we know now, our brave first responders ran back in, not away from the danger.

Christine McGuire, Sedgwick client services director, Melville, New York

Like Pete, I remember how beautiful that Tuesday morning was. My children were in the first, third and fifth grades at the start of 2001 school year, so I was excited to walk all three of them to the same bus. My husband Brien, a lieutenant in the New York City Fire Department, was off duty that day; he left home early in the morning to help build a fence in a nearby town.

I returned home from the bus stop and watched with the rest of the world as the horrific events unfolded on TV. My phone started ringing off the hook, with family and friends frantically asking whether Brien was in the Twin Towers when they fell. We didn’t have cell phones at the time, so I wasn’t able to contact him. He finally called from a pay phone to let me know that the entire FDNY had been called to lower Manhattan and he was headed to Ground Zero.

We didn’t see him again until Sunday morning. Instead of sleeping, he showered and put on a suit, and we went to church as a family. After church, he changed clothes and went right back to the city. For the next several weeks, we only saw him about once a week. He slept in his car or in various firehouses, along with the other first responders. During that time, I did my best to shield our children from the nonstop news coverage. However, they were in school with children whose parents were killed in the attacks or were still unaccounted for.

Brien brought home some things he’d received from those volunteering for the recovery efforts. One of them was a simple red, white and blue ribbon with a medallion on it. Our daughter Megan, then age 10, was attracted to this memento for some reason. She took it up to her room, scanned the image, and wrote this poem:

meganspoem

Megan understood and sensed the magnitude of what had happened. She also appreciated her father’s amazing efforts to help others find closure and healing for all that was lost that day. (That insightful young girl is now 25 years old and getting married in June.)

Our family will never forget the events of that tragic day. This past summer, we attended the funerals of two fellow firefighters who assisted in the aftermath of 9/11. One passed away of an illness resulting from his exposure to harmful conditions during the recovery efforts. The other was the father of our dear friend, FDNY Chief Lawrence Stack, whose remains were never found at Ground Zero. Recently, two vials of blood that he donated before 9/11 were discovered, so his family was finally able to have a funeral; here is a video of the procession.

Brien is about to celebrate 30 years as a New York City firefighter, and we could not be more proud. We continue to mourn those who made the ultimate sacrifice that day, and we will always think of the brave men and women who gave of themselves to aid others.

Pete and Christine

We are so proud that Sedgwick has contributed $5,000 to the Families of Freedom Scholarship Fund to help us mark this 15th anniversary in a meaningful way. It’s a beautiful reflection of the company’s caring countsSM philosophy and commitment to education. The fund provides academic scholarships to the financially needy dependents of those killed or severely injured in the 9/11 attacks and related rescue efforts.

We hope you will join us in supporting the scholarship fund to let those who lost the most that day know that we will never forget.

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

dispense-as-writtenOn a weekly if not daily basis, there are media reports about the growing impacts of addiction to opioids. The Centers for Disease Control and Prevention (CDC) reports that 78 people a day are dying from the effects of opioid overdose.1 Families are being systematically destroyed by the multiplicity of effects of this increasingly pervasive problem. In 2014, there were over 47,000 drug overdose deaths in the United States and over 28,000 of those deaths were caused by opioids (including heroin).2 The current overdose epidemic is unfortunately only one symptom of a greater problem in the U.S. Our nation consumes 80% of all opioids produced in the world, yet the American population makes up only 5% of the total world population.3 This strongly implies there is a societal, cultural profile in America that is unlike anywhere in the world, driving such demand and overuse.

As the national “epidemic” of opioid abuse continues to get increasing attention, it’s important to realize the effect it has on employers. Prescription opioid abuse alone cost employers more than $25 billion in 2007.4 Yet even if the injured worker never develops an opioid misuse disorder, long-term opioid use is still extremely problematic. The evidence tells us that the effectiveness of chronic opioid therapy to address pain is modest and effect on function is minimal.5 In addition, when injured workers are prescribed opioids long term, the length of the claim increases dramatically and even more so when other addictive medications like benzodiazepines (alprazolam, lorazepam) are prescribed.6 Perhaps the most troubling statistic of all, 60% of injured workers on opioids 90 days post-injury will still be on opioids at 5 years.7

Workers’ compensation stakeholders are increasing efforts to call more attention to the use of these potent pain relieving drugs by injured workers. In the highly complex and diverse field of workers’ compensation, entities from state governments to insurers and other workers’ compensation stakeholders are stepping up to address the issues and impacts of opioid use by injured workers in varying degrees through a myriad of methods.

Most work-related injuries involve the musculoskeletal system, with doctors increasingly prescribing short- and long-term opioids to address even minor to modest pain despite broad medical recommendations against long-term use. Because of the prevalence of back injuries in the workplace, opioids are increasingly becoming the treatment of choice for what often starts as a short-term treatment, but frequently becomes long-term with the likelihood of addiction occurring before treatment is completed.

Claims professionals should understand that there are many variations of opioids including fentanyl; morphine; codeine; hydrocodone (Vicodin, Lortab); methadone; oxycodone, (Percocet, OxyContin); hydromorphone (Dilaudid) – each with different levels of potency. For example, fentanyl is 50 to 100 times more potent than heroin. No wonder addiction is so often the end result.

Paul Peak, PharmD, Assistant Vice President of Clinical Pharmacy at Sedgwick, notes that opioids act on receptors in the brain; therefore, it’s expected that certain changes will occur over time as use continues. Each one of us would realize both opioid dependence (this means withdrawal symptoms occur when the drug is stopped) and opioid tolerance (this means more drug is needed to get the same effect as use continues) if we were to take opioids consistently for weeks or months. In many cases, patients who are prescribed opioids chronically will experience a worsening of pain that is actually caused by the opioids themselves.

Because opioids have these profound effects on our brains, engaging injured workers in their own recovery is a best claim practice and it is critical to achieving the best outcomes. This should begin early and a key part of it includes encouraging them to ask their doctors questions when they are being treated with drugs for pain. Some of these questions should include:

  • Is this prescription for pain medicine an opioid?

Doctors should educate patients on what an opioid is and how to use it safely to relieve pain.

  • What are some of the potential adverse effects of opioids?

Opioids can affect breathing and should be used with great caution in patients with respiratory issues. They most often cause moderate to severe constipation. Even short-term use can decrease sleep quality and impair one’s ability while driving.

  • Where can I safely dispose of remaining pills?

To protect others from potential misuse, any excess supply should not be saved for later use. Injured workers should be advised not to give them to friends or family, and to dispose of unused pills appropriately. States often provide disposal options/locations for opioids to reduce the chance of leftovers getting into the hands of unintended users. In addition, CDC guidelines now recommend patients are only given a 3-day or 7-day supply of opioids and some states are now putting laws in place following this recommendation.

  • Am I at risk for abuse?

Risk Assessments are tools that providers can use that have been developed to help determine those people at greatest risk for abusing opioids if prescribed. Peak notes that opioids do have some benefit in the acute phase post-injury, say within four to six weeks after injury. However, when improvement doesn’t occur in this time frame, continuing use of opioids is not appropriate as addiction becomes increasingly assured.

These are among the key questions for treating physicians that injured workers should ask. While engagement is a vital part of patient accountability, physician education is even more critical. Peak explains that more is expected of doctors because they are providing the care. Patients and physicians working together in a close, collaborative relationship is a key part of fighting opioid addiction.

Injured workers and family members should talk to the treating physician immediately if they see signs of addiction or dependence. There are some possible warning signs of addition such as craving the pain pills without pain or when pain is less severe, requesting early refills and/or stockpiling medication, taking more pills at one time or taking them more often than prescribed, or going to multiple prescribers for opioids or other controlled substances. Early detection can help stop the destructive cycle of addiction before it becomes too powerful to resist. Injured workers can also reach out to an addiction counseling organization.

A note of caution for all whose accountabilities touch this area of treatment – terminating prescription opioids “cold turkey” can be dangerous and even fatal. Throughout the life of the claim and at the end of the day for injured workers using opioids, the relationship with their doctor will be the primary factor in determining how the treatment will end and the outcome that is achieved.

Strategies for the claims team

So where does all this leave claims professionals who want to see injured workers recover successfully and appropriately from their workplace injuries? Here are a few final things to consider in the overall strategy of managing claims involving opioid prescriptions and which, if not managed closely, may lead to abuse and addiction.

Develop and define a strategy for identifying and then monitoring physician prescribing patterns and the specific use patterns in each affected case. Some of the tactics that should be considered include:

  • Leveraging pharmacy utilization review services
  • Directing patients to doctors who won’t over prescribe opioids; and those who use prescription drug monitoring programs and tools, which are available in most states
  • Engaging nurse case managers early and regularly; their involvement and intervention can help deter addiction; nurses can advocate for other more clinically-appropriate options, and advocate for best practices including risk assessments, opioid contracts, pill counts and random drug screens
  • Ensuring that injured workers are getting prescriptions through pharmacy benefit management networks
  • Leveraging fraud and investigative resources that are often useful in uncovering underlying, unrelated patterns of behavior that would indicate a propensity for opioid abuse
  • Considering the cost of opioids versus alternatives; while many alternate treatment modalities are on the front-end more expensive, certain drugs may be much more expensive in the long term, especially if they lead to addiction
  • Addressing the opioid issue well before case settlement; as with most longer term open claims scenarios, those with opioid use will only produce worse outcomes and get more expensive over time without appropriate early interventions

Continued vigilance by claims professionals can enable and facilitate a better result at closure and avoid a lot of potential pain for the injured worker along the recovery path.

References

1  CDC. Drug overdose deaths in the United States hit record numbers in 2014.

2  CDC. Morbidity and Mortality Weekly Report. Increases in Drug and Opioid Overdose Deaths — United States, 2000–2014. January 1, 2016. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm?s_cid=mm6450a3_w.

3  Johnson, Denise, Jergler, Don. Insurance Journal. Opioid Epidemic Plagues Workers’ Comp. 5/17/13. http://www.insurancejournal.com/news/national/2013/05/17/292528.htm.

4  Howard G. Birnbaum, PhD, Alan G. White, PhD, Matt Schiller, BA, Tracy Waldman, BA, Jody M. Cleveland, MS, Carl L. Roland, PharmD. Oxford Journals. http://painmedicine.oxfordjournals.org/content/12/4/657. DOI: http://dx.doi.org/10.1111/j.1526-4637.2011.01075.x657-667.First published online: 1 April 2011.

6  Lavin RA, Tao XG, Yuspeh L, Bernacki EJ. Impact of the combined use of benzodiazepines and opioids on workers’ compensation claim cost. http://www.ncbi.nlm.nih.gov/pubmed/25046322.

7  Martin BC, Fan MY, Edlund MJ, Devries A, Braden JB, Sullivan MD. Long-term chronic opioid therapy discontinuation rates from the TROUP study. J Gen Intern Med 2011;26:1450-7.

Additional resources

Chris Mandel
SVP, Strategic Solutions, Sedgwick
Director, Sedgwick Institute

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

Prescription-drug-concerns-gabapentinGabapentin is approved by the Food and Drug Administration for the management of post-herpetic neuralgia, pain associated with shingles, in adults and is used adjunctively in the treatment of partial onset seizures in adults and children. The drug is widely used off-label for a host of other pain syndromes, anxiety, mood disorders and restless leg syndrome. It is marketed globally under the trade name Neurontin® by Pfizer Pharmaceuticals.1 It is sometimes prescribed for pain in workers’ compensation cases.

In practice, when we think of drugs of abuse, the usual “Oxys” and “Benzos” come to mind. Medications such as Gabapentin are not often thought of as addictive or abused because they are not scheduled medications per the Drug Enforcement Agency (DEA). This is not true as physiological and psychological dependence may occur with other non-scheduled medications, such as muscle relaxers which are commonly seen in workers’ compensation claims.

Case report evidence suggests that there is misuse of Gabapentin, more so amongst individuals with prescriptions for the medication and who are using it in combination with opioids, benzodiazepines and alcohol.In July 2016, a case report described 40-65% of individuals with prescriptions for Gabapentin abused the medication. In addition, 15-22% of abuse cases were within populations of individuals who abuse opioids.2 The mechanism for abuse is unknown because it does not bind to the receptors that cause euphoria and increased mood. Some individuals describe a relaxed or elated mood, improved sociability and a marijuana-like high. When coupled with other scheduled medications such as opioids and benzodiazepines, the euphoric effect is multiplied and the user achieves a greater “high”. These effects seem to be dose dependent; as the dose and frequency of Gabapentin is increased, the greater the high effect will be. Similarly, Lyrica ®, which is an analog of Gabapentin, may be misused as well, although its prevalence for abuse was much lower.

Gabapentin, when stopped abruptly, produces a withdrawal syndrome similar to that seen in scheduled medications, such as opioids. These symptoms include disorientation, confusion, increased heart rate, sweating profusely, tremulousness and agitation. Withdrawal symptoms resolve upon resumption of Gabapentin. It is necessary that Gabapentin not be stopped abruptly and rather tapered off slowly as to avoid withdrawal.

It is not wise to assume that every patient that is being prescribed Gabapentin is addicted or abusing the medication; however, when used either alone or in combination with opioid pain medications, benzodiazepines and muscle relaxers, its medical necessity should be established and the patient closely monitored for signs of abuse or misuse. Prescribers and pharmacists should monitor patients for the development of tolerance, dose escalation and requests for early refills. Prescribers should also take quantitative measures by testing for the presence of Gabapentin and its metabolites in urine drug screens. With provider education and responsibility, the misuse and abuse potential of Gabapentin can be contained and prevented.

Dr. Linda Manna, Clinical Pharmacist

References:

  1. Neurontin® [package insert]. New York: Pfizer, Inc.; 2012.
  2. Smith RV, Havens JR, Walsh SL. Gabapentin misuse, abuse and diversion: a systematic review. Addiction. 2016 Jul;111(7):1160-74. doi: 10.1111/add.13324. Epub 2016 Mar 18. Review
  • LinkedIn
  • Twitter
  • Facebook
  • Google Plus
  • Digg
  • RSS
  • Email
  • Print

This week I spoke on a panel with other CEOs in our industry where we looked at the future of our business and projected where we could be in 10 years. I talked about how my daughter and I shared the common interest of watching every moment of the Olympics we could during the past two weeks. As we watched, we frequently saw a new ad from Apple, titled “The Human Family” that just reinforced to me where we need to be as an industry. The ad was filmed with Apple’s iPhone 6, showcasing its brilliance. Many credit the iPhone with transforming mobile communication and computing. Combining ease of use with the expanse of the internet, it provides a platform for the discovery and delivery of digital content.
human-family

An obvious analogy to insurance…

Or at least a vision.

The iPhone is one of the most sophisticated pieces of mobile technology on the planet – necessarily so, in many ways, because the designers want the consumer experience to be simple. When it arrives in its elegant yet effortless packaging, you are eager to tear open the thin layer of clear plastic that is attached without seams and slide open the box that serves as a nest, cradling the technology waiting to be awakened. No manuals, no hassle, a “Hello” in whatever language you prefer – and even charged for immediate use.

The technology behind the screen is complex, made even more so by the fact that it wants to do the work for you. No 34 keys, not even a traditional 10-key phone pad. Just ONE button. One home button to access the expansive capabilities you know exist but don’t want to fully understand – and Apple doesn’t make you. It is content to deliver advanced communication and internet access through one button and an endless selection of apps to satisfy even the most avid consumer.

But we are in insurance, much more complicated and detailed and sophisticated than a phone. We need regulations and forms and policies and waivers and authorities and plan descriptions that require pages and pages of detail. As a consumer, you would be disadvantaged without the voluminous material we send you, usually through the U.S. Postal Service on pieces of paper.

Or so we have convinced ourselves.

Employers have invested in a broad range of programs from preventative to wellness to specialty care and assistance to traditional benefits. They provide all of this to the employee in the form of detailed and often confusing instructions for each so the employee can sort it out as needed. No simple package cradling the program to awaken. No program charged for immediate use.

What if we had one home button? What if the questions and 800 numbers were replaced with, “Hello, how are you feeling today? I’m sorry to hear that. Are you able to go to work today? Would you like to see your doctor today? We care about you today…”

Behind the home button we mask all of the complexity that is the current state of healthcare and plan designs. We sort out for the employee, based on their feedback, what plans or programs can help them and who pays for it. But to the employee there is a single, simple, elegant access to the well-intended but extremely complicated insurance and benefits world.

One home button. That is the vision.

WCI 2016 Conference Centers for ExcellenceDave North, president and CEO, Sedgwick

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

We are just a few days away from the 2016 Workers’ Compensation Educational Conference which will be held on August 21 – 24 in Orlando. Once again, I am looking forward to the opportunity to host a panel that is exploring a very important industry topic – Using data to drive operational solutions.

As a parCofE logo_3 w tagt of the Centers for Excellence two-day track, we will kick off with this important topic which will include my fellow panelists Dr. Adam Seidner, National Medical Director, Travelers and  Cliff Belliveau, Vice President, Business Intelligence, myMatrixx.

Using data to drive operational solutions

Our session will dive into how claims management is a data driven business and employers have more powerful tools to manage their programs than ever before.  Insurance carriers, TPAs, and service providers are embracing big data strategies to improve both experience and outcomes for their stakeholders.  The key to creating effective operational solutions is isolating and harnessing the data and information needed to achieve the best performance.  Team scorecards, company dashboards, and prescriptive analytics are only a few of the tools and techniques being applied to develop strategies, direct resources, and evaluate results currently in the industry.  Moreover, machine learning and artificial intelligence are further driving advancements in today’s automated technology world.

Technology continues to move forward at a jaw dropping pace. The advances just since last year’s event would have taken five years or longer to evolve in the past. So how do you harness data to drive operational solutions within your risk and claims program? While this panel doesn’t have all the answers we are all immersed in the use of technology and data to solve issues for some of the most complex organizations in the world. We will share some insights into what you should be considering right now to meet the demand for solutions.

I want to encourage you to post your questions or suggestions here or tweet them @Sedgwick so our panel can be prepared to comment on what is most important to you. .  I look forward to seeing you Tuesday, August 23rd at 1:00 p.m. for the opening session.

Scott Rogers EVP, Casualty Operations, Sedgwick

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

In a previous blog post, I covered how a person can become infected with the Zika virus.  The pathways for infection include:

  • Bite from an infected mosquito.
  • Sexual intercourse with a person infected with the virus.

Prevention is critical; safety tactics include using DEET insect repellant, wearing protective clothing, eliminating standing water, avoiding impacted geographic areas, and using condoms.

Zika-CDC-poster_protect_yourself_from_mosquito_bites

United States Zika cases

Cases of Zika have been confirmed in 47 states, with 1,657 confirmed cases as of the end of July 2016. The virus is believed to have been acquired through travel outside of the United States. The highest concentrations of cases to date are in New York (449) and Florida (307). The only states without confirmed cases are South Dakota, Wyoming and Idaho.

Symptoms, testing and treatment

Most individuals infected with the virus will not have symptoms or will experience only mild symptoms that can include fever, rash, joint pain, conjunctivitis, muscle aches and headaches. The symptoms can last a few days or up to one week. The virus is detectable in blood and urine and can be tested by a health care provider. It is believed that once a person is infected, he/she is protected from future infections. There is no known treatment for this virus; the best approach is rest, supportive medications like acetaminophen and plenty of fluids.

Advice for those thinking about getting pregnant 

  • Women who have been infected with Zika should wait at least eight weeks before trying to get pregnant.
  • Men should wait at least six months after symptoms began before attempting unprotected sex.
  • Women and men who have traveled to a known Zika exposure area should wait at least eight weeks before trying to get pregnant.

Vaccines

There have been three vaccines developed for the virus that have shown complete prevention in monkeys and are now ready for human clinical trials. Phase I clinical trials have begun, and if all goes well these vaccines may be ready for phase II trials in January 2017.

Teresa Bartlett, MD

SVP, medical quality, Sedgwick

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

CofE logo_3 w tag

Next week we will gather at what is now one of the largest events in the industry – the 2016 Workers’ Compensation Conference August 21 – 24 in Orlando. I want to add that, before the conference begins, a great group of Sedgwick colleagues will be taking part in the Give Kids the World service project on Saturday morning. This is an extremely rewarding opportunity for our industry to give back to the local community. For our colleagues, this helps extend our commitment that caring counts℠ at Sedgwick.

On Tuesday, Sedgwick is again proud to sponsor the “Centers for Excellence” conference track. This year’s theme is “Better Together” and the lineup of speakers is exceptional. As Steve Rissman, program chair for WCI, has said, this is a great venue to bring some of the best thought leaders together under one roof. Incorporating the ability to have open discussions and real-time input from conference attendees helps educate everyone on some of the most relevant and timely issues facing our industry.

As part of the Centers for Excellence, I will be joining a highly knowledgeable panel as we address the topic of “Talent Attraction, Training and Retention of the Workforce.” Many industries now face an aging workforce and our industry is at the forefront of this concern. We will be losing more talented contributors than ever before over the next decade.

We must cohesively as an industry work to attract, educate and retain a new generation of worker. Unlike the toothpaste commercial that says “4 out of 5 dentists recommend,” I feel comfortable saying that 9 out of 10 people in our industry could say they didn’t start out thinking they would work in the workers’ compensation or insurance industry – and yet, here we are today in very fulfilling and rewarding careers.

It is time to change the narrative and let the next generation know that our industry is a great place to work, rich with a wide range of opportunities for people from all walks of life. Every day, we can make a difference in the lives of those who need care during challenging times in their lives. Our panelists will discuss how we are individually approaching this challenge and will share what we believe are best practices to fill the looming talent gap.

We certainly need to reach untapped talent pools and look at new and creative methods. No longer can we put up a help wanted sign and just pick from the applicants. I encourage you to join us Wednesday, August 24th at 9:00 a.m., and in the meantime, leave your comments here to add to the discussion. In the spirit of seeking new ways to reach talent, you can also send your thoughts to us on Twitter @Sedgwick or join us on our Facebook page the day of the discussion as we live stream for those who will not be able to attend.

I look forward to seeing many of you in Orlando and, most importantly, sparking the discussion on how we can keep our industry healthy and offering rewarding opportunities into the future just as it has for all of us today.

WCI 2016 Conference Centers for ExcellenceDave North, president and CEO, Sedgwick